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Chapter 115 : Contamination of Domestic Hot Water in a Tertiary Level Hospital and Resulting Introduction of Control Measure

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Contamination of Domestic Hot Water in a Tertiary Level Hospital and Resulting Introduction of Control Measure, Page 1 of 2

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Abstract:

This chapter analyzes variables in the rebuilding program resulting in in the domestic hot water system (DHWS), legionella monitoring of water and air-conditioning systems, and systems implemented to control contamination. Standard methods for culture of environmental samples and identification of isolates were followed for both water samples and swabs from showerheads. The Infection Control Committee advised the clinical staff to test patients with possible nosocomial pneumonia for sg 1 infection by urine antigen tests. Environmental culture found many sites positive for sg 1 including feed water to the calorifiers and a sample taken just after tempering of the water exiting the calorifier. The peripheral contamination with sg 1 was discovered within months, but when a patient was recognized as possibly being infected, extensive changes to the DHWS were carried out. A UV irradiation plant was installed near the exit of the cold water tanks to reduce further colonization.

Citation: Schousboe M, Bavis A, Podmore R. 2006. Contamination of Domestic Hot Water in a Tertiary Level Hospital and Resulting Introduction of Control Measure, p 477-482. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch115

Key Concept Ranking

Legionella pneumophila
0.58189654
Water
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0.58189654
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FIGURE 1

Christchurch hospital domestic hot water sampling points schematic.

Citation: Schousboe M, Bavis A, Podmore R. 2006. Contamination of Domestic Hot Water in a Tertiary Level Hospital and Resulting Introduction of Control Measure, p 477-482. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch115
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References

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1. Atlas, R. M. 1999. Legionella: from environmental habitats to disease pathology, detection and control. Environ. Microbiol. 1:283293.
2. Building Industry Authority. 1992. The New Zealand Building Code Water Supplies Clause G12, 2nd ed.
3. 1992. Culture of hospital water for members of the family: Legionellaceae. Clinical Microbiology Procedures Handbook, Vol. 2: 11. 3.
4. Darelid, J.,, S. Lofgren, and, B. E. Malmvall. 2002. Control of nosocomial Legionnaires’ disease by keeping the circulating hot water above temperature degrees C: experience from a 10-year surveillance programme in a district general hospital. J. Hosp. Infect. 30:213219.
5. Everts, R. J,, D. R. Murdoch,, S. T. Chambers,, G. I. Town,, S. G. Withington,, I. R. Martin,, M. J. Epton,, C. Frampton,, A. Y. Chereshsky, and, M. I. Schous-boe. 2000. Nosocomial pneumonia in adult medical and surgical patients at Christ-church Hospital. N. Z. Med. J. 113:221224.
6. Goetz, A. M.,, J. E. Stout,, S. L. Jacobs,, M. A. Fisher,, R. E. Ponzer,, S. Drenning, and, V. L. Yu. 1998. Nosocomial Legionnaires’ disease discovered in community hospitals following cultures of the water system: seek and ye shall find. Am. J. Infect. Control. 26:811.
7. Isenberg, H. D. 1992. Clinical Microbiology Procedures Handbook. American Society for Microbiology, Washington D. C.
8. O’Neill, E. and,, H. Humphreys. 2005. Surveillance of hospital water and primary prevention of nosocomial legionellosis: what is the evidence? J. Hosp. Infect. 59:273279.
9. Sabria, M., and, V. L. Yu. 2002. Hospital-acquired Legionellosis: solution for a preventable infection. Lancet Infect. Dis. 2:368373.
10. Thomas, V.,, T. Bouchez,, V. Nicolas,, S. Robert,, J. F. Loret, and, Y. Lévi. 2004. Amoebae in domestic water systems: resistance to disinfections and implication in Legionella persistence. J. Appl. Microbiol. 97:950963.

Tables

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TABLE 1

Number of cultures positive for sg 1

Citation: Schousboe M, Bavis A, Podmore R. 2006. Contamination of Domestic Hot Water in a Tertiary Level Hospital and Resulting Introduction of Control Measure, p 477-482. In Cianciotto N, Kwaik Y, Edelstein P, Fields B, Geary D, Harrison T, Joseph C, Ratcliff R, Stout J, Swanson M (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch115

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