Proximity of the home to a cooling tower and risk of non-outbreak Legionnaires' disease.

Bhopal, Raj; Fallon, R. J.; Buist, E C; Black, RJ; Urquhart, John

doi:10.1136/bmj.302.6773.378

Cited by 80 publications

(35 citation statements)

References 15 publications

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“…6 Acquisition of legionnaires' disease usually occurs following the aspiration or inhalation of aerosols from contaminated potable water or cooling towers. [7][8][9][10][11][12][13][14] Most hospital-acquired outbreaks of legionnaires' disease have been associated with the contamination of hospital drinking water with Legionella species. 15 Efforts to prevent hospital-acquired legionnaires' disease have focused on increasing the temperature of hot water and the supplemental chlorination of drinking water.…”

mentioning

confidence: 99%

Risk of Hospital-Acquired Legionnaires' Disease in Cities Using Monochloramine Versus Other Water Disinfectants

Heffelfinger

Kool²,

Fridkin³

et al. 2003

Infect. Control Hosp. Epidemiol.

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Objective:To measure the association between the disinfection of municipal drinking water with monochloramine and the occurrence of hospital-acquired legionnaires' disease (LD).Setting:One hundred sixty-six U.S. hospitals.Design:Survey of 459 members of the Society for Healthcare Epidemiology of America (SHEA) for hospital features; endemic- and outbreak-related, hospital-acquired LD; the source of the hospital water supply; and the methods of disinfection used by the hospitals and municipal water treatment plants.Results:SHEA members representing 166 (36%) of 459 hospitals responded; 33 (20%) reported one or more episodes of hospital-acquired LD during the period from 1994 to 1998 and 23 (14%) reported an outbreak of hospital-acquired LD during the period from 1989 to 1998. Hospitals with an occurrence of hospital-acquired LD had a higher census (median, 319 vs 221;P= .03), more acute care beds (median, 500 vs 376;P= .04), and more intensive care unit beds (median, 42 vs 24;P= .009) than did other hospitals. They were also more likely to have a transplant service (74% vs 42%;P= .001) and to perform surveillance for hospital-acquired disease (92% vs 61%;P= .001). After adjustment for the presence of a transplant program and surveillance for legionnaires' disease, hospitals supplied with drinking water disinfected with monochloramine by municipal plants were less likely to have sporadic cases or outbreaks of hospital-acquired LD (odds ratio, 0.20; 95% confidence interval, 0.07 to 0.56) than were other hospitals.Conclusion:Water disinfection with monochloramine by municipal water treatment plants significantly reduces the risk of hospital-acquired LD.

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confidence: 99%

Risk of Hospital-Acquired Legionnaires' Disease in Cities Using Monochloramine Versus Other Water Disinfectants

Heffelfinger

Kool²,

Fridkin³

et al. 2003

Infect. Control Hosp. Epidemiol.

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“…In 1991, Bhopal provided evidence that the relative risk of sporadic infection in Glasgow dropped from more than 3.0 within 0.5 km of a cooling tower to 1.19 at a distance of 0.5–0.75 km,11 and he estimated a 28% attributable risk using distances above 1 km as the baseline. This study was extended in 2007 by Dunn et al , working on the same dataset.…”

Section: Discussionmentioning

confidence: 99%

“…For Wales, we used the Welsh equivalent (the Welsh Index of Multiple Deprivation) 18. Deprivation was included in our models because of its potentially strong association with Legionnaires' disease 11. Population density (residents per square kilometre) by Middle Layer Super Output Area (MLSOA) was also computed from 2001 census data 16.…”

Section: Methodsmentioning

confidence: 99%

Wet cooling systems as a source of sporadic Legionnaires' disease: a geographical analysis of data for England and Wales, 1996–2006

Ricketts¹,

Joseph²,

Lee³

et al. 2011

J Epidemiol Community Health

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“…Bhopal et al (1991) have suggested that cooling tower aerosols are responsible for a portion of sporadically occurring cases of Legionnaires' disease in Scotland.…”

Section: Introductionmentioning

confidence: 99%

Enumeration of Legionella pneumophila in cooling tower water systems

Türetgen

Sungur

Çotuk

2005

Environ Monit Assess

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Legionella pneumophila, the causative agent of Legionnaires' disease, is known to colonise and frequently grow in cooling tower waters. Disease is acquired by inhaling aerosol contaminated by legionellae. Determination of the count of Legionella pneumophila in cooling tower waters may, therefore, be useful for risk assessment. In our survey, 103 water samples from 50 cooling towers were examined over a five-year period to indicate the seasonal distribution and the ecology of L. pneumophila, as regards temperature and pH. L. pneumophila serogroup 1 was found in 44% of the isolated strains, which is primarily responsible for the majority of Legionnaires' disease. The large majority of examined towers had levels of L. pneumophila in the high-risk category. These cooling towers have been linked to many outbreaks of Legionnaires' disease.

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Proximity of the home to a cooling tower and risk of non-outbreak Legionnaires' disease.

Abstract: Objective-To study the source of non-outbreak legionnaires' disease, particularly the role of cooling towers, by comparing the locations of patients' homes in relation to the location of cooling towers.

Cited by 80 publications

References 15 publications

Risk of Hospital-Acquired Legionnaires' Disease in Cities Using Monochloramine Versus Other Water Disinfectants

Risk of Hospital-Acquired Legionnaires' Disease in Cities Using Monochloramine Versus Other Water Disinfectants

Wet cooling systems as a source of sporadic Legionnaires' disease: a geographical analysis of data for England and Wales, 1996–2006

Enumeration of Legionella pneumophila in cooling tower water systems

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