Skip to main content
    • Aa
    • Aa

Control of endemic nosocomial Legionnaires' disease by using sterile potable water for high risk patients

  • T. J. Marrie (a1) (a2), D. Haldane (a2), S. Macdonald (a3), K. Clarke (a3), C. Fanning (a3), S. Le Fort-Jost (a3), G. Bezanson (a2) and J. Joly (a4)...

In a setting where potable water is contaminated with Legionella pneumophila serogroup 1, we performed two case control studies. The first case control study consisted of 17 cases of nosocomial Legionnaires' disease (LD) and 33 control (the patients who were admitted to the ward where the case was admitted immediately before and after the case) subjects. Cases had a higher mortality rate 65% vs 12% (P < 0.004); were more likely to have received assisted ventilation (P < 0.00001); to have nasogastric tubes (P < 0.0004) and to be receiving corticosteroids or other immunosuppressive therapy (P < 0.0001). Based on the results of this study, sterile water was used to flush nasogastric tubes and to dilute nasogastric feeds. Only 3 cases of nosocomial LD occurred during the next year compared with 12 the previous year (P < 0.0001). Nine cases subsequently occurred and formed the basis for the second case-control study. Eighteen control subjects were those patients admitted to the same unit where the case developed LD, immediately before and after the case. The mortality rate for the cases was 89% vs 6% for controls (P < 0.00003). The only other significant difference was that cases were more likely to be receiving corticosteroids or other immunosuppressive therapy 89% vs 39% ( < 0.01). We hypothesized that microaspiration of contaminated potable water by immunocompromised patients was a risk factor for nosocomial Legionnaires' disease. From 17 March 1989 onwards such patients were given only sterile potable water. Only two cases of nosocomial LD occurred from June 1989 to September 1990 and both occurred on units where the sterile water policy was not in effect. We conclude that aspiration of contaminated potable water is a possible route for acquisition of nosocomial LD in our hospital and that provision of sterile potable water to high risk patients (those who are receiving corticosteroids or other immunosuppressive drugs; organ transplant recipients or hospitalized in an intensive care unit) should be mandatory.

Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

1.JE McDade , CC Shepard , DW Eraser : Legionnaires' disease. Isolation of a bacterium and demonstration of its role in other respiratory disease. N Engl J Med, 1977: 297: 1197–203.

4.JE Stout , VL Yu , RM Vickers , Ubiquitousness oiLegionella pneumophila in the water supply of a hospital with endemic Legionnaires' disease. N Engl J Med 1982; 306: 466–8.

6.DW Eraser . Potable water as a source for Legionellosis. Environ Hlth Perspec 1985; 62: 337–41.

8.TJ Marrie , S MacDonald , K Clarke , D Haldane . Nosocomial Legionnaires' disease – Lessons from a four year prospective study. Am J Infect Control 1991; 19: 7985.

9.WA Knaus , EA Draper , DP Wagner , APACHE II; A severity of disease classification system. Crit Care Med 1985; 13: 818–22.

15.AL Rousell , VA Chabbert . Taxonomy and epidemiology of gram-negative bacterial plasmids studied by DNA-DNA hybridization in formamide. J Gen Microbiol 1978; 104: 269–76.

16.P McCullough , IA Nelder . Generalized linear models. New York: Chapman and Hall. 1983: 72100.

17.AH Woo , VL Yu , A Goetz . Potential in-hospital modes of transmission of Legionella pneumophila. Demonstration experiments for dissemination by showers, humidifiers and rinsing of ventilation bag apparatus. Am J Med 1986; 80: 567–73.

18.RR Muder , VL Yu , J McClure , Nosocomial Legionnaires' disease uncovered in a prospective pneumonia study: implications for underdiagnosis. JAMA 1982; 249: 3184–92.

20.TD Mastro , BS Fields , RF Breiman , J Campbell , BD Plikaytis , J Spika . Nosocomial Legionnaires' disease and use of medication nebulizers. J Infect Dis 1991: 163: 667–71.

21.PM Arnow , T Chou , D Weil , EN Shapiro , C Kretzschmar . Nosocomial Legionnaires' Disease caused by aerosolized tap water from respiratory devices. J Infect Dis 1982; 146: 460–7.

22.JA Kaan , AM Simoons-Smit , DM MacLaren . Another source of aerosol causing nosocomial Legionnaires' disease. J Infect 1985; 11: 145–8.

30.M Guiguet , J Pierre , P Burn , G Berthelot , S Gottot , C Gibert , AJ Valleron . Epidemiological survey of a major outbreak of nosocomial legionellosis. International J Epidemiol 1987; 16; 466–71.

34.DW Fraser , TR Tsai , W Orenstein , Legionnaires' disease; Description of an epidemic of pneumonia. N Engl J Med 1977; 297; 1189–97.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score