Control of Legionella in hospital potable water systems

Baron, Julianne L.; Morris, Lilah F.; Stout, Janet E.

doi:10.1016/b978-0-08-102565-9.00004-2

Cited by 2 publications

(2 citation statements)

References 131 publications

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“…Some researchers even inadequately argued for the removal of the requirement for routine monitoring of Legionella in EWSs from all drinking water guidelines ( Whiley, 2017 ). At least, at distal sites of PPSs in hospitals, water authorities or medical personnel need to routinely monitor Legionella to protect the health of patients ( Baron et al, 2019 ). In summary, the routine examination of microbial drinking water quality by detecting fecal indicators unreasonably neglects OPs, which are the major disease causative biotic agent in municipal drinking water.…”

Section: Fecal Indicators Fail To Indicate Opportunistic Pathogens In...mentioning

confidence: 99%

“…Third, since free chlorine is more reactive and has a higher redox potential ( Table 2 ) than monochloramine, monochloramine residual is more stable and easier to maintain in EWSs ( Wolfe et al, 1984 ; Cunliffe, 1990 ; Vikesland et al, 1998 ; Vikesland and Valentine, 2000 ; Kim et al, 2002 ; Dupuy et al, 2011 ; Gall et al, 2015 ; Zhang et al, 2018 ). Moreover, monochloramine has a wider working pH range than free chlorine in water ( Ercken et al, 2003 ; Lin et al, 2011 ; Springston and Yocavitch, 2017 ; Baron et al, 2019 ).…”

Section: Key Features Of Legionella That Make It A...mentioning

confidence: 99%

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Legionella: A Promising Supplementary Indicator of Microbial Drinking Water Quality in Municipal Engineered Water Systems

Chi-qian¹,

2021

Front. Environ. Sci.

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Opportunistic pathogens (OPs) are natural inhabitants and the predominant disease causative biotic agents in municipal engineered water systems (EWSs). In EWSs, OPs occur at high frequencies and concentrations, cause drinking-water-related disease outbreaks, and are a major factor threatening public health. Therefore, the prevalence of OPs in EWSs represents microbial drinking water quality. Closely or routinely monitoring the dynamics of OPs in municipal EWSs is thus critical to ensuring drinking water quality and protecting public health. Monitoring the dynamics of conventional (fecal) indicators (e.g., total coliforms, fecal coliforms, and Escherichia coli) is the customary or even exclusive means of assessing microbial drinking water quality. However, those indicators infer only fecal contamination due to treatment (e.g., disinfection within water utilities) failure and EWS infrastructure issues (e.g., water main breaks and infiltration), whereas OPs are not contaminants in drinking water. In addition, those indicators appear in EWSs at low concentrations (often absent in well-maintained EWSs) and are uncorrelated with OPs. For instance, conventional indicators decay, while OPs regrow with increasing hydraulic residence time. As a result, conventional indicators are poor indicators of OPs (the major aspect of microbial drinking water quality) in EWSs. An additional or supplementary indicator that can well infer the prevalence of OPs in EWSs is highly needed. This systematic review argues that Legionella as a dominant OP-containing genus and natural inhabitant in EWSs is a promising candidate for such a supplementary indicator. Through comprehensively comparing the behavior (i.e., occurrence, growth and regrowth, spatiotemporal variations in concentrations, resistance to disinfectant residuals, and responses to physicochemical water quality parameters) of major OPs (e.g., Legionella especially L. pneumophila, Mycobacterium, and Pseudomonas especially P. aeruginosa), this review proves that Legionella is a promising supplementary indicator for the prevalence of OPs in EWSs while other OPs lack this indication feature. Legionella as a dominant natural inhabitant in EWSs occurs frequently, has a high concentration, and correlates with more microbial and physicochemical water quality parameters than other common OPs. Legionella and OPs in EWSs share multiple key features such as high disinfectant resistance, biofilm formation, proliferation within amoebae, and significant spatiotemporal variations in concentrations. Therefore, the presence and concentration of Legionella well indicate the presence and concentrations of OPs (especially L. pneumophila) and microbial drinking water quality in EWSs. In addition, Legionella concentration indicates the efficacies of disinfectant residuals in EWSs. Furthermore, with the development of modern Legionella quantification methods (especially quantitative polymerase chain reactions), monitoring Legionella in ESWs is becoming easier, more affordable, and less labor-intensive. Those features make Legionella a proper supplementary indicator for microbial drinking water quality (especially the prevalence of OPs) in EWSs. Water authorities may use Legionella and conventional indicators in combination to more comprehensively assess microbial drinking water quality in municipal EWSs. Future work should further explore the indication role of Legionella in EWSs and propose drinking water Legionella concentration limits that indicate serious public health effects and require enhanced treatment (e.g., booster disinfection).

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Section: Fecal Indicators Fail To Indicate Opportunistic Pathogens In...mentioning

confidence: 99%

Section: Key Features Of Legionella That Make It A...mentioning

confidence: 99%

Legionella: A Promising Supplementary Indicator of Microbial Drinking Water Quality in Municipal Engineered Water Systems

Chi-qian¹,

2021

Front. Environ. Sci.

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An Insight into the Microbiology, Epidemiology, and Host Cell Biology of Legionella Pneumophila: A Review of Literature

Alrahimi

Aldahlawi

Hassoubah

et al. 2022

Biosci., Biotech. Res. Asia

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Legionnaires’ disease (LD) is a type of severe pneumonia that mainly caused by bacteria of the genus Legionella. LD bacteria reside in the water systems of facilities where lack of water exchange or flow plays a crucial role in enhancing bacterial growth. The under-recognition of the dangers of Legionella along with easing of Coronavirus disease 2019 (COVID-19) lockdown restrictions and global reopening, pose a potential increased risk of developing LD. Various Legionella species can lead to legionellosis infections, including LD and Pontiac fever. Legionellosis cases is generally found in natural or artificial aquatic environments such as cooling towers, hot water tanks, or air conditioning. The bacteria elude the host’s immune responses by various strategies, including releasing effector proteins. Thus, this review provides insight into the microbiology, epidemiology, and host cell biology of L. pneumophila, as well as an emphasis on the bacterial novel survival strategies of L. pneumophila. Also, suggests taking intensive actions towards closed buildings as a potential source of bacterial infection.

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Control of Legionella in hospital potable water systems

Cited by 2 publications

References 131 publications

Legionella: A Promising Supplementary Indicator of Microbial Drinking Water Quality in Municipal Engineered Water Systems

Legionella: A Promising Supplementary Indicator of Microbial Drinking Water Quality in Municipal Engineered Water Systems

An Insight into the Microbiology, Epidemiology, and Host Cell Biology of Legionella Pneumophila: A Review of Literature

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