National Institutes of Health Clinical Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892, USA.
Curr Opin Infect Dis. 2013 Aug;26(4):345-51. doi: 10.1097/QCO.0b013e3283630adf.
The aim is to discuss the epidemiology of infections that arise from contaminated water in healthcare settings, including Legionnaires' disease, other Gram-negative pathogens, nontuberculous mycobacteria, and fungi.
Legionella can colonize a hospital water system and infect patients despite use of preventive disinfectants. Evidence-based measures are available for secondary prevention. Vulnerable patients can develop healthcare-associated infections with waterborne organisms that are transmitted by colonization of plumbing systems, including sinks and their fixtures. Room humidifiers and decorative fountains have been implicated in serious outbreaks, and pose unwarranted risks in healthcare settings.
Design of hospital plumbing must be purposeful and thoughtful to avoid the features that foster growth and dissemination of Legionella and other pathogens. Exposure of patients who have central venous catheters and other invasive devices to tap water poses a risk for infection with waterborne pathogens. Healthcare facilities must conduct aggressive clinical surveillance for Legionnaires' disease and other waterborne infections in order to detect and remediate an outbreak promptly. Hand hygiene is the most important measure to prevent transmission of other Gram-negative waterborne pathogens in the healthcare setting.
本综述旨在讨论与医疗机构中受污染水有关的感染的流行病学，包括军团病、其他革兰氏阴性病原体、非结核分枝杆菌和真菌。
尽管使用了预防性消毒剂，军团菌仍可定植于医院的供水系统并感染患者。有基于证据的二级预防措施可用。易感染患者可能会因水传播生物体而发生与医疗相关的感染，这些生物体通过管道系统（包括水槽及其固定装置）的定植而传播。房间加湿器和装饰喷泉与严重疫情有关，在医疗机构中存在不必要的风险。
医院管道的设计必须有目的和周到，以避免促进军团菌和其他病原体生长和传播的特征。接受中央静脉导管和其他侵入性装置的患者接触自来水会增加感染水传播病原体的风险。医疗机构必须对军团病和其他水源性感染进行积极的临床监测，以便及时发现和补救疫情。手部卫生是预防医疗机构中其他革兰氏阴性水传播病原体传播的最重要措施。
