At points of use with terminal
Tap water filtration
Nosocomial infections (illnesses contracted during a hospital stay) are the focus of enhanced vigilance in health care facilities. Regulations regarding the control of biological risks, particularly memorandum DGS n°2002/243 of April 22, 2002 (which supplanted that of December 31, 1998), are particularly strict for facilities with a high number of sick or contagious patients and/or vulnerable individuals (infants, elderly or convalescent patients, patients with immunosuppression due to a trauma, an operation, an illness, treatment, etc.). Minimizing the risk of contamination via water (waterborne transmission), air (airborne transmission) or carers’ hands (person-to-person transmission) is a constant challenge for local hospitals, hospital centers (local or university hospitals), private clinics, centers for follow-up care and rehabilitation (établissements de soins de suite et de réadaptation, ESSR) and residential care homes for the elderly (établissements d’hébergement pour personnes âgées dépendantes, EHPAD).
In these facilities, the risk of nosocomial infection linked to the water supply is directly due to the presence of pathogenic and opportunistic micro-organisms in the water. These germs can arise from:
• proliferation within the facility’s distribution network (the most common case);
• internal contamination due to the accidental introduction of germs at the point of use by patients (retrograde contamination), at technical points by maintenance staff or elsewhere (technical failure);
• external contamination due to uncontrolled pollution or technical disruption of the public network.
There are many different kinds of waterborne micro-organisms that can cause nosocomial infections: bacteria, cyanobacteria, mycobacteria, protozoa (single-celled parasites), fungi (mycota), algae, viruses, etc. These infections can include:
• digestive infections (dysentery, gastroenteritis, gastrointestinal symptoms, etc.) due to contamination of drinking water by fecal micro-organisms: bacteria (Salmonella, Shigella, Campylobacter, Yersinia), parasitic protozoa (Entamoeba, Giardia, Cryptosporidium) and viruses (rotavirus, enterovirus, hepatitides A and E). Some infections can also be caused by waterborne bacteria (Pseudomonas aeruginosa, Aeormonas hydrophila), especially in patients who are vulnerable, elderly or immunosuppressed.
• respiratory infections (pneumopathies, mycoses) linked to the inhalation of aerosols contaminated by bacteria (Legionella pneumophila, Pseudomonas aeruginosa, Acinetobacter baumanii), atypical mycobacteria (especially Mycobacterium kansasii and Mycobacterium avium) and fungal spores (Aspergillus sp.). Infection with Legionella pneumophila can be particularly serious for patients who are vulnerable, immunosuppressed or elderly. Learn more
• muco-cutaneous infections due to direct contact with or person-to-person transmission of waterborne bacteria (Pseudomonas aeruginosa, Flavobacterium sp., Acinetobacter sp., Enterobacter cloacae, Staphylococcus sp. Mycobacterium sp.). The consequences of this type of infection can be especially serious for patients who are vulnerable, immunosuppressed or elderly (septicemia).
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The transmission of micro-organisms is most often associated with:
• ingestion of drinking water or medical grade water used by health care workers for administering medications or enteral nutrition;
• inhaling water droplets produced by showers or whirlpool baths, by the climate control system (water cooling towers) or by specific medical treatments;
• direct contact of broken skin or mucus membranes with water used for personal hygiene or for cleaning wounds, washing hands, rinsing medical devices, etc.