Table 1.

Summary of HAI with potable water as the probably source.

Organism	Reservoir/infection route	Corrective action	Reference
Nontuberculous Mycobacteria
M. abscessus	Pseudo-infections/infections, distilled water contaminated	Switched to commercial, sterile water and reagents in lab and in endoscope reprocessing	Lai et al. (1998)
M. abscessus	Injection site infections due to contaminated benzalkonium chloride	Recommended that the clinic stop use of benzalkonium chloride or other quaternary ammonium compounds as an injection site disinfectant	Tiwari et al. (2003)
M. abscessus	Surgical, unknown exposure	Antibiotics, surgical excision, no remediation of water system	Garrison et al. (2009)
M. abscessus (massiliense)	Localized, post-surgical infections after laparoscopy and other procedures	Improved cleaning and sterilization protocols	Duarte et al. (2009); Leão et al. (2010)
M. avium complex	Hydrotherapy pools, aerosols	None	Angenent et al. (2005)
M. chelonae	Injection site infections	Automatic injectors for mesotherapy rinsed with tap water between uses, infection control response not specified	Carbonne et al. (2009)
M. chelonae	Pseudo-outbreak, automated bronchoscope washer	Began changing filters on schedule	Chroneou et al. (2008)
M. chelonae (and Methylobacterium mesophilicum)	Pseudo-outbreak, automated endoscope washer	Replaced endoscopes and switched from glutaraldehyde to peracetic acid disinfection	Kressel and Kidd (2001)
M. chelonae	Laparoscopy port-site infections	Stopped rinsing laparoscopic equipment with tap water, switched from glutaraldehyde to ethylene oxide sterilization	Vijayaraghavan et al. (2006)
M. chelonae	Respiratory colonizations/infections, unknown exposure route from drinking water	POU membrane filters installed and maintained on sink faucets	Williams et al. (2011)
M. fortuitum	Pseudo-infections; sputum samples; contaminated with ice	Disinfected ice machine and installed filter; replace ice machines	Gebo et al. (2002); LaBombardi et al. (2002)
M. gordonae	Pseudo-infections; sputum samples; contaminated with drinking water	Advise patients not to rinse mouths with tap water before sampling; replaced rubber tubing in drinking fountain	Arnow et al. (2000); Lalande et al. (2001)
M. mucogenicum	Bacteremia, CVC exit site infection	Removed catheters; protected CVC exit sites from water during bathing; replaced contaminated faucets, and achieved optimal water chlorination	Kline et al. (2004); Cooksey et al. (2008); Livni et al. (2004)
M. paraffinicum	Pseudo-infections and colonizations from ice	Installed inline membrane filters in ice machines	S-H Wang et al. (2009)
M. simiae	Pseudo-infections, unknown exposure route from drinking water	Hyperchlorination	El Sahly et al. (2002)
M. xenopi	Spinal infections	Stopped rinsing surgical devices with tap water after disinfection	Astagneau et al. (2001)
M. xenopi	Pseudo-infections, bronchoscope-associated	Stopped rinsing bronchoscopes with tap water	Bennett et al. (1994)
M. xenopi	Surgical, unknown exposure	Antibiotics, no remediation of water system	Bishburg et al. (2004)
Legionella pneumophila
	Ice machine	Disinfection of ice machine: 2h flush with 2.6% sodium hypochlorite, replace tubing connecting machine to water system; cold water supply: 83 ppm sodium hypochlorite for 48 h; follow-up surveillance: microbiological environmental sampling	Graman et al. (1997)
	Ice machine	Ice from machine was not intended for consumption, hospital had Legionella control policy for drinking water	Bencini et al. (2005)
	Ice and contaminated syringes	Cleaned ice machine, replaced filter, improved aseptic practices	Schuetz et al. (2009)
	Water taps, shower heads	Superheated water, cleaned shower heads with a sonicating washer, and raised the hot water storage tank temperature from 43 to 52 °C	Mermel et al. (1995)
	Showers/central hot water	Replaced showers heated by central hot water with electric showers	Oliveira et al. (2007)
	Nebulizers in a clinical spa	Restructured (updated) water system and heat shock treatment, superheated steam for nebulization machines	Leoni et al. (2006)
	Wash basin	Replaced faucet mixing valves, installed filters, chlorinated hot water system	Brûlet et al. (2008)
	Pseudo-infections, Bronchoscopes	Introduction of regular water filter maintenance program and microbiological surveillance	Mitchell et al. (1997)
	Drinking water, unknown exposure of bone marrow transplant patients	Supplemental heat and chlorine treatment of hot water system	Oren et al. (2002)
	Central hot water system	Peracetic acid, repeated short term treatments only effective temporarily	Ditommaso et al. (2005)
Pseudomonas aeruginosa
	Sinks	Repaired plumbing, replaced sinks, and disinfected sink traps with bleach on a maintenance schedule	Bert et al. (1998)
		Pasteurize taps weekly, use sterile water for food and medicine in patients’ gastric tubes	Bukholm et al. (2002)
		Cleaning and disinfection unsuccessful due to biofilm formation, necessitated a structural review of the hospital’s water system, repeated dismantling and disinfection of drains	Gillespie et al. (2000)
		Treated sink with chlorine	Berthelot et al. (2001)
		Used contact precautions (healthcare workers wore gowns and gloves, patient isolation) for all colonized or infected cases; staff education; enhanced environmental cleaning; disinfection of hand hygiene sink drains; and renovation of hand hygiene sinks to prevent splashing of drain contents Outbreak controlled only after sink renovation	Hota et al. (2009)
		Replaced faucet taps	Ferroni et al. (1998)
		Sterilized faucet aerators, installed single-use filters on ICU water outlets	Trautmann et al. (2001); Reuter et al. (2002); Trautmann et al. (2005)
	Sensor mixer sink faucets	Silver nitrate, replaced sensor taps with non-sensor mixer taps	Durojaiye et al. (2011)
	Bacteremia, sink or shower probable source	Installed disposable sterile filters on all taps and showers, replaced weekly	Vianelli et al. (2006)
	Bacteremia, CVC exit site infection	Chlorination of water lines and use of disposable seven-day filters on all taps and showers, use of microbiologically controlled water for high risk patients	Aumeran et al. (2007)
	Water bath to thaw frozen plasma	Replaced waterbath with a dry heat incubator	Muyldermans et al. (1998)
	Disinfectant hand soap, sink faucets	Installation of water filters and water network hyperchlorination, follow-up surveillance of environmental samples	Fanci et al. (2009)
	General patient room environment	Changed room surface cleaning solution to a disinfectant, added filters to patient room faucets and showerheads, disinfected drains with peroxides	Engelhart et al. (2002)
Other Gram-negative bacteria
Serratia marcescens	Drinking water	Provided sterile drinking water for critical care patients	Horcajada et al. (2006)
Acinetobacter baumannii	Sinks	Changed surface cleaning solution to a disinfectant effective against A. baumannii	Debast et al. (1996)
Stenotrophomonas maltophilia	Sinks in a NICU	Reinforced hand disinfection, switched to sterile water for bathing newborns	Verweij et al. (1998)
S. maltophilia	Faucet aerators, water taps, shower heads, decorative fountain	Disinfection of aerators with bleach	Weber et al. (1999)
Acinetobacter junii	Faucet aerators, sink faucets	Removed aerators	Kappstein et al. (2000)
N on-fermentative Gram-negative bacilli (NFGNB)	Faucet aerators	Use of sterile water in ICU, infection control education of hospital staff	J-L Wang et al. (2009)
Sphingomonas paucimobilis	Catheters (showering)	Instituted routine removal and hypochlorite disinfection of faucet aerators and showerheads	Perola et al. (2002)
Burkholderia cepacia	Antiseptics, clinical solutions, soaps, mouthwash	Patient skin and heparin vial caps were disinfected with alcohol diluted with tap water. Hospital switched to single-use alcohol swabs	Nasser et al. (2004)