Nosocomial Legionellosis Traced to a Contaminated Ice Machine

1997 ◽  
Vol 18 (09) ◽  
pp. 637-640 ◽  
Author(s):  
Paul S. Graman ◽  
Gail A. Quinlan ◽  
June A. Rank
Keyword(s):  
Sodium Hypochlorite ◽  
Legionella Pneumophila ◽  
Cold Water ◽  
Water System ◽  
Hot Water ◽  
University Teaching ◽  
Mouth Care ◽  
Colony Forming Units ◽  
And Control

Abstract Objective: To investigate a case of nosocomial legionellosis, identify pathways of transmission, and effect control of the environmental source. Design: Case investigation and environmental culture surveillance. Setting: A 720-bed university teaching hospital. Case Patient: A ventilator-dependent 66-year-old male developed nosocomial pneumonia due to Legionella pneumophila serogroup 6 after 3 months in an intensive-care unit (ICU). The patient had no intake of potable water except for ice chips from an ice machine in the ICU. Results: Cultures revealed L pneumophila serogroup 6 in the ice (4.3 colony-forming units/mL) and ice machine cold water (too numerous to count). Cultures from adjacent hot and cold taps, plus taps located near the patient, all were negative; ice machines and cold water on seven other patient units also were negative. Only sterile water had been used for tube feedings, mouth care, suctioning, and ventilator humidification. Hospital hot water previously had been colonized with L pneumophila serogroup 6, but all surveillance water cultures had been negative since chlorination of the hot-water system began the previous year; cold-water cultures had never before grown Legionella. The ice machine was disinfected with a 2-hour flush of 2.625% sodium hypochlorite. The supply line to the ice machine was replaced, and the cold-water pipe from the floor below was treated with 83 ppm sodium hypochlorite for 48 hours. All follow-up surveillance cultures of the ice machine remained negative through mid-1996. No additional cases of nosocomial legionellosis occurred. Conclusions: Ice machines may be reservoirs of L pneumophila in hospitals. Both ice and water dispensed from these machines may be contaminated, and nosocomial transmission may occur. Successful long-term decontamination and control can be accomplished with shock chlorination.

scholarly journals A field study of the survival ofLegionella pneumophilain a hospital hot–water system

1990 ◽  
Vol 104 (3) ◽  
pp. 381-387 ◽  
Author(s):  
I. D. Farrell ◽  
J. E. Barker ◽  
E. P. Miles ◽  
J. G. P. Hutchison
Keyword(s):  
Water Supply ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Cold Water ◽  
Water System ◽  
Hot Water ◽  
Undetectable Level ◽  
Drain Water ◽  
Water Feed ◽  
And Control

SUMMARYThe colonization, survival and control ofLegionella pneumophilain a hospital hot–water system was examined. The organism was consistently isolated from calorifier drain–water samples at temperatures of 50°C or below, despite previous chlorination of the system. When the temperature of one of two linked calorifiers was raised to 60°C, by closing off the cold–water feed, the legionella count decreased from c. 104c.f.u./l to an undetectable level. However, 10 min after turning on the cold–water feed which produced a fall in calorifier temperature, the count in the calorifier drain water returned to its original level. Investigations revealed that the cold–water supply was continually feeding the calorifiers withL. pneumophila. Simple modifications in the design of the system were made so that the cold–water feed no longer exceeds 20°C; these measures have considerably reduced the number ofL. pneumophilareaching the calorifiers.

Isolation of Legionella pneumophila from the Cold Water of Hospital Ice Machines: Implications for Origin and Transmission of the Organism

1985 ◽  
Vol 6 (4) ◽  
pp. 141-146 ◽  
Author(s):  
Janet E. Stout ◽  
Victor L. Yu ◽  
Paul Muraca
Keyword(s):  
Legionella Pneumophila ◽  
Distribution System ◽  
Water Distribution ◽  
Water Distribution System ◽  
Cold Water ◽  
Water System ◽  
Primary Source ◽  
Hot Water ◽  
Hospital Environment ◽  
Water Storage Tank

AbstractAlthough the mode of transmission of L. pneumophila is as yet unclear, the hot water distribution system has been shown to be the reservoir for Legionella within the hospital environment. In this report we identify a previously unrecognized reservoir for L. pneumophila within the hospital environment, ie, the cold water dispensers of hospital ice machines. The cold water dispensers of 14 ice machines were cultured monthly over a 1-year period. Positive cultures were obtained from 8 of 14 dispensers, yielding from 1 to 300 CFU/plate. We were able to link the positivity of these cold water sites to the incoming cold water supply by recovering L. pneumophila from the cold water storage tank, which is directly supplied by the incoming municipal water line. This was accomplished by a novel enrichment experiment designed to duplicate the conditions (temperature, sediment, stagnation, and continuous seeding) of the hot water system. Our data indicate that significant contamination of cold water outlets with L. pneumophila can occur. Although no epidemiologic link to disease was made, the fact that the primary source of a patient's drinking water is from the ice machines warrants further investigation of these water sources as possible reservoirs.

scholarly journals Presence of Legionella spp. in Hot Water Networks of Different Italian Residential Buildings: A Three-Year Survey

2017 ◽  
Author(s):  
Michele Totaro ◽  
Paola Valentini ◽  
Anna Laura Costa ◽  
Lorenzo Frendo ◽  
Alessia Cappello ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Water Samples ◽  
Cold Water ◽  
Residential Buildings ◽  
Hot Water ◽  
Water Production ◽  
Water Networks ◽  
Legionella Species ◽  
Solar Thermal System ◽  
And Control

Although the European reports highlight an increase in community-acquired Legionnaires’ disease cases, the risk of Legionella spp. in private houses is underestimated. In Pisa (Italy) we performed a three-year survey on Legionella presence in 121 buildings with an independent hot water production (IB); 64 buildings with a central hot water production (CB); and 35 buildings with a solar thermal system for hot water production (TB). From all the 220 buildings Legionella spp. was researched in two hot water samples collected either at the recirculation point or at on the first floor and on the last floor, while the potable water quality was analyzed in three cold water samples collected at the inlet from the aqueduct network, at the exit from the autoclave, and at the most remove remote? tap. Legionella pneumophila sg1, Legionella pneumophila sg2-16 and not-pneumophila Legionella species were detected in 26% of the hot water networks, mostly in CB and TB. In these buildings we detected correlations between the presence of Legionella and the total chlorine concentration decrease or/and the increase of the temperature. Cold water resulted free from microbiological hazards, with the exception of Serratia liquefaciens and Enterobacter cloacae isolated at the exit from two different autoclaves. We observed an increase in total microbial counts at 22 and 37°C between the samples collected at the most remote taps compared to the ones collected at the inlet from the aqueduct. The study highlights a condition of potential risk for susceptible categories of population and supports the need for measures of risk assessment and control.

scholarly journals Outbreak of Legionnaires' disease at University Hospital, Nottingham. Epidemiology, microbiology and control

1993 ◽  
Vol 110 (1) ◽  
pp. 105-116 ◽  
Author(s):  
A. Colville ◽  
J. Crowley ◽  
D. Dearden ◽  
R. C. B. Slack ◽  
J. V. Lee
Keyword(s):  
Legionella Pneumophila ◽  
Copper Ions ◽  
Virulent Strain ◽  
Water System ◽  
Hot Water ◽  
University Hospital ◽  
Domestic Hot Water ◽  
Large Teaching Hospital ◽  
Legionnaires Disease ◽  
And Control

SUMMARYTwelve patients in a large teaching hospital contracted Legionnaires' disease over a period of 11 months. The source was a domestic hot water system in one of the hospital blocks, which was run at a temperature of 43 °C. Five different subtypes ofLegionella pneumophilaserogroup 1 have been isolated from water in different parts of the hospital, over a period of time. Only one subtype, Benidorm RFLP 14, was implicated in disease. Circumstantial evidence suggested that the outbreak may have been due to recent colonization of the hot water system with a virulent strain ofLegionella pneumophila. The outbreak was controlled by raising the hot water temperature to 60 °C, but careful surveillance uncovered two further cases in the following 30 months. Persistent low numbers ofLegionella pneumophilawere isolated from the domestic hot water of wards where Legionnaires' disease had been contracted, until an electrolytic unit was installed releasing silver and copper ions into this supply.

A simple method for the eradication ofLegionella pneumophilafrom potable water systems

1997 ◽  
Vol 43 (12) ◽  
pp. 1189-1196 ◽  
Author(s):  
Carmen Moreno ◽  
Isabel de Blas ◽  
Francisca Miralles ◽  
David Apraiz ◽  
Vicente Catalan
Keyword(s):  
Legionella Pneumophila ◽  
Potable Water ◽  
Cold Water ◽  
Tap Water ◽  
Water System ◽  
Water Systems ◽  
Hot Water ◽  
Residual Chlorine ◽  
Water Heater ◽  
Simple Method

In this paper we describe a simple method, noncorrosive to pipes, for the eradication of Legionella pneumophila from potable water systems. This method is based on the systematic purging of the pipe networks with cold water containing 1 – 1.5 mg residual chlorine/L. In the hot water system, a new pipe bypassing the water heater was installed, whereas in the air conditioning system, the circuit is purged with water from the tap water system. The feasibility of this method was studied in two hotels in which the presence of Legionella was detected despite treatment of the water by the hyperchlorination method. The evolution of the presence of Legionella was studied by culture and polymerase chain reaction. Eighty samples from hotel A and sixty-seven samples from hotel B were analyzed during the time that the eradication method was applied. Our results showed that this method permitted the effective elimination of L. pneumophila after 5 months in hotel A and 7 months in hotel B.Key words: Legionella pneumophila, eradication.

scholarly journals Reduction of Energy Consumption in Hotels with Aerothermal Energy. Case Study: Canary Islands (Spain)

2018 ◽  
Vol 7 (3.32) ◽  
pp. 127
Author(s):  
Francisco Javier Díaz Perez ◽  
David Chinarro ◽  
M Rosa Pino Otín ◽  
Ricardo Díaz Martín ◽  
Adib Guardiola Mouhaffel
Keyword(s):  
Canary Islands ◽  
Water System ◽  
Heat Pumps ◽  
Hot Water ◽  
Hourly Rate ◽  
The Hours ◽  
Reduction Of Energy Consumption ◽  
Opening And Closing ◽  
And Control

This article presents a management model and control of energy efficiency in hotels adapted to the consumption patterns that ensure the comfort requirements of customers and integrated into the environment of an intelligent tourist complex. The analysis of the hot water system (DHW) of two hotels in the Canary Islands (Spain) in relation to their occupation, yields a solution based on renewable energies using high temperature heat pumps with aerothermal dissipation and supported by boilers of existing LPG propane. The control by programmable automatons (PLC) integrated in a system of control and acquisition of data (SCADA) optimizes the systems to maintain the maximum accumulated energy during the periods of cheapest electric tariff, by means of a system of opening and closing of hydraulic Valves that It manages to adjust the demand of DHW consumption to achieve the highest energy accumulation during the hours with the cheapest electricity tariff. The result after two and a half years of activity registration is a faster return on investment due to the optimized energy management of the system, through the control of operating hours adjusted to the needs of customers and the hourly rate. It has also been predicted that during the estimated 12 years of the system will have saved more than € 1,179,737 and thermal 8,780,005 kWh in a hotel 1 and € 1,315,104 and thermal 9,522,301 kWh in the hotel 2. This model shown can be seen how economically and energetically very efficient.  

Determinants of Legionella pneumophila Contamination of Water Distribution Systems: 15-Hospital Prospective Study

1987 ◽  
Vol 8 (9) ◽  
pp. 357-363 ◽  
Author(s):  
Richard M. Vickers ◽  
Victor L. Yu ◽  
S. Sue Hanna ◽  
Paul Muraca ◽  
Warren Diven ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Distribution System ◽  
Distribution Systems ◽  
Water Distribution ◽  
Cold Water ◽  
Physicochemical Characteristics ◽  
Hot Water ◽  
Environmental Study ◽  
Water Tank ◽  
One Year

AbstractWe conducted a prospective environmental study for Legionella pneumophila in 15 hospitals in Pennsylvania. Hot water tanks, cold water sites, faucets, and show-erheads were surveyed four times over a one-year period. Sixty percent (9/15) of hospitals surveyed were contaminated with L pneumophila. Although contamination could not be linked to a specific municipal water supplier, most of the contaminated supplies came from rivers. Parameters found to be significantly associated with contamination included elevated hot water temperature, vertical configuration of the hot water tank, older tanks, and elevated calcium and magnesium concentrations of the water (P < 0.05). This study suggests that L pneumophila contamination could be predicted based on design of the distribution system, as well as physicochemical characteristics of the water.

Effect of heat flushing on the concentrations of Legionella pneumophila and other heterotrophic microbes in hot water systems of apartment buildings

1996 ◽  
Vol 42 (8) ◽  
pp. 811-818 ◽  
Author(s):  
Outi M. Zacheus ◽  
Pertti J. Martikainen
Keyword(s):  
Water Temperature ◽  
Legionella Pneumophila ◽  
Heterotrophic Bacteria ◽  
Water System ◽  
Water Systems ◽  
Hot Water ◽  
Circulating Water ◽  
Heterotrophic Microbes ◽  
Before And After ◽  
Circulating Water System

The decontamination of Legionella pneumophila and other heterotrophic microbes by heat flushing in four legionellae-positive hot water systems was studied. Before the decontamination procedure, the concentration of legionellae varied from 3.0 × 10−3 to 3.5 × 10−5 cfu/L and the hot water temperature from 43.6 to 51.5 °C. During the contamination the temperature was raised to 60–70 °C. All taps and showers were cleaned from sediments and flushed with hot water twice a day for several minutes. The decontamination lasted for 2–4 weeks. In a few weeks the heat-flushing method reduced the concentration of legionellae below the detection limit (50 cfu/L) in the hot circulating water system just before and after the heat exchanger. The high hot water temperature also decreased the viable counts of heterotrophic bacteria, fungi, and total microbial cells determined by the epifluorescent microscopy. However, the eradication of legionellae failed in a water system where the water temperature remained below 60 °C in some parts of the system. After the decontamination, the temperature of hot water was lowered to 55 °C. Thereafter, all the studied hot water systems were recolonized by legionellae within a few months, showing that the decontamination by heat flushing was temporary. Also, the contamination of other bacteria increased in a few months to the level before decontamination.Key words: legionellae, hot water system, decontamination, water temperature, heterotrophic bacteria.

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