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Hospital water safety is a major priority and constant challenge for healthcare epidemiologists, safety officers, engineers, and administrators. Waterborne infections incur significant morbidity and mortality, and some are preventable. As with other healthcare-associated infections, occurrence of nosocomial waterborne infections erodes public confidence in healthcare facilities.

Pathogens such as Legionella and nontuberculous mycobacteria can colonize the deep infrastructure or outlets of hospital water distribution systems, while other Gram-negative bacteria and molds tend to adhere to biofilms at or near the distal points of use. In this review we discuss frequent routes of transmission, categories of waterborne organisms, considerations for prevention and management of waterborne transmission to patients, and future directions in investigation of waterborne outbreaks.