Hygiene in the homes and the knowledge of the staff members were markedly improved during the last years. Some of the most relevant hygienic problems are today: wearing private clothing instead of special working clothes, or deficits in the knowledge of the management of MRSA-colonised residents.
Public health departments are obliged by law to survey hygienic procedures and condition in residential homes for the aged. Based on the annual hygiene control visits, a standardised hygiene ranking was established with the aggregation of more than 60 detailed single observations in the following fields: building, organisation, training of the staff, actual hygiene situation, repeated deficits, food and kitchen hygiene, and drinking water. This hygiene ranking enables not only intra-institutional comparisons in different years but also the comparison between different homes. The data obtained in 2004 to 2006 demonstrated that this method was very well accepted by the institutions and was readily appreciated as a tool for external quality assessment.
Only few epidemiological data on legionella diseases are available in Germany and studies on the prevalence of legionella antibody response in the population are scarce. We report on an epidemiological study on immune response in residents of homes with heavy and with minor legionella contamination in their hot-water system. 53 inhabitants of houseblocks with central hot-water system and high legionella contamination (6,049 +/- 17,995 cfu/l; 40% > 1,000 cfu/l) were studied. 92 persons living in 1-2 family houses with decentral hot water systems (244 +/- 1,434 cfu/l; 3% > 1,000 cfu/l) served as controls. All persons filled in a questionnaire on bronchial and fever diseases etc; blood specimen were tested for legionella antibodies (different methods: immunofluorescence, and ELISA), and urine specimens were analysed for legionella antigen. During this investigation in the population exposed to Legionella no cases of legionellosis were reported. The prevalence of legionella antibodies was twice as high in the exposed versus the control persons. Significant correlation between cfu/l and legionella antibody titer in the inhabitants were found. One person with high antibody titer and with legionella-free hot-water system in his home had reported about pulmonary problems after having stayed in a hotel. The positive antibodies of the other persons are most likely the result of asymptomatic infections caused by permanent exposure in their home hot-water supply. In conclusion, with regard to the increased prevalence of antibody titers against legionellae in the exposed inhabitants and the significant correlation between antibody titers and cfu/l in hot-water samples, the necessity to control and redevelop hot-water systems in homes is confirmed--even though no cases of legionelloses in the exposed population were reported.
The monitoring of drinking water based on the drinking water regulation is one of the central tasks of public health authorities in Germany. With the coming into force of the new drinking water regulation in the year 2003 also water supply plants "from which water is made available for the public, in particular in schools, kindergartens, hospitals, restaurants and other communal facilities" must be supervised for the first time (TrinkwV section sign 18). Thus, for Frankfurt/Main the number of the facilities/objects which are to be supervised rose from approx. 300 to approx. 4,700. Since appropriate expansion of personnel was not possible, innovative solutions were in demand for implementation of these tasks. These are introduced here.
To investigate the association between the engineering standards of drinking water systems and the extent of the Legionella colonization, we subjected our 2006 published data of the drinking water monitoring of the city's public health services for Frankfurt on Main, Germany, to closer analysis. A total of 413 records were available, with both technical data and results of the Legionella colonization. When comparing the classes of technical deficiencies of the drinking water installations with the Legionella colonization results, 93% of the Legionella data "not dedectable in 100 ml" were found in the group of drinking water installations that were technically assessed as "free of deficiencies". Thus, "good" technical engineering is associated with low or lack of Legionella colonization with a high probability even with hints for a dose-effect phenomenon-the more engineering deficiencies that exist, the higher the Legionella contamination.
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