Classical waterborne pathogens (cholera/typhoid) drove the development of safe water and sanitation during the industrial revolution. Whilst effective against these organisms, other bacteria exploited the potential to form biofilm in the narrow pipes of buildings. Legionella was discovered in 1976. Despite evidence dating back to 1967 (including paediatric deaths in Manchester in 1995 from splashes from a sink contaminating parenteral nutrition) it required the deaths of four neonates and the might of the news media in 2011 for the UK medical services to accept waterborne transmission of other opportunistic plumbing premise pathogens (OPPPs). Human nature, a healthcare construction industry largely devoid of interest in water safety, and failures in recognizing transmission are major forces hindering progress in preventing infection/deaths from waterborne infections. The advent of highly resistant Gram-negative bacteria is highlighting further deficiencies in modern drainage systems. These bacteria are not thought to have special adaptations promoting their dispersal but purely attract our attention to the well-trodden routes used by susceptible organisms, which go undetected. The O'Neill report warns of the bleak future without effective antibiotics. This review examines the evidence as to why modern water services/sanitation continue to present a risk to patient safety (and the general public) and suggests that their designs may be flawed if they are to stem the modern equivalent of cholera, the dissemination of antibiotic resistance.

工业革命期间，经典水传播病原体（霍乱/伤寒）推动了安全用水和卫生设施的发展。虽然对这些生物体有效，但其他细菌利用了在建筑物狭窄管道中形成生物膜的潜力。军团菌于 1976 年被发现。尽管证据可以追溯到 1967 年（包括 1995 年曼彻斯特因水槽溅水污染肠外营养而导致的儿科死亡），但 2011 年英国医疗服务需要四名新生儿的死亡和新闻媒体的力量接受其他机会性管道病原体 (OPPP) 的水传播。人性、医疗保健建筑行业对水安全基本上缺乏兴趣，以及未能识别传播是阻碍预防水传播感染/死亡进展的主要因素。高耐药性革兰氏阴性细菌的出现进一步凸显了现代排水系统的缺陷。人们不认为这些细菌具有促进其传播的特殊适应性，而纯粹是为了吸引我们对易感生物体经常使用的路线的关注，而这些路线未被发现。奥尼尔的报告警告说，如果没有有效的抗生素，未来将是黯淡的。这篇综述审查了为什么现代供水服务/卫生设施继续对患者安全（和公众）构成风险的证据，并表明如果它们要阻止现代霍乱（即抗生素的传播），它们的设计可能存在缺陷反抗。