scholarly journals Occurrence of Legionella in showers at recreational facilities

2017 ◽  
Vol 15 (3) ◽  
pp. 402-409 ◽  
Author(s):  
Patrizia De Filippis ◽  
Cinzia Mozzetti ◽  
Massimo Amicosante ◽  
Gian Loreto D'Alò ◽  
Alessandra Messina ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Distribution Systems ◽  
Water Distribution ◽  
Culture Method ◽  
Plate Count ◽  
Recreational Facilities ◽  
Hygiene Practices ◽  
Serotype 1 ◽  
Polymerase Chain ◽  
Good Hygiene

Critical environments, including water systems in recreational settings, represent an important source of Legionella pneumophila infection in humans. In order to assess the potential risk for legionellosis, we analyzed Legionella contamination of water distribution systems in 36 recreational facilities equipped with swimming pools. One hundred and sixty water samples were analyzed from shower heads or taps located in locker rooms or in bathrooms. By culture method and polymerase chain reaction, 41/160 samples were positive for Legionella from 12/36 recreational centers. Hotels (57.1%) and sports centers (41.2%) were the most contaminated. L. pneumophila serotypes 2–14 (25/41) were more frequently found than serotype 1 (10/41). Samples at temperature ≥30 °C were more frequently positive than samples at temperature <30 °C (n = 39 vs n = 2, p < 0.00001). The presence of L. pneumophila was investigated by comparison with heterotrophic plate count (HPC), an indicator of water quality. The presence of L. pneumophila was associated more frequently with high and intermediate HPC load at 37 °C, therefore should be considered a potential source when HPC at 37 °C is >10 CFU/mL. Maintenance, good hygiene practices, interventions on the hydraulic system and regular controls must be implemented to minimize exposure to L. pneumophila infection risk.

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.

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.

scholarly journals How Molecular Typing Can Support Legionella Environmental Surveillance in Hot Water Distribution Systems: A Hospital Experience

2020 ◽  
Vol 17 (22) ◽  
pp. 8662
Author(s):  
Luna Girolamini ◽  
Silvano Salaris ◽  
Jessica Lizzadro ◽  
Marta Mazzotta ◽  
Maria Rosaria Pascale ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Molecular Typing ◽  
Distribution Systems ◽  
Water Distribution ◽  
Water Distribution Systems ◽  
Gene Sequencing ◽  
Culture Technique ◽  
Hot Water ◽  
Environmental Surveillance ◽  
Risk Map

In this study, we aimed to associate the molecular typing of Legionella isolates with a culture technique during routine Legionella hospital environmental surveillance in hot water distribution systems (HWDSs) to develop a risk map able to be used to prevent nosocomial infections and formulate appropriate preventive measures. Hot water samples were cultured according to ISO 11731:2017. The isolates were serotyped using an agglutination test and genotyped by sequence-based typing (SBT) for Legionella pneumophila or macrophage infectivity potentiator (mip) gene sequencing for non-pneumophila Legionella species. The isolates’ relationship was phylogenetically analyzed. The Legionella distribution and level of contamination were studied in relation to temperature and disinfectant residues. The culture technique detected 62.21% of Legionella positive samples, characterized by L. pneumophila serogroup 1, Legionella non-pneumophila, or both simultaneously. The SBT assigned two sequence types (STs): ST1, the most prevalent in Italy, and ST104, which had never been isolated before. The mip gene sequencing detected L. anisa and L. rubrilucens. The phylogenetic analysis showed distinct clusters for each species. The distribution of Legionella isolates showed significant differences between buildings, with a negative correlation between the measured level of contamination, disinfectant, and temperature. The Legionella molecular approach introduced in HWDSs environmental surveillance permits (i) a risk map to be outlined that can help formulate appropriate disinfection strategies and (ii) rapid epidemiological investigations to quickly identify the source of Legionella infections.

scholarly journals Legionella pneumophila and Protozoan Hosts: Implications for the Control of Hospital and Potable Water Systems

Pathogens ◽  
2020 ◽  
Vol 9 (4) ◽  
pp. 286 ◽  
Author(s):  
Muhammad Atif Nisar ◽  
Kirstin E. Ross ◽  
Melissa H. Brown ◽  
Richard Bentham ◽  
Harriet Whiley
Keyword(s):  
Legionella Pneumophila ◽  
Distribution Systems ◽  
Water Distribution ◽  
Potable Water ◽  
Water Systems ◽  
Water Disinfection ◽  
Health Concern ◽  
Waterborne Pathogen ◽  
Microbial Biofilms ◽  
Pontiac Fever

Legionella pneumophila is an opportunistic waterborne pathogen of public health concern. It is the causative agent of Legionnaires’ disease (LD) and Pontiac fever and is ubiquitous in manufactured water systems, where protozoan hosts and complex microbial communities provide protection from disinfection procedures. This review collates the literature describing interactions between L. pneumophila and protozoan hosts in hospital and municipal potable water distribution systems. The effectiveness of currently available water disinfection protocols to control L. pneumophila and its protozoan hosts is explored. The studies identified in this systematic literature review demonstrated the failure of common disinfection procedures to achieve long term elimination of L. pneumophila and protozoan hosts from potable water. It has been demonstrated that protozoan hosts facilitate the intracellular replication and packaging of viable L. pneumophila in infectious vesicles; whereas, cyst-forming protozoans provide protection from prolonged environmental stress. Disinfection procedures and protozoan hosts also facilitate biogenesis of viable but non-culturable (VBNC) L. pneumophila which have been shown to be highly resistant to many water disinfection protocols. In conclusion, a better understanding of L. pneumophila-protozoan interactions and the structure of complex microbial biofilms is required for the improved management of L. pneumophila and the prevention of LD.

Multiple disinfection processes of Legionella pneumophila positive in hotels’ water distribution systems in Jordan

2019 ◽  
Vol 163 ◽  
pp. 7-16
Author(s):  
Motasem N. Saidan ◽  
Ahlam I. Abdalla ◽  
Nivin Al Alami ◽  
Hanan Al-Naimat
Keyword(s):  
Legionella Pneumophila ◽  
Distribution Systems ◽  
Water Distribution ◽  
Water Distribution Systems

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 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.

scholarly journals Temperature diagnostic to identify high risk areas and optimize Legionella pneumophila surveillance in hot water distribution systems

2015 ◽  
Vol 71 ◽  
pp. 244-256 ◽  
Author(s):  
Emilie Bédard ◽  
Stéphanie Fey ◽  
Dominique Charron ◽  
Cindy Lalancette ◽  
Philippe Cantin ◽  
...  
Keyword(s):  
High Risk ◽  
Legionella Pneumophila ◽  
Distribution Systems ◽  
Water Distribution ◽  
Water Distribution Systems ◽  
Hot Water ◽  
Risk Areas ◽  
Temperature Diagnostic

scholarly journals Clusters of Healthcare-Associated Legionnaires’ Disease in Two Hospitals of Central Greece

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Maria A. Kyritsi ◽  
Varvara A. Mouchtouri ◽  
Anna Katsiafliaka ◽  
Foteini Kolokythopoulou ◽  
Elias Plakokefalos ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Environmental Samples ◽  
Distribution Systems ◽  
Water Distribution ◽  
Control Measures ◽  
Aerosol Therapy ◽  
Environmental Investigation ◽  
Source Of Infection ◽  
Legionnaires Disease ◽  
Healthcare Associated

Healthcare-associated Legionnaires’ disease often leads to fatal respiratory tract infection among hospitalized patients. In this report, three cases of Legionnaires’ disease among patients in two different hospitals (Hospital A and Hospital B) were investigated. After conducting an epidemiologic and environmental investigation, the water distribution systems (WDSs) were identified as the possible source of infection, as Legionella pneumophila serogroup 1 (Lp1) was isolated from both clinical and environmental samples. Patients received aerosol therapy with nebulizers during their hospitalization. Based on the results of the investigation, the hospitals’ infection control committees reviewed their policies for Legionnaires’ disease prevention and implemented control measures focusing on using sterile fluids for aerosol treatments.

scholarly journals Mycobacterium avium Complex (MAC) in Water Distribution Systems and Household Plumbing in the United States

Water ◽  
2020 ◽  
Vol 12 (12) ◽  
pp. 3338
Author(s):  
Joseph O. Falkinham
Keyword(s):  
Drinking Water ◽  
Mycobacterium Avium ◽  
Distribution Systems ◽  
Water Distribution ◽  
Mycobacterium Avium Complex ◽  
Water Distribution Systems ◽  
Treatment Plant ◽  
The United States ◽  
Fecal Coliforms ◽  
Plate Count

Members of the Mycobacterium avium complex (MAC) are waterborne, opportunistic pathogens whose characteristics make urban water distribution systems and household plumbing ideal habitats for their survival, persistence and growth. Rather than contaminants, MAC are colonists of drinking water systems. MAC are normal inhabitants of natural soils and water, and enter drinking water treatment systems through surface sources. A proportion of MAC survive transmission through the treatment plant, and regrow in the distribution system and household plumbing. Once within household plumbing, MAC adhere to surfaces and form biofilms, thus preventing their washout. The thermal tolerance of MAC leads to growth in water heating systems. Stagnation does not reduce MAC numbers, as MAC can grow at low oxygen levels. MAC present challenges to current water monitoring approaches as their numbers do not correlate with E. coli, fecal coliforms or heterotrophic plate count bacteria.

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