Legionella pneumophila contamination in a steam towel warmer in a hospital setting

Higa, Futoshi; Koide, Michio; Haroon, Attiya; Haranaga, Shusaku; Yamashiro, Tetsu; Tateyama, Masao; Fujita, Jiro

doi:10.1016/j.jhin.2011.12.011

Cited by 9 publications

(6 citation statements)

References 4 publications

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“…In 23 publications, potential sources or reservoirs of Legionella were described that were only mentioned in one or two publications selected in this review. The following potential sources were considered in source investigations: discharge vessels of sullage tanks collecting bilge water from ships, a steam turbine condenser, an inoperative bedpan flusher, a steam towel warmer, an industrial air scrubber located at a WWTP (see Wastewater/Wastewater Treatment Plants), , and garden hoses. , Low LOEs (III–V) were assigned because the evidence was inconclusive or another suspected source was found to be the most likely source.…”

Section: Potential Legionella Sourcesmentioning

confidence: 99%

Confirmed and Potential Sources of Legionella Reviewed

Heijnsbergen

Schalk

Euser

et al. 2015

Environ. Sci. Technol.

136

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Legionella bacteria are ubiquitous in natural matrices and man-made systems. However, it is not always clear if these reservoirs can act as source of infection resulting in cases of Legionnaires' disease. This review provides an overview of reservoirs of Legionella reported in the literature, other than drinking water distribution systems. Levels of evidence were developed to discriminate between potential and confirmed sources of Legionella. A total of 17 systems and matrices could be classified as confirmed sources of Legionella. Many other man-made systems or natural matrices were not classified as a confirmed source, since either no patients were linked to these reservoirs or the supporting evidence was weak. However, these systems or matrices could play an important role in the transmission of infectious Legionella bacteria; they might not yet be considered in source investigations, resulting in an underestimation of their importance. To optimize source investigations it is important to have knowledge about all the (potential) sources of Legionella. Further research is needed to unravel what the contribution is of each confirmed source, and possibly also potential sources, to the LD disease burden.

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Section: Potential Legionella Sourcesmentioning

confidence: 99%

Confirmed and Potential Sources of Legionella Reviewed

Heijnsbergen

Schalk

Euser

et al. 2015

Environ. Sci. Technol.

136

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“…Point-of-use plumbing fixture selection may affect risk for colonization; at some hospitals, hands-free faucets have been shown to have higher Legionella contamination rates than manual faucets, and may be more likely to fail disinfection attempts [16–18]. Immunosuppressed patients may acquire the bacteria from hospital water sources via exposure to aerosols from bathing [8, 19–21], steam-heated towels [22], decorative hospital fountains [9, 15, 23], and possibly aspiration of contaminated water [7], among others. Even the distilled water system can become colonized with Legionella , as documented in a Quebec City outbreak of Legionella dumoffii acquired via respiratory therapy equipment and a room humidifier [24].…”

Section: Legionellamentioning

confidence: 99%

The role of water in healthcare-associated infections

Decker

Palmore

2013

Current Opinion in Infectious Diseases

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Purpose of review The aim is to discuss the epidemiology of infections that arise from contaminated water in healthcare settings, including Legionnaire’s disease, other Gram-negative pathogens, nontuberculous mycobacteria, and fungi. Recent findings Legionella can colonize a hospital water system and infect patients despite use of preventive disinfectants. Evidence-based measures are available for secondary prevention. Vulnerable patients can develop care-associated infections with waterborne organisms that are transmitted by colonization of plumbing systems, including sinks and their fixtures. Room humidifiers and decorative fountains have been implicated in serious outbreaks, and pose unwarranted risks in healthcare settings. Summary Design of hospital plumbing must be purposeful and thoughtful to avoid the features that foster growth and dissemination of Legionella and other pathogens. Exposure of patients who have central venous catheters and other invasive devices to tap water poses a risk for infection with waterborne pathogens. Healthcare facilities must conduct aggressive clinical surveillance for Legionnaire’s disease and other waterborne infections in order to detect and remediate an outbreak promptly. Hand hygiene is the most important measure to prevent transmission of other Gram-negative waterborne pathogens in the healthcare setting.

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“…Incidences of Legionellosis have been linked to contaminated shower heads (Hanrahan et al, 1987; Zmirou-Navier et al, 2007), spas (Jernigan et al, 1996; Benkel et al, 2000), baths (Sasaki et al, 2008) a hospital steam towel warmer (Higa et al, 2012), ice machines (Graman et al, 1997; Schuetz et al, 2009), mist generators (Mahoney et al, 1992), decorative water fountains (Fleming et al, 2000; O’Loughlin et al, 2007; Haupt et al, 2012), hospital water distribution systems (Tobin et al, 1981; Hanrahan et al, 1987) dental units (Reinthaler et al, 1988; Atlas et al, 1995) and cooling towers (Isozumi et al, 2005; Nguyen et al, 2006). L. pneumophila has also been detected in potable water and in 2011, 57.6% of all potable water related disease outbreaks in the United States were due to Legionella spp.…”

Section: Exposure Assessmentmentioning

confidence: 99%

Uncertainties associated with assessing the public health risk from Legionella

et al. 2014

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Legionella is an opportunistic pathogen of public health concern. Current regulatory and management guidelines for the control of this organism are informed by risk assessments. However, there are many unanswered questions and uncertainties regarding Legionella epidemiology, strain infectivity, infectious dose, and detection methods. This review follows the EnHealth Risk Assessment Framework, to examine the current information available regarding Legionella risk and discuss the uncertainties and assumptions. This review can be used as a tool for understanding the uncertainties associated with Legionella risk assessment. It also serves to highlight the areas of Legionella research that require future focus. Improvement of these uncertainties will provide information to enhance risk management practices for Legionella, potentially improving public health protection and reducing the economic costs by streamlining current management practices.

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Legionella pneumophila contamination in a steam towel warmer in a hospital setting

Cited by 9 publications

References 4 publications

Confirmed and Potential Sources of Legionella Reviewed

Confirmed and Potential Sources of Legionella Reviewed

The role of water in healthcare-associated infections

Uncertainties associated with assessing the public health risk from Legionella

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