Assessing risk of health care-acquired Legionnaires' disease from environmental sampling: The limits of using a strict percent positivity approach

American Journal of Infection Control

Volumn 40, Issue 10, 2012, Pages 917-921

  Allen, Joseph G ^a,b   Myatt, Theodore A ^a,c   MacIntosh, David L ^a,b   Ludwig, Jerry F ^a   Minegishi, Taeko ^a   Stewart, James H ^a,b   Connors, Bryan F ^a   Grant, Michael P ^a   McCarthy, John F ^a  

^a Environmental Health & Engineering Inc   (United States)

^b HARVARD SCHOOL OF PUBLIC HEALTH   (United States)

^c BRIGHAM AND WOMEN S HOSPITAL   (United States)

Author keywords

Hospital water sampling; Legionella; Legionnaires' disease; Nosocomial legionellosis; Risk management

Indexed keywords

WATER;

FALSE NEGATIVE RESULT; FALSE POSITIVE RESULT; HEALTH HAZARD; HOSPITAL; HUMAN; INFECTION CONTROL; LEGIONELLA; LEGIONNAIRE DISEASE; PEER REVIEW; PREVALENCE; REVIEW; RISK ASSESSMENT; RISK MANAGEMENT; SENSITIVITY AND SPECIFICITY; VALIDITY; WATER CONTAMINATION; WATER SUPPLY;

EID: 84870396947     PISSN: 01966553     EISSN: 15273296     Source Type: Journal    
DOI: 10.1016/j.ajic.2012.01.013     Document Type: Article

References (58)

1. Centers for Disease Control and Prevention. Patient facts: learn more about Legionnaires' disease. Available from: http://www.cdc.gov/legionella/ patient-facts.htm. Accessed November 10, 2011.
2. B.J. Marston, J.F. Plouffe, T.M. File Jr., B.A. Hackman, S.J. Salstrom, H.B. Lipman Community-Based Pneumonia Incidence Study Group Incidence of community-acquired pneumonia requiring hospitalization: results of a population-based active surveillance study in Ohio Arch Intern Med 157 1997 1709 1718 (Pubitemid 27327407)
3. United States Environmental Protection Agency Legionella: human health criteria document EPA-822-R-99-001 1999 United States Environmental Protection Agency Washington [DC]
4. Centers for Disease Control and Prevention. Top 10 things every clinician needs to know about legionellosis. Available from: http://www.cdc.gov/ legionella/top10.htm. Accessed November 10, 2011.
5. P.H. Edelstein Legionella P.R. Murray, E.J. Baron, J.H. Jorgensen, M.L. Landry, M.A. Pfaller, Manual of clinical microbiology 9th ed 2007 ASM Press Washington [DC]
6. B.S. Fields, R.F. Benson, and R.E. Besser Legionella and Legionnaires' disease: 25 years of investigation Clin Microbiol Rev 15 2002 506 526 (Pubitemid 34761355)
7. N. Parthuisot, M. Binet, A. Touron-Bodilis, C. Pougnard, P. Lebaron, and J. Baudart Total and viable Legionella pneumophila cells in hot and natural waters as measured by immunofluroscence-based assays and solid-phase cytometry Applied Environ Microbiol 77 2011 6225 6232
8. J.L. Kool, A.E. Fiore, C.M. Kioski, E.W. Brown, R.F. Benson, and J.M. Pruckler More than 10 years of unrecognized nosocomial transmission of legionnaires' disease among transplant patients Infect Control Hosp Epidemiol 19 1998 898 904 (Pubitemid 128472663)
9. B. Ruf, D. Schurmann, I. Horbach, F.J. Fehrenbach, and H.D. Pohle The incidence of legionella pneumonia: a 1-year prospective study in a large community hospital Lung 167 1989 11 22 (Pubitemid 19105702)
10. V.L. Yu Nosocomial legionellosis Curr Opin Infect Dis 13 2000 385 388 (Pubitemid 30649490)
11. A. Mavridou, E. Smeti, G. Mandilara, O. Pappa, S. Plakadonaki, and E. Grispou Prevalence study of Legionella spp contamination in Greek hospitals Int J Environ Health Res 18 2008 295 304
12. J.E. Stout, R.R. Muder, S. Mietzner, M.M. Wagener, M.B. Perri, and K. DeRoos Role of environmental surveillance in determining the risk of hospital-acquired legionellosis: a national surveillance study with clinical correlations Infect Control Hosp Epidemiol 28 2007 818 824 (Pubitemid 47055921)
13. P.Y. Yu, Y.E. Lin, W.R. Lin, H.Y. Shih, Y.C. Chuang, and R.J. Ben The high prevalence of Legionella pneumophila contamination in hospital potable water systems in Taiwan: implications for hospital infection control in Asia Int J Infect Dis 12 2008 416 420
14. C. Napoli, F. Fasano, R. Iatta, G. Barbuti, T. Cuna, and M.T. Montagna Legionella spp and legionellosis in southeastern Italy: disease epidemiology and environmental surveillance in community and health care facilities BMC Public Health 10 2010 660
15. J.L. Kool, D. Bergmire-Sweat, J.C. Butler, E.W. Brown, D.J. Peabody, and D.S. Massi Hospital characteristics associated with colonization of water systems by Legionella and risk of nosocomial legionnaires' disease: a cohort study of 15 hospitals Infect Control Hosp Epidemiol 20 1999 798 805
16. M. Best, V. Yu, J.E. Stout, A. Gortz, R. Muder, and F. Taylor Legionellaceae in the hospital water supply Lancet 2 1983 307 310
17. S. Boccia, P. Laurenti, P. Borella, U. Moscato, G. Capalbo, and A. Cambieri Prospective 3-year surveillance for nosocomial and environmental Legionella pneumophila: implications for infection control Infect Control Hosp Epidemiol 27 2006 459 465 (Pubitemid 43835527)
18. J.E. Stout, and V.L. Yu Experiences of the first 16 hospitals using copper-silver ionization for Legionella control: implications for the evaluation of other disinfection modalities Infect Control Hosp Epidemiol 24 2003 563 568 (Pubitemid 37039612)
19. S. Ditommaso, C. Biasin, M. Giacomuzzi, C.M. Zotti, R. Arione, and E. Guglielmi Colonization of a water system by Legionella organisms and nosocomial legionellosis: a 5-year report from a large Italian hospital Infect Control Hosp Epidemiol 27 2006 532 535 (Pubitemid 43835544)
20. S. Ditommaso, M. Giacomuzzi, M. Gentile, A.R. Moiraghi, and C.M. Zotti Effective environmental sampling strategies for monitoring Legionella spp contamination in hot water systems Am J Infect Control 38 2010 344 349
21. A.M. Goetz, J.E. Stout, S.L. Jacobs, M.A. Fisher, R.E. Ponzer, and S. Drenning Nosocomial legionnaires' disease discovered in community hospitals following cultures of the water system: seek and ye shall find Am J Infect Control 26 1998 8 11 (Pubitemid 28093898)
22. I. Marchesi, P. Marchegiano, A. Bargellini, S. Cencetti, G. Frezza, and M. Miselli Effectiveness of different methods to control legionella in the water supply: ten-year experience in an Italian university hospital J Hosp Infect 77 2011 47 51
23. M. Sabria, J.M. Modol, M. Garcia-Nunez, E. Reynaga, M.L. Pedro-Botet, and N. Sopena Environmental cultures and hospital-acquired Legionnaires' disease: a 5-year prospective study in 20 hospitals in Catalonia, Spain Infect Control Hosp Epidemiol 25 2004 1072 1076 (Pubitemid 39664735)
24. J.E. Stout Preventing legionellosis ASHRAE J 49 2007 58 62 (Pubitemid 350041758)
25. J.E. Stout, and V.L. Yu Environmental culturing for Legionella: can we build a better mouse trap? Am J Infect Control 38 2010 341 343
26. M. Tesauro, A. Bianchi, M. Consonni, F. Pregliasco, and M.G. Galli Environmental surveillance of Legionella pneumophila in two Italian hospitals Ann Ist Super Sanita 46 2010 274 278
27. V.L. Yu Resolving the controversy on environmental cultures for Legionella: a modest proposal Infect Control Hosp Epidemiol 19 1998 893 897
28. R.L. Ehrlich, M.S. Steele, and N.J. Sabatini Report of the Maryland Scientific Working Group to study Legionella in water systems in healthcare institutions 2000 Maryland Department of Health and Mental Hygiene Baltimore [MD]
29. Allegheny County Health Department Approaches to prevention and control of Legionella infection in Allegheny County health care facilities. First rev ed 1997 Allegheny County Health Department Pittsburgh [PA]
30. State of New York Department of Health. Hospital-associated legionellosis. July 14, 2005. Available from: http://www.health.ny.gov/press/ releases/2005/2005-08-26-legionnaires/hospital-guidelines-legionella.pdf. Accessed November 10, 2011.
31. Centers for Disease Control and Prevention. Guidelines for prevention of nosocomial pneumonia. MMWR January 3, 1997;46:1-85.
32. Veterans Health Administration VHA Directive 2008-010: Prevention of Legionella Disease 2008 Department of Veterans Affairs, Veterans Health Administration Washington [DC] Available from: http://www1.va.gov/ vhapublications/ViewPublication.asp?pub-ID=1654 Accessed November 10, 2011
33. Texas Department of State Health Services. Report of the Texas Legionnaires' Disease Task Force. Infectious Disease Control Unit. May 19, 2010. Available from: http://www.dshs.state.tx.us/idcu/disease/legionnaires/ taskforce/hospitals/. Accessed November 10, 2011.
34. J.E. Stout, and V.L. Yu Hospital-acquired Legionnaires' disease: new developments Curr Opin Infect Dis 16 2003 337 341 (Pubitemid 36936672)
35. Z. Zhang, C. McCann, J.E. Stout, S. Piesczynski, R. Hawks, and R. Vidic Safety and efficacy of chlorine dioxide for Legionella control in a hospital water system Infect Control Hosp Epidemiol 28 2007 1009 1012 (Pubitemid 47218285)
36. J.R. Kohler, M. Maiwald, P.C. Luck, J.H. Helbig, V. Hingst, and H.G. Sonntag Detecting legionellosis by unselected culture of respiratory tract secretions and developing links to hospital water strains J Hosp Infect 41 1999 301 311 (Pubitemid 29192646)
37. P.M. Arnow, T. Chou, D. Weil, E.N. Shapiro, and C. Kretzschmar Nosocomial Legionnaires' disease caused by aerosolized tap water from respiratory devices J Infect Dis 146 1982 460 467 (Pubitemid 12004443)
38. A. Brown, M. Lema, C.A. Ciesielski, and M.J. Blaser Combined plasmid and peptide analysis of clinical and environmental Legionella pneumophila strains associated with a small cluster of Legionnaires' disease cases Infection 13 1985 163 166 (Pubitemid 15002470)
39. P.S. Graman, G.A. Quinlan, and J.A. Rank Nosocomial legionellosis traced to a contaminated ice machine Infect Control Hosp Epidemiol 18 1997 637 640 (Pubitemid 127470497)
40. M. Green, E.R. Wald, B. Dashefsky, K. Barbadora, and R.M. Wadowsky Field inversion gel electrophoretic analysis of Legionella pneumophila strains associated with nosocomial legionellosis in children J Clin Microbiol 34 1996 175 176 (Pubitemid 126506916)
41. C.M. Helms, R.M. Massanari, R.P. Wenzel, M.A. Pfaller, N.P. Moyer, and N. Hall Legionnaires' disease associated with a hospital water system: a five-year progress report on continuous hyperchlorination JAMA 259 1988 2423 2427 (Pubitemid 18098397)
42. E. Leoni, R. Sacchetti, and M. Aporti Active surveillance of legionnaires disease during a prospective observational study of community- and hospital-acquired pneumonia Infect Control Hosp Epidemiol 28 2007 1085 1088 (Pubitemid 47345270)
43. P.W. Lowry, R.J. Blankenship, W. Gridley, N.J. Troup, and L.S. Tompkins A cluster of Legionella sternal wound infections due to postoperative topical exposure to contaminated tap water N Engl J Med 324 1991 109 113
44. L.A. Mermel, S.L. Josephson, C.H. Giorgio, J. Dempsey, and S. Parenteau Association of Legionnaires' disease with construction: contamination of potable water? Infect Control Hosp Epidemiol 16 1995 76 81
45. J.F. Plouffe, L.R. Webster, and B. Hackman Relationship between colonization of hospital building with Legionella pneumophila and hot water temperatures Appl Environ Microbiol 46 1983 769 770 (Pubitemid 13024788)
46. K.N. Shands, J.L. Ho, R.D. Meyer, G.W. Gorman, P.H. Edelstein, and G.F. Mallison Potable water as a source of Legionnaires' disease JAMA 253 1985 1412 1416 (Pubitemid 15128802)
47. M.T. Garcia, B. Baladron, V. Gil, M.L. Tarancon, A. Vilasau, and A. Ibanez Persistence of chlorine-sensitive Legionella pneumophila in hyperchlorinated installations J Appl Microbiol 105 2008 837 847
48. S.P. Blatt, M.D. Parkinson, E. Pace, P. Hoffman, D. Dolan, and P. Lauderdale Nosocomial Legionnaires' disease: aspiration as a primary mode of disease acquisition Am J Med 95 1993 16 22 (Pubitemid 23205922)
49. J.P. Hanrahan, D.L. Morse, V.B. Scharf, J.G. Debbie, G.P. Schmid, and R.M. McKinney A community hospital outbreak of legionellosis: transmission by potable hot water Am J Epidemiol 125 1987 639 649 (Pubitemid 17047137)
50. Y.-S. Chen, Y.-C. Liu, S.S.-J. Lee, H.-C. Tsai, S.-R. Wann, and C.-H. Kao Abbreviated duration of superheat-and-flush and disinfection of taps for Legionella disinfection: lessons learned from failure Am J Infect Control 33 2005 606 610 (Pubitemid 41745206)
51. J. Darelid, S. Lofgren, and B.E. Malmvall Control of nosocomial Legionnaires' disease by keeping the circulating hot water temperature above 55 degrees C: experience from a 10-year surveillance programme in a district general hospital J Hosp Infect 50 2002 213 219 (Pubitemid 37554877)
52. I.H. Ozerol, M. Bayraktar, Z. Cizmeci, R. Durmaz, E. Akbas, and Z. Yildirim Legionnaires' disease: a nosocomial outbreak in Turkey J Hosp Infect 62 2006 50 57 (Pubitemid 43103010)
53. T.N. Palmore, F. Stock, M. White, M. Bordner, A. Michelin, and J.E. Bennett A cluster of cases of nosocomial legionnaires' disease linked to a contaminated hospital decorative water fountain Infect Control Hosp Epidemiol 30 2009 764 768
54. S. Ragull, M. Luisa Pedro-Botet, M. Garcia-Nunez, M. Esteve, N. Sopena, and C. Rey Joly Superheat-and-flush effect on the control of hospital-acquired Legionella infection Med Clin (Barc) 127 2006 211 213 (in Spanish) (Pubitemid 44265302)
55. M.H. Seenivasan, V.L. Yu, and R.R. Muder Legionnaires' disease in long-term care facilities: overview and proposed solutions J Am Geriatr Soc 53 2005 875 880 (Pubitemid 41656937)
56. Y.E. Lin, J.E. Stout, and V.L. Yu Controlling Legionella in hospital drinking water: an evidence-based review of disinfection methods Infect Control Hosp Epidemiol 32 2011 166 173
57. Y.S. Chen, Y.E. Lin, Y.C. Liu, W.K. Huang, H.Y. Shih, and S.R. Wann Efficacy of point-of-entry copper-silver ionisation system in eradicating Legionella pneumophila in a tropical tertiary care hospital: implications for hospitals contaminated with Legionella in both hot and cold water J Hosp Infect 68 2008 152 158
58. A. Aschengrau, and G. Steague Essentials of epidemiology in public health 2nd ed. 2007 Jones & Bartlett Burlington [MA]