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Long-Term Effects of Hospital Water Network Disinfection on Legionella and Other Waterborne Bacteria in an Italian University Hospital

Published online by Cambridge University Press:  10 May 2016

Beatrice Casini ,
Andrea Buzzigoli ,
Maria Luisa Cristina ,
Anna Maria Spagnolo ,
Pietro Del Giudice ,
Silvio Brusaferro ,
Andrea Poscia ,
Umberto Moscato ,
Paola Valentini  and
Angelo Baggiani
...Show all authors
Beatrice Casini*
Affiliation:
Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
Andrea Buzzigoli
Affiliation:
Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
Maria Luisa Cristina
Affiliation:
Department of Health Sciences, University of Genoa, Genoa, Italy
Anna Maria Spagnolo
Affiliation:
Department of Health Sciences, University of Genoa, Genoa, Italy
Pietro Del Giudice
Affiliation:
Department of Medical and Biological Sciences, University of Udine, Udine, Italy
Silvio Brusaferro
Affiliation:
Department of Medical and Biological Sciences, University of Udine, Udine, Italy
Andrea Poscia
Affiliation:
Hygiene Institute, Welfare Department of Public Health, Catholic University of Sacred Hearth, Rome, Italy
Umberto Moscato
Affiliation:
Hygiene Institute, Welfare Department of Public Health, Catholic University of Sacred Hearth, Rome, Italy
Paola Valentini
Affiliation:
Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
Angelo Baggiani
Affiliation:
Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
Gaetano Privitera
Affiliation:
Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy
*
Department of Translational Research, New Technologies in Medicine and Surgery, University of Pisa via S. Zeno 35-39, 56127 Pisa, Italy (beatrice.casini@med.unipi.it)
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Abstract

Objective and Design.

Legionella control still remains a critical issue in healthcare settings where the preferred approach to health risk assessment and management is to develop a water safety plan. We report the experience of a university hospital, where a water safety plan has been applied since 2002, and the results obtained with the application of different methods for disinfecting hot water distribution systems in order to provide guidance for the management of water risk.

Interventions.

The disinfection procedures included continuous chlorination with chlorine dioxide (0.4–0.6 mg/L in recirculation loops) reinforced by endpoint filtration in critical areas and a water treatment based on monochloramine (2-3 mg/L). Real-time polymerase chain reaction and a new immunoseparation and adenosine triphosphate bioluminescence analysis were applied in environmental monitoring.

Results.

After 9 years, the integrated disinfection-filtration strategy significantly reduced positive sites by 55% and the mean count by 78% (P < .05); however, the high costs and the occurrence of a chlorine-tolerant clone belonging to Legionella pneumophila ST269 prompted us to test a new disinfectant. The shift to monochloramine allowed us to eliminate planktonic Legionella and did not require additional endpoint filtration; however, nontuberculous mycobacteria were isolated more frequently as long as the monochloramine concentration was 2 mg/L; their cultivability was never regained by increasing the concentration up to 3 mg/L.

Conclusions.

Any disinfection method needs to be adjusted/fine-tuned in individual hospitals in order to maintain satisfactory results over time, and only a locally adapted evidence-based approach allows assessment of the efficacy and disadvantages of the control measures.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 3 , March 2014 , pp. 293 - 299
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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