Legionella control in the water system of antiquated hospital buildings by shock and continuous hyperchlorination: 5 years experience

Orsi, Giovanni Battista; Vitali, Matteo; Marinelli, Lucia; Ciorba, Veronica; Tufi, Daniela; Cimmuto, Angela Del; Ursillo, Paolo; Fabiani, Massimo; Santis, Susi De; Protano, Carmela; Marzuillo, Carolina; Giusti, Maria De

doi:10.1186/1471-2334-14-394

Cited by 40 publications

(30 citation statements)

References 20 publications

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“…Different factors are required to be studied when selecting the most suitable water disinfection method in health care facilities in order to guarantee water quality (Zhang et al 2007). No method can guarantee absolute total disinfection and when colonization occurs, it is extremely difficult to eliminate it (Scaturro et al 2007;Lin, Stout, and Yu 2011;Cristino, Legnani, and Leoni 2012;Orsi et al 2014). Chlorine (Cl) is widely used as a disinfectant in Portuguese water systems (Diegues 2013) and it is considered efficient.…”

Section: Introductionmentioning

confidence: 99%

Water quality supply in a Portuguese teaching hospital: monitoring and studies on detection of critical points

Norton

Amaro

Martins

et al. 2016

Toxicological & Environmental Chemistry

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Surveillance of drinking water quality is extremely important to human health, assuming greater relevance in hospital environments, especially to those individuals who are immunocompromised. This study is aimed to determine the effect of increasing free chlorine (Cl) concentration in a hospital water network in regard to water quality monitoring and microbial growth control, between 2010 and 2013 in Porto. The average of free Cl concentration in the period under analysis showed some heterogeneity per floor, varying between 0.84 and 1.25 mg/L. In addition, there was a rise in proportion of samples that exceeded WHO guidelines (free Cl 0.5 mg/L), particularly in the last two years of the same period. With respect to microbial analysis, 22.4% of the samples were positive for Legionella spp., 6.4% for Pseudomonas aeruginosa, 15% and 30.4% for aerobic plate counts at 36 and 22 C, respectively. The proportion of positive samples decreased throughout the period under analysis, in particular for Legionella spp. (41.7% in 2010 vs. non-detectable in 2013) and P. aeruginosa (10.8% in 2010 vs. 3.3% in 2013). These results are in accordance with the gradual rise in free Cl concentration (0.78 § 0.94 mg/L in 2010 vs. 1.16 § 0.51 mg/L in 2013). In conclusion, a suitable plan for drinking water quality was instituted which resulted in reducing microbiological growth in the waterwork network, improving public health protection. However, the detection of critical points associated with lower levels of free Cl were found on certain floors/points-of-use, requiring the need to improve the monitoring water treatment system and/or implementation of additional technologies.

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Section: Introductionmentioning

confidence: 99%

Water quality supply in a Portuguese teaching hospital: monitoring and studies on detection of critical points

Norton

Amaro

Martins

et al. 2016

Toxicological & Environmental Chemistry

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“…Although the technique represents the decisive treatment for bacteria control and elimination in most w ater systems most especially in old w ater distribution netw orks (Schoenen, 2002;Orsi et al, 2014), Legionella is reported to be more tolerant to chlorine than other bacteria including Escherichia coli (World Health Organization (WHO), 2007). Evidence of the presence of biofilm is reported to be a key element in its ability to offer such resistance.…”

Section: Characterization Of Efficacy Advantages and Disadvantagesmentioning

confidence: 99%

“…Although the use of chlorine eliminates w ater odour (Wajon et al, 1988), w ater quality is reduced (organoleptic and chemical) often, as a result of chlorine levels (>0.5 < 1.0 mg/L) (Orsi et al, 2014). In terms of health, an increased risk of bladder cancer also appears to be associated w ith the consumption of chlorinated w ater (Cantor, 1997) along w ith other illnesses such as asthma and dermatitis w hich have also been reported (Gorchev and Ozolins, 2011;Faw ell, 2003).…”

Section: Effect Of Hyper Chlorination On W Ater Quality and Its Applimentioning

confidence: 99%

Evidence based review of Legionella elimination in building water systems

Sedzro¹,

Banu²,

Akrong³

2017

Int. J. Water Res. Environ. Eng.

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Legionnaires disease can be acquired through exposure to Legionella pneumophila, a gram-negative bacteria ubiquitous in both natural and engineered water systems. Over the years, a number of disinfection techniques notably, chlorination, ozonation, thermal, UV and copper-silver ionization have been employed across different kinds of engineered water systems with diverse measures of success. Available evidence portends, most of the aforementioned techniques often have to be combined to achieve long-term efficacy. Remarkably, albeit the extensive research and reportage on Legionnaires outbreak in the developed world, very few studies have been carried out with regards to Africa. We reviewed existing literature on the application of the aforementioned techniques in buildings. Our study concurs with earlier studies; most of the disinfection techniques will have to be combined to achieve the desired efficacy. We found very scanty studies on Legionella or reportage of its outbreak within Africa. Our study also found very little in terms of any of the techniques been applied with the specific aim of reducing Legionella proliferation in engineered water systems within Africa. This is alarming, especially, on a continent where several communities have little or no access to quality water and healthcare. In light of the above, stronger measures such as sensitization, pro perly managed water distribution systems, as well as policies aimed at enforcing national and international guidelines on Legionella control is recommended.

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“…10,11 Certain environmental conditions are recognized as increasing the risk from L pneumophila in water systems by either permitting higher levels of growth or creating an infectious aerosol. 12 These include temperatures between 20°C and 45°C, storing water, and the presence of organic and inorganic material in the system. The "traditional" regimen for controlling L pneumophila is based on temperature control, keeping cold water <20°C and hot water stored at least at 60°C, distributed so that it reaches 55°C at outlets within 1 minute.…”

mentioning

confidence: 99%

Controlling Legionella pneumophila in water systems at reduced hot water temperatures with copper and silver ionization

Cloutman-Green

Barbosa

Jimenez

et al. 2019

American Journal of Infection Control

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Background: Hospital-acquired Legionnaires' disease is associated with the presence of Legionella pneumophila in hospital water systems. In the United Kingdom, the Department of Health recommends maintaining hot water temperatures >55°C and cold water temperatures <20°C at the point of delivery to prevent proliferation of L pneumophila in water systems. In this study, we evaluated the efficacy of copper and silver ionization to control L pneumophila at deliberately reduced hot water temperatures (43°C) within a newly installed water system in a new building linked to a large health care facility in the United Kingdom. Methods: One thousand, five hundred ninety-eight water samples were collected between September 2011 and June 2017. Samples were tested using accredited methods for L pneumophila, copper and silver ion levels, and total viable counts. Energy consumption and water usage data were also collected to permit carbon emission calculations. Results: The results of 1,598 routine samples from September 2011 to June 2017, and the recordings of temperatures at outlets in this facility, demonstrated effective (100%) L pneumophila control throughout the study period with an average hot water temperature of 42°C. The energy savings and reduction of carbon emissions were calculated to amount to 33% and 24%, respectively, compared to an equivalent temperaturecontrolled system. Water system management interventions were required to achieve consistently adequate levels of copper and silver across outlets. Conclusions: This study demonstrated that it is possible to control L pneumophila independent of temperature when copper and silver ionization is introduced into a new building in conjunction with an appropriately managed water system.

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Legionella control in the water system of antiquated hospital buildings by shock and continuous hyperchlorination: 5 years experience

Cited by 40 publications

References 20 publications

Water quality supply in a Portuguese teaching hospital: monitoring and studies on detection of critical points

Water quality supply in a Portuguese teaching hospital: monitoring and studies on detection of critical points

Evidence based review of Legionella elimination in building water systems

Controlling Legionella pneumophila in water systems at reduced hot water temperatures with copper and silver ionization

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