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Water exposures in healthcare settings and during healthcare delivery can place patients at risk for infection with water-related organisms and can potentially lead to outbreaks. We aimed to describe Centers for Disease Control and Prevention (CDC) consultations involving water-related organisms leading to healthcare-associated infections (HAIs).
Retrospective observational study.
We reviewed internal CDC records from January 1, 2014, through December 31, 2017, using water-related terms and organisms, excluding Legionella, to identify consultations that involved potential or confirmed transmission of water-related organisms in healthcare. We determined plausible exposure pathways and routes of transmission when possible.
Of 620 consultations during the study period, we identified 134 consultations (21.6%), with 1,380 patients, that involved the investigation of potential water-related HAIs or infection control lapses with the potential for water-related HAIs. Nontuberculous mycobacteria were involved in the greatest number of investigations (n = 40, 29.9%). Most frequently, investigations involved medical products (n = 48, 35.8%), and most of these products were medical devices (n = 40, 83.3%). We identified a variety of plausible water-exposure pathways, including medication preparation near water splash zones and water contamination at the manufacturing sites of medications and medical devices.
Water-related investigations represent a substantial proportion of CDC HAI consultations and likely represent only a fraction of all water-related HAI investigations and outbreaks occurring in US healthcare facilities. Water-related HAI investigations should consider all potential pathways of water exposure. Finally, healthcare facilities should develop and implement water management programs to limit the growth and spread of water-related organisms.
This chapter considers the fact that intelligence and achievement can be predicted from infancy and has theoretical implications. A classic issue in the study of intelligence is whether there is a single, general intelligence or whether there are multiple intelligences. The debate as to whether the nature of intelligence is continuous or discontinuous over age has a long history in the field of developmental psychology. One approach to understanding the biochemical bases of disordered intellectual functioning early in life is to study the effects of the common bodily biochemicals on cognitive functioning in populations with known neurological dysfunction. The study of the origins of intelligence in infancy by measures of early cognitive functioning may aid in clarifying theoretical issues, contribute to a methodologically integrated study of intelligence across a number of scientific disciplines, and, eventually, aid in reducing the incidence of intellectual disability.
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