Prospective 3-Year Surveillance for Nosocomial and EnvironmentalLegionella pneumophila: Implications for Infection Control

2006 ◽  
Vol 27 (5) ◽  
pp. 459-465 ◽  
Author(s):  
S. Boccia ◽  
P. Laurenti ◽  
P. Borella ◽  
U. Moscato ◽  
G. Capalbo ◽  
...  
Keyword(s):  
Infection Control ◽  
Nosocomial Pneumonia ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Water Distribution ◽  
Monitoring Program ◽  
University Hospital ◽  
Contamination Level ◽  
Surveillance Program ◽  
Colony Forming Units

Objectives.To perform a 3-year, prospective surveillance program for legionnaires disease (LD) in a large university hospital in Rome, and to assess the usefulness of the hospital water monitoring program in predicting the risk of nosocomial LD.Methods.Samples from patients with new cases of nosocomial pneumonia were sent for legionella laboratory investigations. Meanwhile, water samples for bacteriological analysis were collected every 6 months from high- and medium-risk hospital wards (10 in total).Legionella pneumophilaisolates collected were serotyped and analyzed by pulsed-field gel electrophoresis.Results.From June 2001 through May 2004, the pneumonia surveillance identified one case of nosocomial LD among 43 cases of nosocomial pneumonia (2.3%). Environmental investigations detectedL. pneumophilain 12 (18.7%) of the 64 water samples, of which 50% belonged to serogroup 1. TheL. pneumophilacount and the percentage of positive locations never exceeded 102colony-forming units/L and 20%, respectively, except when the LD nosocomial case occurred (positive water samples, 40%; I. pneumophila count, <102colony-forming units/L). Genotyping showed 3 prevalent clones ofL. pneumophilain the water distribution network, of which one persisted over the 3 years. One clone contained 3 differentL. pneumophilaserogroups (2, 4, and 6).Conclusions.The low incidence of nosocomial cases of LD appears to be associated with a low percentage (<20%) of positive water samples per semester and with a low contamination level (<102colony-forming units/L). An infection control system for nosocomial LD should, therefore, be based on both environmental and clinical surveillance, together with the appropriate maintenance of the hospital water distribution system.

Long-Term Effects of Hospital Water Network Disinfection onLegionellaand Other Waterborne Bacteria in an Italian University Hospital

2014 ◽  
Vol 35 (3) ◽  
pp. 293-299 ◽  
Author(s):  
Beatrice Casini ◽  
Andrea Buzzigoli ◽  
Maria Luisa Cristina ◽  
Anna Maria Spagnolo ◽  
Pietro Del Giudice ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Distribution Systems ◽  
Water Distribution ◽  
Hot Water ◽  
Control Measures ◽  
University Hospital ◽  
Long Term Effects ◽  
Water Safety ◽  
Safety Plan ◽  
Water Safety Plan

Objective and Design.Legionellacontrol still remains a critical issue in healthcare settings where the preferred approach to health risk assessment and management is to develop a water safety plan. We report the experience of a university hospital, where a water safety plan has been applied since 2002, and the results obtained with the application of different methods for disinfecting hot water distribution systems in order to provide guidance for the management of water risk.Interventions.The disinfection procedures included continuous chlorination with chlorine dioxide (0.4–0.6 mg/L in recirculation loops) reinforced by endpoint filtration in critical areas and a water treatment based on monochloramine (2-3 mg/L). Real-time polymerase chain reaction and a new immunoseparation and adenosine triphosphate bioluminescence analysis were applied in environmental monitoring.Results.After 9 years, the integrated disinfection-filtration strategy significantly reduced positive sites by 55% and the mean count by 78% (P< .05); however, the high costs and the occurrence of a chlorine-tolerant clone belonging toLegionella pneumophilaST269 prompted us to test a new disinfectant. The shift to monochloramine allowed us to eliminate planktonicLegionellaand did not require additional endpoint filtration; however, nontuberculous mycobacteria were isolated more frequently as long as the monochloramine concentration was 2 mg/L; their cultivability was never regained by increasing the concentration up to 3 mg/L.Conclusions.Any disinfection method needs to be adjusted/fine-tuned in individual hospitals in order to maintain satisfactory results over time, and only a locally adapted evidence-based approach allows assessment of the efficacy and disadvantages of the control measures.

scholarly journals Nosocomial legionella pneumonia: demonstration of potable water as the source of infection

1988 ◽  
Vol 101 (3) ◽  
pp. 647-654 ◽  
Author(s):  
B. Ruf ◽  
D. Schürmann ◽  
I. Horbrach ◽  
K. Seodel ◽  
H. D. Pohle
Keyword(s):  
Monoclonal Antibodies ◽  
Water Supply ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Potable Water ◽  
Supply System ◽  
University Hospital ◽  
Environmental Isolates ◽  
Legionella Pneumonia ◽  
Source Of Infection

SUMMARYFrom January 1983 until December 1985, 35 cases of sporadic nosocomial legionella pneumonia, all caused byLegionella pneumophila, were diagnosed in a university hospital.L. pneumophilaserogroup (SG) 1 was cultured from 12 of the 35 cases and compared to correspondingL. pneumophilaSG 1 isolates from water outlets in the patients' immediate environment by subtyping with monoclonal antibodies. The corresponding environmental isolates were identical to 9 out of 12 (75%) of those from the cases. However, even in the remaining three cases identical subtypes were found distributed throughout the hospital water supply. From the hospital water supply four different subtypes ofL. pneumophilaSG 1 were isolated, three of which were implicated in legionella pneumonia. Of 453 water samples taken during the study 298 (65.8%) were positive for legionellae. Species ofLegionellaother thanL. pneumophilahave not been isolated. This may explain the exclusiveness ofL.pneumophilaas the legionella pneumonia-causing agent. Our results suggest that the water supply system was the source of infection.

scholarly journals Environmental Surveillance of Legionella spp. in an Italian University Hospital Results of 10 Years of Analysis

Water ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 2304
Author(s):  
Giovanna Deiana ◽  
Antonella Arghittu ◽  
Marco Dettori ◽  
Maria Dolores Masia ◽  
Maria Grazia Deriu ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Distribution Systems ◽  
Water Distribution ◽  
Linear Trend ◽  
Water Distribution Systems ◽  
University Hospital ◽  
Environmental Surveillance ◽  
National Guidelines ◽  
Increased Risk ◽  
Definitive Method

The occurrence of Legionella spp. in the water distribution systems of large hospitals and other healthcare facilities is considered particularly dangerous, due to the critical nature of the hospitalized patients. The aim of this study is to present a pluri-annual environmental surveillance in a large university hospital assessing the prevalence of Legionella spp. and underlining its variability over the years. The samples of water were collected in accordance with the Italian National Guidelines and the sampling sites considered in this study were selected favoring wards with very high-risk patients and with patients at increased risk. The laboratory analyzed a total of 305 water samples deriving from 24 different sampling points. Legionella spp. were detected in 39.4% of samples, the majority of which were contaminated by Legionella pneumophila serogroups 2–14 (68.7%). Statistically significant differences were found among different seasons with a linear trend in positive proportion from summer to spring. Several experimental interventions to prevent and reduce Legionella colonization were attempted, but there is no a definitive method for the complete eradication of this microorganism. The permanent monitoring of hospital water distribution systems is fundamental to preventing the potential risk of nosocomial Legionellosis and to implementing procedures to minimize the risk of Legionella spp. colonization.

Infection control practices in Jimma, Ethiopia

2019 ◽  
Vol 15 (3) ◽  
Author(s):  
Madeline Kenzie ◽  
Nasia Safdar ◽  
Alemseged Abdissa ◽  
Daniel Yilma ◽  
Shoba Ibrahim ◽  
...  
Keyword(s):  
Supply Chain ◽  
Supply Chain Management ◽  
Los Angeles ◽  
Infection Control ◽  
Systems Engineering ◽  
Adverse Outcomes ◽  
University Hospital ◽  
Infection Prevention And Control ◽  
Surveillance Program ◽  
Chain Management

Healthcare-associated infections (HAIs) are frequent adverse outcomes of medical care. The HAI burden in low- and middle-income countries is much higher and associated with more severe outcomes. The Systems Engineering Initiative for Patient Safety (SEIPS) model provides a framework that can be used to identify barriers and facilitators of infection control practices and evaluate interactions between structures, processes, and outcomes. A qualitative study was done to evaluate the implementation of effective infection control practices at Jimma University Hospital in Jimma, Ethiopia. Twenty-two semi-structured interviews of hospital employees, selected by convenience sampling, were conducted to assess the five components of SEIPS framework: person, physical environment, tasks, organization and tools. The interviews were transcribed, coded for themes, and analyzed using the software Dedoose (Version 8.0.42 SocioCultural Research Consultants, Los Angeles, CA). Staff overwhelmingly reported a shortage of personal protective equipment (PPE) as a barrier to adequate infection prevention and control (IPC) practices but cited poor supply chain management versus financial resources as the cause. Most interviewees also noted unreliable water availability as an impediment for hand hygiene. Prominent facilitators of effective IPC included a manageable workload, sufficient budget, and positive individual attitude towards improving IPC. The major barriers were identified as an inconsistent and incomplete training program for employees, a lack of IPC policies, and a nurse rotation program that increases unit staff turnover. Interventions designed to address the identified barriers include developing IPC policies and protocols, regularly scheduled IPC training, and establishing an HAI surveillance program to better identify IPC trends and track progress. Innovative interventions are needed to improve IPC practices, such as faculty training on supply chain management and utilization of simple local resources to increase hand washing practices.

scholarly journals Environmental Surveillance of Legionellosis within an Italian University Hospital—Results of 15 Years of Analysis

2019 ◽  
Vol 16 (7) ◽  
pp. 1103 ◽  
Author(s):  
Pasqualina Laganà ◽  
Alessio Facciolà ◽  
Roberta Palermo ◽  
Santi Delia
Keyword(s):  
Potential Risk ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Continuous Monitoring ◽  
Water System ◽  
Hot Water ◽  
University Hospital ◽  
Environmental Surveillance ◽  
Standard Procedures ◽  
Legionnaires Disease

Legionnaires’ disease is normally acquired by inhalation of legionellae from a contaminated environmental source. Water systems of large and old buildings, such as hospitals, can be contaminated with legionellae and therefore represent a potential risk for the hospital population. In this study, we demonstrated the constant presence of Legionella in water samples from the water system of a large university hospital in Messina (Sicily, Italy) consisting of 11 separate pavilions during a period of 15 years (2004–2018). In total, 1346 hot water samples were collected between January 2004 and December 2018. During this period, to recover Legionella spp. from water samples, the standard procedures reported by the 2000 Italian Guidelines were adopted; from May 2015 to 2018 Italian Guidelines revised in 2015 (ISS, 2015) were used. Most water samples (72%) were positive to L. pneumophila serogroups 2–14, whereas L. pneumophila serogroup 1 accounted for 18% and non-Legionella pneumophila spp. Accounted for 15%. Most of the positive samples were found in the buildings where the following critical wards are situated: (Intensive Care Unit) ICU, Neurosurgery, Surgeries, Pneumology, and Neonatal Intensive Unit Care. This study highlights the importance of the continuous monitoring of hospital water samples to prevent the potential risk of nosocomial legionellosis.

scholarly journals KESEPANCARAN (HOMOLOGI) LEGIONELLA PNEUMOPHILA JARINGAN DISTRIBUSI AIR DAN PNEUMONIA NOSOKOMIAL

2018 ◽  
Vol 16 (1) ◽  
pp. 1
Author(s):  
Noormartany .
Keyword(s):  
New Species ◽  
16S Rrna ◽  
Nosocomial Pneumonia ◽  
Legionella Pneumophila ◽  
Distribution System ◽  
Water Distribution ◽  
Water Distribution System ◽  
Base Sequence ◽  
A New Species

L. pneumophila is one of the nosocomial pneumonia causes that contaminated hospital water distribution system. The aim of this study was to determine the homology between L. pneumophila 16S rRNA base sequence found in the water distribution systemand the sequence derived from the sputum of nosocomial pneumonia patients identified at RSHS Bandung as well as the homology of L. pneumophila 16S rRNA found in the same system network. The study also include the nosocomial pneumonia patients at RSHSBandung with L. pneumophila from GenBank. The research using descriptive bioinformatics BLAST method by comparative analyticapproach, which performed from April 2006 to February 2008. The material consists of 60 biofilm samples from water distributionsystem and pneumonia nosocomial patient’s sputum is positive L.pneumophila from water distribution system in her/his room. Inthe result was found: out of the 60 biofilm samples from the water distribution system, there are seven (7) L. pneumophila positivePCR and culture. During the 12 months of observation, there is only one (1) out of 31 pneumonia nosocomial patients with positively L. pneumophila PCR and culture. The conclusion so far can be mentioned that: The water distribution system in RSHS for patient roomsmay become the source for nosocomial pneumonia transmission of L. pneumophila and also was detected a new species of L. pneumophilathat is genetically different from that has been found in GenBank.

Pseudo-outbreak ofMycobacterium gordonaeFollowing the Opening of a Newly Constructed Hospital at a Chicago Medical Center

2014 ◽  
Vol 36 (2) ◽  
pp. 198-203 ◽  
Author(s):  
Kavitha Prabaker ◽  
Chethra Muthiah ◽  
Mary K. Hayden ◽  
Robert A. Weinstein ◽  
Jyothirmai Cheerala ◽  
...  
Keyword(s):  
Water Samples ◽  
Potable Water ◽  
Medical Center ◽  
University Hospital ◽  
Gastric Aspirate ◽  
Colony Forming Units ◽  
Hospital Patients ◽  
Potable Water Supply ◽  
Ice Water ◽  
Chicago Medical

OBJECTIVETo identify the source of a pseudo-outbreak ofMycobacterium gordonaeDESIGNOutbreak investigation.SETTINGUniversity Hospital in Chicago, Ilinois.PATIENTSHospital patients withM. gordonae-positive clinical cultures.METHODSAn increase in isolation ofM. gordonaefrom clinical cultures was noted immediately following the opening of a newly constructed hospital in January 2012. We reviewed medical records of patients withM. gordonae-positive cultures collected between January and December 2012 and cultured potable water specimens in new and old hospitals quantitatively for mycobacteria.RESULTSOf 30 patients withM. gordonae-positive clinical cultures, 25 (83.3%) were housed in the new hospital; of 35 positive specimens (sputum, bronchoalveolar lavage, gastric aspirate), 32 (91.4%) had potential for water contamination.M. gordonaewas more common in water collected from the new vs. the old hospital [147 of 157 (93.6%) vs. 91 of 113 (80.5%),P=.001]. Median concentration ofM. gordonaewas higher in the samples from the new vs. the old hospital (208 vs. 48 colony-forming units (CFU)/mL;P<.001). Prevalence and concentration ofM. gordonaewere lower in water samples from ice and water dispensers [13 of 28 (46.4%) and 0 CFU/mL] compared with water samples from patient rooms and common areas [225 of 242 (93%) and 146 CFU/mL,P<.001].CONCLUSIONSM. gordonaewas common in potable water. The pseudo-outbreak ofM. gordonaewas likely due to increased concentrations ofM. gordonaein the potable water supply of the new hospital. A silver ion-impregnated 0.5-μm filter may have been responsible for lower concentrations ofM. gordonaeidentified in ice/water dispenser samples. Hospitals should anticipate that construction activities may amplify the presence of waterborne nontuberculous mycobacterial contaminants.Infect Control Hosp Epidemiol 2014;00(0): 1–6

scholarly journals Prevalence of Legionella spp. and Escherichia coli in the drinking water distribution system of Wrocław (Poland)

2020 ◽  
Vol 20 (3) ◽  
pp. 1083-1090
Author(s):  
M. Wolf-Baca ◽  
A. Siedlecka
Keyword(s):  
Escherichia Coli ◽  
Drinking Water ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Distribution System ◽  
Water Distribution ◽  
Tap Water ◽  
Potential Threat ◽  
E Coli ◽  
Drinking Water Distribution

Abstract Drinking water should be free from bacterial pathogens that threaten human health. The most recognised waterborne opportunistic pathogens, dwelling in tap water, are Legionella pneumophila and Escherichia coli. Drinking water samples were tested for the presence of Legionella spp., L. pneumophila, and E. coli in overall sample microbiomes using a quantitative real-time polymerase chain reaction (qPCR) approach. The results indicate a rather low contribution of Legionella spp. in total bacteria in the tested samples, but L. pneumophila was not detected in any sample. E. coli was detected in only one sample, but at a very low level. The qacEΔ1 gene, conferring resistance to quaternary ammonium compounds, was also not detected in any sample. The results point to generally sufficient quality of drinking water, although the presence of Legionella spp. in tap water samples suggests proliferation of these bacteria in heating units, causing a potential threat to consumer health.

scholarly journals Nosocomial Pneumonia Caused by Three Genetically Different Strains of Legionella pneumophila and Detection of These Strains in the Hospital Water Supply

1998 ◽  
Vol 36 (4) ◽  
pp. 1160-1163 ◽  
Author(s):  
P. Christian Lück ◽  
Hans-Martin Wenchel ◽  
Jürgen H. Helbig
Keyword(s):  
Water Supply ◽  
Nosocomial Pneumonia ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Clinical Specimen ◽  
Water System ◽  
Restriction Patterns ◽  
Dna Restriction ◽  
Different Strains

A 44-year-old woman developed Legionella pneumophilapneumonia after cerebral surgery. Initially, one colony from a clinical specimen and two colonies from water samples, all belonging to serogroup 12, did not match when their DNA restriction patterns were compared. When additional colonies from the water specimens were analyzed, a serogroup 12 strain complementary to that found in the clinical specimen was identified. Other colonies from the clinical specimen were identified as serogroup 12 strains complementary to those identified from the water. In addition, the same serogroup 1 strain was isolated from the patient and the water system.

Legionella pneumophilaGrows Adherent to Surfaces in vitro and in situ

1989 ◽  
Vol 10 (9) ◽  
pp. 408-415 ◽  
Author(s):  
J.B. Wright ◽  
I. Ruseska ◽  
M.A. Athar ◽  
S. Corbett ◽  
J.W. Costerton
Keyword(s):  
Legionella Pneumophila ◽  
Distribution Systems ◽  
Water Distribution ◽  
Fluorescent Antibody ◽  
Monitoring Program ◽  
Plate Count ◽  
Air Cooling ◽  
Antibody Staining

AbstractLegionella pneumophilacontinues to play a role in both community- and nosocomially-acquired pneumonia. We investigated the ability ofL pneumophilato adhere to various types of materials such as those found in the hospital air-cooling and potable water distribution systems. Through the use of a unique sampling apparatus, we were able to regularly acquire planktonic and sessile samples and determine the numbers of bacteria present in both populations, in vitro and in situ.Portions of these apparatuses could be aseptically removed for examination by scanning electron microscopy, or for the determination of the number of viable adherentL pneumophila.The number of bacteria present in each sample was determined by direct plate count, with presumptiveL pneumophilacolonies being positively identified by direct fluorescent antibody staining techniques.The results demonstrated that not only are legionellae capable of colonizing various metallic and nonmetallic surfaces but that they are preferentially found on surfaces. Surface-adherent bacteria may play a profound role as a reservoir of these potential pathogens in aquatic environments. Furthermore, these results suggest that any comprehensive legionella monitoring program must include not only water samples but also an examination of the adherent populations.

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