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Outbreak of Legionnaires' disease at University Hospital, Nottingham. Epidemiology, microbiology and control

Published online by Cambridge University Press:  15 May 2009

A. Colville
Affiliation:
Department of Microbiology andPublic Health Laboratory
J. Crowley
Affiliation:
Environmental Microbiology Reference Unit, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH
D. Dearden
Affiliation:
Department of Microbiology andPublic Health Laboratory
R. C. B. Slack
Affiliation:
Department of Microbiology andPublic Health Laboratory
J. V. Lee
Affiliation:
Environmental Microbiology Reference Unit, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH
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Summary

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Twelve patients in a large teaching hospital contracted Legionnaires' disease over a period of 11 months. The source was a domestic hot water system in one of the hospital blocks, which was run at a temperature of 43 °C. Five different subtypes of Legionella pneumophila serogroup 1 have been isolated from water in different parts of the hospital, over a period of time. Only one subtype, Benidorm RFLP 14, was implicated in disease. Circumstantial evidence suggested that the outbreak may have been due to recent colonization of the hot water system with a virulent strain of Legionella pneumophila. The outbreak was controlled by raising the hot water temperature to 60 °C, but careful surveillance uncovered two further cases in the following 30 months. Persistent low numbers of Legionella pneumophila were isolated from the domestic hot water of wards where Legionnaires' disease had been contracted, until an electrolytic unit was installed releasing silver and copper ions into this supply.

Type
Research Article
Copyright
Copyright © Cambridge University Press 1993

References

REFERENCES

1.Bartlett, CLR, Kurtz, JB, Hutchison, JGP, Turner, GC, Wright, AE. Legionella in hospital and hotel water supplies. Lancet 1983; ii: 1315.CrossRefGoogle Scholar
2.Dennis, PJ, Taylor, JA, Fitzgeorge, RB, Bartlett, CLR, Barrow, GI. Legionella pneumophila in water plumbing systems. Lancet 1982; i: 949–51.CrossRefGoogle Scholar
3.Second Report of the Committee of Inquiry into the Outbreak of Legionnaires' Disease in Stafford 1985. London: HMSO. 1985.Google Scholar
4.Macrae, AD, Lewis, MJ. Legionnaires' Disease in Nottingham. Lancet 1977; ii: 1225–6.CrossRefGoogle Scholar
5.Macfarlane, JT, Ward, MJ, Finch, RG, Macrae, AD. Hospital study of adult community-acquired pneumonia. Lancet 1982; ii: 255–8.CrossRefGoogle Scholar
6.Joly, JR. McKinney, RM. Tobin, JO, Bibb, WF. Watkins, ID. Ramsey, D. Development of a standardized subgrouping scheme for Legionella pneumophila serogroup 1 using monoclonal antibodies. J Clin Microbiol 1986; 23: 768–71.CrossRefGoogle ScholarPubMed
7.Saunders, NA, Harrison, TG, Haththotuwa, A, Kachwalla, N, Taylor, AG. A method for typing strains of Legionella pneumophila serogroup 1 by analysis of restriction fragment length polymorphisms. J Med Microbiol 1990; 31: 4555.CrossRefGoogle ScholarPubMed
8. Anon. DHSS Code of practice – the control of legionella in health care premises. London: HMSO. 1988.Google Scholar
9. Anon. The water supply (water quality) regulations 1989. statutory instrument 1989 No. 1147. London: HMSO. 1989.Google Scholar
10.Fischer-Hoch, SP, Bartlett, CLR, Tobin, JO'H. et al. Investigation and control of an outbreak of Legionnaires' Disease in a district general hospital. Lancet 1981: i: 932–6.CrossRefGoogle Scholar
11.Tobin, JO'H, Beare, J, Dunnill, MS, et al. Legionnaires' Disease in a transplant unit: isolation of the causative agent from shower baths. Lancet 1980; ii: 118–21.CrossRefGoogle Scholar
12.Johnson, JT, Yu, VL, Best, MG. et al. Nosocomial legionellosis in surgical patients with head and neck cancer: implications for epidemiological reservoir and mode of transmission. Lancet 1985: ii: 298300.CrossRefGoogle Scholar
13.Moiraghi, Ruggenini A, Castellani, Pastoris M, Dennis, PJ. et al. Legionella pneumophila in a hospital in Turin. Italy. A retrospective one year study. Epidemiol Infect 1989: 102: 21–9.Google Scholar
14.Meenhorst, PL, Reingold, AL, Groothuis, DG. et al. Water related nosocomal pneumonia caused by Legionella pneumophila serogroups 1 and 10. J Inf Dis 1985: 152: 356–64.CrossRefGoogle Scholar
15.Fischer-Hoch, SP, Smith, MG, Colbourne, JS. Legionella pneumophila in hospital hot water cylinders. Lancet 1982: i: 1073.CrossRefGoogle Scholar
16.Ezzeddine, H, van Ossel, C, Delmee, M, Wauters, G. Legionella spp. in a hospital hot water system: effect of control measures. J Hosp Infect 1989: 13: 121–31.CrossRefGoogle Scholar
17.O'Mahony, MC. Stanwell-Smith, RE, Tillett, HE. et al. The Stafford outbreak of Legionnaires' disease. Epidemiol Infect 1990: 104: 361–80.CrossRefGoogle ScholarPubMed
18.Timbury, MC, Donaldson, JR, McCartney, AC. et al. Outbreak of Legionnaires' disease in Glasgow Royal Infirmary: microbiological aspects. J Hyg 1986: 97: 393403.CrossRefGoogle Scholar
19.Plouffe, JF, Para, MF, Maher, WE, Hackman, B. Webster, L. Subtypes of Legionella pneumophila serogroup 1 associated with different attack rates. Lancet 1983: ii: 649–50.CrossRefGoogle Scholar
20.Watkins, ID, Tobin, JO'H, Dennis, PJ, Brown, W, Newnham, R, Kurtz, JB. Legionella pneumophila serogroup 1 subgrouping by monoclonal antibodies: an epidemiological tool. J Hyg 1985; 95: 211–6.CrossRefGoogle ScholarPubMed
21.Ruf, B, Schurmann, D, Horbach, I, Seidel, K, Pohle, HD. Nosocomial legionella pneumonia: demonstrable potable water as the source of infection. Epidemiol Infect 1988; 101: 647–51.CrossRefGoogle ScholarPubMed
22.Dournon, E, Bibb, WF, Rajagopalan, P, Desplaces, N, McKinney, RM. Monoclonal antibody reactivity as a virulence marker for Legionella pneumophila serogroup 1 strains. J Infect Dis 1988; 157: 496501.CrossRefGoogle ScholarPubMed
23.Ribeiro, CD, Burge, SH, Palmer, SR, Tobin, JO'H. Watkins, ID. Legionella pneumophila in a hospital hot water system following a nosocomial outbreak: prevalence. monoclonal antibody subgrouping. effect of control measures. Epidemiol Infect 1987: 98: 253–62.CrossRefGoogle Scholar
24.Dowling, JN, Saha, AK, Glew, RH. Virulence factors of the family Legionellaceae. Microbiol Rev 1992: 56: 3260.CrossRefGoogle ScholarPubMed