Moist environments and aqueous solutions in health-care settings have the potential to serve as reservoirs for waterborne microorganisms. Under favorable environmental circumstances (e.g., warm temperature and the presence of a source of nutrition), many bacterial and some protozoal microorganisms can either proliferate in active growth or remain for long periods in highly stable, environmentally resistant (yet infectious) forms. Modes of transmission for waterborne infections include
direct contact [e.g., that required for hydrotherapy];
ingestion of water [e.g., through consuming contaminated ice];
indirect-contact transmission [e.g., from an improperly reprocessed medical device];
inhalation of aerosols dispersed from water sources; and
aspiration of contaminated water.
The first three modes of transmission are commonly associated with infections caused by gram-negative bacteria and nontuberculous mycobacteria (NTM). Aerosols generated from water sources contaminated with Legionella spp. often serve as the vehicle for introducing legionellae to the respiratory tract.
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