Mangelfull forebygging av hjerneslag

Pettersen, Petter Morten

doi:10.4045/tidsskr.16.1072

Cited by 2 publications

(2 citation statements)

References 3 publications

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“…In Norway, it is recommended to set the water heater temperature above 70 • C to make water heaters a hostile environment for Legionella (Pettersen, 2015;Rhoads et al, 2015). Therefore, most domestic and commercial water heaters sold in Norway come with a pre-set temperature of 75 • C (adjustable in the range of 60 to 90 • C) and are supplemented with a thermostatic mixing valve that is adjustable within the range of 45 to 80 • C (preset at 55 • C).…”

Section: Discussionmentioning

confidence: 99%

The benefits of flushing for mitigating Legionella spp. in non-chlorinated building plumbing systems

et al. 2023

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Flushing is a common corrective action recommended by Legionella management guidelines to remove stagnant water and replenish disinfectant. Due to water age and different local regulations, buildings may receive water with low or no residual disinfectant. In such situations, the evidence for flushing efficacy is often anecdotal, and the benefits are poorly quantified. Using a pilot-scale premise plumbing system, flushed shower outlets were evaluated against non-flushed outlets during simulated periods of both active and low water demand. Water and biofilm concentrations of total bacteria, Legionella spp., and Vermamoeba vermiformis were quantified using real-time quantitative PCR. Even after all outlets returned to active water demand, flushed shower outlets continued to have lower quantities of Legionella compared to non-flushed outlets for several days, but the decrease was of little practical benefit (<0.5 log10[copies/L]). During prolonged periods of low water demand, however, there was no apparent benefit to flushing. Total bacteria grew to stationary phase within 3 ± 1 days, while Legionella spp. took 12 ± 6 days, regardless of whether the pipes had recently been flushed or not. Flushing with hot or cold water had little to no effect on the concentrations of total bacteria and Legionella in pipe wall biofilms. Flushing with cold water (9.6 and 13.2°C) decreased total bacteria concentrations in the water by 0.96 and 1.00 log10[copies/L], respectively and by 1.27 and 1.74 log10[copies/L] with hot water (49 and 60°C, respectively) but the difference in Legionella spp. concentrations between flushing with cold (1.55 log10[copies/L] for both) and hot water (1.32 to 1.88 log10[copies/L], respectively) was negligible. This suggests that hot water flushing, even at 60°C, provides little or no added benefit for managing Legionella in non-chlorinated building plumbing systems versus cold water flushing. Finally, the immediate benefits of flushing in terms of reductions in total bacteria and Legionella in the water were comparable as well as the rates at which those populations recovered during post-flush or post-shower stagnation.

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Section: Discussionmentioning

confidence: 99%

The benefits of flushing for mitigating Legionella spp. in non-chlorinated building plumbing systems

et al. 2023

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“…Since then, many LD outbreaks have been associated with CTs, mainly in industrialized countries worldwide including Spain, France, Italy, the United Kingdom, Norway, Australia, Germany, and countries in North America, among others [ 5 , 8 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 ]. Due to the increase in legionellosis cases, public health authorities have introduced recommendations, mandatory guidelines, management plans, and legislation to prevent and control outbreaks from CTs [ 1 , 13 , 18 , 19 , 20 , 21 , 22 ]. The frequent presence of Legionella in CTs is considered an important risk factor for local outbreaks worldwide [ 5 , 16 ].…”

Section: Introductionmentioning

confidence: 99%

Heterotrophic Plate Count Can Predict the Presence of Legionella spp. in Cooling Towers

2023

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Legionella pneumophila (Lp) colonizes aquatic environments and is a potential pathogen to humans, causing outbreaks of Legionnaire’s disease. It is mainly associated with contaminated cooling towers (CTs). Several regulations, including Spanish legislation (Sl), have introduced the analysis of heterotrophic plate count (HPC) bacteria and Legionella spp. (Lsp) in management plans to prevent and control Legionella outbreaks from CTs. The 2003 Sl for CTs (RD 865/2003) considered that concentrations of HPC bacteria ≤10,000 cfu/mL and of Lsp ≤100 cfu/L are safe; therefore, no action is required, whereas management actions should be implemented above these standards. We have investigated to what extent the proposed standard for HPC bacteria is useful to predict the presence of Lsp in cooling waters. For this, we analyzed Lsp and HPC concentrations, water temperature, and the levels of chlorine in 1376 water samples from 17 CTs. The results showed that in the 1138 water samples negative for Legionella spp. (LN), the HPC geometric mean was significantly lower (83 cfu/mL, p < 0.05) than in the positive Lsp. samples (135 cfu/mL). Of the 238 (17.3%) LP samples, 88.4% (210/238) were associated with values of HPC ≤10,000 cfu/mL and most of them showed HPC concentrations ≤100 (53.7%). In addition, a relatively low percentage of LP (28/238, 11.6%) samples were associated with HPC bacteria concentrations >10,000 cfu/mL, indicating that this standard does not predict the colonization risk for Legionella in the CTs studied. The present study has demonstrated that a threshold concentration ≤100 cfu/mL of HPC bacteria could better predict the higher concentration of Legionella in CTs, which will aid in preventing possible outbreaks.

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Mangelfull forebygging av hjerneslag

Abstract: 97En studie fra britisk allmennpraksis viser at den primaerforebyggende behandling av hjerneslag er for dårlig.

Cited by 2 publications

References 3 publications

The benefits of flushing for mitigating Legionella spp. in non-chlorinated building plumbing systems

The benefits of flushing for mitigating Legionella spp. in non-chlorinated building plumbing systems

Heterotrophic Plate Count Can Predict the Presence of Legionella spp. in Cooling Towers

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