Bacteria
Gram negative bacilli are well established
waterborne pathogens, particularly in the healthcare setting. As more
complex healthcare is pro vided in the home environment, infections linked to
the home 
water sup ply may result. For example, Myco bacterium species,
Roseomonas gilardii and Ewingella americana have been linked to infections in
patients receiving continuous ambulatory peritoneal dialysis both within the
healthcare facility and the home environment. The water supply may contaminate
the catheter at the insertion site or the fluid bags used for dialysis.
Salmonella typhimurium, Cam pylo bacterjejuni,
Shigella typhimurium,Vibrio cholerae and Pleiomonas shiggelloides are other
bacteria that can be found in contaminated water systems and have been linked
to community acquired infection
(see Table ).
Nontuberculous mycobacteria (NTM) found in water has been cited as a cause of
hospital acquired infec tion. Municipal water systems
are a major reservoir
for NTM. In one study of U.S. dialysis centers, 83 percent of municipal water
supplies were colonized by NTM. More recently, MycoW Opportunistic
Contaminants Potentially Lurking in Today’s Water Systems
By Cheryl Squier BSN, CIC; Yu-sen E. Lin, Ph.D.;
and Janet E. Stout, Ph.D. Summary: The number of immunocompromised individuals
is increasing within our communities. This places a greater emphasis on
maintaining the quality of drinking water. The following article identifies
potential waterborne pathogens and specific measures that can be taken to
prevent infections.
bacterium avium in a hospital water system was linked to
disease in HIV infected patients.
According to Victor L. Yu, M.D., chief of Infectious Diseases
at the VA Pittsburgh Health Care System, data from the Centers for Disease
Control and Prevention (CDC) suggest that at least 29,808 Americans have died
of hospital acquired Legionnaires’ disease since 1983. Legionella is a high
profile bacterium, which is a source of outbreaks in hotels, apartment
buildings and healthcare facilities. Many
hospitals routinely test their water
for Legionella. Awareness of the presence or absence of Legionella in a
healthcare facility assists in identifying cases of hospital acquired Legion
naires’ disease. Allegheny County, Pa., was the first county to establish
guidelines for environmental culturing of healthcare facilities. The state of
Maryland recently issued guide lines for healthcare facilities that can be
accessed via the Internet (www. dhmh.state.md.us/html/ legionella.htm).
In 1999, the CDC proposed that bone marrow transplant centers
routinely culture their water supply for Legionella. The Joint Commission for
the Accreditation of Hospital Organizations considers this of sufficient
importance to issue a new standard that will go into effect in 2001. This will
require that hospitals “manage pathogenic biological agents in cooling towers,
domestic hot water, and other aerosolizing water systems.”