Challenges in the Hospital Water System and Innovations to Prevent Healthcare-Associated Infections

Opinion statementHealthcare-associated infections (HAI) related to hospital water distribution systems have been well-described. More recently, outbreaks linked to the wastewater system as well as water-containing medical devices have increased awareness of potential environmental sources of water-related HAI. In this review, we summarize outbreaks and challenges associated with hospital water distribution and wastewater systems, as well as potential mitigation strategies. The heightened attention on water-related HAI has sparked new strategies and innovations to mitigate these risks, including engineered or structural modifications to plumbing components, enhanced disinfection of premise plumbing, and novel tools to reduce biofilm formation. Bundled approaches are often used. Focus should remain on basic infection prevention strategies and physical separation of clean items from surfaces potentially contaminated by water sources. Hospital premise plumbing is a reservoir of opportunistic pathogens, which presents unique challenges for infection prevention. Although numerous mitigation strategies have been described in the literature, basic infection prevention practices remain key. Additional investigation is needed to find effective and sustainable techniques to reduce the risk of water-related HAI and improve patient safety.