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.

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.

scholarly journals Legionella Contamination in Hot Water of Italian Hotels

2005 ◽  
Vol 71 (10) ◽  
pp. 5805-5813 ◽  
Author(s):  
Paola Borella ◽  
Maria Teresa Montagna ◽  
Serena Stampi ◽  
Giovanna Stancanelli ◽  
Vincenzo Romano-Spica ◽  
...  
Keyword(s):  
Risk Factors ◽  
Legionella Pneumophila ◽  
Water Systems ◽  
Hot Water ◽  
Cross Sectional ◽  
Multicenter Survey ◽  
Multivariate Logistic Model ◽  
Legionnaires Disease ◽  
Building Characteristics

ABSTRACT A cross-sectional multicenter survey of Italian hotels was conducted to investigate Legionella spp. contamination of hot water. Chemical parameters (hardness, free chlorine concentration, and trace element concentrations), water systems, and building characteristics were evaluated to study risk factors for colonization. The hot water systems of Italian hotels were strongly colonized by Legionella; 75% of the buildings examined and 60% of the water samples were contaminated, mainly at levels of ≥103 CFU liter−1, and Legionella pneumophila was the most frequently isolated species (87%). L. pneumophila serogroup 1 was isolated from 45.8% of the contaminated sites and from 32.5% of the hotels examined. When a multivariate logistic model was used, only hotel age was associated with contamination, but the risk factors differed depending on the contaminating species and serogroup. Soft water with higher chlorine levels and higher temperatures were associated with L. pneumophila serogroup 1 colonization, whereas the opposite was observed for serogroups 2 to 14. In conclusion, Italian hotels, particularly those located in old buildings, represent a major source of risk for Legionnaires' disease due to the high frequency of Legionella contamination, high germ concentration, and major L. pneumophila serogroup 1 colonization. The possible role of chlorine in favoring the survival of Legionella species is discussed.

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.

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 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 Lessons From an Outbreak of Legionnaires’ Disease on a Hematology-Oncology Unit

2016 ◽  
Vol 38 (3) ◽  
pp. 306-313 ◽  
Author(s):  
Louise K. Francois Watkins ◽  
Karrie-Ann E. Toews ◽  
Aaron M. Harris ◽  
Sherri Davidson ◽  
Stephanie Ayers-Millsap ◽  
...  
Keyword(s):  
Legionella Pneumophila ◽  
Potable Water ◽  
Single Case ◽  
Healthcare Providers ◽  
Water System ◽  
Positive Sequence ◽  
Environmental Isolates ◽  
Legionnaires Disease ◽  
Oncology Unit ◽  
Healthcare Associated

OBJECTIVESTo define the scope of an outbreak of Legionnaires’ disease (LD), to identify the source, and to stop transmission.DESIGN AND SETTINGEpidemiologic investigation of an LD outbreak among patients and a visitor exposed to a newly constructed hematology-oncology unit.METHODSAn LD case was defined as radiographically confirmed pneumonia in a person with positive urinary antigen testing and/or respiratory culture forLegionellaand exposure to the hematology-oncology unit after February 20, 2014. Cases were classified as definitely or probably healthcare-associated based on whether they were exposed to the unit for all or part of the incubation period (2–10 days). We conducted an environmental assessment and collected water samples for culture. Clinical and environmental isolates were compared by monoclonal antibody (MAb) and sequence-based typing.RESULTSOver a 12-week period, 10 cases were identified, including 6 definite and 4 probable cases. Environmental sampling revealedLegionella pneumophilaserogroup 1 (Lp1) in the potable water at 9 of 10 unit sites (90%), including all patient rooms tested. The 3 clinical isolates were identical to environmental isolates from the unit (MAb2-positive, sequence type ST36). No cases occurred with exposure after the implementation of water restrictions followed by point-of-use filters.CONCLUSIONSContamination of the unit’s potable water system with Lp1 strain ST36 was the likely source of this outbreak. Healthcare providers should routinely test patients who develop pneumonia at least 2 days after hospital admission for LD. A single case of LD that is definitely healthcare associated should prompt a full investigation.Infect Control Hosp Epidemiol2017;38:306–313

Computational framework for evaluating risk trade-offs in costs associated with Legionnaires’ Disease risk, energy, and scalding risk for hospital hot water systems

2021 ◽  
Author(s):  
Ashley Heida ◽  
Alexis Mraz ◽  
Mark Hamilton ◽  
Mark Weir ◽  
Kerry A Hamilton
Keyword(s):  
Legionella Pneumophila ◽  
Disease Risk ◽  
Disease Outbreaks ◽  
Febrile Illness ◽  
Water Systems ◽  
Hot Water ◽  
Computational Framework ◽  
Trade Offs ◽  
Pontiac Fever ◽  
Legionnaires Disease

Legionella pneumophila are bacteria that when inhaled cause Legionnaires’ Disease (LD) and febrile illness Pontiac Fever. As of 2014, LD is the most frequent cause of waterborne disease outbreaks due...

scholarly journals Effects of Disinfection on Legionella spp., Eukarya, and Biofilms in a Hot Water System

2012 ◽  
Vol 78 (19) ◽  
pp. 6850-6858 ◽  
Author(s):  
Maha Farhat ◽  
Marina Moletta-Denat ◽  
Jacques Frère ◽  
Séverine Onillon ◽  
Marie-Cécile Trouilhé ◽  
...  
Keyword(s):  
Community Structure ◽  
Heat Shock ◽  
Legionella Pneumophila ◽  
Water System ◽  
Single Strand Conformation Polymorphism ◽  
Pilot Scale ◽  
Small Subunit ◽  
Hot Water ◽  
Content Type ◽  
Chemical Treatments

ABSTRACTLegionellaspecies are frequently detected in hot water systems, attached to the surface as a biofilm. In this work, the dynamics ofLegionellaspp. and diverse bacteria and eukarya associated together in the biofilm, coming from a pilot scale 1 system simulating a real hot water system, were investigated throughout 6 months after two successive heat shock treatments followed by three successive chemical treatments. Community structure was assessed by a fingerprint technique, single-strand conformation polymorphism (SSCP). In addition, the diversity and dynamics ofLegionellaand eukarya were investigated by small-subunit (SSU) ribosomal cloning and sequencing. Our results showed that pathogenicLegionellaspecies remained after the heat shock and chemical treatments (Legionella pneumophilaandLegionella anisa, respectively). The biofilm was not removed, and the bacterial community structure was transitorily affected by the treatments. Moreover, several amoebae had been detected in the biofilm before treatments (Thecamoebaesp.,Vannellasp., andHartmanella vermiformis) and after the first heat shock treatment, but onlyH. vermiformisremained. However, another protozoan affiliated with Alveolata, which is known as a host cell forLegionella, dominated the eukaryal species after the second heat shock and chemical treatment tests. Therefore, effectiveLegionelladisinfection may be dependent on the elimination of these important microbial components. We suggest that eradicatingLegionellain hot water networks requires better study of bacterial and eukaryal species associated withLegionellain biofilms.

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