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Infection Prevention pp 243–250Cite as

Testing Water for Legionella Prevention

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Abstract

Nosocomial Legionnaires’ disease, caused by the waterborne bacterial species Legionella, is a potentially preventable hospital-associated infection. Legionella bacteria are ubiquitous in both natural water sources and manmade potable water systems. Exposure of vulnerable hospitalized patients to Legionella bacteria in a hospital’s potable water system can result in clinically significant and potentially mortal disease. Testing a healthcare system’s potable water system is always indicated in the workup of healthcare-associated Legionnaires’ disease cases and may be performed for primary and secondary prevention. Legionella require specific conditions to grow, and culture methodology may affect the sensitivity of testing. The timing, methodology, and follow-up of water testing for Legionella in the healthcare setting remain controversial.

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References

  1. Glick THGM, Berman B, Mallison G, Rhodes WW Jr, Kassanoff I. Pontiac fever. An epidemic of unknown etiology in a health department: I. Clinical and epidemiologic aspects. Am J Epidemiol. 1978;107(2):149–60.

    Article  CAS  PubMed  Google Scholar 

  2. Tsai TFFD, Plikaytis BD, McCauley W, Martin SM, Fraser DW. Legionnaires’ disease: clinical features of the epidemic in Philadelphia. Ann Intern Med. 1979;90(4):509–17.

    Article  CAS  PubMed  Google Scholar 

  3. Legionella (Legionnaires’ Disease and Pontiac Fever) [http://www.cdc.gov/legionella/about/index.html].

  4. Blatt SPPM, Pace E, Hoffman P, Dolan D, Lauderdale P, Zajac RA, Melcher GP. Nosocomial Legionnaires’ disease: aspiration as a primary mode of disease acquisition. Am J Med. 1993;95(1):16–22.

    Article  CAS  PubMed  Google Scholar 

  5. Department ACH. Approaches to prevention and control of legionella infection in Allegheny County health care facilities. Allegheny: Allegheny County Health Department; 1997.

    Google Scholar 

  6. Legionella (Legionnaires’ Disease and Pontiac Fever) [http://www.cdc.gov/legionella/health-depts/inv-tools-cluster/lab-inv-tools/procedures-manual.html].

  7. Montagna MTCM, Giglio OD, Spagnolo AM, Napoli C, Cannova L, Deriu MG, Delia SA, Giuliano A, Guida M, Laganà P, Liguori G, Mura I, Pennino F, Rossini A, Tardivo S, Torre I, Torregrossa MV, Villafrate MR, Albertini R, Pasquarella C. Serological and molecular identification of Legionella spp. isolated from water and surrounding air samples in Italian healthcare facilities. Environ Res. 2016;146:47–50.

    Article  CAS  PubMed  Google Scholar 

  8. Rhoads WJPA, Edwards MA. Convective mixing in distal pipes exacerbates Legionella pneumophila growth in hot water plumbing. Pathogens. 2016;5(1):E29.

    Article  PubMed  Google Scholar 

  9. Bartram JCY, Lee JV, Pond K, Surman-Lee S. Legionella and the prevention of Legionellosis. Geneva: World Health Organization (WHO); 2007.

    Google Scholar 

  10. Cross DFBA, Dimond EG. The faucet aerator – a source of pseudomonas infection. N Engl J Med. 1966;274(25):1430–1.

    Article  CAS  PubMed  Google Scholar 

  11. Sydnor ERBG, Gimburg A, Cosgrove SE, Perl TM, Maragakis LL. Electronic-eye faucets: Legionella species contamination in healthcare settings. Infect Control Hosp Epidemiol. 2012;33(3):235–40.

    Article  PubMed  Google Scholar 

  12. Mäkinen R, Miettinen I, Pitkänen T, Kusnetsov J, Pursiainen A, Kovanen S, Riihinen K, Keinänen-Toivola MM. Manual faucets induce more biofilms than electronic faucets. Can J Microbiol. 2013;59(6):407–12.

    Article  PubMed  Google Scholar 

  13. Sampling Procedure and Potential Sampling Sites [http://www.cdc.gov/legionella/downloads/cdc-sampling-procedure.pdf].

  14. Ta AC, Stout J, Yu VL, Wagener MM. 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(8):2118–23.

    CAS  PubMed  PubMed Central  Google Scholar 

  15. Koziol-Montewka MMA, Stojek N, Palusinska-Szysz M, Danielak M, Wojtowicz M, Niewiedziol J, Koncewicz R, Niedzwiadek J, Paluch-Oles J, Trzeciak H, Drozanski W, Dutkiewicz J. Monitoring legionella species in hospital water systems. Link with disease and evaluation of different detection methods. Ann Agric Environ Med. 2008;15(1):143–7.

    PubMed  Google Scholar 

  16. Flanders WDKK, Shelton BG. Effects of holding time and measurement error on culturing Legionella in environmental water samples. Water Res. 2014;62:293–301.

    Article  PubMed  Google Scholar 

  17. Chang CW, Chou F. Methodologies for quantifying culturable, viable, and total Legionella pneumophila in indoor air. Indoor Air. 2011;21(4):291–9.

    Article  PubMed  Google Scholar 

  18. Weiss E, Westfall H. Substrate utilization by Legionella cells after cryopreservation in phosphate buffer. Appl Environ Microbiol. 1984;48(2):380–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  19. Morrill WE, Barbaree J, Fields BS, Sanden GN, Martin WT. Increased recovery of Legionella micdadei and Legionella bozemanii on buffered charcoal yeast extract agar supplemented with albumin. J Clin Microbiol. 1990;28(3):616–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Wadowsky RM, Yee R. Glycine-containing selective medium for isolation of Legionellaceae from environmental specimens. Appl Environ Microbiol. 1981;42(5):768–72.

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Reinthaler FF, Sattler J, Schaffler-Dullnig K, Weinmayr B, Marth E. Comparative study of procedures for isolation and cultivation of Legionella pneumophila from tap water in hospitals. J Clin Microbiol. 1993;31(5):1213–6.

    CAS  PubMed  PubMed Central  Google Scholar 

  22. BD: BBL™ BCYE Agar QUALITY CONTROL PROCEDURES. In. Sparks, Maryland: Becton, Dickinson and Company; 2015.

    Google Scholar 

  23. (ISO) ISO: ISO 11731-2 Water quality – Detection and enumeration of Legionella. International Organization for Standardization Geneva 2004.

    Google Scholar 

  24. Bartie CVS, Nel LH. Identification methods for Legionella from environmental samples. Water Res. 2003;37(6):1362–70.

    Article  CAS  PubMed  Google Scholar 

  25. Demirjian A, Lucas C, Garrison LE, Kozak-Muiznieks NA, States S, Brown EW, Wortham JM, Beaudoin A, Casey ML, Marriott C, Ludwig AM, Sonel AF, Muder RR, Hicks LA. The importance of clinical surveillance in detecting Legionnaires’ disease outbreaks: a large outbreak in a hospital with a Legionella disinfection system-Pennsylvania, 2011–2012. Clin Infect Dis. 2015;60(11):1596–602.

    Article  CAS  PubMed  Google Scholar 

  26. Appendix III: 7-3. Water sampling guidelines [https://www.osha.gov/dts/osta/otm/otm_iii/otm_iii_7.html].

  27. Lucas CE, Taylor T Jr, Fields BS. Accuracy and precision of Legionella isolation by US laboratories in the ELITE program pilot study. Water Res. 2011;45(15):4428–36.

    Article  CAS  PubMed  Google Scholar 

  28. King CH, Shotts E Jr, Wooley RE, Porter KG. Survival of coliforms and bacterial pathogens within protozoa during chlorination. Appl Environ Microbiol. 1988;54(12):3023–33.

    CAS  PubMed  PubMed Central  Google Scholar 

  29. Díaz-Flores Á, Montero J, Castro FJ, Alejandres EM, Bayón C, Solís I, Fernández-Lafuente R, Rodríguez G. Comparing methods of determining Legionella spp in complex water matrices. BMC Microbiol. 2015;15:91.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Alleron L, Merlet N, Lacombe C, Frère J. Long-term survival of Legionella pneumophila in the viable but nonculturable state after monochloramine treatment. Curr Microbiol. 2008;57(5):497–502.

    Article  CAS  PubMed  Google Scholar 

  31. Legionnaires’ disease part 2: the control of legionella bacteria in hot and cold water systems. Norwich: Health and Safety Executive; 2014.

    Google Scholar 

  32. Affairs DoV: prevention of healthcare-associated legionella disease and scald injury from potable water distribution systems. VHA Directive 1061 2014.

    Google Scholar 

  33. Mermel LA, Josephson S, Giorgio CH, Dempsey J, Parenteau S. Association of Legionnaires’ disease with construction: contamination of potable water? Infect Control Hosp Epidemiol. 1995;16(2):76–81.

    Article  CAS  PubMed  Google Scholar 

  34. Timbury MC, Donaldson J, McCartney AC, Fallon RJ, Sleigh JD, Lyon D, Orange GV, Baird DR, Winter J, Wilson TS. Outbreak of Legionnaires’ disease in Glasgow Royal Infirmary: microbiological aspects. J Hyg (Lond). 1986;97(3):393–403.

    Article  CAS  Google Scholar 

  35. Phares CR, Russell E, Thigpen MC, Service W, Crist MB, Salyers M, Engel J, Benson RF, Fields B, Moore MR. Legionnaires’ disease among residents of a long-term care facility: the sentinel event in a community outbreak. Am J Infect Control. 2007;35(5):319–23.

    Article  PubMed  Google Scholar 

  36. Yu VL, Beam T Jr, Lumish RM, Vickers RM, Fleming J, McDermott C, Romano J. Routine culturing for Legionella in the hospital environment may be a good idea: a three-hospital prospective study. Am J Med Sci. 1987;294(2):97–9.

    Article  CAS  PubMed  Google Scholar 

  37. O’Neill E, Humphreys H. Surveillance of hospital water and primary prevention of nosocomial legionellosis: what is the evidence? J Hosp Infect. 2005;59(4):273–9.

    Article  PubMed  Google Scholar 

  38. CDC CfDCaP: guidelines for environmental infection control in health-care facilities. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) 2003.

    Google Scholar 

  39. Parr A, Whitney E, Berkelman RL. Legionellosis on the rise: a review of guidelines for prevention in the United States. J Public Health Manag Pract. 2015;21(5):E17–26.

    Article  PubMed  PubMed Central  Google Scholar 

  40. Legionellosis: risk management for building water systems. ASHRAE 2015, Standard 188–2015.

    Google Scholar 

  41. Yu V. Resolving the controversy on environmental cultures for Legionella: a modest proposal. Infect Control Hosp Epidemiol. 1998;19(12):893–7.

    Article  CAS  PubMed  Google Scholar 

  42. Patterson WJ, Hay J, McLuckie JC. Colonization of transplant unit water supplies with Legionella and protozoa: precautions required to reduce the risk of legionellosis. J Hosp Infect. 1997;37(1):7–17.

    Article  CAS  PubMed  Google Scholar 

  43. Best M, Yu V, Stout J, Goetz A, Muder RR, Taylor F. Legionellaceae in the hospital water-supply. Epidemiological link with disease and evaluation of a method for control of nosocomial legionnaires’ disease and Pittsburgh pneumonia. Lancet. 1983;2(8345):307–10.

    Article  CAS  PubMed  Google Scholar 

  44. Prevention and control of Legionnaires’ disease [http://www.health.ny.gov/press/releases/2005/2005-08-26_legionnaires/hospital_guidelines_legionella.pdf].

  45. Protection against Legionella [https://www.health.ny.gov/regulations/emergency/docs/protection_against_legionella.pdf].

  46. Services MDoHH: summary of Legionellosis outbreak – Genesee County, June 2014–March 2015.

    Google Scholar 

  47. Yu VL, Plouffe J, Pastoris MC, Stout JE, Schousboe M, Widmer A, Summersgill J, File T, Heath CM, Paterson DL, Chereshsky A. Distribution of Legionella species and serogroups isolated by culture in patients with sporadic community-acquired legionellosis: an international collaborative survey. J Infect Dis. 2002;186(1):127–8.

    Article  PubMed  Google Scholar 

  48. Muder RR, Yu V. Infection due to Legionella species other than L. pneumophila. Clin Infect Dis. 2002;35(8):990–8.

    Article  PubMed  Google Scholar 

  49. Gaia V, Fry N, Harrison TG, Peduzzi R. Sequence-based typing of Legionella pneumophila serogroup 1 offers the potential for true portability in legionellosis outbreak investigation. J Clin Microbiol. 2003;41(7):2932–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Gaia V, Fry N, Afshar B, Lück PC, Meugnier H, Etienne J, Peduzzi R, Harrison TG. Consensus sequence-based scheme for epidemiological typing of clinical and environmental isolates of Legionella pneumophila. J Clin Microbiol. 2005;43(5):2047–52.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Ratzow S, Gaia V, Helbig JH, Fry NK, Lück PC. Addition of neuA, the gene encoding N-acylneuraminate cytidylyl transferase, increases the discriminatory ability of the consensus sequence-based scheme for typing Legionella pneumophila serogroup 1 strains. J Clin Microbiol. 2007;45(6):1965–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  52. EWGLI Sequence-Based Typing (SBT) database for Legionella pneumophila [http://www.hpa-bioinformatics.org.uk/legionella/legionella_sbt/php/sbt_homepage.php].

  53. Lévesque S, Plante P, Mendis N, Cantin P, Marchand G, Charest H, Raymond F, Huot C, Goupil-Sormany I, Desbiens F, Faucher SP, Corbeil J, Tremblay C. Genomic characterization of a large outbreak of Legionella pneumophila serogroup 1 strains in Quebec City, 2012. PLoS One. 2014;9(8):e103852.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Tobiansky L, Drath A, Dubery B, Koornhof HJ. Seasonality of Legionella isolates from environmental sources. Isr J Med Sci. 1986;22(9):640–3.

    CAS  PubMed  Google Scholar 

  55. Initiative ACHDPRH: Updated guidelines for the control of legionella in western Pennsylvania. 2014.

    Google Scholar 

  56. (EWGLI) EWGfLI: EWGLI technical guidelines for the investigation, control and prevention of travel associated Legionnaires’ Disease. 2011, 1.1.

    Google Scholar 

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Authors and Affiliations

  1. Infectious Diseases Section, VA Pittsburgh Healthcare System, University Drive C, Medicine IIIE-U, Pittsburgh, PA, 15240, USA

    Brooke K. Decker & Cornelius J. Clancy

Authors
  1. Brooke K. Decker
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  2. Cornelius J. Clancy
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Correspondence to Brooke K. Decker .

Editor information

Editors and Affiliations

  1. VCUHS Epidemiology and Infection Control, North Hospital, Richmond, Virginia, USA

    Gonzalo Bearman

  2. Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Silvia Munoz-Price

  3. University of Maryland, Baltimore, Maryland, USA

    Daniel J. Morgan

  4. Department of Medical Affairs and Division of Infectious Diseases, Cedars-Sinai Health System, Los Angeles, California, USA

    Rekha K. Murthy

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Decker, B.K., Clancy, C.J. (2018). Testing Water for Legionella Prevention. In: Bearman, G., Munoz-Price, S., Morgan, D., Murthy, R. (eds) Infection Prevention. Springer, Cham. https://doi.org/10.1007/978-3-319-60980-5_25

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  • DOI: https://doi.org/10.1007/978-3-319-60980-5_25

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