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 Environmental Surveillance of Legionellosis within an Italian University Hospital. Results of 15 Years of Analysis

2019 ◽  
Author(s):  
Pasqualina Laganà ◽  
Alessio Facciolà ◽  
Roberta Palermo ◽  
Santi Delia
Keyword(s):  
Potential Risk ◽  
Water Samples ◽  
Continuous Monitoring ◽  
Water System ◽  
Water Systems ◽  
Hot Water ◽  
University Hospital ◽  
Source Water ◽  
Environmental Surveillance ◽  
Standard Procedures

Legionnaires’ disease is normally acquired by inhalation of legionellae from a contaminated environmental source. Water systems of large buildings, such as hospitals, are often 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 Italian Guidelines emanated in 2000 were adopted; from May 2015 to 2018 Italian Guidelines revised in 2015 (ISS, 2015), were used. The most water samples (72%) were positive to L. pneumophila serogroups 2-14 whereas L. pneumophila serogroup 1 accounted for the 18% and Legionella spp. for the 15%. Most of the positive samples were found in the buildings where are situated critical wards as ICU, Neurosurgery, Surgeries, Pneumology and Neonatal Intensive Unit Care. We highlighted the importance of a continuous monitoring of hospital water samples to prevent the potential risk of nosocomial legionellosis.

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.

scholarly journals Multiple Types of Legionella pneumophilaSerogroup 6 in a Hospital Heated-Water System Associated with Sporadic Infections

1999 ◽  
Vol 37 (7) ◽  
pp. 2189-2196 ◽  
Author(s):  
Paolo Visca ◽  
Paola Goldoni ◽  
P. Christian Lück ◽  
Jürgen H. Helbig ◽  
Lorena Cattani ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Water Samples ◽  
Water System ◽  
Hot Water ◽  
Control Measures ◽  
Hospital Environment ◽  
Modes Of Transmission ◽  
Sequence Of Events ◽  
Single Clone ◽  
Arbitrarily Primed Pcr

Five sporadic cases of nosocomial Legionnaires’ disease were documented from 1989 to 1997 in a hospital in northern Italy. Two of them, which occurred in a 75-year-old man suffering from ischemic cardiopathy and in an 8-year-old girl suffering from acute leukemia, had fatal outcomes. Legionella pneumophila serogroup 6 was isolated from both patients and from hot-water samples taken at different sites in the hospital. These facts led us to consider the possibility that a single clone of L. pneumophila serogroup 6 had persisted in the hospital environment for 8 years and had caused sporadic infections. Comparison of clinical and environmental strains by monoclonal subtyping, macrorestriction analysis (MRA), and arbitrarily primed PCR (AP-PCR) showed that the strains were clustered into three different epidemiological types, of which only two types caused infection. An excellent correspondence between the MRA and AP-PCR results was observed, with both techniques having high discriminatory powers. However, it was not possible to differentiate the isolates by means of ribotyping and analysis of rrnoperon polymorphism. Environmental strains that antigenically and chromosomally matched the infecting organism were present at the time of infection in hot-water samples taken from the ward where the patients had stayed. Interpretation of the temporal sequence of events on the basis of the typing results for clinical and environmental isolates enabled the identification of the ward where the patients became infected and the modes of transmission of Legionellainfection. The long-term persistence in the hot-water system of different clones of L. pneumophila serogroup 6 indicates that repeated heat-based control measures were ineffective in eradicating the organism.

scholarly journals Legionella pneumophila in a hospital water system following a nosocomial outbreak: prevalence, monoclonal antibody subgrouping and effect of control measures

1987 ◽  
Vol 98 (3) ◽  
pp. 253-262 ◽  
Author(s):  
C. D. Ribeiro ◽  
S. H. Burge ◽  
S. R. Palmer ◽  
J. O'H. Tobin ◽  
I. D. Watkins
Keyword(s):  
Monoclonal Antibody ◽  
Legionella Pneumophila ◽  
Water Samples ◽  
Water System ◽  
Extended Period ◽  
Control Measures ◽  
Nosocomial Outbreak ◽  
Water Supplies ◽  
Chemical Sterilization ◽  
Legionnaires Disease

SUMMARYSwabs and water samples from a hospital water system were cultured for legionellae over an extended period. Legionella pneumophila serogroup 1, including outbreak associated strains, were isolated in small numbers from approximately 5% of these samples despite implementation of the current DHSS/Welsh Office regulations. No cases of nosocomial legionnaires' disease were proven during the study. Physical cleaning and chemical sterilization of taps, and replacement of washers with ‘approved’ brands did not eradicate the organisms. Eradication of legionellae in hospital water supplies appears to be unnecessary in preventing nosocomial legionnaires' disease provided the current DHSS/Welsh Office recommendations are implemented.

scholarly journals Factors Influencing Legionella Contamination of Domestic Household Showers

Pathogens ◽  
2019 ◽  
Vol 8 (1) ◽  
pp. 27 ◽  
Author(s):  
Deanna Hayes-Phillips ◽  
Richard Bentham ◽  
Kirstin Ross ◽  
Harriet Whiley
Keyword(s):  
Risk Factors ◽  
Water Temperature ◽  
Legionella Pneumophila ◽  
Public Awareness ◽  
Water System ◽  
South Australia ◽  
Hot Water ◽  
Factors Associated ◽  
Potential Source ◽  
Legionnaires Disease

Legionnaires’ disease is a potentially fatal pneumonia like infection caused by inhalation or aspiration of water particles contaminated with pathogenic Legionella spp. Household showers have been identified as a potential source of sporadic, community-acquired Legionnaires’ disease. This study used qPCR to enumerate Legionella spp. and Legionella pneumophila in water samples collected from domestic showers across metropolitan Adelaide, South Australia. A survey was used to identify risk factors associated with contamination and to examine awareness of Legionella control in the home. The hot water temperature was also measured. A total of 74.6% (50/68) and 64.2% (43/68) showers were positive for Legionella spp. and L. pneumophila, respectively. Statistically significant associations were found between Legionella spp. concentration and maximum hot water temperature (p = 0.000), frequency of shower use (p = 0.000) and age of house (p = 0.037). Lower Legionella spp. concentrations were associated with higher hot water temperatures, showers used at least every week and houses less than 5 years old. However, examination of risk factors associated with L. pneumophila found that there were no statistically significant associations (p > 0.05) with L. pneumophila concentrations and temperature, type of hot water system, age of system, age of house or frequency of use. This study demonstrated that domestic showers were frequently colonized by Legionella spp. and L. pneumophila and should be considered a potential source of sporadic Legionnaires’ disease. Increasing hot water temperature and running showers every week to enable water sitting in pipes to be replenished by the municipal water supply were identified as strategies to reduce the risk of Legionella in showers. The lack of public awareness in this study identified the need for public health campaigns to inform vulnerable populations of the steps they can take to reduce the risk of Legionella contamination and exposure.

Nosocomial Outbreak of Legionnaires' Disease: Molecular Epidemiology and Disease Control Measures

1987 ◽  
Vol 8 (2) ◽  
pp. 53-58 ◽  
Author(s):  
Jeffrey M. Johnston ◽  
Robert H. Latham ◽  
Frederick A. Meier ◽  
Jon A. Green ◽  
Rebecca Boshard ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Potable Water ◽  
Cooling Tower ◽  
Water System ◽  
Hot Water ◽  
Control Measures ◽  
Laboratory Techniques ◽  
Legionnaires Disease ◽  
Water Holding ◽  
Methods Of Control

AbstractMolecular laboratory techniques were used to study the epidemiology of an outbreak of nosocomial Legionnaires' disease. All patient isolates were Legionella pneumophila serogroup 1 and showed identical plasmid profiles and reactions with serogroup-specific monoclonal antibodies. L pneumophila was also cultured from four of five cooling tower water samples; however, the isolate from only one tower was serogroup 1 of the same sub-type as patient isolates. Since the cases were temporally clustered and epidemiologically associated with exposure to cooling tower aerosols, the single cooling tower implicated by molecular analysis was the most likely source of the outbreak. Chlorination of cooling tower ponds has eradicated the epidemic strain. Since potable water also harbored the infecting organism and was the probable source for cooling tower contamination, decontamination of the hospital water system was also undertaken. Superchlorination of hot water holding tanks to 17 ppm on a weekly basis has effectively eradicated L pneumophila from the potable water system and appears to be a reasonable, simple, and relatively inexpensive alternative to previously described methods of control.

scholarly journals Incrimination of an environmental source of a case of Legionnaires' disease by pyrolysis mass spectrometry

1991 ◽  
Vol 107 (1) ◽  
pp. 127-132 ◽  
Author(s):  
P. R. Sisson ◽  
R. Freeman ◽  
N. F. Lightfoot ◽  
I. R. Richardson
Keyword(s):  
Mass Spectrometry ◽  
Legionella Pneumophila ◽  
Water System ◽  
Hot Water ◽  
Pyrolysis Mass Spectrometry ◽  
Environmental Isolates ◽  
Relevant Reference ◽  
Cheap Method ◽  
Legionnaires Disease ◽  
Reference Strains

SUMMARYFollowing a case of Legionnaires' diseaseLegionella pneumophilaof the same serogroup was isolated from the hot water system of the hotel which had been epidemiologically implicated as the source of the infection. Pyrolysis mass spectrometry (PyMS) was used to compare 11 isolates from the hotel water sample with the patient's strain. Epidemiologically unrelated isolates, both clinical and environmental, of the same serogroup and monoclonal antibody type ofL. pneumophilawere included in the same analysis, together with relevant reference strains. The patient strain was shown to be indistinguishable from seven of the hotel water isolates, but clearly different from other unrelated clinical isolates, the reference strains and some of the other environmental isolates. PyMS is a rapid and cheap method for inter-strain comparison forL. pneumophila.

scholarly journals Cluster of Legionnaires’ Disease in an Italian Prison

2019 ◽  
Vol 16 (11) ◽  
pp. 2062
Author(s):  
Teresa Fasciana ◽  
Chiara Mascarella ◽  
Salvatore Antonino Distefano ◽  
Cinzia Calà ◽  
Giuseppina Capra ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Water Samples ◽  
Water System ◽  
Growth Conditions ◽  
Etiologic Agent ◽  
Clinical Samples ◽  
Reference Laboratory ◽  
High Concentration ◽  
Western Sicily ◽  
Legionnaires Disease

Background: Legionella pneumophila (Lp) is the most common etiologic agent causing Legionnaires’ Disease (LD). Water systems offer the best growth conditions for Lp and support its spread by producing aerosols. From 2015 to 2017, the Regional Reference Laboratory of Clinical and Environmental Surveillance of Legionellosis of Palermo monitored the presence of Lp in nine prisons in Western Sicily. During this investigation, we compared Lp isolates from environmental samples in a prison located in Palermo with isolates from two prisoners in the same prison. Methods: We collected 93 water samples from nine Sicilian prisons and the bronchoalveolar lavages (BALs) of two prisoners considered cases of LD. These samples were processed following the procedures described in the Italian Guidelines for the Prevention and Control of Legionellosis of 2015. Then, genotyping was performed on 19 Lp colonies (17 from water samples and 2 from clinical samples) using the Sequence-Based Typing (SBT) method, according to European Study Group for Legionella Infections (ESGLI) protocols. Results: Lp serogroup (sg) 6 was the most prevalent serogroup isolated from the prisons analyzed (40%), followed by Lp sg 1 (16%). Most of all, in four penitentiary institutions, we detected a high concentration of Lp >104 Colony Forming Unit/Liter (CFU/L). The environmental molecular investigation found the following Sequence Types (STs) in Lp sg 6: ST 93, ST 292, ST 461, ST 728, ST 1317 and ST 1362, while most of the isolates in sg 1 belonged to ST 1. We also found a new ST that has since been assigned the number 2451 in the ESGLI-SBT database. From the several Lp sg 1 colonies isolated from the two BALs, we identified ST 2451. Conclusions: In this article, we described the results obtained from environmental and epidemiological investigations of Lp isolated from prisons in Western Sicily. Furthermore, we reported the first cluster of Legionnaires’ in an Italian prison and the molecular typing of Lp sg 1 from one prison’s water system and two BALs, identified the source of the contamination, and discovered a new ST.

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.

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