{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T06:53:45Z","timestamp":1787727225000,"version":"build-2784847793"},"reference-count":23,"publisher":"IWA Publishing","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":25,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["iwaponline.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,1,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p\/>\n                  <jats:p>Wastewater surveillance (WWS) at healthcare facilities is a nascent field with knowledge gaps in the feasibility of conducting such surveillance at this specialized facility type, and for how to best implement and interpret wastewater (WW) data. WWS was piloted at skilled nursing facilities, including conducting tracer studies, optimization of a low-flow strainer for autosampler WW collection, and preliminary testing of a WW access survey. An expanded WW access survey with collaboration from additional partners was distributed to 16 post-acute\/long-term care facilities. The lessons learned obtained through the pilot \u2018use cases\u2019 demonstrated minimal clogging and consistent collection of WW using a low-flow strainer (\u00b10.36 L) and tracer studies highlighted the importance to confirm facility effluent source with an average visual dye detection between 1.5 and 2.5 min from the toilet flush. The expanded WW access survey assessed the feasibility of WWS regarding physical onsite manhole access, safety aspects, effluent flow, and other factors, where 75% (12 of 16) of surveyed facilities demonstrated feasibility. Healthcare facility-level WWS includes specialized methodological approaches prior to implementation to achieve the intended public health impact. These considerations support the continued overall goal of detecting emerging biological public health threats at healthcare facilities using WWS.<\/jats:p>","DOI":"10.2166\/wh.2025.167","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T16:01:55Z","timestamp":1768579315000},"page":"50-64","update-policy":"https:\/\/doi.org\/10.2166\/iwapcrossmarkpolicypage","source":"Crossref","is-referenced-by-count":4,"title":["Healthcare wastewater surveillance: methodological considerations for sampling, feasibility, and implementation"],"prefix":"10.2166","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0435-7595","authenticated-orcid":false,"given":"Angela","family":"Coulliette-Salmond","sequence":"first","affiliation":[{"name":"a CDC, Division of Healthcare Quality Promotion, Atlanta, GA, USA"},{"name":"b U.S. Public Health Service, Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1047-2605","authenticated-orcid":false,"given":"Florence","family":"Whitehill","sequence":"additional","affiliation":[{"name":"a CDC, Division of Healthcare Quality Promotion, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4312-2481","authenticated-orcid":false,"given":"Amanda K.","family":"Lyons","sequence":"additional","affiliation":[{"name":"a CDC, Division of Healthcare Quality Promotion, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6342-3748","authenticated-orcid":false,"given":"Bethelhem","family":"Abera","sequence":"additional","affiliation":[{"name":"a CDC, Division of Healthcare Quality Promotion, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8204-1687","authenticated-orcid":false,"given":"Colin","family":"Adler","sequence":"additional","affiliation":[{"name":"a CDC, Division of Healthcare Quality Promotion, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1090-7621","authenticated-orcid":false,"given":"Maroya Spalding","family":"Walters","sequence":"additional","affiliation":[{"name":"a CDC, Division of Healthcare Quality Promotion, Atlanta, GA, USA"},{"name":"b U.S. Public Health Service, Rockville, MD, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6800-0283","authenticated-orcid":false,"given":"Magdalena","family":"Medrzycki","sequence":"additional","affiliation":[{"name":"a CDC, Division of Healthcare Quality Promotion, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2005-9355","authenticated-orcid":false,"given":"Christine","family":"Ganim","sequence":"additional","affiliation":[{"name":"a CDC, Division of Healthcare Quality Promotion, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6235-9404","authenticated-orcid":false,"given":"Mariya","family":"Campbell","sequence":"additional","affiliation":[{"name":"a CDC, Division of Healthcare Quality Promotion, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2992-6221","authenticated-orcid":false,"given":"Michael Y.","family":"Lin","sequence":"additional","affiliation":[{"name":"c Rush University Medical Center, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5401-449X","authenticated-orcid":false,"given":"Rachel S.","family":"Poretsky","sequence":"additional","affiliation":[{"name":"d University of Illinois-Chicago, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7540-6509","authenticated-orcid":false,"given":"Adam","family":"Horton","sequence":"additional","affiliation":[{"name":"d University of Illinois-Chicago, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5431-6794","authenticated-orcid":false,"given":"Jennifer","family":"Weidhaas","sequence":"additional","affiliation":[{"name":"e University of Utah, Salt Lake City, UT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0008-6353","authenticated-orcid":false,"given":"James","family":"VanDerslice","sequence":"additional","affiliation":[{"name":"e University of Utah, Salt Lake City, UT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4252-9434","authenticated-orcid":false,"given":"L. Scott","family":"Benson","sequence":"additional","affiliation":[{"name":"e University of Utah, Salt Lake City, UT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9675-9764","authenticated-orcid":false,"given":"Erin M.","family":"Driver","sequence":"additional","affiliation":[{"name":"f The Biodesign Institute, Arizona State University, Tempe, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf U.","family":"Halden","sequence":"additional","affiliation":[{"name":"f The Biodesign Institute, Arizona State University, Tempe, AZ, USA"},{"name":"g School of Sustainable Engineering and the Built Environment, Tempe, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2991-7325","authenticated-orcid":false,"given":"Kerry A.","family":"Hamilton","sequence":"additional","affiliation":[{"name":"f The Biodesign Institute, Arizona State University, Tempe, AZ, USA"},{"name":"g School of Sustainable Engineering and the Built Environment, Tempe, AZ, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3168-1286","authenticated-orcid":false,"given":"Margaret","family":"Williams","sequence":"additional","affiliation":[{"name":"a CDC, Division of Healthcare Quality Promotion, Atlanta, GA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"945","published-online":{"date-parts":[[2025,12,22]]},"reference":[{"key":"key-10.2166\/wh.2025.167-1","doi-asserted-by":"publisher","DOI":"10.1016\/j.watres.2021.117369"},{"key":"key-10.2166\/wh.2025.167-2","unstructured":"AHA (2019) Fact Sheet: Long-Term Care Hospitals. Chicago, IL: America Hospital Association. Available at: https:\/\/www.aha.org\/fact-sheets\/2019-04-05-fact-sheet-long-term-care-hospitals [Accessed 9th April 2025]."},{"key":"key-10.2166\/wh.2025.167-3","volume-title":"Antibiotic Resistance Threats in the United States, 2019","author":"CDC","year":"2019"},{"key":"key-10.2166\/wh.2025.167-4","unstructured":"CDC (2022) Public Health Strategies to Prevent the Spread of Novel and Targeted Multidrug-Resistant Organisms (MDROs). Atlanta, GA: Centers for Disease Control. Available at: https:\/\/www.cdc.gov\/healthcare-associated-infections\/php\/preventing-mdros\/mdro-prevention-strategies.html?CDC_AAref_Val=https:\/\/www.cdc.gov\/hai\/mdro-guides\/prevention-strategy.html [Accessed 19th December 2024]."},{"key":"key-10.2166\/wh.2025.167-5","doi-asserted-by":"publisher","DOI":"10.1017\/ash.2022.78"},{"key":"key-10.2166\/wh.2025.167-6","unstructured":"CMS (2016a) Fact Sheet: Medicare Skilled Nursing Facility (SNF) Transparency Data (CY2013). Baltimore, MD: U.S. Centers for Medicare and Medicaid Services. [Accessed 9th April 2025]."},{"key":"key-10.2166\/wh.2025.167-7","unstructured":"CMS (2016b) What are Long-Term Care Hospital?. Baltimore, MD: U.S. Centers for Medicare and Medicaid Services. Available at: https:\/\/www.medicare.gov\/publications\/11347-long-term-care-hospitals.pdf#:\u223c:text=Long%E2%80%90term%20care%20hospitals%20%28LTCHs%29%20are%20certified%20as%20acute%E2%80%90care,there%20from%20an%20intensive%20or%20critical%20care%20unit. [Accessed 9th April 2025]."},{"key":"key-10.2166\/wh.2025.167-8","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwae419"},{"key":"key-10.2166\/wh.2025.167-9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2023.12.016"},{"key":"key-10.2166\/wh.2025.167-10","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2020.140804"},{"key":"key-10.2166\/wh.2025.167-11","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmicom.2025.105087"},{"key":"key-10.2166\/wh.2025.167-12","doi-asserted-by":"publisher","DOI":"10.3201\/eid3003.230888"},{"key":"key-10.2166\/wh.2025.167-13","doi-asserted-by":"publisher","DOI":"10.1016\/j.scitotenv.2025.179124"},{"key":"key-10.2166\/wh.2025.167-14","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/jiaf534"},{"key":"key-10.2166\/wh.2025.167-15","volume-title":"Biosafety in Microbiological and Biomedical Laboratories","author":"Meechan","year":"2020"},{"key":"key-10.2166\/wh.2025.167-16","doi-asserted-by":"crossref","unstructured":"NAS (2024) Increasing the Utility of Wastewater-Based Disease Surveillance for Public Health Action: A Phase 2 Report. Washington, DC: National Academies Press (US). doi:10.17226\/27516.","DOI":"10.17226\/27516"},{"key":"key-10.2166\/wh.2025.167-17","article-title":"Sewer monitoring for antimicrobial resistance genes and organisms at healthcare facilities","author":"Poretsky","year":"2025","journal-title":"Journal of Infectious Diseases"},{"key":"key-10.2166\/wh.2025.167-18","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0500088102"},{"key":"key-10.2166\/wh.2025.167-19","doi-asserted-by":"publisher","DOI":"10.2166\/wh.2025.374"},{"key":"key-10.2166\/wh.2025.167-20","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2025.106503"},{"key":"key-10.2166\/wh.2025.167-21","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6430a4"},{"key":"key-10.2166\/wh.2025.167-22","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.0409523102"},{"key":"key-10.2166\/wh.2025.167-23","doi-asserted-by":"crossref","unstructured":"Warren E., VanDerslice J., Benson L. S., Brazelton W. J., Tanner W., Lyons A. K., Whitehill F., Coulliette-Salmond A., Fusco S. & Weidhaas J. (2025) Evaluation of detection methods for wastewater surveillance of antimicrobial-resistant bacteria from healthcare facilities, [Preprint]. https:\/\/doi.org\/10.64898\/2025.12.14.694051.","DOI":"10.64898\/2025.12.14.694051"}],"container-title":["Journal of Water and Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/iwaponline.com\/jwh\/article-pdf\/24\/1\/50\/1604644\/jwh2025167.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/iwaponline.com\/jwh\/article-pdf\/24\/1\/50\/1604644\/jwh2025167.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T15:38:58Z","timestamp":1770046738000},"score":1,"resource":{"primary":{"URL":"https:\/\/iwaponline.com\/jwh\/article\/24\/1\/50\/110650\/Healthcare-wastewater-surveillance-methodological"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12,22]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2025,12,22]]},"published-print":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.2166\/wh.2025.167","relation":{},"ISSN":["1477-8920","1996-7829"],"issn-type":[{"value":"1477-8920","type":"print"},{"value":"1996-7829","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,22]]}}}