Drainage systems, an occluded source of sanitation related outbreaks

Blom, Kristina

Papers were found in PubMed and Google Scholar starting 1907 using key words such as sanitation, infection, transmission, drains, sinks, outbreaks, drainage systems, sewage, wastewater treatment plants, bacteria, virus, resistance, antibiotics, biofilm, infection prevention, and health care associated infections. The fact that contamination on surfaces, transmission of pathogens, and infections must be prevented not only in health care but also in industry and in the community led to that experiences from these disciplines were explored if useful also to health care. Internet was searched to find news from community cases and guidelines on what conditions and requirements that e.g. food industry must comply with as well as workers at risk of exposure to sewage. Guidance documents were found at the databases of e.g. World Health Organization, Health and Safety Executive (UK), Centers for Disease Control and Prevention (CDC), Atlanta, GA and quality management systems were found by searching God Manufacturing Practice and hazard analysis critical control points (HACCP). Also, regulations from authorities such as Environmental Protection Agency were considered [24] to be relevant to assess the risk to be exposed to sewage. The search outcome, 71 references, is summarized in this review and describes aspects that support the finding that drainage systems if not properly installed or designed and maintained shall be considered as hazardous that may cause infections and emergence of pathogens armed with additional resistance and virulence as well as other diseases e.g. allergies against mold.