Flushing of Stagnant Premise Water Systems after the COVID-19 Shutdown Can Reduce Infection Risk by <i>Legionella</i> and <i>Mycobacterium</i> spp.

Hozalski, Raymond M.; LaPara, Timothy M.; Zhao, Xiaotian; Kim, Taegyu; Waak, Michael B.; Burch, Tucker R.; McCarty, Michael E.

doi:10.1021/acs.est.0c06357

Cited by 65 publications

(112 citation statements)

References 46 publications

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“…These are all critical aspects related to Legionella persistence in man-made systems that contribute to a higher or lower legionellosis risk. The studies considered in Table 1 cover different water settings, including cooling towers [55][56][57], premise plumbing from hospitals [51,52,54,[58][59][60][61][62][63][64] and hotels [45,48,[64][65][66][67][68][69], residential potable water systems [46,70,71], and other facilities [72][73][74][75][76][77][78].…”

Section: Main Research Topicsmentioning

confidence: 99%

“…Chemical Disinfection Programs shape bacterial communities and reduce Legionella positivities (chlorination, chloramine, chlorine dioxide, copper-silver ionization, hydrogen peroxide and silver salts, NEOW) [51,52,54,56,61,62,66,72,73,[79][80][81] Effective temperature control reduces Legionella incidence [60,70,82] Water stagnation vs. water flushing [48,59,65,71,78,83]…”

Section: Microbial Control Strategiesmentioning

confidence: 99%

“…Before implementing the flushing procedure, L. pneumophila was detected in all sampling points, but after regular flushing, the levels started to decrease. Similarly to what happens with temperature, water flushing in drinking-water-related systems is usually co-adjuvanted by other strategies, such as temperature increase or chemical dosage [65,78]. Routine water flushing is particularly important when disinfectant agents are added to water systems since it assures that disinfectant levels are maintained throughout the whole system [94].…”

Section: Water Stagnation Vs Water Flushingmentioning

confidence: 99%

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Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

2021

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Legionella is responsible for the life-threatening pneumonia commonly known as Legionnaires’ disease or legionellosis. Legionellosis is known to be preventable if proper measures are put into practice. Despite the efforts to improve preventive approaches, Legionella control remains one of the most challenging issues in the water treatment industry. Legionellosis incidence is on the rise and is expected to keep increasing as global challenges become a reality. This puts great emphasis on prevention, which must be grounded in strengthened Legionella management practices. Herein, an overview of field-based studies (the system as a test rig) is provided to unravel the common roots of research and the main contributions to Legionella’s understanding. The perpetuation of a water-focused monitoring approach and the importance of protozoa and biofilms will then be discussed as bottom-line questions for reliable Legionella real-field surveillance. Finally, an integrated monitoring model is proposed to study and control Legionella in water systems by combining discrete and continuous information about water and biofilm. Although the successful implementation of such a model requires a broader discussion across the scientific community and practitioners, this might be a starting point to build more consistent Legionella management strategies that can effectively mitigate legionellosis risks by reinforcing a pro-active Legionella prevention philosophy.

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Section: Main Research Topicsmentioning

confidence: 99%

Section: Microbial Control Strategiesmentioning

confidence: 99%

Section: Water Stagnation Vs Water Flushingmentioning

confidence: 99%

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Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

2021

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“…One of the potential limitations in this study was to find Legionella free premises and buildings, because generally man-made water systems were colonized by Legionella. Hozalski et al (2020) reported that flushing stagnant network water systems after the COVID-19 shutdown can reduce Legionella infection risk. The same study suggested that flushing could rapidly improve water quality in restricted buildings, but the improvement may only last a few days.…”

Section: Resultsmentioning

confidence: 99%

Legionella surveillance in stagnant water systems during COVID-19 lockdown in Istanbul

Türetgen¹

2021

MJM

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Aim:The aim of this study was to monitor the restricted water systems during the period of COVID-19 lockdown for the waterborne pathogen Legionella pneumophila. Selected water systems were monitored to evaluate the effect of stagnation in terms of Legionella colonization. Methodology and results: A total of 160 water samples were taken from buildings which were temporarily shut down or had restricted usage between April-December 2020. None of the sampling points had Legionella positive history in the last three years. All water samples were tested using classic microbiological culture as the gold standard and rapid Vermicon ScanVIT Legionella test kit combined with epifluorescence microscopy. Sixteen (10%) out of 160 water samples were recorded as Legionella-positive by both methods, where none of them was positive before the COVID-19 lockdown. All positives were tested as L. pneumophila serogroup 1 with latex agglutination kit. Conclusion, significance and impact of study: Colonization of Legionella in stagnant water systems occurs rapidly. Before reopening, routine monitoring in buildings is extremely important especially under restricted use or closure is in case. Flushing, disinfecting and testing are crucial for minimizing the health risks for the public health.

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“…These include well designed hospital water systems, and maintenance of hot water systems, to ensure inhibitory temperatures are maintained. Hot water pipes need to be properly insulated to prevent the warming of adjacent cold-water pipes, stagnation sites such as blind pipe sections and holding tanks eliminated, and material that supports legionella growth minimised [139][140][141][142]. A metanalysis has shown that temperatures of 55-59 • C are associated with a low probability of Legionella species being detectable in water samples, and in cold water kept below 20 • C [143,144].…”

Section: Prevention and Public Healthmentioning

confidence: 99%

Legionellosis Caused by Non-Legionella pneumophila Species, with a Focus on Legionella longbeachae

et al. 2021

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Although known as causes of community-acquired pneumonia and Pontiac fever, the global burden of infection caused by Legionella species other than Legionella pneumophila is under-recognised. Non-L. pneumophila legionellae have a worldwide distribution, although common testing strategies for legionellosis favour detection of L. pneumophila over other Legionella species, leading to an inherent diagnostic bias and under-detection of cases. When systematically tested for in Australia and New Zealand, L. longbeachae was shown to be a leading cause of community-acquired pneumonia. Exposure to potting soils and compost is a particular risk for infection from L. longbeachae, and L. longbeachae may be better adapted to soil and composting plant material than other Legionella species. It is possible that the high rate of L. longbeachae reported in Australia and New Zealand is related to the composition of commercial potting soils which, unlike European products, contain pine bark and sawdust. Genetic studies have demonstrated that the Legionella genomes are highly plastic, with areas of the chromosome showing high levels of recombination as well as horizontal gene transfer both within and between species via plasmids. This, combined with various secretion systems and extensive effector repertoires that enable the bacterium to hijack host cell functions and resources, is instrumental in shaping its pathogenesis, survival and growth. Prevention of legionellosis is hampered by surveillance systems that are compromised by ascertainment bias, which limits commitment to an effective public health response. Current prevention strategies in Australia and New Zealand are directed at individual gardeners who use potting soils and compost. This consists of advice to avoid aerosols generated by the use of potting soils and use masks and gloves, but there is little evidence that this is effective. There is a need to better understand the epidemiology of L. longbeachae and other Legionella species in order to develop effective treatment and preventative strategies globally.

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Flushing of Stagnant Premise Water Systems after the COVID-19 Shutdown Can Reduce Infection Risk by Legionella and Mycobacterium spp.

Cited by 65 publications

References 46 publications

Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

Legionella and Biofilms—Integrated Surveillance to Bridge Science and Real-Field Demands

Legionella surveillance in stagnant water systems during COVID-19 lockdown in Istanbul

Legionellosis Caused by Non-Legionella pneumophila Species, with a Focus on Legionella longbeachae

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