Reducing Waterborne Pathogens In Your NICU

Evi Dewhurst / November 2016

Waterborne pathogens image

Waterborne pathogens in the NICU have been identified health hazards for many years now. Although invisible to the human eye, they are regardless a very real threat to human health.

While they are a danger in adult patient populations, these pathogens can pose an even more significant risk to the smallest and most vulnerable patients: critical care infants with immature immune systems.

Learning more about these pathogens can help your neonatal intensive care unit stay focused on improving water safety in the NICU. Let’s review a few of these nasty little bugs, shall we?

Legionella Species

Legionella tops most peoples’ list as the best-known waterborne pathogen. Legionella species is responsible for Legionnaires’ disease, or Legionellosis, which is a severe form of pneumonia. It impacts an estimated 10,000 to 18,000 people in the United States every year.1 It is found in both potable water (drinking water) and non-potable water.

Y.E. Lin et al studied Legionella in the hospital setting and determined, “Prevention is both life-saving and less expensive in the long run, given the litigation and unfavorable publicity.” In this they refer to the Allegheny County Health Department, Pittsburgh, Pennsylvania Guidelines recommendation of instituting environmental cultures followed by remedial action before the disease strikes.

Premeditated, preventative action is encouraged in order to reduce incidence, and spread, of Legionella.

Content Provider: CDC/ Janice Haney Carr

Pseudomonas aeruginosa

Pseudomonas aeruginosa can also be found in water. It can cause ear infections, eye infections, and rashes for those of us with a clean bill of health. It gets much more dangerous for immunocompromised individuals, and in fact, most often occurs in the hospital setting (and to the most critical patients) for that reason.

This pathogen gets even more serious when you consider that Pseudomonas are becoming more difficult to treat, thanks to growing antibiotic resistance. These multidrug-resistant Pseudomonas can actually be downright deadly for patients. The CDC reports, “An estimated 51,000 healthcare-associated P. aeruginosa infections occur in the United States each year. More than 6,000 (13%) of these are multidrug-resistant, with roughly 400 deaths per year attributed to these infections.”2

Pseudomonas can be transferred and shared in the hospital by healthcare workers’ hands and by equipment which is not properly cleaned. Proper hand hygiene and environmental cleaning can greatly reduce its potential transmission.


Content Provider: CDC/ Matthew J. Arduino

Acinetobacter species

Commonly found in soil and water, Acinetobacter is a group of bacteria that is transmitted in much the same way as Pseudomonas. This pathogen is especially fond of weakened immune systems. It often makes its way into intensive care units.

Acinetobacter is fairly harmless to robust immune systems, and so is not as often reported outside of critical care health facilities. In the immunocompromised patient, Acinetobacter can cause pneumonia or serious blood or wound infections.

The lifespan of Acinetobacter is quite lengthy – it can live on skin surface for several days, where it waits for access to an easy opening, or to be conveniently carried to another patient. And a bonus for this pathogenic little guy: it too gets more drug resistant over time. Based on this, it’s simple to understand why it grows and thrives in intensive care environments.

Content Provider: CDC/ Catherine Armbruster; Margaret Williams

And so many more

Water carries many more additional risks for intensive care patients: Stenotrophomonas maltophilia, Klebsiella pneumonia, Aspergillus, Cryptosporidium, Atypical mycobacteria… And my personal (non)favorites: fungi, amoebas, and protozoa. I can guess you feel the same way I do: both grossed out and concerned by the dangers these pathogens present to NICU patients.

Steps to reduce waterborne pathogens in your unit

Every NICU uses water. Water is used for bathing infants, washing hands, and even the milk warming process, just to name a few.

As mentioned earlier, there are two effective ways to reduce potential for waterborne pathogens in your unit:

  • Proper hand hygiene
  • Regular and thorough equipment cleaning

This requires a team-wide mentality and strict reinforcement. It’s easy to minimize the potentially insidious danger water can pose when healthcare professionals are confronted with so many other critical healthcare decisions on a daily basis.

The CDC has released a water management program kit for hospitals just like yours. In this kit are tools to help your team achieve its water safety and management goals. Implement these tools to educate and encourage your team to stay on track.

Another easy way to reduce those pathogens:

  • Use a waterless milk warming process

Water is no longer necessary for milk warming. Waterless milk warming tools are available, such as the Waterless Milk Warmer and the Guardian Warmer. Neither require water for the NICU milk warming process. They offer advanced milk warming capabilities that can meet the varied needs of your patients.

When all is said and done, it comes down to this: reducing water exposure and use is beneficial to alleviate the incidence of hospital acquired infections related to waterborne pathogens. Proper hand hygiene, regular and thorough equipment cleaning, and eliminating unnecessary water use can help.

As waterborne pathogen antibiotic resistance grows, healthcare efforts to address them will increase. Planning your water safety management strategy and efforts now will benefit your NICU, and your at-risk infant patients.


  1. “About the disease.”, Accessed October 2016.
  2. “Healthcare Associated Infections (HAIs): Pseudomonas aeruginosa in healthcare settings.”, Accessed October 2016.

About the Author

Evi Dewhurst is a Senior Marketing Manager for Medela, Inc. As a proud mother of two young children, she is passionate about healthcare for youngsters everywhere and has a serious soft spot for babies. She is part of the dedicated team at Medela, who together are committed to designing and manufacturing products to advance human milk healthcare. Have a question? Evi can be reached at