Dissemination of antibiotic resistance and other healthcare waterborne pathogens. The price of poor design, construction, usage and maintenance of modern water/sanitation services.

Abstract

Summary Classical waterborne pathogens (cholera/typhoid) drove the development of safe water and sanitation during the industrial revolution. Whilst effective against these organisms, other bacteria exploited the potential to form biofilm in the narrow pipes of buildings. Legionella was discovered in 1976. Despite evidence dating back to 1967 (including paediatric deaths in Manchester in 1995 from splashes from a sink contaminating parenteral nutrition) it required the deaths of four neonates and the might of the news media in 2011 for the UK medical services to accept waterborne transmission of other opportunistic plumbing premise pathogens (OPPPs). Human nature, a healthcare construction industry largely devoid of interest in water safety, and failures in recognizing transmission are major forces hindering progress in preventing infection/deaths from waterborne infections. The advent of highly resistant Gram-negative bacteria is highlighting further deficiencies in modern drainage systems. These bacteria are not thought to have special adaptations promoting their dispersal but purely attract our attention to the well-trodden routes used by susceptible organisms, which go undetected. The O'Neill report warns of the bleak future without effective antibiotics. This review examines the evidence as to why modern water services/sanitation continue to present a risk to patient safety (and the general public) and suggests that their designs may be flawed if they are to stem the modern equivalent of cholera, the dissemination of antibiotic resistance.