Water-associated organisms can cause serious patient infections. Healthcare facilities often have complex distribution pathways and other features which serve as a favorable environment for the proliferation of opportunistic pathogens such as nontuberculous mycobacteria and Legionella, among many others. Routine clinical care can result in exposure and transmission, either directly or indirectly, from sinks, showers, toilets, and ice machines. Patients also may be exposed to these organisms through medical products (i.e., medications and medical devices), which can become contaminated at the point of manufacture or at the healthcare facility through improper handling (e.g., storage, preparation, or administration of the products near water sources). Water-associated organisms have caused many outbreaks in healthcare settings and these outbreaks can be challenging to detect and control. A number of resources are available to help investigate and halt healthcare outbreaks due to water-associated organisms.

Featured Resources:

• CDC created a website of helpful information, resources, and tools that healthcare facilities can utilize when faced with infectious risks to patients due to water: Reduce Risk from Water | HAI | CDC
• CDC has created a tool that healthcare facilities can utilize when investigating healthcare-associated infections that may be due to water exposures: Tap Water Quality and Infrastructure Discussion Guide for Investigation of Potential Water-Associated Infections in Healthcare Facilities (cdc.gov)
• Researchers from the University of North Carolina reviewed the literature for healthcare outbreaks associated with water, outlined common transmission routes, and proposed infection prevention strategies: Healthcare Outbreaks Associated With a Water Reservoir and Infection Prevention Strategies | Clinical Infectious Diseases | Oxford Academic (oup.com)
• When faced with a healthcare outbreak due to water-related organisms, healthcare facilities should consider avoiding the use of nonsterile water in the care of patients, especially those who are critically ill or immunocompromised: Tap Water Avoidance Decreases Rates of Hospital-onset Pulmonary Nontuberculous Mycobacteria - PMC (nih.gov)

Additional Resources:

• CDC conducted a summary of its investigations involving water-associated organisms and provided a list of commonly encountered water transmission routes during clinical care that can cause patient infections: Investigation of healthcare infection risks from water-related organisms: Summary of CDC consultations, 2014—2017 | Infection Control & Hospital Epidemiology | Cambridge Core
• Researchers have identified common hospital medical devices that use water and have led to outbreaks due to risk of transmission of water-associated organisms to patients. The authors of this review propose infection control measures to help mitigate the risks posed by these common hospital medical devices: Outbreaks of healthcare-associated infections linked to water-containing hospital equipment: a literature review | Antimicrobial Resistance & Infection Control | Full Text (biomedcentral.com)
• A 2017 CMS Memo requires certain healthcare facilities, including acute care hospitals and long-term care facilities, to have water management programs in place: QSO17-30-18 (cms.gov).

Commonly encountered water-associated organisms in healthcare with CORHA reference links:

• Nontuberculous mycobacteria
• Burkholderia cepacia complex [in development]
• Legionella

Last Updated Jan. 14, 2023