Tap water in the United States meets strict safety standards, but it is not sterile. Germs can be present when water leaves the tap. At home they rarely cause serious harm. In hospitals and other health care facilities, though, water is used in more ways and patients are far more vulnerable to infection — and some plumbing conditions can let germs multiply to dangerous levels, spreading antimicrobial-resistant organisms and causing health care–associated infections.
Key terms
| Term | Meaning |
|---|---|
| Premise plumbing | a building’s water system — hot and cold water, devices such as water heaters and HVAC humidifiers, fixtures such as showers and faucets, and drains — connected to the main by service lines |
| Opportunistic pathogens of premise plumbing (OPPP) | germs in building water systems that are more likely to sicken people who are at risk or immunocompromised |
| Biofilm | microbes that stick to each other and to wet surfaces, like the insides of pipes; it can persist in drains for a long time and may be impossible to remove |
| Water age | how long water may sit in the pipes |
What patient safety depends on
- Water coming in meets all quality standards. System disruptions, pressure drops, loss of disinfectant (such as low chlorine) and water main breaks can all affect it.
- Plumbing is designed and maintained to limit OPPP growth in both supply and wastewater systems — taking account of the system’s age and design, additions and renovations, water age, and making sure there are no dead ends where water stagnates.
- Staff reduce exposure through infection control practices, including water-specific ones.
1. Run a water management program
The Centers for Medicare & Medicaid Services, The Joint Commission, the Veterans Health Administration and CDC all consider it essential that hospitals and nursing homes have a water management program aligned with ASHRAE industry standards. A program includes:
- a multidisciplinary team — facility managers, infection prevention staff, clinicians, administrators and/or someone from the local water utility
- a description of the building’s water systems, with flow diagrams
- an evaluation of hazardous conditions where germs can grow and spread
- control measures, where they are, and how they are monitored
- interventions when control limits are not met
- checks that the program works as designed
- documentation and communication of everything
CDC offers a Healthcare Facility Water Management Program Checklist and a Tap Water Quality and Infrastructure Discussion Guide to help build one.
2. Assess the risk
A Water Infection Control Risk Assessment (WICRA) looks at how patients could be exposed — through drinking, hygiene and clinical care — by evaluating water sources, modes of transmission, patient susceptibility, patient exposure and program preparedness.
3. Stop sinks and drains from spreading germs
Sinks, toilets and hoppers can become contaminated with multidrug-resistant organisms, and because several kinds of bacteria can share one drain, drains can be places where resistance genes pass between species. Water hitting a contaminated drain cover, or a flushed toilet or hopper, can splash germs onto people and surfaces nearby.
- Don’t put patient care or personal items on counters beside sinks.
- Don’t pour IV fluids, total parenteral nutrition, antibiotics, body fluids or unfinished drinks down patient room sinks — they feed biofilm that can harbor resistant organisms. Use a solid waste container, a hopper or sluice, or a utility sink with plenty of flushing.
- Clean and disinfect daily the sink basin, faucet, handles and surrounding counter.
- During an outbreak, consider an EPA-registered biofilm disinfectant for drains.
- Close lids before flushing; where there are no lids, close the door between the toilet or hopper and patient care areas.
Sink design: choose deep, splash-resistant sinks; angle or offset faucets so they don’t pour straight onto the drain; add splash guards beside medication preparation areas; keep hand-hygiene supplies within easy reach; and regulate water pressure so sinks don’t splash at full flow.
When outbreaks happen
Water-related outbreaks are hard to manage because hospital water systems harbor biofilm, suffer stagnation and vary in design. CDC’s outbreak response tool for acute care hospitals covers investigating exposures, working with partners and targeted interventions, with a flexible, multidisciplinary approach fitted to each facility.
Germs linked to hospital water
CDC lists many, among them:
- Gram-negative bacteria — Pseudomonas aeruginosa, the Burkholderia cepacia complex, Stenotrophomonas maltophilia, Acinetobacter baumannii, Elizabethkingia and Legionella pneumophila
- Non-fecal coliforms — Enterobacter cloacae, Klebsiella, Pantoea agglomerans and Serratia marcescens
- Nontuberculous mycobacteria — including the Mycobacterium abscessus, M. fortuitum and M. avium complexes, M. chelonae and M. xenopi
- Other bacteria — Microbacterium, Tsukamurella, Rhodococcus and Gordonia
- Fungi — yeasts such as Candida parapsilosis, Aspergillus, Fusarium and Exophiala
- Protozoa — Acanthamoeba, Vermamoeba vermiformis and Naegleria
Sources
Based on "Considerations for Reducing Risk: Water in Healthcare Facilities," Centers for Disease Control and Prevention; a work of the United States government in the public domain. Several organism names misspelled in the source (“cepcia,” “Pantoae,” “Gordonae”) are corrected here.
许可协议： CC0 1.0（公有领域） · 改编自 www.cdc.gov
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