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In a recent publication in the journal, Emerging Infectious Diseasesthe results of a survey on the sterility and use of tap water in household medical devices like CPAPs and nasal rinsing show that far too many people believe it is safe to use in that capacity and that clear public health education is necessary.

Public domain image/ JoJoJo04

First, as the article notes that tap water is not sterile and even after being treated to meet safe drinking standards, low levels of microorganisms remain in drinking water distribution systems, wells, and premise plumbing- some which are not safe for aerosolized inhalation and ocular or nasal irrigation, eg Pseudomonas aeruginosa, nontuberculous mycobacteria (NTM), Legionella spp., Acanthamoeba spp., and Naegleria fowleri.

The researchers looked into whether people might not understand that tap water is not sterile, leading to its use for specific purposes, such as nasal rinsing, inhalation, and contact lens rinsing that are not recommended.

What they found in the cross-sectional study included:

  1. 33% of respondents incorrectly answered that tap water does not have bacteria or living things present.
  2. 62% said that tap water could be used for rinsing sinuses.
  3. 50% said that tap water could be used for rinsing contact lenses
  4. and 42% said it was okay to use with respiratory devices.

In addition, researchers asked about actual use of tap water in medical devices and got the following results:

  1. 24% reported filling humidifiers or CPAP machines with tap water
  2. 13% reported using tap water for nasal rinsing
  3. and 9% reported using tap water for rinsing contact lenses.

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Persons should be informed that they can reduce their exposure to waterborne pathogens by using distilled water or water that has been appropriately boiled and cooled and by regularly cleaning and disinfecting all respiratory devices that use water.

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 are effective risk communication strategies that can influence population behavior change.

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