Healthcare outbreaks associated with a water reservoir and infection prevention strategies

Hajime Kanamori, David J. Weber, William A. Rutala

Research output: Contribution to journalArticlepeer-review

137 Citations (Scopus)


Hospital water may serve as a reservoir of healthcare-associated pathogens, and contaminated water can lead to outbreaks and severe infections. The clinical features of waterborne outbreaks and infections as well as prevention strategies and control measures are reviewed. The common waterborne pathogens were bacteria, including Legionella and other gram-negative bacteria, and nontuberculous mycobacteria, although fungi and viruses were occasionally described. These pathogens caused a variety of infections, including bacteremia and invasive and disseminated diseases, particularly among immunocompromised hosts and critically ill adults as well as neonates. Waterborne outbreaks occurred in healthcare settings with emergence of new reported reservoirs, including electronic faucets (Pseudomonas aeruginosa and Legionella), decorative water wall fountains (Legionella), and heater-cooler devices used in cardiac surgery (Mycobacterium chimaera). Advanced molecular techniques are useful for achieving a better understanding of reservoirs and transmission pathways of waterborne pathogens. Developing prevention strategies based on water reservoirs provides a practical approach for healthcare personnel.

Original languageEnglish
Pages (from-to)1423-1435
Number of pages13
JournalClinical Infectious Diseases
Issue number11
Publication statusPublished - 2016 Jun 1
Externally publishedYes


  • healthcare-associated infections
  • outbreaks
  • water
  • waterborne outbreaks

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases


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