State Regulation of Hospital Water Temperature

Mandel, Adam S.; Sprauer, Mary Ann; Sniadack, David H.; Ostroff, Stephen M.

doi:10.2307/30149747

Cited by 12 publications

(7 citation statements)

References 8 publications

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“…The bacteria were also isolated from the hospital hot waterdistribution supply of 11 private health-care facilities in Italy over a period of 1 year (Legnani et al 2002). Hospitals are ideal locations for the transmission of LD, where a large number of individuals are at risk; plumbing systems are frequently old and complex, favouring amplification of the organism; and water temperatures are often reduced to prevent scalding of patients (Mandel et al 1993).…”

Section: Introductionmentioning

confidence: 99%

Persistence of chlorine-sensitiveLegionella pneumophilain hyperchlorinated installations

Garcı́a

Baladrón

Gil

et al. 2008

Journal of Applied Microbiology

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Aims: To study the persistence of Legionella over time in different disinfected facilities and analysing whether failures in bacterial eradication could be the result of a decrease in the susceptibility of the persistent strains to subsequent treatments. Methods and Results: A long‐term environmental surveillance was carried out in three different facilities associated with cases of Legionnaires’ disease (a hospital, a fishing boat and a hotel). Despite several hyperchlorination episodes, amplified fragment length polymorphism, pulsed field gel electrophoresis‐SfiI and arbitrarily primed polymerase chain reaction methods demonstrated that a specific clone of L. pneumophila serogroup 1 was able to survive for 17, 5 and 10 years in the hospital, fishing boat and the hotel, respectively. Isolates from different years from the same facility showed similar minimal inhibitory concentration and minimal bactericidal concentration values against eight different disinfectants. Conclusions: Hyperchlorination over long periods of time did not prevent the persistence of L. pneumophila. The lack of effectiveness did not appear to be the result of a decreased susceptibility of Legionella to chlorine. Hyperchlorination did not modify in vitro susceptibility of Legionella to other disinfectants to which the bacteria had not previously been exposed. Significance and Impact of the Study: Persistent Legionella in treated installations remain sensitive to disinfectants; hence, new strategies of treatment, different from hyperchlorination, should be developed to achieve bacterial eradication.

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Section: Introductionmentioning

confidence: 99%

Persistence of chlorine-sensitiveLegionella pneumophilain hyperchlorinated installations

Garcı́a

Baladrón

Gil

et al. 2008

Journal of Applied Microbiology

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“…The complexity of hospital potable-water systems and restrictions on maximal hot-water temperatures (enacted to prevent scalding in some locales 16 ) make hospital hotwater systems ideal for amplification of Legionella growth. Previous studies have documented that many hospital potable-water systems are contaminated with Legionella.…”

Section: Discussionmentioning

confidence: 99%

A Survey of Methods Used to Detect Nosocomial Legionellosis Among Participants in the National Nosocomial Infections Surveillance System

et al. 1999

Infect. Control Hosp. Epidemiol.

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Nosocomial LD is relatively common among NNIS hospitals, especially those performing organ transplants. Environmental sampling for Legionella is a common practice among NNIS hospitals, and Legionella often are isolated from sampled hospital cooling towers and hospital potable-water systems. Hospitals have responded to suspected nosocomial LD infection with a variety of water sampling and control strategies; some have not attempted to sample or decontaminate water systems despite identified transmission.

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“…As of 2006, L. pneumophila became the third most common etiological agent in waterborne disease outbreak surveillance data, averaging 10,000-15,000 cases annually [2]. Due to the increased susceptibly of patients in healthcare environments, L. pneumophila is also a significant healthcare-associated infection hazard [3][4][5]. The water-associated transmission of L. pneumophila was first recognized in 1980 during an outbreak in a British hospital transplantation ward that was linked to the ward's showers [6].…”

Section: Fundamental Background Of L Pneumophila and Disease Endpointsmentioning

confidence: 99%

“…The D R 1 Qx estimates and deposition fraction for region-2 (DF 2 ; Table 1) by modeling the dose lost to region-2 at flow rate x (D R 2 Qx ; Equation (6)). Equation (7) uses these previous results from Equations (4)(5)(6) to model the dose to the alveolated region of the lungs at flow rate x (D R 3 Qx ) using the deposition fraction for region-3 (DF 3 ; Table 1). D R 3 Qx is the dose that deposits within the alveoli, which is the dose that is used to estimate the risk of infection for flow rate x (P inf, x ).…”

Section: Exposure Model and Probability Of Infectionmentioning

confidence: 99%

An Advanced Risk Modeling Method to Estimate Legionellosis Risks Within a Diverse Population

Weir

Mraz

Mitchell

2019

Water

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Quantitative microbial risk assessment (QMRA) is a computational science leveraged to optimize infectious disease controls at both population and individual levels. Often, diverse populations will have different health risks based on a population's susceptibility or outcome severity due to heterogeneity within the host. Unfortunately, due to a host homogeneity assumption in the microbial dose-response models' derivation, the current QMRA method of modeling exposure volume heterogeneity is not an accurate method for pathogens such as Legionella pneumophila. Therefore, a new method to model within-group heterogeneity is needed. The method developed in this research uses USA national incidence rates from the Centers for Disease Control and Prevention (CDC) to calculate proxies for the morbidity ratio that are descriptive of the within-group variability. From these proxies, an example QMRA model is developed to demonstrate their use. This method makes the QMRA results more representative of clinical outcomes and increases population-specific precision. Further, the risks estimated demonstrate a significant difference between demographic groups known to have heterogeneous health outcomes after infection. The method both improves fidelity to the real health impacts resulting from L. pneumophila infection and allows for the estimation of severe disability-adjusted life years (DALYs) for Legionnaires' disease, moderate DALYs for Pontiac fever, and post-acute DALYs for sequela after recovering from Legionnaires' disease.

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State Regulation of Hospital Water Temperature

Cited by 12 publications

References 8 publications

Persistence of chlorine-sensitiveLegionella pneumophilain hyperchlorinated installations

Persistence of chlorine-sensitiveLegionella pneumophilain hyperchlorinated installations

A Survey of Methods Used to Detect Nosocomial Legionellosis Among Participants in the National Nosocomial Infections Surveillance System

An Advanced Risk Modeling Method to Estimate Legionellosis Risks Within a Diverse Population

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