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Chapter 80 : Eleven Years of Experience with Novel Strategies for Control in a Large Teaching Hospital

Authors: J. V. Lee1, S. B. Surman1, A. Kirby2, F. Seddon2
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Affiliations: 1: PHLS Water and Environmental Microbiology Research Unit, Public Health Laboratory, Queen's Medical Centre, University Hospital, Nottingham NG7 2UH, England; 2: Estates Department, Queen's Medical Centre, University Hospital, Nottingham NG7 2UH, England
Content Type: Monograph
Publication Year: 2002

Category: Bacterial Pathogenesis

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Eleven Years of Experience with Novel Strategies for Control in a Large Teaching Hospital, Page 1 of 2

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Abstract:

The Queen's Medical Centre (QMC) is a large teaching hospital housing approximately 1,400 beds. Each block has its own independent circulating hot water system (HWS). The West Block and Medical School have storage calorifiers (water heaters) equipped with antistratification pumps, and the water is circulated at 60 to 62№C. The circulation of hot water at 60№C so that it is delivered to every outlet at 50№C within 1 min of opening is the recommended strategy for the control of in the United Kingdom. A number of problems are associated with the installation of thermostatic mixer valves (TMVs). They are expensive to purchase; require much maintenance, particularly if the water is hard; and the failure of the nonreturn valves fitted within them can result in cold water passing into the hot or vice versa, depending on the relative pressure differences. At the end of March 2000, the cold water supply to the ward was equipped with a chlorine dioxide dosing system, which ensures that a chlorine dioxide residual of at least 0.5 mg/liter reaches beyond the TMV to the shower hose and head. To date, this does not appear to have significantly reduced the legionellae. It may be that legionellae can only be maintained at undetectable levels by routinely removing and disinfecting the TMVs and shower components. To enable this, the units would have to be designed for quick release so that they can be rapidly recycled.

Citation: Lee J, Surman S, Kirby A, Seddon F. 2002. Eleven Years of Experience with Novel Strategies for Control in a Large Teaching Hospital, p 398-401. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch80

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Eleven Years of Experience with Novel Strategies for Legtonella Control in a Large Teaching Hospital
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Citation: Lee J, Surman S, Kirby A, Seddon F. 2002. Eleven Years of Experience with Novel Strategies for Control in a Large Teaching Hospital, p 398-401. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch80
/content/10.1128/9781555817985.chap80.fig80-1
FIGURE 1

The mean numbers of species (□, log CFU + 1/liter) and mean silver concentrations ( ♦, µg/liter) in the QMC East Block former 43°C hot water system before and following the installation of a silver/copper ionizer. The shaded area indicates the target range of silver concentrations when the study began.

10.1128/9781555817985/fig80-1_thmb.gif
10.1128/9781555817985/fig80-1.gif
Image of FIGURE 1
FIGURE 1

The mean numbers of species (□, log CFU + 1/liter) and mean silver concentrations ( ♦, µg/liter) in the QMC East Block former 43°C hot water system before and following the installation of a silver/copper ionizer. The shaded area indicates the target range of silver concentrations when the study began.

Citation: Lee J, Surman S, Kirby A, Seddon F. 2002. Eleven Years of Experience with Novel Strategies for Control in a Large Teaching Hospital, p 398-401. In Marre R, Abu Kwaik Y, Bartlett C, Cianciotto N, Fields B, Frosch M, Hacker J, Lück P (ed), . ASM Press, Washington, DC. doi: 10.1128/9781555817985.ch80
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References

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1. Colville, A.,, J. Crowley,, D. Dearden,, R. C. B. Slack,, and J. V. Lee. 1993. Outbreak of Legionnaires' disease at University Hospital, Nottingham—epidemiology, microbiology and control. Epidemiol. Infect. 110: 105– 116.
2. Health and Safety Commission. 1995. Health and Safety Commission Approved Code of Practice L8. The Prevention and Control of Legionellosis (Including Legionnaires' Disease). HMSO, London, United Kingdom.
3. Health and Safety Executive. 1993. Health and Safety Executive Series booklet HS(G)70. The Control of Legionellosis Including Legionnaires' Disease, 2nd ed. HMSO, London, United Kingdom.
4.NHS Estates. 1992. Health Guidance Note—"Safe" Hot Water and Surface Temperatures. HMSO, London, United Kingdom.

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