Legionella Contamination of Domestic Hot Water in a Tertiary Level Hospital and Resulting Introduction of Control Measure

Mona Schousboe; Alan Bavis; Ros Podmore

doi:10.1128/9781555815660.ch115

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

Authors: Mona Schousboe¹, Alan Bavis², Ros Podmore³

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Affiliations: 1: Canterbury Health Laboratories, P O Box 151, Christchurch, New Zealand; 2: Maintenance and Engineering Department, Christ-church Hospital, P O Box 151, Christchurch, New Zealand; 3: Canterbury Health Laboratories, P O Box 151, Christchurch, New Zealand

Content Type: Monograph

Publication Year: 2006

Category: Bacterial Pathogenesis

Book DOI: 10.1128/9781555815660

Chapter DOI: 10.1128/9781555815660.ch115

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Abstract:

This chapter analyzes variables in the rebuilding program resulting in Legionella in the domestic hot water system (DHWS), legionella monitoring of water and air-conditioning systems, and systems implemented to control contamination. Standard methods for Legionella 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 Legionella pneumophila sg 1 infection by urine antigen tests. Environmental culture found many sites positive for L. pneumophila 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 L. pneumophila 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. Legionella 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), Legionella. ASM Press, Washington, DC. doi: 10.1128/9781555815660.ch115

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Legionella Contamination of Domestic Hot Water in a Tertiary Level Hospital and Resulting Introduction of Control Measure

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/content/10.1128/9781555815660.ch115.ch115fig01

FIGURE 1

Christchurch hospital domestic hot water sampling points schematic.

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10.1128/9781555815660/f0478-01.gif

FIGURE 1

Christchurch hospital domestic hot water sampling points schematic.

References

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1. Atlas, R. M. 1999. Legionella: from environmental habitats to disease pathology, detection and control. Environ. Microbiol. 1: 283– 293.

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: 213– 219.

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: 221– 224.

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: 8– 11.

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: 273– 279.

9. Sabria, M., and, V. L. Yu. 2002. Hospital-acquired Legionellosis: solution for a preventable infection. Lancet Infect. Dis. 2: 368– 373.

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: 950– 963.

Tables

Legionella Contamination of Domestic Hot Water in a Tertiary Level Hospital and Resulting Introduction of Control Measure

/content/10.1128/9781555815660.ch115.ch115tab01

TABLE 1

Number of cultures positive for L. pneumophila sg 1

TABLE 1

Number of cultures positive for L. pneumophila sg 1

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