ICUs Might Consider Avoiding Tap Water To Limit Pseudomonas Infections from Faucets Interview with:

Dr. Cohen Regev, M.D Head of the infectious diseases and infection control units Sanz Medical Center, Laniado hospital Netanya, Israel

Dr. Cohen Regev

Dr. Cohen Regev, M.D
Head of the infectious diseases and infection control units
Sanz Medical Center, Laniado hospital
Netanya, Israel What is the background for this study?

Response: During 3 months in 2012 we had a number of clinical isolates of Pseudomonas aeruginosa (PA) in our neonatal intensive care unit (NICU) and a high incidence of colonization among ventilated patients in our medical-surgical intensive care unit (MSICU). The origin of PA may be from various environmental sources (‘exogenous’), from the patients’ own microbiome (‘endogenous’), or from both. Since in NICUs the origin is usually exogenous, we investigated the sources of the bacteria, focusing on the faucets of these units, as they were previously incriminated as causes of outbreaks in ICUs.

The study was conducted in Sanz medical center, a 400-bed community hospital located in central Israel. In the NICU we obtained several environmental cultures from faucets using a bacterial swab by rubbing the tip into the distal part of the faucet. Aerators were dismantled from all faucets, cultured from their inner part using a swab and were not repositioned. Contaminated faucets were occasionally replaced or treated with enzymatic fluid and sterilization by Ethylene Oxide. During the intervention and since, neonates were bathed only with warmed sterile water, and tap water was allowed only for hand hygiene practices.

In the MSICU tap water was used only for bathing the patients. All other uses of tap water, such as drinking, moistening and mouth treatments, were allowed using only sterile water. The units’ faucets were sampled on two different days concurrently with surveillance cultures of pharyngeal, sputum and urine from the patients.

Bacteria were identified with VITEK 2 (Biomerieux®) and typing was done by Enterobacterial Repetitive Intergenic Consensus (ERIC) PCR. What are the main findings?

Response: Our main findings were:

  1. Both units’ faucets were highly colonized with Pseudomonas aeruginosa and with other waterborne bacteria
  2. Faucets were persistently contaminated with the same PA strain until replaced by a new strain or by other waterborne bacteria.
  3. Faucets replacement and treatment were futile.
  4. Patients and their adjacent faucets commonly harbored identical Pseudomonas aeruginosa strains, on the same sampling time, in both units.
  5. In the NICU, after the intervention, which included mainly the ban of tap water for bathing, we witnessed a persistent decrease in the number of clinical PA isolates. What should readers take away from your report?

Response: Although the association between faucet colonization with Pseudomonas aeruginosa and ICU outbreaks was well described over a decade ago, tap water is still widely used in intensive care units. Guidelines also do not prohibit its use in order to prevent PA infection.

In this study we showed again the importance of faucet contamination with PA and its capacity to disseminate to adjacent patients and taps.

In the NICU, strict use of sterile water for bathing neonates may have contributed to a reduction in clinical isolation of PA post intervention. What recommendations do you have for future research as a result of this study?

Response: A prospective study engaged with screening of patients and faucets concomitantly for Pseudomonas aeruginosa with molecular strain analysis is in fact in progress in our MSICU. This study might shed more light on the debate regarding the origin of PA colonization among intensive care patients (exogenous vs. endogenous), and possibly also on the relative importance of faucet contamination with PA. Is there anything else you would like to add?

Response: NICUs experiencing colonization of Pseudomonas aeruginosa or other waterborne organisms should be vigilant with the use of tap water and may consider switching to sterile water for bathing neonates.

Adult ICUs may consider avoiding tap water altogether, by using disposable cloths prepackaged with 2% chlorhexidine gluconate for bathing patients. Tap water should not be used for drinking or for mouth moistening and treatments.

Generally, the use of alcohol-based rubs should be promoted over the use of tap water in medical facilities, thereby reducing the hazards related to contaminated water or faucets with waterborne bacteria. Thank you for your contribution to the community.


Water faucets as a source of Pseudomonas aeruginosa infection and colonization in neonatal and adult intensive care unit patients

Cohen, Regev et al.
American Journal of Infection Control , Volume 0 , Issue 0

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on August 29, 2016 by Marie Benz MD FAAD