State Regulation of Hospital Water Temperature

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

doi:10.1086/646657

Cited by 7 publications

(4 citation statements)

References 9 publications

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“…These guidelines recommend maintaining water systems at temperatures unfavorable for the amplification of legionellae. However, many states have regulations that limit the water temperature in health care facilities as a means of reducing scalding injuries (194). In Great Britain, elevated water temperatures were recommended as the primary means of preventing legionellosis in hospitals in 1991 (55).…”

Section: Nosocomial Outbreaks and Preventionmentioning

confidence: 99%

Legionella and Legionnaires' Disease: 25 Years of Investigation

2002

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There is still a low level of clinical awareness regarding Legionnaires' disease 25 years after it was first detected. The causative agents, legionellae, are freshwater bacteria with a fascinating ecology. These bacteria are intracellular pathogens of freshwater protozoa and utilize a similar mechanism to infect human phagocytic cells. There have been major advances in delineating the pathogenesis of legionellae through the identification of genes which allow the organism to bypass the endocytic pathways of both protozoan and human cells. Other bacteria that may share this novel infectious process are Coxiella burnetti and Brucella spp. More than 40 species and numerous serogroups of legionellae have been identified. Most diagnostic tests are directed at the species that causes most of the reported human cases of legionellosis, L. pneumophila serogroup 1. For this reason, information on the incidence of human respiratory disease attributable to other species and serogroups of legionellae is lacking. Improvements in diagnostic tests such as the urine antigen assay have inadvertently caused a decrease in the use of culture to detect infection, resulting in incomplete surveillance for legionellosis. Large, focal outbreaks of Legionnaires' disease continue to occur worldwide, and there is a critical need for surveillance for travel-related legionellosis in the United States. There is optimism that newly developed guidelines and water treatment practices can greatly reduce the incidence of this preventable illness

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Section: Nosocomial Outbreaks and Preventionmentioning

confidence: 99%

Legionella and Legionnaires' Disease: 25 Years of Investigation

2002

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“…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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“…25 The water temperature from hospital faucets is not tightly controlled, ranging from 43.3 °C to 53.9°C, and is unregulated in 23% of the states in the United States. 26 Hot water from faucets varies considerably in temperature throughout the day because of demands on the hot water system, the time the water is left to run, and the distance from the primary heat source. "Instant Hot" faucets with temperatures as high as 82.2°C are sometimes used to warm expressed breast milk.…”

Section: Literature Reviewmentioning

confidence: 99%