Hostname: page-component-cd9895bd7-jkksz Total loading time: 0 Render date: 2024-12-22T16:20:38.788Z Has data issue: false hasContentIssue false
  • English
  • Français

Fatal nosocomial Legionnaires' disease: relevance of contamination of hospital water supply by temperature-dependent buoyancy-driven flow from spur pipes

Published online by Cambridge University Press:  15 May 2009

W. J. Patterson ,
D. V. Seal ,
E. Curran ,
T. M. Sinclair  and
J. C. McLuckie
W. J. Patterson*
Affiliation:
Glasgow Royal Infirmary, Castle Street, Glasgow G4 0SF
D. V. Seal
Affiliation:
Glasgow Royal Infirmary, Castle Street, Glasgow G4 0SF
E. Curran
Affiliation:
Glasgow Royal Infirmary, Castle Street, Glasgow G4 0SF
T. M. Sinclair
Affiliation:
Glasgow Royal Infirmary, Castle Street, Glasgow G4 0SF
J. C. McLuckie
Affiliation:
Principal Engineer NHS in Scotland, Management Executive Estates Division, St Andrew's House, Edinburgh
*
* Please address correspondence to: Dr W. J. Patterson, Consultant in Public Health Medicine. North Yorkshire Health Authority, York Local Office. Ryedale Building, 60 Piccadilly. York YO1 1PE.
Rights & Permissions [Opens in a new window]

Summary

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.

The investigation, epidemiology, and effectiveness of control procedures during an outbreak of Legionnaires' disease involving three immunosuppressed patients are described. The source of infection appeared to be a network of fire hydrant spurs connected directly to the incoming hospital mains water supply. Removal of these hydrants considerably reduced, but failed to eliminate, contamination of water storage facilities. As an emergency control procedure the incoming mains water was chlorinated continuously. Additional modifications to improve temperature regulation and reduce stagnation also failed to eliminate the legionellae.

A perspex test-rig was constructed to model the pre-existing hospital water supply and storage system. This showed that through the hydraulic mechanism known as ‘temperature buoyancy’, contaminated water could be efficiently and quickly exchanged between a stagnant spur pipe and its mains supply. Contamination of hospital storage tanks from such sources has not previously been considered a risk factor for Legionnaires' disease. We recommend that hospital water storage tanks are supplied by a dedicated mains pipe without spurs.

Type
Research Article
Information
Epidemiology & Infection , Volume 112 , Issue 3 , June 1994 , pp. 513 - 525
Copyright
Copyright © Cambridge University Press 1994

References

REFERENCES

1. Public Health Laboratory Service Collaborative Study of Legionella Species in Water Systems. HAC 1985.Google Scholar
2.Muraca, P, Stout, JE, Yu, VL. Comparative assessment of chlorine, heat, ozone, and UV light for killing Legionella pneumophila. Appl Environ Microbiol 1987: 53. 447–53.CrossRefGoogle ScholarPubMed
3. The control of legionellae in health care premises. A code of practice. London: HMSO. 1988.Google Scholar
4. The hospital infection manual. Including a code of practice for the Scottish health service. Scottish Home and Health Department. 1988.Google Scholar
5. Surveillance definitions for Legionnaires' disease. Respiratory Diseases Section. Communicable Diseases Surveillance Centre. 09 1992.Google Scholar
6.Kohler, RB, Winn, WC, Wheat, LJ. Onset and duration of urinary antigen excretion in Legionnaires disease. J Clin Microbiol 1984: 20: 605–7.CrossRefGoogle ScholarPubMed
7.Mitchell, K. Rapid diagnosis of legionella infections and identification of Legionella species isolated from man and the environment [PhD thesis]. Glasgow University. 1991.Google Scholar
8.Edelstein, PH. Improved semi-selected medium for isolation of Legionella pneumophlia from contaminated clinical and environmental specimens. J Clin Microbiol 1981: 14: 298–303.CrossRefGoogle Scholar
9.Watkins, ID, Tobin, JO'H, Dennis, PJ, Brawn, W, Newnham, R, Kurtz, JB. L. pneumophila sg1 subgrouping by monoclonal antibodies: an epidemiological tool. J Hyg 1985: 95: 211–16.CrossRefGoogle Scholar
10.The building services research and information association. Investigation of the extent of water exchange between pipe and spur. Report 66850/1. 1991.Google Scholar
11.DHSS and Welsh Office. Accommodation for pharmaceutical services. Health Building Note 1988; No 29: Para 8.44.Google Scholar
12.Goetz, A, Victor, L, Yu, MD. Screening for nosocomial legionellosis by cultures of the water supply and targeting of high-risk patients for specialized laboratory testing. Am J Infect Control 1991; 19: 63–6.CrossRefGoogle ScholarPubMed
13.Glick, TH, Gregg, MB, Berman, B, Mallison, G, Rhodes, WW, Kassanoff, I. Pontiac fever. An epidemic of unknown aetiology in a health department: clinical and epidemiological aspects. Am J Epidemiol 1978:107: 149–60.CrossRefGoogle Scholar
14.Baskerville, A, Fitzgeorge, RB, Broster, M, Hambleton, P, Dennis, PJ. Experimental transmission of Legionnaires' disease by exposure to aerosols of Legionella pneumophlia. Lancet 1981; ii: 1389–90.CrossRefGoogle Scholar
15.O'Mahony, MC, Stanwell-Smith, RE, Tillett, HE et al. The Stafford outbreak of Legionnaires' disease. Epidemiol Infect 1990; 104: 361–80.CrossRefGoogle ScholarPubMed
16.Outbreak of legionellosis in a community. Report of an Ad-Hoc committee. Lancet 1986: ii: 380–3.Google Scholar
17.Bhopal, RS, Barr, G. Maintenance of cooling towers following two outbreaks of Legionnaires disease in a city. Epidemiol Infect 1990; 104: 29–38.CrossRefGoogle ScholarPubMed
18.Timbury, MC, Donaldson, FR, McCartney, AC et al. , Outbreak of Legionnaires' disease in Glasgow Royal Infirmary: microbiological aspects. J Hyg 1986: 97: 393–403.CrossRefGoogle Scholar
19.Tobin, JO'H, Bartlett, CLR, Waitkins, SA et al. , Legionnaires' disease: further evidence to implicate water storage and distribution systems as sources. BMJ 1981: 282: 573.CrossRefGoogle ScholarPubMed
20.Best, M, Yu, VL, Stout, J Goetz, Muder, RR, Taylor, F. Legionellaceae in the hospital water supply. Epidemiological link with disease and evaluation of a method for control of nosocomial Legionnaires' disease and Pittsburgh pneumonia. Lancet 1983: ii: 307–10.CrossRefGoogle Scholar
21.Woo, AH, Yu, VL, Goetz, A. Potential in-hospital modes of transmission of Legionella pneumophila. Am J Med 1986; 80: 567–83.CrossRefGoogle ScholarPubMed
22.Harf, C, Monteil, H. Pathogenic microorganisms in environmental waters: a potential risk for human health. Water Internal 1989; 14: 75–9.CrossRefGoogle Scholar
23.Arnow, PM, Weil, K, Para, MF. Prevalence and significance of Legionella pneumophila contamination of residential hot-tap water systems. J Infect Dis 1985: 152: 145–51.CrossRefGoogle ScholarPubMed
24.Stout, JE, Yu, VL, Yee, YC, Vaccarello, S, Diven, W, Lee, TC. Legionella pneumophila in residential water supplies: environmental surveillance with clinical assessment for Legionnaires' disease. Epidemiol Infect 1992: 109: 49–57.Google ScholarPubMed
25..Stout, JE, Yu, VL, Best, MG. Ecology of Legionelia pneumophila within water distribution systems. Appl Environ Microbiol 1985: 49: 221–8.CrossRefGoogle ScholarPubMed
26. Legionnaires' disease surveillance: England and Wales 1991. Communicable Disease Report 1992: 2: No 11.Google Scholar
27.Tobin, JO'H, Swann, RA, Bartlett, CLR. Isolation of Legionella pneumophila from water systems: methods and preliminary results. BMJ 1981: 282: 515–17.CrossRefGoogle ScholarPubMed
28.Colville, A, Crowley, J, Dearden, D, Slack, RCB, Lee, JV. Outbreak of Legionnaires' disease at University Hospital Nottingham. Epidemiology, microbiology and control. Epidemiol Infect 1993: 110: 105–16.CrossRefGoogle ScholarPubMed
29.Edelstein, PH. Control of legionella in hospitals. J Hosp Infect 1986; 8: 109–15.CrossRefGoogle ScholarPubMed