Legionellaceae in the Hospital Water-Supply

Best, Michele; Stout, Janet E.; Muder, R R; Yu, V L; Goetz, Angella; Taylor, Floyd H.

doi:10.1016/s0140-6736(83)90290-8

Cited by 221 publications

(27 citation statements)

References 17 publications

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“…Pasteurization of water distribution systems is often preferentially selected as a disinfection process due to the fact that no special equipment is needed and it can be implemented expeditiously (Chen et al, 2005). Previous studies have demonstrated the success of this process in reducing the number of Legionella present (Best et al, 1983; Zacheus and Martikainen, 1996; Darelid et al, 2002; Peiró Callizo et al, 2005). However, despite the successful decrease in Legionella , either complete elimination was not achieved (Darelid et al, 2002) or the system was quickly recolonized after thermal disinfection (Zacheus and Martikainen, 1996).…”

Section: Thermal Disinfection Of Manufactured Water Systemsmentioning

confidence: 99%

Legionella Persistence in Manufactured Water Systems: Pasteurization Potentially Selecting for Thermal Tolerance

2017

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Legionella is an opportunistic waterborne pathogen of increasing public health significance. Pasteurization, otherwise known as super-heat and flush (increasing water temperature to above 70°C and flushing all outlets), has been identified as an important mechanism for the disinfection of Legionella in manufactured water systems. However, several studies have reported that this procedure was ineffective at remediating water distribution systems as Legionella was able to maintain long term persistent contamination. Up to 25% of L. pneumophila cells survived heat treatment of 70°C, but all of these were in a viable but non-culturable state. This demonstrates the limitations of the culture method of Legionella detection currently used to evaluate disinfection protocols. In addition, it has been demonstrated that pasteurization and nutrient starvation can select for thermal tolerant strains, where L. pneumophila was consistently identified as having greater thermal tolerance compared to other Legionella species. This review demonstrates that further research is needed to investigate the effectiveness of pasteurization as a disinfection method. In particular, it focuses on the potential for pasteurization to select for thermal tolerant L. pneumophila strains which, as the primary causative agent of Legionnaires disease, have greater public health significance compared to other Legionella species.

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Section: Thermal Disinfection Of Manufactured Water Systemsmentioning

confidence: 99%

Legionella Persistence in Manufactured Water Systems: Pasteurization Potentially Selecting for Thermal Tolerance

2017

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“…A recent outbreak involving 21 patients and 5 attributable deaths at the Veterans Affairs Pittsburgh Healthcare System was notable in that 29 out of 44 water samples (66%) were positive for Legionella [23]. This proportion far exceeded the 30% threshold of ‘heavy colonization’ proposed by Yu and colleagues above which nosocomial cases of Legionnaire’s disease occur more frequently [35, 36]. Some water isolates matched the outbreak strain, despite appropriate copper and silver levels [23].…”

Section: Legionellamentioning

confidence: 99%

The role of water in healthcare-associated infections

Decker

Palmore

2013

Current Opinion in Infectious Diseases

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Purpose of review The aim is to discuss the epidemiology of infections that arise from contaminated water in healthcare settings, including Legionnaire’s disease, other Gram-negative pathogens, nontuberculous mycobacteria, and fungi. Recent findings Legionella can colonize a hospital water system and infect patients despite use of preventive disinfectants. Evidence-based measures are available for secondary prevention. Vulnerable patients can develop care-associated infections with waterborne organisms that are transmitted by colonization of plumbing systems, including sinks and their fixtures. Room humidifiers and decorative fountains have been implicated in serious outbreaks, and pose unwarranted risks in healthcare settings. Summary Design of hospital plumbing must be purposeful and thoughtful to avoid the features that foster growth and dissemination of Legionella and other pathogens. Exposure of patients who have central venous catheters and other invasive devices to tap water poses a risk for infection with waterborne pathogens. Healthcare facilities must conduct aggressive clinical surveillance for Legionnaire’s disease and other waterborne infections in order to detect and remediate an outbreak promptly. Hand hygiene is the most important measure to prevent transmission of other Gram-negative waterborne pathogens in the healthcare setting.

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“…Best et al (1983) designed a schedule for control of L. pneumophila and L. micdadei in a hospital plumbing system that included intermittent boosting of hot water tank temperature to 60 to 77°C, and two 30-minute fixture flushes (24 hours apart) in patient areas. After 72 hours, the water temperature was returned to less than 54°C.…”

Section: Control Of Legionella In the Environmentmentioning

confidence: 99%

Drinking Water Microbiology

McFeters¹

1990

Brock/Springer Series in Contemporary Bioscience

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Legionellaceae in the Hospital Water-Supply

Cited by 221 publications

References 17 publications

Legionella Persistence in Manufactured Water Systems: Pasteurization Potentially Selecting for Thermal Tolerance

Legionella Persistence in Manufactured Water Systems: Pasteurization Potentially Selecting for Thermal Tolerance

The role of water in healthcare-associated infections

Drinking Water Microbiology

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