October 17, 2014
In 2004, SPL published the first field trial of chlorine dioxide for control of Legionella pneumophila applied to a hospital's secondary water distribution system. (See Keeping Legionella out of Water Systems. Sidari, F.P., Stout, J.E., VanBriesen, J.M., Bowman, A.M., Grubb, D., Neuner, A., Wagener, M.M., Yu, V.L., Journal of the American Water Works Association, Vol. 96, No. 1, pp. 111-119, January 2004.) The results of that 18-month study, which appeared in the Journal AWWA, showed chlorine dioxide was effective in controlling Legionella.
Recently, SPL conducted a case study of that same hospital, which had been using chlorine dioxide since 2000, to validate the conclusions of the 2004 study and evaluate long-term use of this biocide. The article Maintaining Legionella Control in Building Water Systems by Frank P, Sidari III, Janet E Stout. et al., appears in the October issue Journal American Water Works Association.
October 17, 2014
A point-of-use (POU) filter meets manufacturer’s claims for controlling Legionella for 62 days according to a study in the October issue of the American Journal of Infection Control released online.
October 17, 2014 (Pittsburgh)—A Legionella point-of-use (POU) filter meets manufacturer’s claims for controlling the bacteria for 62 days says according to the October issue of the American Journal of Infection Control released online.
Special Pathogens Laboratory researchers, Janet E. Stout, PhD, and Julianne Baron, PhD, collaborated with a cancer center in Northwestern Pennsylvania to evaluate the next generation faucet filter called Q point (Pall Medical).
The 17-week study showed the filter controlled Legionella for 62 days—the first to surpass the 30-day life cycle of other POU filters currently on the market.
According to Dr. Stout, director of Special Pathogens Laboratory, “This new filter could provide a more convenient and cost-effective solution for infection prevention due to exposure to waterborne pathogens like Legionella and Pseudomonas for immune-compromised patients.”
In addition to controlling Legionella, the filter entirely eliminated heterotrophic plate count bacteria—total bacteria in water used as an indicator for biocide effectiveness and water quality—for the first two weeks.
October 09, 2014
Legionella disinfection changes the microbial ecology or microbiome in a hospital hot water system, says a study published in PLOS ONE Journal.
“As secondary disinfection is becoming more widely used to control Legionella, we need to understand how these chemicals change the bacterial flora in the water and what these changes imply,” says Janet E. Stout, PhD, director of Special Pathogens Laboratory.
Dr. Stout, principal investigator of the study, and researcher Julianne Baron, PhD, from the University of Pittsburgh Graduate School of Public Health used next generation molecular sequencing methods—high throughput Illumina 16S rRNA region sequencing and 454 sequencing, to evaluate samples from a hospital’s hot water system treated with onsite monochloramine.
The results in, Shift in the Microbial Ecology of a Hospital Hot Water System Following the Introduction of an On-Site Monochloramine Disinfection System, show an immediate shift in the microbial population or microbiome. These techniques along with traditional culture, showed changes in Legionella, including rebound during a period of ineffective treatment.
“The microbiome of the built environment is a new frontier of science. As science and medicine are exploring how bacteria can impact health, it only makes sense to look at the changes in our drinking water,” says Stout. “More studies are needed to understand the consequences of Legionella disinfection technologies in water systems.”
October 09, 2014
Does holding time, the time it takes to ship and plate water samples for Legionella, impact the accuracy of test results? Can Legionella growth vary so much that culture results are unreliable?
A study published in October's Water Research has debunked these notions. In Effects of holding time and measurement error on culturing Legionella in environmental water samples researchers (Flanders, et al.) found that such assertions result from not factoring in measurement of error.
Measurement of error or measure of uncertainty, a basic scientific principle, provides a statistical range for variation that can occur during ordinary laboratory processes. This ensures that with all microbiological procedures a standard deviation or standard error is factored into test results.
Researchers found that when taking measurement of error into account, holding time had no practical impact on the interpretation of results. In short, there is no race against time. Be assured that shipping your water samples overnight will give you reliable results.
September 26, 2014
The fourth public review of BSR/ASHRAE Standard 188P Legionellosis: Risk Management for Building Water Systems is open for comments on the ASHRAE website. The deadline for comments is midnight November 10, 2014.
You can access the public review draft at on this page: https://osr.ashrae.org/default.aspx.
To give your feedback, just click comment to the left of the standard's title. In order to comment, you will need to create a login account.
July 22, 2014
The agency’s reactive approach to Legionnaires’ disease causes thousands of preventable infections every year.
... Legionella, the cause of Legionnaires’ disease, was originally identified after an outbreak at an American Legion Convention in a Philadelphia hotel in 1976 that killed 34 and sickened 221. The bacterium lurks at low levels in natural fresh water sources (such as rivers, lakes and streams) in virtually every part the world, most often with little impact on humans. It becomes hazardous when it survives municipal water treatments and subsequently contaminates and grows in man-made building water systems such as hot tubs, decorative fountains, shower heads and cooling towers. Left undetected in these locations, it can multiply to high concentrations. People become sickened after inhaling contaminated aerosol droplets generated from these sources.
Unlike most other pneumonias caused by microorganisms, this disease is not transmitted person-to-person; it is purely of environmental origin.
The only way to determine whether a water source is a high-risk Legionella-contaminated system is to take samples of the water to see whether the bacteria grow in a simple and inexpensive culture test in a laboratory.
Although they receive little attention, outbreaks are not uncommon. By far, however, most cases of Legionnaires’ disease are individual sporadic cases that are not known to be associated with larger outbreak clusters, although this may be due to the fact that most sporadic cases are never thoroughly investigated. (Legionnaires’ disease symptoms are similar to other pneumonias and can only be diagnosed by specific laboratory tests.) Estimates of the number of cases annually in the United States range from 8,000 to more than 25,000.
An obvious question is what federal health officials are doing to protect Americans from this disease. The answer is both complicated and puzzling. The approach of the CDC’s National Center for Immunization and Respiratory Diseases (NCIRD), which has the responsibility for Legionnaires’ disease prevention, is flawed. Perhaps that is not surprising, given that prevention appears not to be NDIRD’s strong suit; its officials also recommended eliminating the fourth booster dose for the childhood pneumococcal vaccine although that would reduce the efficacy of vaccination and result in the death of children (the subject of a previous Forbes article).
The CDC’s recommendations for preventing Legionnaires’ disease have been predominantly focused on what might termed a disease surveillance strategy–a reactive process that relies on screening for disease after cases are detected, at which time a response is quickly undertaken to prevent further infections. Although this strategy works well for person-to-person transmissible diseases where the source of the disease is another infected individual, it is not well suited to situations in which the source of disease is in the environment...
July 16, 2014
Infection control workers at UPMC Presbyterian hospital this week found Legionella bacteria in sinks in three patient rooms, but officials said no patients have tested positive for Legionnaires' disease, a potentially fatal pneumonia.
As a preventive measure, officials at the region's largest hospital moved 11 patients from the affected unit to other parts of the hospital, Tami Minnier, UPMC's chief quality officer, said on Tuesday. The patients are being monitored.
Workers identified the Legionella contamination in a pulmonary medicine unit on the hospital's 10th floor, she said. The unit, which houses vulnerable patients with lung disease, recently was remodeled and routine water testing was done when it reopened.
“When you go and look for something really aggressively and you monitor it, and you track it, you find it,” Minnier said. “The most important thing is that when you find it, you remediate it. It does not mean that anything is wrong.”
UPMC reported the Legionella finding to the Allegheny County Health Department and the Pennsylvania Department of Health.
“They're taking appropriate steps to deal with the issue,” said Guillermo Cole, spokesman for the county Health Department.
Legionella occur naturally in the environment, and health experts have said Western Pennsylvania's combination of abundant water and old plumbing can help the bacteria to flourish.
“Regardless of the disinfection technology, because a water distribution system is complex and the water doesn't evenly flow through the system, you may have positivity despite having disinfection,” said Janet Stout, a microbiologist and director of the Special Pathogens Laboratory, Uptown.
July 01, 2014
The University of Pittsburgh flushed plumbing twice this month at the University Club and Family House University Place in Oakland because a resident contracted Legionnaires' disease, officials confirmed on Monday.
It isn't clear whether the person contracted the disease from bacteria-tainted tap water in the building at 123 University Place, said Randy Struk, president-elect of the Family House board. He did not know the person's condition and could not release the name.
The patient was staying at the Family House residence for medical patients and their families. “As far as I'm aware, nothing has been confirmed as linked” to the water supply, Struk said.
Family House leases from Pitt the top four floors of the eight-story University Club building, where the nonprofit community group maintains and rents out 48 bedrooms on a short-term basis. It had the tap water tested for Legionella bacteria on June 16 when workers learned about the lone Legionnaires' diagnosis, Struk said.
When the water tested positive for the bacteria, Pitt heated and flushed pipes on June 20, university spokesman Ken Service said.
Struk said a second heat-and-flush process cleaned the plumbing on Friday because a second test showed small amounts of Legionella might remain
“We have carried out what is believed to be the recommended, standard procedure for addressing Legionella bacteria,” Service said. He said Pitt knew of no similar problems at neighboring buildings.
At the Uptown-based Special Pathogens Laboratory, CEO Janet E. Stout said Family House and Pitt responded well. Her lab handled the water testing, though Stout said she could not comment on the concentration of Legionella it found.
“It was sufficient to warrant a response by the facility,” Stout said. “They took a very aggressive and proactive response, and very rapidly.”
Excerpt from Triblive, Monday, June 30, 2014, by Adam Smeltz
June 23, 2014
The Royal Society of Public Health is offering a free, two-speaker webinar, Water System Microbiological Control Methods, on Wednesday, June 25 at 8 a.m. EST. The webinar is a special session featuring two eminent speakers in order to cover the large and important topic of water system microbiological control methods. Looking first at chemical control methods, Dr Janet Stout will cover the use of chlorine, chlorine dioxide, peracetic acid, sodium hydroxide and monochloramine in relevant environments including pools, dialysis, and birthing pools, as well as looking into the pros and the consequences of chemical control use, including cracking and brittle pipes. Elise Maynard will then cover the physical control methods, looking at point of entry filtration, UV lights, thermal, flushing, re-engineering and point of use filtration.
- Water System Microbiological Chemical Control Methods by Dr. Janet E. Stout, director of Special Pathogens Laboratory
- Water System Microbiological Physical Control Methods by Elise Maynard, Vice-Chair Water Management Society.
Sponsored by Pall Medical, the event is chaired by Dr. Catherine Whapham of Global Marketing Manager for Healthcare Water.
Wednesday, June 25, 8 a.m. EST
June 18, 2014
Public Health England and NHS warn of hazard as newborn needs intensive care after birth in pool infected with bacteria
Public Health England and NHS England issued the warning for pools which have built-in heaters and recirculation pumps and can be filled with water two weeks in advance of the birth.
The alert comes after a case of legionnaires' lung disease was identified in a baby born in a home birth in one of the pools. Water samples confirmed the presence of legionella bacteria.
The child is now in intensive care in hospital. It has been the first reported case of legionnaires' disease linked to a birthing pool in England, PHE said.
Experts are working to establish whether or not the bacteria from the tested home pool is the same strain as that which infected the baby.
Prof Nick Phin, head of legionnaires' disease at PHE, said: "This is an extremely unusual situation, which we are taking very seriously.
"We advise that heated birthing pools, filled in advance of labour and where the temperature is then maintained by use of a heater and pump, are not used in the home setting while we investigate further and until definitive advice on disinfection and safety is available."
NHS England issued a patient safety alert to notify the healthcare system, and midwives in particular, of the possible risk associated with the use of the heated birthing pools at home.
The alert recommends that heated birthing pools are not used for labour or birth. A full risk assessment is being carried out in the meantime.
Excerpt from The Guardian.