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Nosocomial Legionellosis Traced to a Contaminated Ice Machine

Published online by Cambridge University Press:  02 January 2015

Paul S. Graman ,
Gail A. Quinlan  and
June A. Rank
Paul S. Graman*
Affiliation:
Infectious Diseases Unit and Infection Control Program, Department of Medicine, Strong Memorial Hospital, and the University of Rochester School of Medicine and Dentistry, Rochester, New York
Gail A. Quinlan
Affiliation:
Infectious Diseases Unit and Infection Control Program, Department of Medicine, Strong Memorial Hospital, and the University of Rochester School of Medicine and Dentistry, Rochester, New York
June A. Rank
Affiliation:
Infectious Diseases Unit and Infection Control Program, Department of Medicine, Strong Memorial Hospital, and the University of Rochester School of Medicine and Dentistry, Rochester, New York
*
Infectious Diseases Unit, University of Rochester Medical Center, 601 Elmwood Ave, Box 689, Rochester, NY 14642
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Abstract

Objective:

To investigate a case of nosocomial legionellosis, identify pathways of transmission, and effect control of the environmental source.

Design:

Case investigation and environmental culture surveillance.

Setting:

A 720-bed university teaching hospital.

Case Patient:

A ventilator-dependent 66-year-old male developed nosocomial pneumonia due to Legionella pneumophila serogroup 6 after 3 months in an intensive-care unit (ICU). The patient had no intake of potable water except for ice chips from an ice machine in the ICU.

Results:

Cultures revealed L pneumophila serogroup 6 in the ice (4.3 colony-forming units/mL) and ice machine cold water (too numerous to count). Cultures from adjacent hot and cold taps, plus taps located near the patient, all were negative; ice machines and cold water on seven other patient units also were negative. Only sterile water had been used for tube feedings, mouth care, suctioning, and ventilator humidification. Hospital hot water previously had been colonized with L pneumophila serogroup 6, but all surveillance water cultures had been negative since chlorination of the hot-water system began the previous year; cold-water cultures had never before grown Legionella.

The ice machine was disinfected with a 2-hour flush of 2.625% sodium hypochlorite. The supply line to the ice machine was replaced, and the cold-water pipe from the floor below was treated with 83 ppm sodium hypochlorite for 48 hours. All follow-up surveillance cultures of the ice machine remained negative through mid-1996. No additional cases of nosocomial legionellosis occurred.

Conclusions:

Ice machines may be reservoirs of L pneumophila in hospitals. Both ice and water dispensed from these machines may be contaminated, and nosocomial transmission may occur. Successful long-term decontamination and control can be accomplished with shock chlorination.

Type
Originals Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 9 , September 1997 , pp. 637 - 640
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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