Legionella Control and Prevention in Health Facilities

Legionella control technology by copper silver ionisation water treatment for cooling towers, pools, hotels, spas, resorts, hospitals, healthcare facilities and nursing homes


For legionella control in Hospitals and Cooling Towers we recommend our largest Ionization system 350-105

Legionella is often found together with pseudomonas the second most common cause of nosocomial pneumonia.

Approvals and Recognitions: 

The Environmental Protection Agency recognizes copper silver ionisation as a "control method designed to disinfect an entire water distribution system" for Legionella control and prevention. 

Sept. 2000 - LEGIONELLA : DRINKING WATER FACT SHEET Nov. 1999 - LEGIONELLA : Human Health Criteria Document

The Occupational Safety & Health Administration states that a means to control Legionella growth includes “the use of metal ions such as copper or silver (which have a biocidal effect)”. OSHA technical manual on Legionnaires' disease, section iii: chapter 7

 

 References:

Disinfection of Bacteria In Water Systems by Using Electrolytically Generated Copper: Silver & Reduced Levels of Free Chlorine  AUTHORS: Yahya MT, Landeen LK, Mesina MC, Kutz SM, Schultze R, & Gerba CP:  Canadian Journal of Microbiology 36: 109-116, 1990

PURPOSE OF STUDY:
The recommended minimum level of free chlorine for disinfection of public swimming pools is 1 mg/liter (1 ppm).  This level is difficult to maintain due to the chlorine-demanding organic material introduced by bathers themselves as well as the environment. Eye and skin irritation may also occur at the minimum chlorine level needed for effective disinfection.  Electrolytically generated copper/silver ions are also microbiocidal and are much less subject to degradation but are slower acting than chlorine. Therefore, the authors tested the hypothesis that using the two methods together would accomplish effective disinfection while reducing the level of free chlorine required.

MATERIALS AND METHODS:
Two 32-gallon plastic containers, one indoors (temperature range 22 to 25) and the second outdoors exposed to sunlight (temperature range 18 to 36) were filled with tap water. After chemical analysis and adjustment of pH and test levels of disinfectants, bath water and urine were added to stimulate typical swimming conditions. Four treatment regimens were tested: (1) No added disinfectants (2) Free chlorine alone at the generally recommended level of 1 mg/liter (3) Free chlorine at 0.3 mg/liter combined with copper and silver ions at a ration of 400 ug/liter of copper to 40 ug/liter of silver (4) Copper and silver ions alone at the same ratio as above. An isolate of Staphylococcus sp was employed for bacterial challenge testing since previous work had shown that staphylococci are more resistant to disinfection than are coliform bacteria. The experiment was continued for 12 weeks.

RESULTS:
In the test of free chlorine alone, location proved to be critical. In the outdoor setting subject to strong sunlight and high temperatures, no residual chlorine could be detected 3 to 4 hours after optimization. Indoor, where environmental factors were much less extreme, a residual level of 0.1 to 0.3 mg/liter was found after 24 hours.
Bacterial counts were kept within drinking water standards (as recommended for swimming pools) by either high levels of chlorine alone or by the combination regimen of copper and silver ions with low levels of chlorine: the difference in total bacterial numbers was not significant. Hen challenged with Staphylococcus sp isolate, the combination of copper and silver ions with low levels of chlorine achieved a 2.4 log 10 reduction in bacterial numbers within 2 minutes, while the single-agent regimes (free chlorine alone, or copper/silver alone) showed only 1.5 & 0.03 log 10 reductions respectively. Under Staphylococcus sp challenge, the combined copper/silver and free chlorine had a faster log 10 reduction of microbial numbers than did treatment with a high level of chlorine alone.

CONCLUSIONS:
The addition of electrolytically generated copper/silver ions in the radio tested (400 ug/liter copper (0.4 ppm) to 40 ug/liter silver (0.04 ppm)) allowed reduction in the concentration of free chlorine to one third of the level customarily recommended. The use of copper/silver may provide resisting protection in swimming pools after chlorine has been rendered ineffective due to contamination from swimmers and the natural environment.

Efficacy of Copper / Silver Ions & Reduced Levels of Free Chlorine in Inactivation of Legionella pneumophilia.

AUTHORS: Landeen LK, Yahya MT, and Gerba CP
PUBLICATION REF: Applied & Enviromental Microbiology 55: 3045-3050,1989

PURPOSE OF STUDY:
Relatively high levels of chlorination are known to be effective in inactivating Legionella pneumophilia in drinking water. However, high levels of free chlorine may degrade rapidly, especially at high temperatures, producing only temporary suppression rather than continuous disinfection. Also, high chlorine levels may lead to the development of resistant strains and be corrosive to plumbing fixtures. Therefore, the authors investigated the effectiveness of electrolytically generated copper and silver ions together with low concentrations as an alternative disinfection treatment.

MATERIALS AND METHODS:
Pellets of Legionella pneumophilia were suspended in samples of filtered well water and bacterial inactivation rates were determined using chlorination alone at low concentrations of 0.1, 0.2, 0.32, & 0.4 mg/liter. Then electrolytically generated copper & silver ions at copper to silver ratio of 200 and 20, 400 and 40, and 800 and 80 ug/liter were tested both separately and in combination with chlorination to evaluate any incremental bactericidal effect. The majority of experiments were conducted at room temperature with some tests performed at elevated temperatures (39 to 40). Inactivation rates for each experimental regimen were calculated by linear regression analysis. Buffering was avoided because phosphate buffer had been found to interfere with the disinfection efficacy of copper in previous test using Escherichia Coli.

RESULTS:
Bacterial inactivation with chlorination alone was progressively greater as concentrations were increased from 0.1 to 0.4 mg/liter. Although the rates were relatively slower, a similar inactivating effect was demonstrated in tests of copper and silver ions alone: the ratio of 800 (copper) to 80 (silver) ug/liter was significantly faster than ratios of either 200 and 20 or 499 and 40 ug/liter.
When the chlorination and copper/silver disinfection methods were combined, inactivation rates and amounts of bacterial reduction were enhanced. The 400 to 40 copper and silver regimen augments the measure rate of bacterial inactivation at all tested chlorine levels; the difference was statistically significant at a chlorine concentration of 0.4 mg/liter. Although reported by other investigators, significantly increased inactivation rates at high temperatures were not observed in this study.

CONCLUSIONS:
Electronically generated copper & silver ions increased the level of inactivation of Legionella pneumophilia achieved in filtered well water above the levels observed with free chlorine alone. This effect was consistent at all copper & silver ratios tested and at various low concentrations of chlorine. The improvement was statistically significant when 400 ug/liter of silver were added to a chlorine concentration of 0.4 mg/liter. Thus copper/silver ion treatment was shown to provide effective disinfection against Legionella pneumophilia while maintaining free chlorine levels sufficiently low to avoid the known disadvantages of relatively high concentrations


Links:

Very useful information on Legionnaires' disease: FAQ from HC Information Resources Inc at http://hcinfo.com/ldfaq.htm

http://www.legionella.org/

Experiences of the First 16 Hospitals Using Copper-Silver Ionization for Legionella Control:  Implications for the Evaluation of Other Disinfection Modalities
by Janet E. Stout and Victor L. Yu (Infection Control and Hospital Epidemiology, 24: 563-568, 2003.)

            Hospital-acquired Legionniares' disease can be prevented by disinfection of hospital water systems.  The experience of the first 16 hospitals (the Sweet 16) that used  copper-silver ionization for Legionella control from 5-11 years is reported.  No cases of hospital-acquired Legionnaires' disease have occurred in any of these hospitals since 1995.  This study represents the final step in a proposed 4-step evaluation process of disinfection methods that includes (1) demonstrated efficacy in vitro (laboratory assays), (2) anecdotal experiences in individual hospitals, (3) controlled studies in individual hospitals, and (4) validation in confirmatory reports from multiple hospitals during a prolonged period (years).  Copper-silver ionization is now the only disinfection modality to fulfill all four evaluation criteria. 
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A proactive approach to prevention of health care–acquired Legionnaires’ disease: The Allegheny County (Pittsburgh) experience

by Cheryl L. Squier, Janet E. Stout, Sharon Krsytofiak, Joan McMahon, Marilyn M. Wagener, Bruce Dixon, and Victor L. Yu (American Journal of Infection Control, 2005)

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Legionella surveillance: political and social implications--a little knowledge is a dangerous thing.

by Victor L. Yu (Journal of Infectious Diseases 185:259-261, 2002, University of Chicago Press)

          Fear of adverse publicity and litigation are obstacles to a rational scientific approach to Legionnaires’ disease prevention. “Surveillance should be complemented by education of the public and lay media. The public must be informed that Legionella are common colonizers (as are Pseudomonas species) of man-made water distribution systems that are rarely pathogenic for immunocompetent hosts and that Legionnaires’ disease is not a contagious disease. Ignorance leads to panic and panic leads to irrational actions. We have observed the implementation of emergency measures that are expensive, logistically tedious, and have little impact on the risk of acquiring Legionnaires’ disease.”

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Legionnaries' Disease Contracted from Patient Homes: The Coming of the Third Plague?

by M.L. Pedro-Botet, Janet E. Stout and Victor L. Yu 

Eur J Clin Microbiol Infect Dis, 21:699-705, 2002, Springer-Verlag

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Hospital -acquired Legionellosis: Solution for a preventable infection

by Miguel Sabria and Victor L. Yu 

The Lancet Infectious Diseases, 2:368-373, June 2002

        Although cooling towers were linked to the cases of Legionnaires' disease in the years after its discovery, potable water has been the environmental source for almost all reported hospital outbreaks. Microaspiration is the major mode of transmission in hospital-acquired Legionnaires' disease; showering is not a mode of transmission. Since the clinical manifestations are non-specific, and specialized laboratory testing is required, hospital-acquired legionellosis is easily underdiagnosed. Discovery of a single case of hospital-acquired Legionnaires' disease is an important sentinel of additional undiscovered cases. Routine environmental culture of the hospital water supply for Legionella has proven to be an important strategy in prevention..

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Prevention of Legionnaires' disease in transplant recipients: recommendations for a standardized approach

 by N. Singh, J.E. Stout, V.L. Yu

 Transplant Infectious Diseases 6:58-62, 2004

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Approaches to Prevention and Control of Legionella Infection

        - Allegheny County Health Department Guidelines         Allegheny County Health Department, Pennsylvania. 2nd Edition, January, 1997.


Culture Your Water System for Legionella or Not?

Yu, V.L., " Resolving the Controversy on Environmental Cultures for Legionella: A Modest Proposal, Infection Control and Hospital Epidemiology, 19, pp. 893-897, 1998

          This editorial reviews the proactive position of Pittsburgh investigators in prevention of hospital-acquired Legionnaires’ disease. Pittsburgh investigators document that knowledge that the hospital water is colonized is a scientifically-based method that effectively prevents cases of hospital-acquired Legionnaires’ disease. In contrast, U.S. CDC does not favor culturing the hospital water supply unless one or more hospitalized patients contract Legionnaires’ disease. The scientific evidence and effectiveness of both positions is reviewed.


Report of the Maryland Scientific Working Group to Study Legionella in Water Systems in Healthcare Institutions

June 14, 2000, Baltimore, Maryland

In October, 1999, Georges Benjamin, MD, Secretary, Maryland Department of Health and Mental Hygiene (DHMH), formed a Scientific Working Group to review scientific and technical data and gather information from experts on the current status of prevention and management of water system-related Legionella bacteria.  These guidelines are the most comprehensive guidelines on Legionella prevention for hospitals.

REFERENCES

  1. Prevention: "Hospital water should be cultured and, if contaminated, should be disinfected with one of two methods: heating to 70-80°C followed by flushing of distal sites for 30 minutes (“super heat and flush”) or installation of copper-silver ionization units" (Semin Respir Infect 1998;13:147).

  2. McDade, J.E., Sheppard, C.C., Fraser, D.W., et al. Legionnaires’ disease: isolation of a bacterium and demonstration of its role in other respiratory diseases. N. Engl. J. Med. 1977;287:1197-1203.
  3. Winn, Jr., W.C. Legionella. In Manual of Clinical Microbiology, 7th Ed. Murray, P.R., Barron, E.J., Pfaller, M.A., Tenover, F.C. and Yolken, R.H. Eds. Washington, D.C., American Society for Microbiology 1999:573-585.

3. Parry, M.F., Stampleman, L., Hutchinson, J.H., et al. Waterborne Legionella bozemanii and nosocomial pneumonia in immunosuppressed patients. Ann. Intern. Med. 1985;103:205-210.
4. Doebbeling, B.N., Ishak, M.A., Wade, B.H., et al. Nosocomial Legionella micdadei pneumonia: 10 years experience and case-control study. J. Hosp. Infect. 1989;13:2898-298.
5. Reingold, A.L., Thomason, B.M., Brake, B.J. Legionella pneumonia in the United States: the distribution of serogroups and species causing human illness. J. Infect. Dis. 1984;149-819.
6. Girod, J.C., Reichman, W.C., Winn, Jr., D.N., et al. Pneumonic and nonpneumonic forms of legionellosis. The result of a common source exposure to Legionella pneumophila. Arch. Intern. Med. 1982;142:545-547.
7. Stout, J.E. and Yu, V.L. Legionellosis. N. Engl. J. Med. 1997;337:682-687.
8. Marston, B.J., Plouffe, J.F., File, T.M., et al. Incidence of community-acquired pneumonia requiring hospitalization: results of a population-based surveillance study in Ohio. Arch. Intern. Med. 1997;157:1709-1718.
9. Breiman, R.F. and Butler, J.C. Legionnaires’ disease: clinical, epidemiological, and public health perspectives. Semin. Respir. Infect. 1998;13:84-89.
10. Klein, N.C. and Cunha, B.A. Treatment of legionnaires’ disease. Semin. Respir. Infect. 1998;13:140-146.
11. Martin, S.J., Pendland, S.L., Chen, C., et al. In vitro synergy testing of macrolide-quinolone combinations against 41 isolates of Legionella. Antimicrob. Agents Chemother. 1996;40:1419-1421.
12. Straus, W.L., Plouffe, J.F., File, T.M., et al. Risk factors for domestic acquisition of Legionnaire’s disease. Arch. Intern. Med. 1996;156:1685-1692.
13. Marston, B.J., Lipman, H.B., Breimen, R.F. Surveillance for Legionnaire’s disease: risk factors for morbidity and mortality. Arch. Intern. Med. 1994;154:2417-2422.
14. Centers for Disease Control and Prevention. Guidelines for Prevention of Nosocomial Pneumonia. Morbid. Mortal. Weekly Rep. 1997;46 (RR-1):1-79.
15. Hospital Infection Control Program Advisory Committee. Legionnaires’ Disease: Recommendations for the prevention of nosocomial Legionnaires’ Disease. March 26, 1996. www.cdc.gov/ncidod/diseases/hip/pneumonia/2_legion.htm
16. Kool, J.L., Fiore, A.E., Kioski, C.M., et al. More than 10 years of unrecognized nosocomial transmission of legionnaire’s disease among transplant patients. Infect. Control Hosp. Epidemiol. 1998;19:898-904.
17. Lepine, L., Jernigan, D.B., Butler, J.C., et al. A recurrent outbreak of nosocomial legionnaire’s disease detected by urinary antigen testing: evidence for long-term colonization of a hospital plumbing system. Infect. Control Hosp. Epidemiol. 1998;19:905-910.
18. Fiore, A.E., Butler, J.C., Emori, T.G. and Gaynes, R.P. A survey of methods used to detect nosocomial legionellosis among participants in the National Nosocomial Infections Surveillance System. Infect. Control Hosp. Epidemiol. 1999;20:412-416.
19. Centers for Disease Control and Prevention. Case definitions for infectious conditions under public health surveillance. Morbid. Mortal. Weekly Rep. 1997;46 (RR-10).
20. Centers for Disease Control and Prevention. Case definitions for public health surveillance. Morbid. Mortal. Weekly Rep. 1990;39 (RR-13).
21. Kazandjian, D., Chiew, R., and Gilbert, G.L. Rapid diagnosis of Legionella pneumophila serogroup 1 infection with the Binax enzyme immunoassay urinary antigen test. J. Clin. Microbiol. 1997;35:954-956.
22. Stout, J.E. Laboratory diagnosis of Legionnaires’ disease: the expanding role of the Legionella urinary antigen test. Clin. Microbiol. Newsletter 2000;22:62-64.
23. Ta, A.C., Stout, J.E., Yu, V.L., and Wagener, M.L. Comparison of culture methods for monitoring Legionella species in hospital potable water systems and recommendations for standardization of such methods. J. Clin. Microbiol. 1995;33:118-212.
24. Goetz, A.M., Stout, J.E., Jacobs, S.L., et. al. Nosocomial Legionnaires’ disease discovered in community hospitals following cultures of the water system: seek and ye shall find. Am. J. Infect. Control 1998;26:8-11.
25. Buesching, W.J., et al. Enhanced primary isolation of Legionella pneumophila from clinical specimens by low pH treatment. J. Clin. Microbiol. 1983;17:1153-1155.
26. Stout, J.E., Yu, V.L., and Best, M.G. Ecology of Legionella pneumophila within water distribution systems. Appl. Eviron. Microbiol. 1985;49:221-228.
27. Blatt, S.P., Parkinson, M.D., Pace, E., et al. Nosocomial Legionnaires’ disease: aspiration as a primary mode of disease acquisition. Am. J. Med. 1993;95:16-22.
28. Venzia, R.A., Agresta, M.D., Hanley, E.M., et al. Nosocomial legionellosis associated with aspiration of nasogastric feedings diluted in tap water. Infect. Control Hosp. Epidemiol. 1994;15:529-533.
29. Hanrahan, J.P., Morse, D.L., Scharf, V.B., et al. A community hospital outbreak of legionellosis: transmission by potable hot water. Am. J. Epidemiol. 10987;125:639-649.
30. Arnow, P.M., Chou, T., Shapiro, E.N., and Kretzschmar, C. Nosocomial Legionnaires’ disease caused by aerosolized tap water from respiratory devices. J. Infect. Dis. 1982;146:460-467.
31. Breiman, R.F., Fields, B.S., Sanden, G.N., et al. Association of shower use with Legionnaires’ disease. JAMA 1990;263:2924-2926.
32. Brown, C.M., Nuorti, P.J., Breiman, R.F., et al. A community outbreak of Legionnaires’ disease linked to hospital cooling towers: an epidemiological method to calculate dose of exposure. Int. J. Epidemiol. 1999;28:353-359.
33. Keller, D.W., Hajjeh, R., DeMaria, A., et al. Community outbreak of Legionnaires’ disease: an investigation confirming the potential for cooling towers to transmit Legionella species. Clin. Infect. Dis. 1996;22:257-261.
34. Fiore, A.E., Nuorti, J.P., Levine, O.S., et al. Epidemic Legionnaires’ disease two decades later: old sources, new diagnostic methods. Clin. Infect. Dis. 1998;26:426-433.
35. Stone, M., Ahmed, J., Evans, J. The continuing risk of domestic hot water scalds to the elderly. Burns 2000;26:347-50.
36. Second Report of the Committee of Inquiry into the Outbreak of Legionnaires’ Disease in Stafford in April 1985, London, England. Her Majesty’s Stationary Office (HMSO) 1987.
37. Alary, M., Joly J.R. Factors contributing to the contamination of hospital water distribution systems. J. Infect. Dis. 1992;165:565-9.
38. Vickers, R.M., Yu, V.L., Hanna, S.S., et al. Determinants of Legionella pneumophila contamination of water distribution systems: 15-hospital prospective study. Infect. Control 1987;8:357-363.
39. Patterson, W.J., Hay, J., Seal, D.V., McLuckie, J.C. Colonization of transplant unit water supplies with Legionella and protozoa: precautions required to reduce the risk of legionellosis. J. Hosp. Infect. 1997;37:7-17.
40. Marrie, T.J., Green, T., Burbridge, S. Legionellaceae in the potable water of Nova Scotia hospital and Halifax residences. Epidemiol. Infect. 1994;112:143-150.
41. Liu, W.K., Yu, V.L., McClure, J., Kominos, S. Nosocomial legionnaires’ disease uncovered in a prospective pneumonia study: implications for underdiagnosis. JAMA 1983;249:3184-8.
42. Kool, J.L., Bergmire-Sweey, D., Butler, J.C., et al. Hospital characterisitics associated with colonization of water systems by Legionella and risk of nosocomial legionnaires’ disease: a cohort study of 15 hospitals. Infect. Control Hosp. Epidemiol. 1999;20:798-805.
43. Yu, V.L. Resolving the controversy on environmental cultures for Legionella: A modest proposal. Infect. Control Hosp. Epidemiol. 1998;19:893-7.
44. Stout, J.E., Best, M.G., and Yu, V.L. Susceptibility of Members of the family Legionellaceae to thermal stress: Implications for heat eradication methods in water distribution systems. Appl. Environ. Microbiol. 1986;52:396-399.
45. Heimberger, T., Birkhead, G., Bornstein, D., et al. Control of nosocomial Legionnaire’s disease through hot water flushing and supplemental chlorination of potable water. J. Infect. Dis. 1991;163:413.
46. Synder, M.B., Siwicki, M., Wireman, J., et al. Reduction in Legionella pneumophila through heat flushing followed by continuous supplemental chlorination of hospital hot water. J. Infect. Dis. 1990;162:127-132.
47. Grosserode, M., Wenzel, R., Pfaller, M., and Helms, C. Continuous hyperchlorination for control of nosocomial Legionella pneumophila: a ten year follow-up of efficacy, environmental effects, and costs. In: Legionella-Current Status and Emerging Perspectives. Barbaree, J.M., Breiman, R.F. and Dufour, A.P., Eds. Washington, D.C. American Society for Microbiology; 1993.
48. Landeen, L.K., Yahya, M.T. and Gerba, C.P. Efficacy of copper and silver ions and reduced levels of free chlorine in inactivation of Legionella pneumophila. Appl. Environ. Microbiol. 1989;55:3045-3050.
49. Liu, Z., Stout, J.L., Tedesco, L., et al. Controlled evaluation of copper-silver ionization in eradicating Legionella pneumophila from a hospital water distribution system. J. Infect. Dis. 1994;169:919-922.
50. Liu, Z. Stout, J.E., Boldin, M., et al. Intermittent use of copper-silver ionization for Legionella control in water distribution systems: a potential option in buildings housing individuals at low risk of infection. Clin. Infect. Dis. 1998;26:138-140.
51. Stout, J.E., Lin, Y.E., Goetz, A.M., and Muder, R.R. Controlling Legionella in hospital water systems: experience with the superheat-and-flush method and copper-silver ionization. Infect. Control Hosp. Epidemiol. 1998;19:911-914.
52. Mietzner, S., Schwille, R.C., Farley, A., et al. Efficacy of thermal treatment and copper-silver ionization for controlling Legionella pneumophila in high-volume hot water plumbing systems in hospitals. Am. J. Infect. Control 1997;25:452-457.
53. Biurrun, A., Caballero, L., Pelaz, C., et al. Treatment of a Legionella pneumophila-colonized water distribution system using copper-silver ionization and continuous chlorination. Infect. Control Hosp. Epidemiol. 1999;20:426-428.
54. Rohr, U, Senger, M., Selenda, F., Turley, R., Wilhelm, M. Four years of experience with silver-copper ionization for control of legionella in a German university hospital hot water plumbing system. Clin. Infect. Dis. 1999;29:1507-11.
55. Muraca, P., Stout, J.E., and Yu, V.L. Comparative assessment of chlorine, heat, ozone, and UV light for killing Legionella pneumophila within a model plumbing system. Appl. Environ. Microbiol. 1987;53:447-453.
56. Farr, B.M., et al. Evaluation of UV light for disinfection of hospital works contaminated with Legionella. Lancet 1988;2:669.

57. Cunliffe, D.A. Inactivation of Legionella pneumophila by monochloramine. J. Appl. Bacteriol. 1990;68:453-459.

58. Kool, J.L., Carpenter, J.C., and Fields, B.S. Effect of monochloramine disinfection of municipal drinking water on risk of nosocomial Legionnaire’s disease. Lancet 1999;353:272-277.
59. Pic-Albas, L., Donegan, N.E., Witherell, L.E., et al. Short trial of monochloramine for legionella disinfection in a hospital setting. Abstract, 4th Decennial international Conference on Nosocomial and Healthcare-Associated Infections. Atlanta, GA, March 5-9, 2000.
60. ASHRAE Guideline 12-2000. Minimizing the risk of legionellosis associated with building water systems. American Society of Heating, Refrigerating and Air-Conditioning Engineers, Atlanta, GA., 1999. (available through the ASHRAE web site: www.ASHRAE.org)
61. Best, M., Yu, V.L., Stout, J.E., et al. Legionellaceae in the hospital water supply- epidemiological link with disease and evaluation of a method of control of nosocomial legionnaires’ disease and Pittsburgh pneumonia. Lancet 1983;2:307-310.
62. Allegheny County Health Department. Approaches to prevention and control of Legionella infection in Allegheny county health care facilities. 2nd ed. Pittsburgh, PA: Allegheny County Health Department. 1997:1-15.
63. Dixon, Bruce; statement to Time/CNN, broadcast Nov. 21, 1999

The following three notes were excerpted from Legionella E-news, a free newsletter available at    http://hcinfo.com."
1. Three Cases and One Death at Rochester, N.Y. Hospital

Three patients at a hospital in Rochester, N.Y. contracted Legionnaires' disease within the last four weeks. One has died. The first case was diagnosed on Jan. 27, 2006  in a patient who was admitted mid-January with advanced cancer. The second patient, who had been suffering from hepatitis, died Sunday, Feb. 19, 2006. The third patient, who was admitted Feb. 2 and receiving chemotherapy treatment for leukemia, was in satisfactory condition as of Tuesday, Feb. 21. After Legionella bacteria was found in the hospital's water system on Feb. 13, all patients were given bottled water, showering was restricted, and the water system was chlorinated. Source: News reports

2. THREE CASES AND ONE DEATH AMONG GUESTS OF FLORIDA HOTEL

A 144-room hotel in Daytona Beach, Florida was voluntarily closed by the owner on Feb 3, 2006 following confirmed cases of Legionnaires' disease in three people who stayed there in January 2006. A county health official said the hotel is the only known connection among the three cases, one of whom has died. The first two cases occurred in early January, both in men over the age of 60. Source: Orlando Sentinel

3. TEN WAYS TO MINIMIZE STAGNATION IN PLUMBING SYSTEMS

"Ebb & Flow: Ten Ways to Minimize Stagnation in Domestic Water Systems," by Matt Freije (Health Facilities Management, January 2006), is posted at http://www.hospitalconnect.com/hfmmagazine/jsp/articledisplay.jsp?dcrpath=HFMMAGAZINE/PubsNewsArticleGen/data/0601HFM_FEA_Infrastructure&domain=HFMMAGAZINE

Legionella E-news is a free monthly international e-newsletter that covers recent outbreaks, new publications, and new technology. To subscribe, go to http://hcinfo.com

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This page last updated on February 27, 2006

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