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Table 8 An overview of all the water containing devices in hospitals

From: Outbreaks of healthcare-associated infections linked to water-containing hospital equipment: a literature review

Medical equipment

N of articles

Risks

Transmission route

Patient population

Prevention

Heater-cooler unit

 > 10 due to global outbreak

Ventilators

Airborne through the airflow of the HCU into the operating room

Cardiopulmonary bypass surgery patients

Use different kind of HCU

Place HCU as far away from the patient

Hemodialysis equipment

11

Water purity

Improper functioning → backflow

Through healthcare workers. Gloves as fomite

Direct contact through backflow of the dialysis line

Dialysis patients

Water with microbial contamination of < 0.1 CFU/mL and endotoxin contamination of < 0.03 IU/mLExtra filter

Neonatal incubators

7

Humidity regulation

Aerosolization into incubator

Through healthcare workers. Gloves as fomite

Premature neonates

Extra HEPA filter

Possible new designs

Dental units

 > 10

Water stagnation

Aerosol droplets

Direct contact with contaminated water due to biofilm that is formed during water stagnation

Aerosol droplets due to the use of dental devices

Dental patients

Nonchemical and chemical agents to prevent and remove biofilm

Fluid warmers

3

Integrity of the membrane

Direct contact with the patient’s blood through a hole in the fluid warmer

Patients suffering from hypothermia, often in high risk departments (ICU, surgery, A&E)

Proper handling prior to using to check the integrity of the tubes

Nebulizers

5

Aerosol droplets

Through healthcare workers. Gloves as fomite

Aerosolization into room air

Direct airway inoculation through connected ventilation system

patients with COPD, pneumonia or tracheostomy patients

Proper cleaning and handling

Avoid multiple users

Water traps

4

Water condensate

Through healthcare workers. Gloves as fomite

Aerosolization of water condensate

Patients who receive respiratory care through a ventilator: surgery and at ICU

Proper cleaning and disposal of the condensate

Water baths

3

Water in water baths

Integrity of the bag

Hands of healthcare workers. Gloves as fomite

Direct contact due to fracture in the bag

Patients who need cryoprecipitate transfusion

Proper cleaning of the water bath

Handle the cryoprecipitate with care

Replace the water baths