Control of nosocomial Legionnaires' disease by keeping the circulating hot water temperature above 55°C: experience from a 10-year surveillance programme in a district general hospital

Darelid, Johan; Löfgren, Sture; Malmvall, Bo‐Eric

doi:10.1053/jhin.2002.1185

Cited by 86 publications

(64 citation statements)

References 28 publications

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“…We also studied hydrogen peroxide, which has not yet been used extensively to control Legionella in hospital water distribution systems (36,37). A comparison was carried out between these new procedures and two popular methods, chlorine dioxide and hyperthermia, which have widely been reported to be effective (38)(39)(40)(41)(42).…”

Section: Discussionmentioning

confidence: 99%

Control of Legionella Contamination and Risk of Corrosion in Hospital Water Networks following Various Disinfection Procedures

Marchesi

Mansi

Marcelloni

et al. 2016

Appl Environ Microbiol

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bPhysical and chemical disinfection methods have been proposed with the aim of controlling Legionella water contamination. To date, the most effective procedures for reducing bacterial contamination have not yet been defined. The aim of this study was to assess the long-term effectiveness of various disinfection procedures in order to reduce both culturable and nonculturable (NC) legionellae in different hospital water networks treated with heat, chlorine dioxide, monochloramine, and hydrogen peroxide. The temperature levels and biocide concentrations that proved to give reliable results were analyzed. In order to study the possible effects on the water pipes, we verified the extent of corrosion on experimental coupons after applying each method for 6 months. The percentage of positive points was at its lowest after treatment with monochloramine, followed by chlorine dioxide, hydrogen peroxide, and hyperthermia. Different selections of Legionella spp. were observed, as networks treated with chlorinebased disinfectants were contaminated mainly by Legionella pneumophila serogroup 1, hyperthermia was associated with serogroups 2 to 14, and hydrogen peroxide treatment was associated mainly with non-pneumophila species. NC cells were detected only in heat-treated waters, and also when the temperature was approximately 60°C. The corrosion rates of the coupons were within a satisfactory limit for water networks, but the morphologies differed. We confirm here that chemical disinfection controls Legionella colonization more effectively than hyperthermia does. Monochloramine was the most effective treatment, while hydrogen peroxide may be a promising alternative to chlorine-based disinfectants due to its ability to select for other, less virulent or nonpathogenic species.

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Section: Discussionmentioning

confidence: 99%

Control of Legionella Contamination and Risk of Corrosion in Hospital Water Networks following Various Disinfection Procedures

Marchesi

Mansi

Marcelloni

et al. 2016

Appl Environ Microbiol

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show abstract

“…Such interventions have been successful for short periods of time, after which the bacteria reappear in these sources (20,103). Thus, eradication of L. pneumophila from the environmental sources of infection requires continuous treatment of the water with agents such as monochloramine or copper-silver ions in addition to maintenance of the water temperature above ϳ55°C (30,51,66,67). Compared to in vitro-grown L. pneumophila, amoeba-grown bacteria have been shown to be highly resistant to chemical disinfectants and to treatment with biocides (11).…”

Section: The Role Of Free-living Amoebae In Persistence Of Legionellamentioning

confidence: 99%

Amoebae as Training Grounds for Intracellular Bacterial Pathogens

Molmeret

Horn

Wagner

et al. 2005

Appl Environ Microbiol

457

460

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“…This can be done by increasing the temperature in the output water or regulating the water temperature by shock absorbers. These methods can only be used on hot water line and if not very carefully there may be an increase of the risk of burn wounds in patients [46,47]. Using chemical agents for chlorination of the water system is most commonly used method.…”

Section: Preventing Nosocomial Infections With Water Borne Bacteriamentioning

confidence: 99%

Risk of Getting Nosocomial Water-Borne Infections from the Main Water Systems in Hospitals

Andersen¹,

Høg²,

Joensen³

2017

JLS

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Drinking water may be a risk factor for human infections if the water supply is contaminated with biofilm producing bacteria such as Legionella pneumophilae or Pseudomonas aeruginosa. Several situations have to be considered when water supply to new buildings is planned. The aim of this paper is to review situations that have to be considered in new buildings and give an example on a new water supply contaminated with biofilm producing water bacteria and the precautions introduced to eliminate the contamination. When new buildings are planned it should be considered where to get the water and what is the microbiological quality of the water. If the water is contaminated there will be troubles from the beginning. The material for the pipes should be considered as biofilm which is produced in greater amounts and faster in PEG pipes than in stainless steel pipes. The choice of material depends on the expected lifetime of the building, the dimensions of the pipes, and the choice of forceps, how often the taps are used and thereby the flow in the system. The higher flow the less and slower biofilm formation. It is important to reduce the number of taps to a minimum to ovoid "dead ends" if they are not or only seldom used. Alternatively all taps could be opened automatically regularly. It is important to establish precautions to ovoid contamination of the water system in the period from when it is established until the building is taken in use. The period can be several months during which the system can act as a "dead end" if no precautions, such as regularly opening of all taps, are taken. The microbiological quality of the water in the system should be controlled before the building is taken in use. In a new building, where the water supply and the water in the building was not controlled before the building was taken in use, extremely high total and Legionella germ counts were found. The water was disinfected with low concentrations of chloride with very little effect. After disinfection with high concentrations of chloride for few hours and placing a sterile filter at the water entrance both the total and Legionella germ count decreased to an acceptable level.

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Control of nosocomial Legionnaires' disease by keeping the circulating hot water temperature above 55°C: experience from a 10-year surveillance programme in a district general hospital

Cited by 86 publications

References 28 publications

Control of Legionella Contamination and Risk of Corrosion in Hospital Water Networks following Various Disinfection Procedures

Control of Legionella Contamination and Risk of Corrosion in Hospital Water Networks following Various Disinfection Procedures

Amoebae as Training Grounds for Intracellular Bacterial Pathogens

Risk of Getting Nosocomial Water-Borne Infections from the Main Water Systems in Hospitals

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