Infection Control in Healthcare Water Systems

Infection control in healthcare water systems addresses the management of waterborne pathogens within hospital plumbing networks, sinks, shower drains and distribution infrastructure. Opportunistic Gram-negative bacteria, such as Pseudomonas aeruginosa and carbapenemase-producing Enterobacteriaceae, can establish persistent biofilms in pipework and sink traps, from which they disperse through aerosolisation or droplet splatter. These reservoirs pose significant risks to immunocompromised patients, particularly in intensive care and haematology units, where water contact is frequent. Effective control strategies combine environmental surveillance, engineering modifications and procedural measures. Surveillance employs culture-based and genomic methods to detect persister cells and resistance plasmids in built-environment niches. Engineering interventions include redesigning sink and drain geometries, installing heating or vibration devices in trap assemblies and adopting waterless patient care models. Procedural measures encompass routine sink disinfection, waste hopper covers and antimicrobial stewardship to reduce selective pressure. Integrated approaches that leverage real-time genomic monitoring alongside targeted infrastructure changes have demonstrably reduced pathogen colonisation and transmission. International guidelines now recognise the hospital-built environment as a core component of infection prevention and control programmes, emphasising the interplay between plumbing microbiomes, resistance gene flow and patient safety.

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Infection Control in Healthcare Water Systems publication trend

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Technical terms

Biofilm: A structured community of microorganisms adhered to a surface and embedded in a self-produced extracellular matrix.

Carbapenemase-producing organisms (CPO): Bacteria that synthesise enzymes capable of hydrolysing carbapenem antibiotics.

Horizontal gene transfer (HGT): The non-inheritance transfer of genetic material between organisms, often mediated by plasmids.

Waterless patient care: A care approach that removes traditional water sources in patient rooms to minimise environmental pathogen reservoirs.

Multidrug-resistant organisms (MDRO): Pathogens that exhibit resistance to multiple classes of antimicrobial agents.

References

1. Outbreak of carbapenemase-producing Citrobacter farmeri in an intensive care haematology department linked to a persistent wastewater reservoir in one hospital room, France, 2019 to 2022. Eurosurveillance (2024).
2. Intensive care unit sinks are persistently colonized with multidrug resistant bacteria and mobilizable, resistance-conferring plasmids. mSystems (2023).
3. Outbreak of Pseudomonas aeruginosa producing VIM carbapenemase in an intensive care unit and its termination by implementation of waterless patient care. Critical Care (2021).