More than 10 Years of Unrecognized Nosocomial Transmission of Legionnaires' Disease Among Transplant Patients

Kool, J. L.; Fiore, Anthony E.; Kioski, Clare; Brown, Ellen; Benson, Robert F.; Pruckler, Janet M.; Glasby, Constance; Butler, Jay C.; Cage, Gary D.; Carpenter, Joseph; Mandel, Richard; England, Bob; Breiman, Robert F.

doi:10.1086/647760

Cited by 75 publications

(47 citation statements)

References 28 publications

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“…[5][6][7] Extent of colonization is calculated based on the percent distal site positivity (ie, the percent of water faucets that yield Legionella as compared with the total number of cultures taken). If more than 30% of the sampled outlets are positive (especially for Legionella pneumophila), actions should be taken to mitigate the risk to hospitalized patients.…”

mentioning

confidence: 99%

Environmental culturing for Legionella: Can we build a better mouse trap?

Stout

2010

American Journal of Infection Control

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mentioning

confidence: 99%

Environmental culturing for Legionella: Can we build a better mouse trap?

Stout

2010

American Journal of Infection Control

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“…[7][8][9][10][11][12][13][14] Most hospital-acquired outbreaks of legionnaires' disease have been associated with the contamination of hospital drinking water with Legionella species. 15 Efforts to prevent hospital-acquired legionnaires' disease have focused on increasing the temperature of hot water and the supplemental chlorination of drinking water. [16][17][18] Although these measures may be effective in controlling the growth of Legionella species in drinking water systems, high water temperatures may result in scalding injuries and supplemental chlorination may hasten the development of corrosion and leaks in plumbing systems.…”

mentioning

confidence: 99%

Risk of Hospital-Acquired Legionnaires' Disease in Cities Using Monochloramine Versus Other Water Disinfectants

Heffelfinger

Kool²,

Fridkin³

et al. 2003

Infect. Control Hosp. Epidemiol.

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Objective:To measure the association between the disinfection of municipal drinking water with monochloramine and the occurrence of hospital-acquired legionnaires' disease (LD).Setting:One hundred sixty-six U.S. hospitals.Design:Survey of 459 members of the Society for Healthcare Epidemiology of America (SHEA) for hospital features; endemic- and outbreak-related, hospital-acquired LD; the source of the hospital water supply; and the methods of disinfection used by the hospitals and municipal water treatment plants.Results:SHEA members representing 166 (36%) of 459 hospitals responded; 33 (20%) reported one or more episodes of hospital-acquired LD during the period from 1994 to 1998 and 23 (14%) reported an outbreak of hospital-acquired LD during the period from 1989 to 1998. Hospitals with an occurrence of hospital-acquired LD had a higher census (median, 319 vs 221;P= .03), more acute care beds (median, 500 vs 376;P= .04), and more intensive care unit beds (median, 42 vs 24;P= .009) than did other hospitals. They were also more likely to have a transplant service (74% vs 42%;P= .001) and to perform surveillance for hospital-acquired disease (92% vs 61%;P= .001). After adjustment for the presence of a transplant program and surveillance for legionnaires' disease, hospitals supplied with drinking water disinfected with monochloramine by municipal plants were less likely to have sporadic cases or outbreaks of hospital-acquired LD (odds ratio, 0.20; 95% confidence interval, 0.07 to 0.56) than were other hospitals.Conclusion:Water disinfection with monochloramine by municipal water treatment plants significantly reduces the risk of hospital-acquired LD.

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“…1,2 Despite increased awareness of and advances in the treatment of these infections, the mortality rate for nosocomial Legionella pneumonia remains in the range of 35% to 40%. 3,4 Furthermore, cases of nosocomial legionnaires' disease can be a source of negative publicity and litigation for hospitals because these infections are generally believed to be preventable. Because the natural habitat of these organisms is water, they are widespread in institutional water systems.…”

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confidence: 99%

A 17-Month Evaluation of a Chlorine Dioxide Water Treatment System to Control Legionella Species in a Hospital Water Supply

Srinivasan

Bova

Ross

et al. 2003

Infect. Control Hosp. Epidemiol.

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Objective:To assess the safety and efficacy of a chlorine dioxide water treatment system in controlling Legionella in a hospital water supply.Design:For 17 months following installation of the system, we performed regular water cultures throughout the building, assessed chlorine dioxide and chlorite levels, and monitored metal corrosion.Results:Sites that grew Legionella species decreased from 41% at baseline to 4% (P = .001). L. anisa was the only species recovered and it was found in samples of both hot and cold water. Levels of chlorine dioxide and chlorite were below Environmental Protection Agency (EPA) limits for these chemicals in potable water. Further, enhanced carbon filtration effectively removed the chemicals, even at chlorine dioxide levels of more than twice what was used to treat the water. After 9 months, corrosion of copper test strips exposed to the chlorine dioxide was not higher than that of control strips. During the evaluation period, there were no cases of nosocomial Legionella in the building with the system, whereas there was one case in another building.Conclusions:Our results indicate that operation of a chlorine dioxide system effectively removed Legionella species from a hospital water supply. Furthermore, we found that the system was safe, as levels of chlorine dioxide and chlorite were below EPA limits. The system did not appear to cause increased corrosion of copper pipes. Our results indicate that chlorine dioxide may hold promise as a solution to the problem of Legionella contamination of hospital water supplies.

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More than 10 Years of Unrecognized Nosocomial Transmission of Legionnaires' Disease Among Transplant Patients

Cited by 75 publications

References 28 publications

Environmental culturing for Legionella: Can we build a better mouse trap?

Environmental culturing for Legionella: Can we build a better mouse trap?

Risk of Hospital-Acquired Legionnaires' Disease in Cities Using Monochloramine Versus Other Water Disinfectants

A 17-Month Evaluation of a Chlorine Dioxide Water Treatment System to Control Legionella Species in a Hospital Water Supply

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