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Chapter 116 : Review of Nosocomial Legionella Outbreaks
This chapter reviews the evidence of different disinfection methods to stop outbreaks of Legionnaires’ diseases (LD). Articles describing original outbreaks of Legionella were selected for the review. Full reports of potentially relevant publications were obtained and checked for eligibility. Decisions on which trials to include were based on full text articles. The following parameters were extracted: country, year of publication, year of outbreak, duration of outbreak, source of outbreak, facility and department, number of patients involved, number of health care workers involved, mortality, disinfection methods, and success of methods. Legionella outbreaks have a significant impact on patient morbidity and mortality in hospitals. In 68% of outbreaks, the source was the hospital water system or showers. In these cases, disinfection methods focusing on the water system should be chosen. The success of these disinfection methods depends on the status of the water system and the disinfection method used. This implies that technical measurements are very important factors for termination of outbreaks, despite other effective disinfection methods such as chlorination (70.6%) and elevating temperature once per month (71.4%). The safest interventions are sterile water for patient care or point-of-use filters. Interestingly, the number of published outbreaks has decreased since the 1980s, whereas the literature about Legionella did not. Whether or not this is due to better plumbing design of hospital water systems and more successful disinfection methods remains to be proven.