Hostname: page-component-76fb5796d-5g6vh Total loading time: 0 Render date: 2024-04-27T03:43:24.470Z Has data issue: false hasContentIssue false
  • English
  • Français

Evaluation of a New Monochloramine Generation System for Controlling Legionella in Building Hot Water Systems

Published online by Cambridge University Press:  10 May 2016

Scott Duda ,
Sheena Kandiah ,
Janet E. Stout ,
Julianne L. Baron ,
Mohamed Yassin ,
Marie Fabrizio ,
Juliet Ferrelli ,
Rahman Hariri ,
Marilyn M. Wagener  and
John Goepfert
...Show all authors
Scott Duda
Affiliation:
Special Pathogens Laboratory, Pittsburgh, Pennsylvania
Sheena Kandiah
Affiliation:
University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania
Janet E. Stout*
Affiliation:
Special Pathogens Laboratory, Pittsburgh, Pennsylvania Swanson School of Engineering, Department of Civil and Environmental Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
Julianne L. Baron
Affiliation:
Infectious Diseases and Microbiology Department, University of Pittsburgh, Pittsburgh, Pennsylvania
Mohamed Yassin
Affiliation:
University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania
Marie Fabrizio
Affiliation:
University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania
Juliet Ferrelli
Affiliation:
University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania
Rahman Hariri
Affiliation:
University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania
Marilyn M. Wagener
Affiliation:
Epidemiology Department, University of Pittsburgh, Pittsburgh, Pennsylvania
John Goepfert
Affiliation:
University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania
James Bond
Affiliation:
University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania
Joseph Hannigan
Affiliation:
Klenzoid, Conshohocken, Pennsylvania
Denzil Rogers
Affiliation:
University of Pittsburgh Medical Center Mercy Hospital, Pittsburgh, Pennsylvania
*
Special Pathogens Laboratory, 1401 Forbes Avenue, Suite 209, Pittsburgh, PA 15219 (jstout@specialpathogenslab.com).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To evaluate the efficacy of a new monochloramine generation system for control of Legionella in a hospital hot water distribution system

Setting.

A 495-bed tertiary care hospital in Pittsburgh, Pennsylvania. The hospital has 12 floors covering approximately 78,000 m2.

Methods.

The hospital hot water system was monitored for a total of 29 months, including a 5-month baseline sampling period prior to installation of the monochloramine system and 24 months of surveillance after system installation (postdisinfection period). Water samples were collected for microbiological analysis (Legionella species, Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Acinetobacter species, nitrifying bacteria, heterotrophic plate count [HPC] bacteria, and nontuberculous mycobacteria). Chemical parameters monitored during the investigation included monochloramine, chlorine (free and total), nitrate, nitrite, total ammonia, copper, silver, lead, and pH.

Results.

A significant reduction in Legionella distal site positivity was observed between the pre- and postdisinfection periods, with positivity decreasing from an average of 53% (baseline) to an average of 9% after monochloramine application (P > .05). Although geometric mean HPC concentrations decreased by approximately 2 log colony-forming units per milliliter during monochloramine treatment, we did not observe significant changes in other microbial populations.

Conclusions.

This is the first evaluation in the United States of a commercially available monochloramine system installed on a hospital hot water system for Legionella disinfection, and it demonstrated a significant reduction in Legionella colonization. Significant increases in microbial populations or other negative effects previously associated with monochloramine use in large municipal cold water systems were not observed.

Infect Control Hosp Epidemiol 2014;35(11):1356–1363

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 11 , November 2014 , pp. 1356 - 1363
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Centers for Disease Control and Prevention (CDC). Legionellosis—United States, 2000–2009. MMWR Morb Mortal Wkly Rep 2011;60(32):1083–1086.Google Scholar
2. Allegheny County Health Department. Approaches to the prevention and control of Legionella infection in Allegheny County health care facilities. 2nd ed. Pittsburgh, PA: Allegheny County Health Department, 1997. http://www.legionella.org/achd_guideline.pdf. Accessed April 8, 2014.Google Scholar
3. Veterans Health Administration (VHA). VHA directive 2008-010: prevention of Legionella disease. Washington, DC: Department of Veterans Affairs, 2008. http://www1.va.gov/vhapublications/ViewPublication.asp?pub_ID=1654. Accessed April 8, 2014.Google Scholar
4. Centers for Disease Control and Prevention and the Healthcare Infection Control Practices Advisory Committee. Guidelines for preventing health-care-associated pneumonia, 2003. MMWR Morb Mortal Wkly Rep 2004;53(RR-3):110–113.Google Scholar
5. Lin, YE, Stout, JE, Yu, VL. Controlling Legionella in hospital drinking water: an evidence-based review of disinfection methods. Infect Control Hosp Epidemiol 2011;32(2):166–173.Google Scholar
6. LeChevallier, MW, Cawthon, CD, Lee, RG. Factors promoting survival of bacteria in chlorinated water supplies. Appl Microbiol 1988;54:649–654.Google Scholar
7. Donlan, R, Murga, R, Carpenter, J, Brown, E, Besser, R, Fields, BS. Monochloramine disinfection of biofilm-associated Legionella pneumophila in a potable water model system. In: Marre, R, Abu Kwail, Y, Bartlett, C, et al, eds. Legionella. Washington, DC: American Society for Microbiology, 2002:406–410.Google Scholar
8. Gao, Y, McCall, EC, Stout, JE, Vidic, RD, Yu, VL. Monochloramine and chlorine dioxide as alternative disinfection methods for Legionella control. In: Program and abstracts of the Annual Meeting of the American Water Works Association. Denver, CO: American Water Works Association, 2000.Google Scholar
9. Heffelfinger, JD, Kool, JL, Fridkin, S, et al. Risk of hospital-acquired Legionnaires’ disease in cities using monochloramine versus other water disinfectants. Infect Control Hosp Epidemiol 2003;24:569–574.CrossRefGoogle ScholarPubMed
10. Kool, JL, Carpenter, JC, Fields, BS. Effect of monochloramine disinfection of municipal drinking water on risk of nosocomial Legionnaires’ disease. Lancet 1999;353(9149):272–277.CrossRefGoogle ScholarPubMed
11. Flannery, B, Gelling, LB, Vugia, DJ, et al. Reducing Legionella colonization of water systems with monochloramine. Emer Infect Dis 2006;12:588–596.Google Scholar
12. Marchesi, I, Marchegiano, P, Bargellini, A, et al. Control of Legionella contamination in a hospital water distribution system by monochloramine. Am J Infect Control 2012;40:279–281.Google Scholar
13. Casini, B, Buzzigoli, A, Cristina, ML, et al. Long-term effects of hospital water network disinfection on Legionella and other waterborne bacteria in an Italian University hospital. Infect Control Hosp Epidemiol 2014;35(3):293–299.Google Scholar
14. Ta, AC, Stout, JE, 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;33:2118–2123.Google Scholar
15. US Environmental Protection Agency (EPA). National primary drinking water regulations. EPA 816-F-09–004. May 2009. http://water.epa.gov/drink/contaminants/upload/mcl-2.pdf. Accessed February 14, 2013.Google Scholar
16. Stout, JE, Muder, RR, Mietzner, S, et al. Role of environmental surveillance in determining the risk of hospital-acquired legionellosis: a national surveillance study with clinical correlations. Infect Control Hosp Epidemiol 2007;28(7):818–824.Google Scholar
17. Stout, JE, Yu, VL. Environmental culturing for Legionella: can we build a better mouse trap? Am J Infect Control 2010;38:341–343.Google Scholar
18. Pressman, JG, Lee, WH, Bishop, PL, Wahman, DG. Effect of free ammonia concentration on monochloramine penetration within a nitrifying biofilm and its effect on activity, viability, and recovery. Water Res 2012;46:882–894.Google Scholar
19. Jakubek, D, Guillaume, C, Binet, M, Leblon, G, DuBow, M, Le Brun, M. Susceptibility of Legionella strains to the chlorinated biocide, monochloramine. Microbes Environ 2013;28(3):336–345.Google Scholar
20. Karagiannis, I, Brandsema, P, Van Der Sande, M. Warm, wet weather associated with increased Legionnaires’ disease incidence in The Netherlands. Epidemiol Infect 2009;137(2):181–187.Google Scholar
21. Pryor, M, Springthorpe, S, Riffard, S, et al. Investigation of opportunistic pathogens in municipal drinking water under different supply and treatment regimes. Water Sci Tech 2004;50(1):83–90.Google Scholar
22. Zhang, Z, McCann, C, Hanrahan, J, et al. Legionella control by chlorine dioxide in hospital water systems. JAWWA 2009;101(5):117–127.Google Scholar
23. Hicks, LA, Travis, T, Witherell, LE, et al. Evaluation of the impact of monochloramine introduction on Legionella colonization in a hospital potable water system. In: Program and abstracts of the 19th Annual Meeting of the Society for Healthcare Epidemiology of America, San Diego, CA, March 19–22, 2009.Google Scholar
24. Chaberny, A, Iris, F, Gastemeier, P. Should electronic faucets be recommended in hospitals? Infect Control Hosp Epidemiol 2004;25:997–1000.Google Scholar
25. Halabi, M, Wiesholzer-Pittly, M, Schoeberly, J, Mittermayerz, H. Non-touch fittings in hospitals: a possible source of Pseudomonas aeruginosa and Legionella spp. J Hosp Infect 2001;49:117–121.Google Scholar
26. Leprat, R, Denizot, V, Bertrand, X, Talon, B. Non-touch fittings in hospitals: a possible source of Pseudomonas aeruginosa and Legionella spp. J Hosp Infect 2003;53:77–82.Google Scholar
27. Sydnor, RM, Bova, G, Gimburg, A, Cosgrove, SE, Perl, TM, Maragakis, LL. Electronic-eye faucets: Legionella species contamination in healthcare settings. Infect Control Hosp Epidemiol 2012;33(3):235–240.Google Scholar
28. Stout, JE, Yu, VL. 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 2003;24:563–568.Google Scholar