Skip directly to site content Skip directly to page options Skip directly to A-Z link Skip directly to A-Z link Skip directly to A-Z link
Volume 21, Number 6—June 2015
Letter

Reducing the Risk for Waterborne Nosocomial Neonatal Legionellosis

On This Page
Article Metrics

Cite This Article

To the Editor: I read with interest the report by Wei et al. (1) regarding 2 cases of neonatal legionellosis associated with infant formula prepared with hospital tap water. Two hospitals were involved, and water samples from both were positive for Legionella pneumophila bacteria that had molecular profiles indistinguishable from those for bacteria from the infected neonates. As Wei et al. (1) and others have established, control of waterborne pathogens, such as Legionella spp., in health care institutions remains a work in progress.

Recently, leading medical centers have recognized the efficacy and cost-effectiveness of performing certain measures to ensure the safety of hospital water. These measures include routine microbial analyses of tap water and use of waterborne pathogen prevention and control measures such as hot water flushing of plumbing; use of chlorination, chlorine dioxide, monochloramine, copper–silver ionization, or ultraviolet light; ozonation; and point-of-use water filtration. Each method has advantages and disadvantages related to ease of implementation, cost, maintenance issues, and short- and long-term effectiveness. Randomized controlled trials comparing the efficacy of these strategies are lacking, but the availability of guidance for using waterborne pathogen prevention and control strategies has resulted in substantial declines in health care–associated legionellosis (2). Efforts at waterborne pathogen detection and control are complicated by the role of biofilm, comprising microbes embedded in the polymeric matrix attached to internal plumbing surfaces, which protects waterborne pathogens from adverse environmental conditions, including antimicrobial agents and systemic controls (e.g., ultraviolet light, metals, acid pH) (2,3).

Prevention of legionnellosis in health care settings offers a clinically beneficial and cost-effective alternative to intermittent case detection and outbreak control. For example, it has been demonstrated that, even in the absence of a recognized outbreak, hospital units caring for immunosuppressed patients can reduce infection rates by using water filtration at the point of use (4). Although further efforts are needed to systematically evaluate Legionella spp. control measures, a progressive approach to prevent health care–associated legionellosis includes routine microbial analysis of tap water in units for patients at high risk for infection, use of systemic water disinfection technology, and use of point-of-use water filtration in units where care is rendered for patients most vulnerable to infection with Legionella spp.

Top

Joseph S. CerviaComments to Author 

Author affiliation: Hofstra–North Shore/Long Island Jewish Health System School of Medicine, Hempstead, New York, USA

Top

References

  1. Wei  SH, Chou  P, Tseng  LR, Lin  HC, Wang  JH, Sheu  JN, Nosocomial neonatal legionellosis associated with water in infant formula, Taiwan. Emerg Infect Dis. 2014;20:19214. DOIPubMed
  2. Donlan  RM. Biofilms: microbial life on surfaces. Emerg Infect Dis. 2002;8:88190. DOIPubMed
  3. Lindsay  D, von Holy  A. Bacterial biofilms within the clinical setting: what healthcare professionals should know. J Hosp Infect. 2006;64:31325. DOIPubMed
  4. Cervia  JS, Farber  B, Armellino  D, Klocke  J, Bayer  RL, McAlister  M, Point-of-use water filtration reduces healthcare-associated infections in bone marrow transplant recipients. Transpl Infect Dis. 2010;12:23841. DOIPubMed

Top

Cite This Article

DOI: 10.3201/eid2106.141779

Related Links

Top

Table of Contents – Volume 21, Number 6—June 2015

Comments

Please use the form below to submit correspondence to the authors or contact them at the following address:

Joseph S. Cervia, Hofstra–North Shore/Long Island Jewish Health System School of Medicine—Infectious Diseases, 400 Community Dr, Manhasset, NY 11030, USA

Send To

character(s) remaining.

Comment submitted successfully, thank you for your feedback.

Top

Page created: May 18, 2015
Page updated: May 18, 2015
Page reviewed: May 18, 2015
The conclusions, findings, and opinions expressed by authors contributing to this journal do not necessarily reflect the official position of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors' affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.
file_external