Irrigation water can be a source of pathogenic contamination of fresh produce. The quality of the water used during primary production is important to control to ensure food safety and protect human health. Several measures to control the microbiological quality of irrigation water are available for growers, including preventative and mitigation strategies. However, clear guidance for growers on which strategies could be used to reduce microbiological contamination is needed. This study evaluates pathogenic microorganisms of concern in fresh produce and water, the microbiological criteria of water intended for agricultural purposes, as well as preventative and mitigative microbial reduction strategies. This article provides suggestions for control measures that growers can take during primary production to reduce foodborne pathogenic contamination coming from irrigation water. Results show that controlling the water source, regime, and timing of irrigation may help to reduce the potential exposure of fresh produce to contamination. Moreover, mitigation strategies like electrolysis, ozone, UV, and photocatalysts hold promise either as a single treatment, with pretreatments that remove suspended material, or as combined treatments with another chemical or physical treatment(s). Based on the literature data, a decision tree was developed for growers, which describes preventative and mitigation strategies for irrigation water disinfection based on the fecal coliform load of the irrigation water and water turbidity. It helps guide growers when trying to evaluate possible control measures given the quality of the irrigation water available. Overall, the strategies available to control irrigation water used for fresh produce should be evaluated on a case-by-case basis as one strategy or technology does not apply to all scenarios.