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Control of Legionella pneumophila Contamination in a Respiratory Hydrotherapy System With Sulfurous Spa Water

Published online by Cambridge University Press:  21 June 2016

E. Leoni ,
R. Sacchetti ,
F. Zanetti  and
P. P. Legnani
E. Leoni*
Affiliation:
Department of Medicine and Public Health, Division of Hygiene, University of Bologna, Italy
R. Sacchetti
Affiliation:
Department of Medicine and Public Health, Division of Hygiene, University of Bologna, Italy
F. Zanetti
Affiliation:
Department of Medicine and Public Health, Division of Hygiene, University of Bologna, Italy
P. P. Legnani
Affiliation:
Department of Medicine and Public Health, Division of Hygiene, University of Bologna, Italy
*
Dipartimento di Medicina e Sanitá Pubblica, Via S. Giacomo 12, 40126 Bologna, Italy ([email protected])
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Abstract

Objective.

To evaluate the effectiveness of different disinfection treatments in a spa water system contaminated by Legionella pneumophila and associated with a case of Legionella pneumonia.

Design.

During an 18-month period, the spa water was analyzed by taking samples from the well, the recirculation line, and the final distribution devices (nebulizers and nasal irrigators). Various attempts were made to eradicate Legionella organisms by chemical and thermal shock. The final protocol consisted of heat shock treatment at 70°C-75°C for 3 hours, 2 nights per week, followed by a lowering of the water temperature to 30°C ± 1°C for use in the plant. In addition, 3 times a week superheated steam (at a pressure of 1 atmosphere) was introduced for 1 hour into the nebulization machines.

Setting.

A spa at which sulfurous water was used for hydrotherapy by means of aerosol and nasal irrigation.

Patient.

A 74-year-old woman with legionnaires disease.

Results.

After the case of infection occurred, L. pneumophila was isolated from the recirculation line at a concentration of 400,000 cfu/L and from the nebulizers and nasal irrigators at levels ranging from 3,300 to 1,800,000 cfu/L. The colonizing organisms consisted of a mixture of L. pneumophila serogroup 1 (12%) and serogroup 5 (88%). The shock treatment with chlorine dioxide and peracetic acid resulted in the eradication of Legionella organisms from the recirculation line but not from the water generated from the final distribution devices. After the restructuring of the plant and the application of thermal shock protocol, an evaluation after 12 months revealed no evidence of Legionella contamination.

Conclusion.

To prevent Legionella colonization, disinfection treatment is effective if associated with carefully selected materials, good circuit design, and good maintenance practices.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 7 , July 2006 , pp. 716 - 721
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1. Verissimo, A, Marrao, G, da Silva, FG, da Costa, MS. Distribution of Legionella spp. in hydrothermal areas in continental Portugal and the island of Sao Miguel, Azores. Appl Environ Microbiol 1991; 57:2921–2927.CrossRefGoogle ScholarPubMed
2. Schaffler-Dulling, K, Reinthaler, FF, Marth, E. The detection of Legionellae in thermal water [in German]. Zentralbl Hyg Umweltmed 1992; 192:473–478.Google Scholar
3. Kuroki, T, Yagita, K, Yabuuchi, E, et al. Isolation of Legionella and free-living amoebae at hot spring spas in Kanagawa, Japan. Kansenshogaku Zasshi 1998; 72:1050–1055.CrossRefGoogle ScholarPubMed
4. Martinelli, F, Carasi, S, Scarcella, C, Speziani, F. Detection of Legionella pneumophila at thermal spas. New Microbiol 2001; 24:259–264.Google ScholarPubMed
5. Alim, A, Hakgudener, Y, Poyraz, O. Legionella pneumophila in thermal pools of hot springs in the central Anatolian district. Mikrobiyol Bul 2002; 36:237–246.Google ScholarPubMed
6. Mashiba, K, Hamamoto, T, Torikai, K. A case of legionnaires' disease due to aspiration of hot spring water and isolation of Legionella pneumophila from hot spring water. Kansenshogaku Zasshi 1993; 67:163–166.CrossRefGoogle ScholarPubMed
7. Nakadate, T, Yamauchi, K, Inoue, H. An outbreak of Legionnaire's disease associated with a Japanese spa. Nihon Kokyuki Gakkai Zasshi 1999; 37: 601–607.Google ScholarPubMed
8. Molmoret, M, Jarraud, S, Mori, JP, et al. Different growth rates in amoeba of genotypically related environmental and clinical Legionella pneumophila strains isolated from a thermal spa. Epidemiol Infect 2001; 126:231–239.CrossRefGoogle Scholar
9. Ito, L, Naito, J, Kadowaki, S, et al. Hot spring bath and Legionella pneumonia: an association confirmed by genomic identification. Intern Med 2002; 41:859–863.CrossRefGoogle ScholarPubMed
10. Centers for Disease Control and Prevention. Surveillance data from public spa inspections. United States, May-September 2002. MMWR Morb Mortal Wkly Rep 2004; 53:553–555.Google Scholar
11. Spitalny, KC, Vogt, RL, Orciari, LA, Witherell, LE, Etkind, P, Novick, LF. Pontiac fever associated with a whirlpool spa. Am J Epidemiol 1984; 120: 809–817.CrossRefGoogle ScholarPubMed
12. Goldberg, DJ, Wrench, JG, Collier, PW, et al. Lochgoilhead fever: outbreak of non-pneumonic legionellosis due to Legionella micdadei . Lancet 1989; 1:316–318.CrossRefGoogle ScholarPubMed
13. Fields, BS, Haupt, T, Davis, JP, Arduino, MJ, Miller, PH, Butler, JC. Pontiac fever due to Legionella micdadei from a whirlpool spa: possible role of bacterial endotoxin. J Infect Dis 2001; 184:1289–1292.Google ScholarPubMed
14. Rocha, G, Verissimo, A, Bowker, R, Bornstein, N, Da Costa, MS. Relationship between Legionella spp. and antibody titres at a therapeutic thermal spa in Portugal. Epidemiol Infect 1995; 115:79–88.CrossRefGoogle Scholar
15. Bornstein, N, Marmet, D, Surgot, M, et al. Exposure to Legionellaceae at a hot spring spa: a prospective clinical and serological study. Epidemiol Infect 1989; 102:31–36.CrossRefGoogle Scholar
16. Bornstein, N, Marmet, D, Surgot, M, et al. Legionella gratiana sp. nov. isolated from French spa water. Res Microbiol 1989; 140:541–552.CrossRefGoogle ScholarPubMed
17. Arnow, PM, Chou, T, Weil, D, Shapiro, EN, Kretzschmar, C. Nosocomial legionnaires' disease caused by aerosolized tap water from respiratory devices. J Infect Dis 1982; 146:460–467.CrossRefGoogle ScholarPubMed
18. Joly, JR, Dery, P, Gauvreau, L, Cote, L, Trepanier, C.Legionnaires' disease caused by Legionella dumoffi in distilled water. CMAJ 1986; 135:1274–1277.Google Scholar
19. Mastro, TD, Fields, BS, Breiman, RF, Campbell, J, Plikaytis, BD, Spika, JS. Nosocomial legionnaires' disease and use of medication nebulizers. J Infect Dis 1991; 163:667–671.CrossRefGoogle ScholarPubMed
20. Woo, AH, Goetz, A, Yu, VL. Transmission of legionella by respiratory equipment and aerosol generating devices. Chest 1992; 102:1566–1590.Google ScholarPubMed
21. Stout, JE, Lin, YS, Goetz, AM, Muder, RR. Controlling Legionella in hospital water systems: experience with superheat-and-flush method and copper-silver ionization. Infect Control Hosp Epidemiol 1998; 19:911–914.CrossRefGoogle ScholarPubMed
22. Hall, KK, Giannetta, ET, Getchell-White, SI, Durbin, LJ, Farr, BM. Ultraviolet light disinfection of hospital water for preventing nosocomial Legionella infection: a 13-year follow-up. Infect Control Hosp Epidemiol 2003; 24:580–583.CrossRefGoogle ScholarPubMed
23. Srinivasan, A, Bova, G, Ross, T, et al. A 17-month evaluation of a chlorine dioxide water treatment system to control Legionella species in a hospital water supply. Infect Control Hosp Epidemiol 2003; 24:575–579.CrossRefGoogle Scholar
24. American Public Health Association, American Water Works Association, Water Environment Federation. Standard Methods for the Examination of Water and Wastewater. 20th ed. Washington, DC: American Public Health Association; 1998.Google Scholar
25. Leoni, E, Legnani, PP. Comparison of selective procedures for isolation and enumeration of Legionella species from hot water systems. J Appl Microbiol 2001; 90:27–33.CrossRefGoogle ScholarPubMed
26. Sidari, FP, Stout, JE, VanBriesen, JM, et al. Keeping Legionella out of water systems. J Am Water Works Assoc 2004; 96:111–119.CrossRefGoogle Scholar
27. Ditommaso, S, Biasin, C, Giacomuzzi, M, Zotti, CM, Cavanna, A, RuggeniniMoiraghi, A. Peracetic acid in the disinfection of a hospital water system contaminated with Legionella species. Infect Control Hosp Epidemiol 2005; 26:490–493.CrossRefGoogle ScholarPubMed
28. Conferenza permanente per i rapporti tra lo Stato le Regioni e le Province autonome di Trento e Bolzano. Linee guida recanti indicazioni sulla legionellosi per i gestori di strutture turistico-ricettive e termali. Provvedimento 13.01.2005. G.U. n. 28, 04.02.2005.Google Scholar