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Persistence of Legionella in Routinely Disinfected Heater-Cooler Units and Heater Units assessed by Propidium Monoazide qPCR. Pathogens 2020; 9:pathogens9110978. [PMID: 33238543 PMCID: PMC7700499 DOI: 10.3390/pathogens9110978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Evidence to date indicates that heater-cooler units (HCUs) and heater units (HUs) can generate potentially infectious aerosols containing a range of opportunistic pathogens such as Mycobacterium chimaera, other non-tuberculous mycobacterial (NTM) species, Pseudomonas aeruginosa and Legionella spp. Our purpose was to determine the extent of Legionella contamination and total viable count (TVC) in HCUs and HUs and to analyze the relationship by water system design of devices of two different brands (LivaNova vs. Maquet). METHODS Legionella spp. were detected and quantified by our optimized PMA-qPCR protocol; TVCs were assessed according to ISO protocol 6222. Analyses were performed in the first sampling round and after six months of surveillance. RESULTS Overall, Legionella spp. was detected in 65.7% of devices. In the second sampling round, Legionella positivity rates were significantly lower in water samples from the Maquet devices compared to the LivaNova ones (27.3% vs. 61.5%). LivaNova HCUs also yielded more Legionella, and aquatic bacteria counts than Maquet in both first and second-round samples. CONCLUSIONS We recommend that all surgical patients and staff exposed to aerosols from thermoregulatory devices should be followed up for Legionella infection and that microbiological surveillance on such devices should be conducted regularly as precautionary principle.
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Coniglio MA, Ferrante M, Yassin MH. Preventing Healthcare-Associated Legionellosis: Results after 3 Years of Continuous Disinfection of Hot Water with Monochloramine and an Effective Water Safety Plan. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081594. [PMID: 30060459 PMCID: PMC6121960 DOI: 10.3390/ijerph15081594] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 07/22/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022]
Abstract
The purpose of this study is to report the experience of the implementation and application of a 3-year Water Safety Plan (WSP) together with the secondary disinfection of water by monochloramine to control and prevent healthcare-associated legionellosis in an Italian hospital strongly colonized by Legionella. Risk assessment was carried out by the WSP team. The main critical control points focused on in developing the WSP for the control of Legionella was the water distribution system. A sampling plan for the detection of Legionella was implemented. A widespread contamination of the hot water distribution system by L. pneumophila sg5 was found. Results after 3 years of the continuous disinfection of hot water with monochloramine indicate the eradication of Legionella. The implementation and application of a WSP in a hospital, together with the disinfection of the water distribution system with monochloramine, can be effective in controlling the growth of Legionella and in preventing nosocomial legionellosis.
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Affiliation(s)
- Maria Anna Coniglio
- Legionella Reference Laboratory, Department of Medical, Surgical Sciences and Advanced Technologies "G.F. Ingrassia", University of Catania, via Santa Sofia 87, 95123 Catania, Italy.
- Hygiene Complex Operative Unit, A.O.U. Policlinico-Vittorio Emanuele, via S. Sofia 87, 95123 Catania, Italy.
| | - Margherita Ferrante
- Hygiene Complex Operative Unit, A.O.U. Policlinico-Vittorio Emanuele, via S. Sofia 87, 95123 Catania, Italy.
| | - Mohamed H Yassin
- Infection Control Department, University of Pittsburgh Medical Center (UPMC), Pittsburgh, PA 15213, USA.
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Hiding in Plain Sight: Contaminated Ice Machines Are a Potential Source for Dissemination of Gram-Negative Bacteria and Candida Species in Healthcare Facilities. Infect Control Hosp Epidemiol 2018; 39:253-258. [PMID: 29382408 DOI: 10.1017/ice.2017.321] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Contaminated ice machines have been linked to transmission of pathogens in healthcare facilities. OBJECTIVE To determine the frequency and sites of contamination of ice machines in multiple healthcare facilities and to investigate potential mechanisms of microorganism dispersal from contaminated ice machines to patients. DESIGN Multicenter culture survey and simulation study. SETTING The study took place in 5 hospitals and 2 nursing homes in northeastern Ohio. METHODS We cultured multiple sites on ice machines from patient care areas. To investigate potential mechanisms of microbial dispersal from contaminated ice machines, we observed the use of ice machines and conducted simulations using a fluorescent tracer and cultures. RESULTS Samples from 64 ice machines in the 5 hospitals and 2 nursing homes (range, 3-16 per facility) were cultured. Gram-negative bacilli and/or Candida spp were recovered from 100% of drain pans, 52% of ice and/or water chutes, and 72% of drain-pan grilles. During the operation of ice machines, ice often fell through the grille, resulting in splattering, with dispersal of contaminated water from the drain pan to the drain-pan grille, cups, and the hands of those using the ice machine. Contamination of the inner surface of the ice chute resulted in contamination of ice cubes exiting the chute. CONCLUSIONS Our findings demonstrate that ice machines in healthcare facilities are often contaminated with gram-negative bacilli and Candida species, and provide a potential mechanism by which these organisms may be dispersed. Effective interventions are needed to reduce the risk of dissemination of pathogenic organisms from ice machines. Infect Control Hosp Epidemiol 2018;39:253-258.
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Settanni L, Gaglio R, Stucchi C, De Martino S, Francesca N, Moschetti G. Presence of pathogenic bacteria in ice cubes and evaluation of their survival in different systems. ANN MICROBIOL 2017. [DOI: 10.1007/s13213-017-1311-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Kanwar A, Domitrovic TN, Koganti S, Fuldauer P, Cadnum JL, Bonomo RA, Donskey CJ. A cold hard menace: A contaminated ice machine as a potential source for transmission of carbapenem-resistant Acinetobacter baumannii. Am J Infect Control 2017. [PMID: 28625698 DOI: 10.1016/j.ajic.2017.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
During an investigation of potential sources of transmission of multidrug-resistant gram-negative bacilli on a spinal cord injury unit, we recovered genetically related carbapenem-resistant Acinetobacter baumannii isolates from the stool of 3 patients, the hands of a nurse, and an ice machine water outlet spout and drain. Our findings suggest that contaminated ice machines could serve as a potential reservoir for dissemination of multidrug-resistant gram-negative bacilli.
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Affiliation(s)
- Anubhav Kanwar
- Division of Infectious Diseases and HIV Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH.
| | | | - Sreelatha Koganti
- Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
| | - Peter Fuldauer
- Pathology and Laboratory Medicine Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
| | - Robert A Bonomo
- Case Western Reserve University School of Medicine, Cleveland, OH; Geriatric Research Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, OH; Geriatric Research Education and Clinical Center, Louis Stokes Veterans Affairs Medical Center, Cleveland, OH
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7
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Kanamori H, Weber DJ, Rutala WA. Healthcare Outbreaks Associated With a Water Reservoir and Infection Prevention Strategies. Clin Infect Dis 2016; 62:1423-35. [DOI: 10.1093/cid/ciw122] [Citation(s) in RCA: 150] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 02/19/2016] [Indexed: 12/13/2022] Open
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8
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Contamination of Hospital Water Supplies in Gilan, Iran, with Legionella pneumophila, Escherichia coli, and Pseudomonas aeruginosa. Interdiscip Perspect Infect Dis 2015; 2015:809842. [PMID: 26448745 PMCID: PMC4576014 DOI: 10.1155/2015/809842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Revised: 08/23/2015] [Accepted: 08/26/2015] [Indexed: 11/17/2022] Open
Abstract
This study is designed to determine the contamination degree of hospital water supplies with Pseudomonas aeruginosa, Legionella pneumophila, and E. coli in Gilan, Iran. Samples were collected directly into sterile containers and concentrated by centrifuge. Half part of any sample transferred to yeast extract broth and the second part transferred to Trypticase Soy Broth and incubated for 3 days. DNA was extracted by using commercial kit. Four rounds of PCR were performed as follows: multiplex PCR for detecting Pseudomonas aeruginosa, Integron 1, and Metallo-β-lactamases gene; PCR for detecting Legionella pneumophila and mip gene separately; PCR for detecting E. coli; and another PCR for detecting whole bacterial presence. Contamination rates of cold, warm, and incubator water samples with P. aeruginosa, were 16.6%, 37.5%, and 6.8% consequently. Degrees of contamination with L. pneumophila were 3.3%, 9.3%, and 10.9% and with E. coli were zero, 6.2%, and zero. Total bacterial contamination of cold, warm, and incubator water samples was 93.3%, 84.4%, and 89.0% consequently. Metallo-β-lactamases gene was found in 20.0% of all samples. Contamination degree with P. aeruginosa was considerable and with L. pneumophila was moderate. Metallo-β-lactamases gene was found frequently indicating widespread multiple drug resistance bacteria. We suggest using new decontamination method based on nanotechnology.
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van Heijnsbergen E, Schalk JAC, Euser SM, Brandsema PS, den Boer JW, de Roda Husman AM. Confirmed and Potential Sources of Legionella Reviewed. ENVIRONMENTAL SCIENCE & TECHNOLOGY 2015; 49:4797-815. [PMID: 25774976 DOI: 10.1021/acs.est.5b00142] [Citation(s) in RCA: 81] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Legionella bacteria are ubiquitous in natural matrices and man-made systems. However, it is not always clear if these reservoirs can act as source of infection resulting in cases of Legionnaires' disease. This review provides an overview of reservoirs of Legionella reported in the literature, other than drinking water distribution systems. Levels of evidence were developed to discriminate between potential and confirmed sources of Legionella. A total of 17 systems and matrices could be classified as confirmed sources of Legionella. Many other man-made systems or natural matrices were not classified as a confirmed source, since either no patients were linked to these reservoirs or the supporting evidence was weak. However, these systems or matrices could play an important role in the transmission of infectious Legionella bacteria; they might not yet be considered in source investigations, resulting in an underestimation of their importance. To optimize source investigations it is important to have knowledge about all the (potential) sources of Legionella. Further research is needed to unravel what the contribution is of each confirmed source, and possibly also potential sources, to the LD disease burden.
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Affiliation(s)
- Eri van Heijnsbergen
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Johanna A C Schalk
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Sjoerd M Euser
- ‡Regional Public Health Laboratory Kennemerland, Haarlem, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
| | - Petra S Brandsema
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Jeroen W den Boer
- ‡Regional Public Health Laboratory Kennemerland, Haarlem, Boerhaavelaan 26, 2035 RC Haarlem, The Netherlands
| | - Ana Maria de Roda Husman
- †National Institute for Public Health and the Environment, A. van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
- §Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
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Whiley H, Keegan A, Fallowfield H, Ross K. Uncertainties associated with assessing the public health risk from Legionella. Front Microbiol 2014; 5:501. [PMID: 25309526 PMCID: PMC4174118 DOI: 10.3389/fmicb.2014.00501] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 09/05/2014] [Indexed: 11/13/2022] Open
Abstract
Legionella is an opportunistic pathogen of public health concern. Current regulatory and management guidelines for the control of this organism are informed by risk assessments. However, there are many unanswered questions and uncertainties regarding Legionella epidemiology, strain infectivity, infectious dose, and detection methods. This review follows the EnHealth Risk Assessment Framework, to examine the current information available regarding Legionella risk and discuss the uncertainties and assumptions. This review can be used as a tool for understanding the uncertainties associated with Legionella risk assessment. It also serves to highlight the areas of Legionella research that require future focus. Improvement of these uncertainties will provide information to enhance risk management practices for Legionella, potentially improving public health protection and reducing the economic costs by streamlining current management practices.
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Affiliation(s)
- Harriet Whiley
- Health and the Environment, Flinders UniversityAdelaide, SA, Australia
| | | | | | - Kirstin Ross
- Health and the Environment, Flinders UniversityAdelaide, SA, Australia
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Waturangi DE, Wennars M, Suhartono MX, Wijaya YF. Edible ice in Jakarta, Indonesia, is contaminated with multidrug-resistant Vibrio cholerae with virulence potential. J Med Microbiol 2013; 62:352-359. [DOI: 10.1099/jmm.0.048769-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Diana E. Waturangi
- Faculty of Biotechnology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Melissa Wennars
- Faculty of Biotechnology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Magda X. Suhartono
- Faculty of Biotechnology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
| | - Yenata F. Wijaya
- Faculty of Biotechnology, Atma Jaya Catholic University of Indonesia, Jakarta, Indonesia
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Williams MM, Armbruster CR, Arduino MJ. Plumbing of hospital premises is a reservoir for opportunistically pathogenic microorganisms: a review. BIOFOULING 2013; 29:147-62. [PMID: 23327332 PMCID: PMC9326810 DOI: 10.1080/08927014.2012.757308] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Several bacterial species that are natural inhabitants of potable water distribution system biofilms are opportunistic pathogens important to sensitive patients in healthcare facilities. Waterborne healthcare-associated infections (HAI) may occur during the many uses of potable water in the healthcare environment. Prevention of infection is made more challenging by lack of data on infection rate and gaps in understanding of the ecology, virulence, and infectious dose of these opportunistic pathogens. Some healthcare facilities have been successful in reducing infections by following current water safety guidelines. This review describes several infections, and remediation steps that have been implemented to reduce waterborne HAIs.
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Affiliation(s)
- Margaret M Williams
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Allen JG, Myatt TA, MacIntosh DL, Ludwig JF, Minegishi T, Stewart JH, Connors BF, Grant MP, McCarthy JF. Assessing risk of health care-acquired Legionnaires' disease from environmental sampling: the limits of using a strict percent positivity approach. Am J Infect Control 2012; 40:917-21. [PMID: 22633439 DOI: 10.1016/j.ajic.2012.01.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2011] [Revised: 01/12/2012] [Accepted: 01/12/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Elevated percent positivity (≥30%) of Legionella in hospital domestic water systems has been suggested as a metric for assessing the risk of health care-acquired Legionnaires' disease (LD). METHODS We examined the validity of this metric by analyzing data from peer-reviewed studies containing reports of Legionella prevalence in hospital water (ie, percent positivity) and temporally matched reports of patients with health care-acquired LD. RESULTS Our literature review identified 31 peer-reviewed publications reporting matched data. We abstracted a total of 206 data points, representing 119 hospitals, from these articles. We determined that the proposed 30% positivity metric has 59% sensitivity and 74% specificity (ie, a 41% false-negative rate and a 26% false-positive rate). These notable error rates could have significant implications, given that we identified 16 peer-reviewed articles and 6 government guidance documents that referenced the 30% positivity metric as a risk assessment tool. CONCLUSIONS Environmental sampling of hospital water distribution systems for Legionella can be an important component of risk management for LD. However, the possible consequence of using a percent positivity metric with low sensitivity and specificity is that many hospitals might fail to mitigate when a true risk is present, or might unnecessarily allocate limited resources to deal with a negligible risk.
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Haupt TE, Heffernan RT, Kazmierczak JJ, Nehls-Lowe H, Rheineck B, Powell C, Leonhardt KK, Chitnis AS, Davis JP. An outbreak of Legionnaires disease associated with a decorative water wall fountain in a hospital. Infect Control Hosp Epidemiol 2011; 33:185-91. [PMID: 22227989 DOI: 10.1086/663711] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To detect an outbreak-related source of Legionella, control the outbreak, and prevent additional Legionella infections from occurring. DESIGN AND SETTING Epidemiologic investigation of an acute outbreak of hospital-associated Legionnaires disease among outpatients and visitors to a Wisconsin hospital. PATIENTS Patients with laboratory-confirmed Legionnaires disease who resided in southeastern Wisconsin and had illness onsets during February and March 2010. METHODS Patients with Legionnaires disease were interviewed using a hypothesis-generating questionnaire. On-site investigation included sampling of water and other potential environmental sources for Legionella testing. Case-finding measures included extensive notification of individuals potentially exposed at the hospital and alerts to area healthcare and laboratory personnel. RESULTS Laboratory-confirmed Legionnaires disease was diagnosed in 8 patients, all of whom were present at the same hospital during the 10 days prior to their illness onsets. Six patients had known exposure to a water wall-type decorative fountain near the main hospital entrance. Although the decorative fountain underwent routine cleaning and maintenance, high counts of Legionella pneumophila serogroup 1 were isolated from cultures of a foam material found above the fountain trough. CONCLUSION This outbreak of Legionnaires disease was associated with exposure to a decorative fountain located in a hospital public area. Routine cleaning and maintenance of fountains does not eliminate the risk of bacterial contamination. Our findings highlight the need to evaluate the safety of water fountains installed in any area of a healthcare facility.
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Affiliation(s)
- Thomas E Haupt
- Wisconsin Division of Public Health, Madison, Wisconsin 53701, USA.
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Palmore TN, Stock F, White M, Bordner M, Michelin A, Bennett JE, Murray PR, Henderson DK. A cluster of cases of nosocomial legionnaires disease linked to a contaminated hospital decorative water fountain. Infect Control Hosp Epidemiol 2009; 30:764-8. [PMID: 19580436 DOI: 10.1086/598855] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Nosocomial outbreaks of Legionnaires disease have been linked to contaminated water in hospitals. Immunocompromised patients are particularly vulnerable and, when infected, have a high mortality rate. We report the investigation of a cluster of cases of nosocomial pneumonia attributable to Legionella pneumophila serogroup 1 that occurred among patients on our stem cell transplantation unit. METHODS We conducted a record review to identify common points of potential exposure, followed by environmental and water sampling for Legionella species from those sources. We used an air sampler to in an attempt to detect aerosolized Legionella and pulsed-field gel electrophoresis to compare clinical and environmental isolates. RESULTS The most likely sources identified were the water supply in the patients' rooms and a decorative fountain in the radiation oncology suite. Samples from the patients' rooms did not grow Legionella species. Cultures of the fountain, which had been restarted 4 months earlier after being shut off for 5 months, yielded L. pneumophila serogroup 1. The isolates from both patients and the fountain were identical by pulsed-field gel electrophoresis. Both patients developed pneumonia within 10 days of completing radiation therapy, and each reported having observed the fountain at close range. Both patients' infections were identified early and treated promptly, and both recovered. CONCLUSIONS This cluster was caused by contamination of a decorative fountain despite its being equipped with a filter and ozone generator. Fountains are a potential source of nosocomial Legionnaires disease despite standard maintenance and sanitizing measures. In our opinion, fountains present unacceptable risk in hospitals serving immunocompromised patients.
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Affiliation(s)
- Tara N Palmore
- Warren Grant Magnusen Clinical Center, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland 20892-1888, USA.
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Giglio S, Monis PT, Saint CP. Legionella confirmation using real-time PCR and SYTO9 is an alternative to current methodology. Appl Environ Microbiol 2006; 71:8944-8. [PMID: 16332896 PMCID: PMC1317362 DOI: 10.1128/aem.71.12.8944-8948.2005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
The currently accepted culture techniques for the detection of Legionella spp. in water samples (AS/NZS 3896:1998 and ISO 11731 standard methods) are slow and laborious, requiring from 7 to 14 days for a result. We describe a fully validated rapid confirmation technique that uses real-time PCR incorporating the intercalating dye SYTO9 for the direct identification of primary cultures, significantly decreasing turnaround time and allowing faster remedial action to be taken by the industry.
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Affiliation(s)
- Steven Giglio
- Australian Water Quality Centre, PMB 3, Salisbury, South Australia 5108, Australia.
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Bencini MA, Yzerman EPF, Koornstra RHT, Nolte CCM, den Boer JW, Bruin JP. A case of Legionnaires' disease caused by aspiration of ice water. ARCHIVES OF ENVIRONMENTAL & OCCUPATIONAL HEALTH 2005; 60:302-6. [PMID: 17447574 DOI: 10.3200/aeoh.60.6.302-306] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The authors discuss the case of a 79-year-old patient who suffered from a swallowing disorder and developed Legionnaires' disease 2 days after her dismissal from an orthopedics ward, where she had recovered from hip surgery. To determine the source of the Legionnaires' disease, the authors performed an environmental investigation, which included a national, standardized questionnaire and a microbiological investigation of suspected sources. The investigation revealed ice from an ice-making machine in the hospital as the most probable source of the infection through aspiration, even though the hospital had rigorously adhered to strict assessment and decontamination schedules. The infectious serogroup was one that was not common to the area. From the data available, the authors inferred that a dose of 1-2000 colony-forming units might have caused Legionnaires' disease in this patient.
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Affiliation(s)
- Max A Bencini
- Regional Public Health Laboratory of Haarlem, The Netherlands.
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Ortolano GA, McAlister MB, Angelbeck JA, Schaffer J, Russell RL, Maynard E, Wenz B. Hospital water point-of-use filtration: a complementary strategy to reduce the risk of nosocomial infection. Am J Infect Control 2005; 33:S1-19. [PMID: 15940112 DOI: 10.1016/j.ajic.2005.03.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Cholera, hepatitis and typhoid are well-recognized water-borne illnesses that take the lives of many every year in areas of uncontrollable flood, but far less attention is afforded to the allegedly safe potable water in affluent nations and the presumed healthful quality of water in communities and hospitals. Recent literature, however, points to increasing awareness of serious clinical sequelae particularly experienced by immunocompromised patients at high risk for disease and death from exposure to water-borne microbes in hospitals. This review reflects the literature indicting hospital water as an important source for nosocomial infections, examines patient populations at greatest risk, uncovers examples of failures in remedial water treatment methods and the reasons for them, and introduces point-of-use water filtration as a practical alternative or complementary component of an infection control strategy that may reduce the risk of nosocomial infections.
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Makimoto K, Ashida N, Qureshi N, Tsuchida T, Sekikawa A. Development of a nosocomial outbreak investigation database. J Hosp Infect 2005; 59:215-9. [PMID: 15694978 DOI: 10.1016/j.jhin.2004.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2004] [Accepted: 06/15/2004] [Indexed: 10/25/2022]
Abstract
A pilot web-based database was created to facilitate epidemiological investigation of nosocomial outbreaks. The database provides highly structured abstracts in a case study format to serve as a guide for investigations. Problems encountered in abstracting over 330 published reports included missing information and classification of study methods. The database offers a new way to review outbreaks, for example, in terms of their impact measured by various combinations of database fields, such as the number of cases, attack rate, pathogens, service/ward and mode of transmission. Feedback from users of the database suggests its usefulness. Creation of a large web-based database seems to be both desirable and feasible.
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Affiliation(s)
- K Makimoto
- Osaka University, Graduate School of Medicine, Division of Nursing, 1-7 Yamadaoka, Suita, Osaka, 565-087,1 Japan.
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Falcão JP, Falcão DP, Gomes TAT. Ice as a vehicle for diarrheagenic Escherichia coli. Int J Food Microbiol 2004; 91:99-103. [PMID: 14967565 DOI: 10.1016/s0168-1605(03)00327-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2003] [Revised: 04/18/2003] [Accepted: 05/12/2003] [Indexed: 11/18/2022]
Abstract
In a recent study of the microbiological quality of commercial ice, 50 Escherichia coli isolates belonging to different serotypes were found. The potential hazard from these isolates was examined by testing their adherence patterns in HeLa cells and searching for the presence of DNA sequences related to E. coli virulence properties. Twelve potentially diarrheagenic isolates were found and classified as enteroaggregative E. coli (EAEC) based on their ability to produce aggregative adherence to HeLa cells. The remaining isolates were devoid of the virulence properties searched for. The EAEC isolates belonged to 10 different serotypes, among which O128ab:H35 is often found in diarrheic feces. None of these isolates reacted with a specific EAEC DNA probe or carried any of the known EAEC virulence genes. These data indicate that ice may be an important vehicle for transmission of enteropathogens, especially of the EAEC group.
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Affiliation(s)
- Juliana P Falcão
- Departamento de Ciências Biológicas, Faculdade de Ciências Farmacêuticas, Universidade Estadual Paulista, Rodovia Araraquara/Jau, Km 1, 14801-902 Araraquara, SP, Brazil
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Holmes GP, Bond GB, Fader RC, Fulcher SF. A Cluster of cases of Mycobacterium szulgai keratitis that occurred after laser-assisted in situ keratomileusis. Clin Infect Dis 2002; 34:1039-46. [PMID: 11914991 DOI: 10.1086/339487] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2001] [Revised: 11/19/2001] [Indexed: 11/04/2022] Open
Abstract
Laser-assisted in situ keratomileusis (LASIK) is a recently developed ophthalmic procedure. When 2 patients developed keratitis caused by Mycobacterium szulgai after they underwent LASIK surgery, we conducted a retrospective cohort study of all LASIK procedures performed at Scott & White Clinic (Temple, Texas) during a 4.5-month period. Seven patients had compatible symptoms and signs, 5 of whom had confirmed M. szulgai keratitis. Five cases occurred among 30 procedures performed by doctor A, and there were no cases among 62 procedures performed by doctor B (approximate relative risk, 12.0; 95% confidence interval, 1.6-679.0; P=.0029). Doctor A had chilled syringes of saline solution in ice for intraoperative lavage-the only factor that differentiated the procedures of the 2 surgeons. Cultures of samples from the source ice machine's drain identified M. szulgai; the strain was identical to isolates recovered from all confirmed cases and differed from 4 standard M. szulgai strains, as determined by pulsed-field gel electrophoresis. Intraoperative contamination from ice water apparently led to M. szulgai keratitis in these patients.
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Affiliation(s)
- Gary P Holmes
- Division of Infectious Diseases, Department of Medicine, Scott & White Memorial Hospital and Clinic, Temple, TX, 76508, USA.
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Levi Y. Écologie microbienne des réseaux d'eau potable et risque microbiologique : l'exemple de Legionella pneumophila. ACTA ACUST UNITED AC 2001. [DOI: 10.1016/s0338-9898(01)80387-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Leaver M. Legionellae. Collegian 1998; 5:38-9. [PMID: 9644340 DOI: 10.1016/s1322-7696(08)60283-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Legionellae cannot be eradicated from the water supply, since they are naturally occurring and ubiquitous. Routine bacteriologic culturing of man made aquatic environments is not recommended (Soule et al 1995). Therefore any water use that results in production of aerosols should be regularly evaluated to ensure the source has not been contaminated with the bacteria. Any aerosolised water entering a sterile area such as the lungs should be sterile. Tap water should not be used to rinse any respiratory therapy equipment. Routine maintenance of water supplies to eliminate sediment and scale from tanks and trays is essential (Benenson 1995, Lowry & Tompkins 1993). Australian & New Zealand Standard AS/NZ 3666-1995 Parts 1 and 2 outline these requirements.
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