Although tap water in the United States is - with very few (and usually temporary) exceptions - safe to drink and cook with, it isn't sterile. Many times over the past dozen years I've written of the dangers of using unsterilized tap water in Neti Pots due to organisms like Naegleria fowleri and Balamuthia mandrillaris.
In 2011 2 residents of Louisiana died after using tap water for nasal irrigation, prompting the Louisiana Health Department to recommend that people `use distilled, sterile or previously boiled water to make up the irrigation solution’ (see Neti Pots & Naegleria Fowleri).
In 2013, we saw the tragic story of a 4-year-old Mississippi child visiting a St. Bernard Parish home, who (according to this NOLA.COM report) appears to have contracted the amoeba while playing with a water hose and a slip-and-slide.
Last October we saw similar concerns over Legionella in Denmark (see Denmark's SSI Issues Warning On Legionella in Hot Water Systems) after Europeans were advised to conserve energy due to the impasse with Russia over their invasion of Ukraine.
Even hospitals can be affected, as we saw in EID Journal: Elizabethkingia & Association with Tap Water & Handwashing, Singapore, where a small nosocomial outbreak was linked to contaminated hand washing stations, which ironically, spread the organism to patients by HCWs after washing their hands.
As mentioned often in the past, CAP (Community Acquired Pneumonia) is the #1 cause of hospitalization of adults with an infectious disease in the United States. Each year it is a major cause of morbidity and mortality, particularly among the elderly.
Often the causative agent, and source of infection, are never identified. Many, however, are likely due to exposure to waterborne organisms.
Despite these (and many other) examples - as the following survey shows - many Americans don't think twice about using tap water in medical devices like Neti pots, CPAP humidifiers, and personal and room humidifiers.
I've only included some excerpts, so follow the link to read the report in its entirety.
(Mis)perception and Use of Unsterile Water in Home Medical Devices, PN View 360+ Survey, United States, August 2021
Shanna Miko, Sarah A. Collier, Claire E. Burns-Lynch, Ashley A. Andújar, Katharine M. Benedict, Julia C. Haston, Catherine O. Hough, and Jennifer R. Cope
Abstract
Tap water is not sterile, and its use in home medical devices can result in infections from waterborne pathogens. However, many participants in a recent survey in the United States said tap water could safely be used for home medical devices. These results can inform communication materials to reduce the high consequence of infections.
Tap water in the United States is treated to meet safe drinking standards; however, low levels of microorganisms remain in drinking water distribution systems, wells, and premise plumbing (1,2). Although most of these microorganisms are harmless and the water is safe for drinking and cooking, it might not always be safe for other uses, such as aerosolized inhalation and ocular or nasal irrigation (2–4). Microorganisms that can be found in water systems include Pseudomonas aeruginosa, nontuberculous mycobacteria (NTM), Legionella spp., Acanthamoeba spp., and Naegleria fowleri (1,2).
In the United States, biofilm-associated pathogens such as Pseudomonas spp., NTM, and Legionella spp. are responsible for a large portion of the 120,000 hospitalizations, 7,000 deaths, and billions in direct healthcare costs annually related to waterborne diseases (5).
Persons who are at a higher risk for acquiring high-consequence opportunistic infections include the elderly, infants and young children, and persons who have weakened immune systems and other concurrent conditions (2,6). Some persons who have weakened immune syat are not recommended.One study reported demographic data on household water use for home medical devices (8). Few data describe the understanding of sterile water sources by the population of the United States. This study aimed to quantify population perceptions of sterile water, water sources, and actual use of water for home medical purposes among US adults and identify differences among demographic groups regarding perceptions and use of water. These findings can help focus educational efforts to increase awareness of safe water use practices for home medical activities, supporting healthcare providers and public health practitioners in advising their patients and communities about safe water practices for home medical activities.(SNIP)
Conclusions
The results of this survey highlight opportunities to reinforce messaging regarding appropriate uses of tap water and recommendations for using water in medical devices at home. Although most persons understand what sterile water is and acknowledge that tap water is not sterile, a large proportion of persons responded that tap water can be used for nasal rinsing devices, contact lens rinsing, and filling respiratory devices. These findings represent an opportunity for public health practitioners and water utilities to continue communicating the value of US tap water and its appropriate use.
(SNIP)
Biofilm-associated waterborne pathogens make up a substantial portion of waterborne disease-related illnesses and deaths in the United States. Our results indicate demographic groups to which future public health and provider efforts should be directed to promote appropriate household tap water management practices when using home medical devices that aerosolize water or irrigate the eyes and nose. Public health messaging and healthcare provider guidance that incorporates risk factors for these device users and aligns with recommendations of the Centers for Disease Control and Prevention (2) are effective risk communication strategies that can influence population behavior change.
Dr. Miko is a nurse and Epidemic Intelligence Service Officer in the Department of Food, Water, and Environmental Diseases, National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA. Her primary research interest is improving public health nationally and internationally through preventing and controlling disease, disability, and death caused by waterborne and environmental incidents and building capacity for better health outcomes.
