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Systematic active environmental surveillance successfully identified and controlled the Legionella contamination in the hospital

  • Junya Nakade
    Affiliations
    Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan

    Department of Hospital Pharmacy, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
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  • Yoko Nakamura
    Affiliations
    Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan

    Division of Nursing, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
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  • Yusuke Katayama
    Affiliations
    Division of Nursing, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
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  • Hiroyuki Obata
    Affiliations
    Facilities Department, Takara-machi Facility Support Office, Kanazawa University, Kanazawa, Ishikawa, Japan
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  • Yoshinori Takahashi
    Affiliations
    Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan

    Department of Rheumatology, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
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  • Yoshitaka Zaimoku
    Affiliations
    Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan

    Department of Hematology, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
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  • Yumi Fujii
    Affiliations
    Department of Breast Surgery, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
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  • Yasunori Iwata
    Correspondence
    Corresponding author. Department of Infection Control and Prevention, University Hospital, Department of Nephrology and Laboratory Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
    Affiliations
    Department of Infection Control and Prevention, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan

    Department of Nephrology and Laboratory Medicine, University Hospital, Kanazawa University, Kanazawa, Ishikawa, Japan
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Published:September 29, 2022DOI:https://doi.org/10.1016/j.jiac.2022.09.010

      Abstract

      Introduction

      Legionella disease can manifest as severe respiratory tract infection with a high mortality rate and is sometimes associated with a hospital outbreak by a contaminated water supply. A patient with breast cancer admitted about a month before. High fever was observed 18 days after admission and the Legionella antigen test showed the positive result.

      Methods

      Due to the incidence of Legionella infection, we demonstrated the active surveillance of Legionella contamination in the entire hospital.

      Results

      Cultures of her environmental samples revealed that hot water in two bathrooms were contaminated with Legionella. In our hospital, the hot water is heated and pumped up on the roof and distributed to each room. The contaminated bathrooms were related to the same plumbing. Therefore, we further collected samples throughout the hot water system. Legionella was not detected in the central part of the system. However, we detected Legionella in the hot water sampled from other five rooms, which were also associated with the same plumbing of the two bathrooms. The temperature and chlorine concentration of the hot water were not high enough to inactivate Legionella at the end of the plumbing. After the adjustment of the water temperature and chlorine concentration, Legionella became undetectable. Our prompt and active surveillance successfully identified the plumbing of the hot water system as the source of Legionella contamination and took precautions against future outbreaks.

      Conclusions

      Monitoring of water temperature and chloride concentration at the end of the hot water circulation is important to prevent nosocomial Legionella disease.

      Keywords

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