Water management practices and antibiotic-resistant Pseudomonas aeruginosa contamination in Ethiopian tertiary hospitals: implications for waterborne healthcare-associated infections

The threat of healthcare-associated infections is significantly heightened when they are caused by drug-resistant pathogens. This study evaluates hospital water management practices and contamination by antibiotic-resistant Pseudomonas aeruginosa in tertiary hospitals of Ethiopia. Data collection occurred between December 2023 and January 2024. Qualitative data from interviews and observations were analysed thematically. One hundred and twenty water and biofilm samples were collected, followed by identification and antimicrobial susceptibility profiling of P. aeruginosa. Neither hospital had a specific water management programme for preventive maintenance or system management. We found a 16% prevalence of P. aeruginosa. Overall, 26.3% of the isolates were resistant to at least one antibiotic. The highest resistance was observed against imipenem. We identified two isolates from the maternity ward of Hospital A that exhibited multidrug resistance to ciprofloxacin, amikacin, and imipenem. The structural and operational compliance of the hospital water management programmes in both hospitals falls significantly short of international standards. A higher rate of Pseudomonas positivity, including a greater prevalence of resistant strains, suggests persistent hospital water contamination. Given these findings, we recommend that both hospitals establish a multidisciplinary water safety team to oversee and optimize water quality management.