H P Loveday1, J A Wilson2, K Kerr3, R Pitchers4, J T Walker5, J Browne1. 1. Richard Wells Research Centre, University of West London, London, UK. 2. Institute of Practice, Interdisciplinary Research & Enterprise, University of West London, London, UK. Electronic address: jennie.wilson@uwl.ac.uk. 3. Department of Medical Microbiology, Harrogate and District NHS Foundation Trust, Hull York Medical School, York, UK. 4. Water Research Council plc, Swindon, UK. 5. Biosafety Unit, Health Protection Agency, Porton Down, UK.
Abstract
BACKGROUND: Pseudomonas aeruginosa is an opportunistic pathogen with a particular propensity to cause disease in the immunocompromised. Water systems have been reported to contribute to P. aeruginosa transmission in healthcare settings. AIM: To systematically assess the evidence that healthcare water systems are associated with P. aeruginosa infection; to review aspects of design that can increase their potential to act as a reservoir; and to compare the efficacy of strategies for eradicating contamination and preventing infection. METHODS: A rapid review methodology with a three-step search strategy was used to identify published studies. Scientific advisors were used to identify unpublished studies. FINDINGS: Twenty-five relevant studies were included. There was plausible evidence of transmission of P. aeruginosa from water systems to patients and vice versa, although no direct evidence to explain the exact mode of transfer. Two studies provided plausible evidence for effective interventions: point-of-use filters and increasing chlorine disinfection. Non-touch taps and aspects of water system design were identified as probable risk factors for P. aeruginosa biofilm formation and subsequent transmission to patients. Poor hand hygiene or compliance with contact precautions were identified as potential contributory factors; plausible evidence to confirm this was not available. CONCLUSIONS: Water systems can act as a source of P. aeruginosa infection in healthcare settings, although the route of transmission is unclear. Contamination appears to be confined to the distal ends of a water system and can persist for prolonged periods. Further studies are required to establish effective methods of preventing transmission and eradicating P. aeruginosa from plumbing systems.
BACKGROUND:Pseudomonas aeruginosa is an opportunistic pathogen with a particular propensity to cause disease in the immunocompromised. Water systems have been reported to contribute to P. aeruginosa transmission in healthcare settings. AIM: To systematically assess the evidence that healthcare water systems are associated with P. aeruginosa infection; to review aspects of design that can increase their potential to act as a reservoir; and to compare the efficacy of strategies for eradicating contamination and preventing infection. METHODS: A rapid review methodology with a three-step search strategy was used to identify published studies. Scientific advisors were used to identify unpublished studies. FINDINGS: Twenty-five relevant studies were included. There was plausible evidence of transmission of P. aeruginosa from water systems to patients and vice versa, although no direct evidence to explain the exact mode of transfer. Two studies provided plausible evidence for effective interventions: point-of-use filters and increasing chlorine disinfection. Non-touch taps and aspects of water system design were identified as probable risk factors for P. aeruginosa biofilm formation and subsequent transmission to patients. Poor hand hygiene or compliance with contact precautions were identified as potential contributory factors; plausible evidence to confirm this was not available. CONCLUSIONS:Water systems can act as a source of P. aeruginosa infection in healthcare settings, although the route of transmission is unclear. Contamination appears to be confined to the distal ends of a water system and can persist for prolonged periods. Further studies are required to establish effective methods of preventing transmission and eradicating P. aeruginosa from plumbing systems.
Authors: Christopher W Marshall; Erin S Gloag; Christina Lim; Daniel J Wozniak; Vaughn S Cooper Journal: Sci Adv Date: 2021-07-16 Impact factor: 14.136
Authors: Lucia Bonadonna; Rossella Briancesco; Anna Maria Coccia; Pierluigi Meloni; Giuseppina La Rosa; Umberto Moscato Journal: Int J Environ Res Public Health Date: 2021-06-09 Impact factor: 3.390