title: Association between healthcare water systems and Pseudomonas aeruginosa infections: a rapid systematic review.
abstract: BACKGROUND
  Pseudomonas aeruginosa is an opportunistic pathogen with a particular propensity to cause disease in the immunocompromised. Water systems have been reported to contribute to P. aeruginosa transmission in healthcare settings.
  
  
  OBJECTIVE
  To systematically assess the evidence that healthcare water systems are associated with P. aeruginosa infection; to review aspects of design that can increase their potential to act as a reservoir; and to compare the efficacy of strategies for eradicating contamination and preventing infection.
  
  
  METHODS
  A rapid review methodology with a three-step search strategy was used to identify published studies. Scientific advisors were used to identify unpublished studies.
  
  
  RESULTS
  Twenty-five relevant studies were included. There was plausible evidence of transmission of P. aeruginosa from water systems to patients and vice versa, although no direct evidence to explain the exact mode of transfer. Two studies provided plausible evidence for effective interventions: point-of-use filters and increasing chlorine disinfection. Non-touch taps and aspects of water system design were identified as probable risk factors for P. aeruginosa biofilm formation and subsequent transmission to patients. Poor hand hygiene or compliance with contact precautions were identified as potential contributory factors; plausible evidence to confirm this was not available.
  
  
  CONCLUSIONS
  Water systems can act as a source of P. aeruginosa infection in healthcare settings, although the route of transmission is unclear. Contamination appears to be confined to the distal ends of a water system and can persist for prolonged periods. Further studies are required to establish effective methods of preventing transmission and eradicating P. aeruginosa from plumbing systems.
authors.affiliation: Richard Wells Research Centre, University of West London, London, UK.
authors.forename: H P
authors.initials: HP
authors.lastname: Loveday
authors.affiliation: Institute of Practice, Interdisciplinary Research & Enterprise, University of West London, London, UK. Electronic address: jennie.wilson@uwl.ac.uk.
authors.forename: J A
authors.initials: JA
authors.lastname: Wilson
authors.affiliation: Department of Medical Microbiology, Harrogate and District NHS Foundation Trust, Hull York Medical School, York, UK.
authors.forename: K
authors.initials: K
authors.lastname: Kerr
authors.affiliation: Water Research Council plc, Swindon, UK.
authors.forename: R
authors.initials: R
authors.lastname: Pitchers
authors.affiliation: Biosafety Unit, Health Protection Agency, Porton Down, UK.
authors.forename: J T
authors.initials: JT
authors.lastname: Walker
authors.affiliation: Richard Wells Research Centre, University of West London, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Browne
mesh_terms: D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D060766:Drinking Water / Q000382:microbiology*; D006268:Health Facilities; D006801:Humans; D011552:Pseudomonas Infections / Q000453:epidemiology* / Q000382:microbiology; D011550:Pseudomonas aeruginosa / Q000302:isolation & purification*
chemical_list: D060766:Drinking Water
keywords: Colonization; Infection; Plumbing; Pseudomonas aeruginosa; Transmission; Water