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Frequently Asked Questions (FAQ) from General Information About Legionnaires' Disease
Prevention of hospital-acquired legionellosis More hospitals are facing the dilemma of Legionella outbreaks as they discover the drinking water is the source. This article provides an update of the use of PCR detection for water, the use of CFU/ml vs distal site positivity as an indicator of risk, risk assessment, neurologic complications in patients, and new laboratory tests for patient management.
Controlling Legionella in Hospital Drinking
Water: An Evidence-Based Review of Disinfection Methods "State-of-the-Art” disinfection methods applied to drinking water are reviewed. Many commonly-used approaches are not evidence-based and ineffective but are expensive and logistically tedious to implement. Efficacy must be defined by disappearance of Legionella from the drinking water. Disinfection concentrations and % distal site positivity must be measured regularly for the lifespan of the system. Infection control professionals must take the lead in selecting the disinfection modality and the commercial vendor. Evidence-based medicine with documented record of success should be the criteria for selection; anecdotal testimonials are often unreliable . Healthcare facility managers should be consulted in an advisory role .
Role of Environmental
Surveillance in Determining the Risk of Hospital-Acquired Legionellosis: A
National Surveillance Study With Clinical Correlations In a prospective study involving 20 US hospitals, environmental culturing for Legionella followed by clinical surveillance uncovered cases of hospital-acquired Legionella pneumonia that would have otherwise gone unrecognized.
Environmental
culturing for Legionella: Can we build a better mouse trap? This report discusses best practices for Legionella detection in water systems. Topics include swab vs water, frequency of cultures, which sites to culture, and an overall Action Plan.
Cooling towers and
legionellosis: A conundrum with proposed solutions A skeptical critique of the role of cooling towers in causing Legionnaires' disease.
Legionnaires' Disease in Long-Term Care Facilities: Overview and Proposed
Solutions
Preventing
Legionellosis Community-acquired Legionnaires' disease: Implications for underdiagnosis and laboratory testing by Victor L. Yu and Janet E. Stout (Clin Infect Dis 2008;46:1365-1367)
by Squier CL, Association for Professionals in Infection Control - 3 Rivers Chapter, and the Allegheny County Health Dept. (American Journal of Infection Control, 2005) Health care–acquired legionellosis declined significantly after the issuance of proactive guidelines for routine environmental culturing for Legionella in all Allegheny County healthcare facilities. The decline was due to increasing index of suspicion by physicians and initiation of disinfection methods if indicated. Two unanticipated benefits were (1) cases of legionellosis in the community and long-term care facilities were uncovered and (2) litigation and unfavorable publicity involving ACHD hospitals ceased. Legionella surveillance: political and social implications--a little knowledge is a dangerous thing. by Victor L. Yu (Journal of Infectious Diseases 185:259-261, 2002, University of Chicago Press) Fear of adverse publicity and litigation are obstacles to a rational scientific approach to Legionnaires’ disease prevention. “Surveillance should be complemented by education of the public and lay media. The public must be informed that Legionella are common colonizers (as are Pseudomonas species) of man-made water distribution systems that are rarely pathogenic for immunocompetent hosts and that Legionnaires’ disease is not a contagious disease. Ignorance leads to panic and panic leads to irrational actions. We have observed the implementation of emergency measures that are expensive, logistically tedious, and have little impact on the risk of acquiring Legionnaires’ disease.” Legionnaries' Disease Contracted from Patient Homes: The Coming of the Third Plague? by M.L. Pedro-Botet, Janet E. Stout and Victor L. Yu Eur J Clin Microbiol Infect Dis, 21:699-705, 2002, Springer-Verlag Approaches to Prevention and Control of Legionella Infection - Allegheny County Health Department Guidelines (click to download) Allegheny County Health Department, Pennsylvania. 2nd Edition, January, 1997. Culture Your Water System for Legionella or Not? Yu, V.L., " Resolving the Controversy on Environmental Cultures for Legionella: A Modest Proposal, Infection Control and Hospital Epidemiology, 19, pp. 893-897, 1998 (click to download) This editorial reviews the proactive position of Pittsburgh investigators in prevention of hospital-acquired Legionnaires’ disease. Pittsburgh investigators document that knowledge that the hospital water is colonized is a scientifically-based method that effectively prevents cases of hospital-acquired Legionnaires’ disease. In contrast, U.S. CDC does not favor culturing the hospital water supply unless one or more hospitalized patients contract Legionnaires’ disease. The scientific evidence and effectiveness of both positions is reviewed. On-Line Download Center Publications contains articles from the medical peer-review literature which are available on-line including Clinical Manifestations of Legionnaires' Disease, Disinfection of Legionella in Water Distribution Systems, Laboratory Diagnosis of Legionnaires' Disease, Antibiotic Therapy of Legionnaires' Disease, Epidemiology, Mode of Transmission of Legionnaires' Disease, Environmental Source of Legionella, Other Legionella Species including Pittsburgh Pneumonia Agent (L. micdadei). [more details] Our Mission
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