Information was prepared by W. Alan Harris, RN, BSN

Additional Information for Health Care Providers

According to the CDC, there are 900,000 or more cases of waterborne illness diagnosed annually, about 900 of which are fatal. 

Most waterborne illnesses (cholera, typhus, dysentery, E. coli, etc.) are thwarted by the addition of chlorine to city water (this is ineffective if there is a breach in a water main)

In some states, more than half of the population drinks from unregulated water sources.


Who is at Risk?

Children are at risk because they drink more water per unit of weight than adults, and they metabolize and excrete toxins less efficiently.

Older adults are at risk because of decreased blood flow to liver and kidneys.

Anyone drinking well water (where bacteria may be present), or water from an unregulated source (where possible biological contaminants are not killed by properly regulated water treatment facilities).

Those who may be drinking from a water source where a water main has unknowingly been breached (especially rural areas).


Common Contaminants

Common bacterial contaminants include: Legionella, E. Coli, Cryptosporidium, Giardia intestinalis, Campylobacter jejuni, and Salmonella.

Viruses may also contaminate water, and are much less susceptible to chlorine disinfection. It is likely, however, that many cases of diagnosed “viral stomach flu” are actually a result of the above noted bacterial water contaminants. 

Halogenated hydrocarbons (in adhesives, paint, and spot removers) are among the most common water supply contaminants in this country. Even low-level exposure may have teratogenic effects, cause immune dysfunction, or lead to kidney and liver damage.

Lead is neurotoxic, and effects on children are especially detrimental. Even low levels may cause decreases in IQ and changes in peripheral nerve function. Infants and young children exposed to lead may have cognitive and physical developmental delays, as well as learning disabilities. ENCOURAGE PARENTS OF INFANTS TO USE FILTERED OR DISTILLED WATER WHEN PREPARING BABY FORMULA. Exposure in adults leads to kidney problems and hypertension. The CDC considers venous blood levels of 10mcg/dL as elevated, but acknowledges that symptoms may not be seen until upwards of 60mcg/dL. 


What can I do?

Obtain your patient’s drinking water history, and consider waterborne illness when diagnosing gastroenteritis. Encourage them to be vigilant about water testing if you suspect water contamination. 

ENCOURAGE PARENTS OF INFANTS TO USE FILTERED OR DISTILLED WATER WHEN PREPARING BABY FORMULA.


Is Bottled Water Better?

Bottled water is not necessarily safer than tap water; up to 25% of the bottled water in the U.S. is actually tap water. Furthermore, bottled water falls under the jurisdiction of the FDA as opposed to the EPA, and has significantly less rigorous standards with regards to possible contaminants contained therein.



Reference:

Chalupka, S. Tainted Water on Tap. American Journal of Nursing 2005; 105 (11): 40-52.
Information was prepared by W. Alan Harris, RN, BSN