Skip to main content Accessibility help
×
Home

The Impact of Aerators on Water Contamination by Emerging Gram-Negative Opportunists in At-Risk Hospital Departments

  • Maria Luisa Cristina (a1), Anna Maria Spagnolo (a1), Beatrice Casini (a2), Angelo Baggiani (a2), Pietro Del Giudice (a3), Silvio Brusaferro (a3), Andrea Poscia (a4), Umberto Moscato (a4), Fernanda Perdelli (a1) and Paolo Orlando (a1)...

Abstract

Objective.

Our aim was to evaluate the impact of aerators on water microbiological contamination in at-risk hospital departments, with a view to quantifying the possible risk of patient exposure to waterborne microorganisms.

Design.

We analyzed the microbiological and chemical-physical characteristics of hot and cold water in some critical hospital departments.

Setting.

Two hospitals in northern Italy.

Methods.

We took 304 water samples over a 1-year period, at 3-month intervals, from taps used by healthcare personnel for handwashing, surgical washing, and the washing of medical equipment. We analyzed heterotrophic plate counts (HPCs) at 36°C and 22°C, nonfastidious gram-negative bacteria (GNB-NE), and Legionella pneumophila.

Results.

The percentages of positivity and mean values of HPCs at 22°C, HPCs at 36°C, and GNB-NE loads were significantly higher at outlet points than in the plumbing system. In particular, GNB-NE positivity was higher at outlet points than in the plumbing system in both the cold water (31.58% vs 6.58% of samples were positive) and hot water (21.05% vs 3.95%) supplies. Our results also revealed contamination by L. pneumophila both in the plumbing system and at outlet points, with percentages of positive samples varying according to the serogroup examined (serogroups 1 and 2-14). The mean concentrations displayed statistically significant (P < .001) differences between the outlet points (27,382.89 ± 42,245.33 colony-forming units [cfu]/L) and the plumbing system (19,461.84 ± 29,982.11 cfu/L).

Conclusions.

These results reveal a high level of contamination of aerators by various species of gram-negative opportunists that are potentially very dangerous for immunocompromised patients and, therefore, the need to improve the management of these devices.

Copyright

Corresponding author

Department of Health Sciences, University of Genoa, Via Pastore, 1-16132 Genova, Italy (cristinaml@unige.it)

References

Hide All
1. Blanc, DS, Nahimana, I, Petignat, C, Wenger, A, Bille, J, Francioli, P. Faucets as a reservoir of endemic Pseudomonas aeruginosa colonization/infections in intensive care units. Intensive Care Med 2004;30:19641968.
2. Conger, NG, O'Connell, RJ, Laurel, VL, et al. Mycobacterium simiae outbreak associated with a hospital water supply. Infect Control Hosp Epidemiol 2004;25:10501055.
3. Mineshita, M, Nakamori, Y, Seida, Y, Hiwatashi, S. Legionella pneumonia due to exposure to 24-hour bath water contaminated by Legionella pneumophila serogroup-5. Intern Med 2005;44:662665.
4. National Health and Medical Research Council. Australian Guidelines for the Prevention and Control of Infection in Healthcare. Commonwealth of Australia, 2010.
5. Squier, C, Yu, VL, Stout, JE. Waterborne nosocomial infections. Curr Infect Dis Rep 2000;2:490496.
6. Spagnolo, AM, Cristina, ML, Casini, B, Perdelli, F. Legionella pneumophila in healthcare facilities. Rev Med Microbiol 2013;24: 7080.
7. Anaissie, EJ, Penzak, SR, Dignani, MC. The hospital water supply as a source of nosocomial infections: a plea for action. Arch Intern Med 2002;162:14831492.
8. Sehulster, LM, Chinn, RYW, Arduino, MJ, et al. Guidelines for Environmental Infection Control in Health-Care Facilities: Recommendations from the Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Chicago: American Society for Healthcare Engineering/American Hospital Association, 2004.
9. Grundmann, H, Kropec, A, Hartung, D, Berner, R, Daschner, F. Pseudomonas aeruginosa in a neonatal intensive care unit: reservoirs and ecology of the nosocomial pathogen. J Infect Dis 1993;168:943947.
10. Trautmann, M, Michalsky, T, Wiedeck, H, Radosavljevic, V, Ruhnke, M. Tap water colonization with Pseudomonas aeruginosa in a surgical intensive care unit (ICU) and relation to Pseudomonas infections of ICU patients. Infect Control Hosp Epidemiol 2001;22:4952.
11. Cristina, ML, Spagnolo, AM, Ottria, G, et al. Spread of multidrug carbapenem-resistant Acinetobacter baumannii in different wards of an Italian hospital. Am J Infect Control 2011;39:790794.
12. Cristina, ML, Spagnolo, AM, Cenderello, N, et al. Multidrug-resistant Acinetobacter baumannii outbreak: an investigation of the possible routes of transmission. Public Health 2013;127:386391.
13. Berthelot, P, Grattard, F, Mallaval, FO, Ros, A, Lucht, F, Pozzetto, B. Epidemiology of nosocomial infections due to Pseudomonas aeruginosa, Burkholderia cepacia and Stenotrophomonas maltophilia . Pathol Biol 2005;53:341348.
14. Biliński, P, Holownia, P, Wojtyła, C , Parafińska, K, Tomaszewski, W, Kapka-Skrzypczak, L. Managing water safety in healthcare. Part 2–practical measures and considerations taken for water-borne pathogen control. Ann Agric Environ Med 2012; 19:619624.
15. Ministère de la Santé e des Solidarités. L'eau dans les établissements de santé. 2007. http://www.sante.gouv.fr/IMG/pdf/Guide_technique_de_l_eau_dans_les_etablissements_de_sante_-_edition_2005.pdf. Accessed June 3, 2013.
16. Exner, M, Kramer, A, Lajoie, L, Gebel, J, Engelhart, S, Hartemann, P. Prevention and control of health care-associated waterborne infections in health care facilities. Am J Infect Control 2005;33: S26S40.
17. International Organization for Standardization (ISO). Water quality: enumeration of culturable micro-organisms. Colony count by inoculation in a nutrient agar culture medium. ISO 6222. 1999.
18. International Organization for Standardization (ISO). Water quality: detection and enumeration of Legionella. ISO 11731. 1998.
19. Ditommaso, S, Giacomuzzi, M, Gentile, M, Moiraghi, AR, Zotti, CM. Effective environmental sampling strategies for monitoring Legionella spp contamination in hot water systems. Am J Infect Control 2010;38:344349.
20. Italian Parliament. Digs 31/2001. Attuazione della direttiva 98/83/CE relativa alla qualità delle acque destinate al consumo umano. 2001. http://www.camera.it/parlam/leggi/deleghe/01031dl.htm. Accessed April 20, 2013.
21. Italian Health Ministry. Linee guida per la prevenzione ed il controllo della legionellosi. 2000. http://www.salute.gov.it/imgs/C_17_normativa_1601_allegato.pdf Accessed April 20, 2013.
22. Weber, DJ, Rutala, WA, Blanchet, CN, Jordan, M, Gergen, MF. Faucet aerators: a source of patient colonization with Stenotro-phomonas maltophilia . Am J Infect Control 1999;27:5963.
23. Wang, JL, Chen, ML, Lin, YE, Chang, SC, Chen, YC. Association between contaminated faucets and colonization or infection by nonfermenting gram-negative bacteria in intensive care units in Taiwan. J Clin Microbiol 2009;47:32263330.
24. Kappstein, I, Grundmann, H, Hauer, T, Niemeyer, C. Aerators as a reservoir of Acinetobacter junii: an outbreak of bacteraemia in paediatric oncology patients. J Hosp Infect 2000;44:2730.
25. Hong, KB, Oh, HS, Song, JS, et al. Investigation and control of an outbreak of imipenem-resistant Acinetobacter baumannii infection in a pediatric intensive care unit. Pediatr Infect Dis J 2012;31:685690.
26. Hota, S, Hirji, Z, Stockton, K, Lemieux, C, Dedier, H, Wolfaardt, G, Gardam, MA. Outbreak of multidrug-resistant Pseudomonas aeruginosa colonization and infection secondary to imperfect intensive care unit room design. Infect Control Hosp Epidemiol 2009;30:2533.
27. Shrivastava, R, Upreti, RK, Jain, SR, Prasad, KN, Seth, PK, Chaturvedi, UC. Suboptimal chlorine treatment of drinking water leads to selection of multidrug-resistant Pseudomonas aeruginosa . Ecotoxicol Environ Saf 2004;58:277283.
28. Doleans, A, Aureli, H, Reyrolle, M, et al. Clinical and environmental distributions of Legionella strains in France are different. J Clin Microbiol 2004;42:458460.
29. Messi, P, Anacarso, I, Bargellini, A, et al. Ecological behaviour of three serogroups of Legionella pneumophila within a model plumbing system. Biofouling 2011;27:165172.
30. European Surveillance Scheme for Travel Associated Legionaires' Disease and the European Working Group for Legionella Infections. European guidelines for control and prevention of travel associated Legionnaires' disease. 2005. http://www.legionellaonline.it/linee-guidaEWGLI_gen2005.pdf. Accessed April 20, 2013.
31. Cristino, S, Legnani, PP, Leoni, E. Plan for the control of Legionella infections in long-term care facilities: role of environmental monitoring. Int J Hyg Environ Health 2011;215:279285.
32. World Health Organization (WHO). Guidelines for drinking-water quality. 4th ed. Geneva: WHO, 2011.
33. Williams, MM, Armbruster, CR, Arduino, MJ. Plumbing of hospital premises is a reservoir for opportunistically pathogenic microorganisms: a review. Biofouling 2013;29:147162.
34. Trautmann, M, Lepper, PM, Haller, M. Ecology of Pseudomonas aeruginosa in the intensive care unit and the evolving role of water outlets as a reservoir of the organism. Am J Infect Control 2005;33:S41S49.

Related content

Powered by UNSILO

The Impact of Aerators on Water Contamination by Emerging Gram-Negative Opportunists in At-Risk Hospital Departments

  • Maria Luisa Cristina (a1), Anna Maria Spagnolo (a1), Beatrice Casini (a2), Angelo Baggiani (a2), Pietro Del Giudice (a3), Silvio Brusaferro (a3), Andrea Poscia (a4), Umberto Moscato (a4), Fernanda Perdelli (a1) and Paolo Orlando (a1)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.