RESEARCH PAPER
Occurrence of Legionella sp. bacteria in hot water systems in hospitals and nursing homes in the Świętokrzyskie Province of south-eastern Poland
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1
Collegium Medicum, Jan Kochanowski University, Kielce, Poland
2
Institute of Rural Health, Lublin, Poland
3
Medical University, Lublin, Poland
4
International European University, Kyiv, Ukraine
5
Institute of Environmental Protection – National Research Institute (IEP-NRI), Warsaw, Poland
Ann Agric Environ Med. 2023;30(4):654-660
Limitations of the study. The study was based on a
retrospective analysis of hot water test results. Identification
of Legionella bacteria at species level was not performed. In
addition, the study covered only a limited number of facilities
located in one province.
KEYWORDS
TOPICS
ABSTRACT
Introduction and objective:
The occurrence of bacteria of the genus Legionella sp. in hot water supply systems in buildings is a real threat to human health, especially for patients in hospitals and residents of nursing homes. The aim of the study was determination of the degree of colonization of hot water systems in hospitals and nursing homes in the Świętokrzyskie Province in south-east Poland.
Material and methods:
Between 2014 – 2018, samples were collected from hot water systems in 30 hospitals and 32 nursing homes in order to determine the degree of contamination. 631 samples collected of the bacteria Legionella sp were analyzed.
Results:
Excessive contamination (≥ 100CFU/100 ml) with the bacteria Legionella sp. was detected in 12.12% (n=71) of samples. Contamination was significantly more frequently detected in samples from hot water systems in nursing homes, compared to hospitals (16.48% vs. 10.37%). Above-standard contamination of hot water systems with Legionella sp. bacteria occurred in 34.43% of the facilities, and was more frequent in hospitals (41.38%) than in the nursing homes (28.13%). In 21.3% of the facilities, contamination was detected many times during the study period.
Conclusions:
Excessive contamination of hot water systems with Legionella sp. bacteria in the examined facilities was a common phenomenon. The presence of the pathogen in the installations of these facilities may constitute a considerable health hazard for patients and residents.
ACKNOWLEDGEMENTS
Project financed under the program the Minister of Education and Science called “Regional Initiative of Excellence” in the years 2019-2023, project no. 024/RID/2018/19, amount of financing 11 999 000,00 PLN
REFERENCES (42)
1.
European Centre for Disease Prevention and Control. Legionnaires’ disease. In: ECDC. Annual Epidemiological Report for 2021. Stockholm: ECDC; 2023.
5.
Wu HY, Yan H, Zheng ML, Sun MM, Wang Q, Hu CM, Zhan XY, Yuan MG, Qu PH, Hu CH. Legionella qingyii sp. nov., isolated from water samples in China. Int J Syst Evol Microbiol. 2019;69(7):2017–2022.
https://doi.org/10.1099/ijsem.....
8.
Walker JT, McDermott PJ. Confirming the Presence of Legionella pneumophila in Your Water System: A Review of Current Legionella Testing Methods. J AOAC Int. 2021 Aug 20;104(4):1135–1147. doi:
https://10.1093/jaoacint/qsab0....
9.
Graham FF. The mysterious illness that drove them to their knees – Ah, that Legionnaires’ disease – A historical reflection of the work in Legionnaires’ disease in New Zealand (1978 to mid-1990s) and the ‘One Health’ paradigm. One Health 2020;10:100149.
https://doi.org/10.1016/j.oneh....
10.
Potočnjak M, MagdaleniĆ Z, Dijan M, RebiĆ D, Gobin I. Environmental factors affecting the survival of soil dwelling Legionella longbeachae in water. Ann Agric Environ Med. 2016;23(3):452–5.
https://doi.org/10.5604/123219....
11.
Totaro M, Valentini P, Costa A, Frendo L, Cappello A, Casini B, Miccoli M, Privitera G, Baggiani A. Presence of Legionella spp. in Hot Water Networks of Different Italian Residential Buildings: A Three-Year Survey. Inter J Environ Res Public Health. 2017;14(11):1296.
https://doi.org/10.3390%2Fijer....
12.
Wallet F, Fontenay L, Cabanes P-A. Probabilistic Analysis of a French Legionellosis Outbreak Shows Potential Role of Wastewater Basin. Microorganisms. 2022;10(2):422.
https://doi.org/10.3390/microo....
13.
Hamilton KA, Prussin AJ 2nd, Ahmed W, Haas CN. Outbreaks of Legionnaires’ Disease and Pontiac Fever 2006–2017. Curr Environ Health Rep. 2018 Jun;5(2):263–271.
https://doi: 10.1007/s40572-018-0201-4.
14.
Kyritsi MA, Mouchtouri VA, Katsiafliaka A, Kolokythopoulou F, Plakokefalos E, Nakoulas V, Rachiotis G, Hadjichristodoulou C. Clusters of Healthcare-Associated Legionnaires’ Disease in Two Hospitals of Central Greece. Case Rep Infect Dis. 2018;2018:2570758.
https://doi.org/10.1155/2018/2....
15.
Andriesse GI, Verhoef J. Nosocomial pneumonia: rationalizing the approach to empirical therapy. Treat Respir Med. 2006;5(1):11–30.
https://doi.org/10.2165/001518....
16.
Borges V, Nunes A, Sampaio DA, Vieira L, Machado J, Simoes MJ, Gonçalves P, Gomes JP. Legionella pneumophila strain associated with the first evidence of person-to-person transmission of Legionnaires’ disease: a unique mosaic genetic backbone. Sci Rep. 2016;6:26261.
https://doi.org/10.1038/srep26....
17.
Correia AM, Ferreira JS, Borges V, Nunes A, Gomes B, Capucho R, Gonçalves J, Antunes DM, Almeida S, Mendes A, Guerreiro M, Sampaio DA, Vieira L, Machado J, Simões MJ, Gonçalves P, Gomes JP. Probable Person-to-Person Transmission of Legionnaires’ Disease. N Engl J Med. 2016;374(5):497–8.
https://doi.org/10.7717%2Fpeer....
18.
Ziltener P, Reinheckel T, Oxenius A. Neutrophil and Alveolar Macrophage-Mediated Innate Immune Control of Legionella pneumophila Lung Infection via TNF and ROS. PLoS Pathog. 2016 Apr 22;12(4):e1005591. doi:
https://doi.org/10.1371/journa....
20.
Sikora A, Wójtowicz-Bobin M, Sikora A, Kozioł-Montewska M, Strzelec-Nowak D. Microbiological characteristic bacteria of the genus legionella: clinical forms of infection, diagnosis and treatment – part II. Forum Zakażeń 2014;5(2):73–7.
http://dx.doi.org/10.15374/FZ2....
21.
Phin N, Parry-Ford F, Harrison T, Stagg HR, Zhang N, Kumar K, Lortholary O, Zumla A, Abubakar I. Epidemiology and clinical management of Legionnaires’ disease. Lancet Infect Dis. 2014;14(10):1011–21.
https://doi.org/10.1016/s1473-....
22.
Ambrose J, Hampton LM, Fleming-Dutra KE, Marten C, McClusky C, Perry C, Clemmons NA, McCormic Z, Peik S, Mancuso J, Brown E, Kozak N, Travis T, Lucas C, Fields B, Hicks L, Cersovsky SB. Large outbreak of Legionnaires’ disease and Pontiac fever at a military base. Epidemiol Infect. 2014 Nov;142(11):2336–46.
https://doi:10.1017/S095026881....
23.
Tossa P, Deloge-Abarkan M, Zmirou-Navier D, Hartemann P, Mathieu L. Pontiac fever: an operational definition for epidemiological studies. BMC Public Health 2006;6:112.
https://doi.org/10.1186/1471-2....
24.
Palusińska-Szysz M, Cendrowska-Pinkosz M. Występowanie i chorobotwórczość bakterii z rodziny Legionellaceae. Postepy Hig Med Dosw. 2008;62:337–53.
25.
Guidelines for drinking-water quality: Fourth edition incorporating the first and second addenda Geneva: World Health Organization; 2022.
https://www.who.int/publicatio... (access: 09.10.2023).
27.
Rozporządzenie Ministra Zdrowia z dnia 29 marca 2007 r. w sprawie jakości wody przeznaczonej do spożycia przez ludzi (DzU 2007 nr 61 poz. 417)
https://isap.sejm.gov.pl/isap.... (access: 09.10.2023).
28.
Fragou K, Kokkinos P, Gogos C, Alamanos Y, Vantarakis A. Prevalence of Legionella spp. in water systems of hospitals and hotels in South Western Greece. Int J Environ Health Res. 2012;22(4):340–54.
https://doi.org/10.1080/096031....
29.
Stout JE, Muder RR, Mietzner S, Wagener MM, et al. Role of environmental surveillance in determining the risk of hospital-acquired legionellosis: a national surveillance study with clinical correlations. Infect Control Hosp Epidemiol. 2007;28(7):818–24.
https://doi.org/10.1086/518754.
30.
Sarjomaa M, Urdahl P, Ramsli E, Borchgrevink-Lund CF, Ask E. Prevention of Legionnaires’ disease in hospitals. Tidsskr Nor Laegeforen. 2011;131(16):1554–7.
https://doi.org/10.4045/tidssk....
31.
Stout JE, Yu VL. Legionella in the hospital water supply: a plea for decision making based on evidence-based medicine. Infect Control Hosp Epidemiol. 2001;22(11):670–2.
https://doi.org/10.1086/501842.
32.
Napoli C, Fasano F, Iatta R, Barbuti G, Cuna T, Montagna MT. Legionella spp. and legionellosis in southeastern Italy: disease epidemiology and environmental surveillance in community and health care facilities. BMC Public Health. 2010;10:660.
https://doi.org/10.1186/1471-2....
33.
Gładysz I, Sikora A, Wójtowicz-Bobin M, Karczewski J. Legionella spp. in Polish hospitals in 2009–2013 and 2014–2016: An epidemiological analysis. Postepy Hig Med Dosw. 2021;75:85–90.
http://dx.doi.org/10.5604/01.3....
34.
Gładysz I, Karczewski J, Sikora A. Occurrence of Legionella spp. in social welfare homes in Poland. Med Og Nauk Zdr. 2022;28(1):92–94. doi:10.26444/monz/147272.
35.
Szczerbiński R, Karczewski j, Gabrylewska A. Występowanie pałeczek Legionella sp. w instalacjach ciepłej wody użytkowej w zakładach opieki zdrowotnej i domach pomocy społecznej w województwie podlaskim. Probl Hig Epidemiol. 2011;92(4):920–923.
36.
Matejuk A, Posmyk U, Simon K. Występowanie pałeczek Legionella sp. w instalacjach wodnych obiektów użyteczności publicznej w województwie opolskim, w latach 2010–2011. Przegl Epidemiol. 2012;66(4):623–8.
37.
Sikora A, Wójtowicz-Bobin M, Kozioł-Montewka M, Magryś A, Gładysz I. Prevalence of Legionella pneumophila in water distribution systems in hospitals and public buildings of the Lublin region of eastern Poland. Ann Agric Environ Med. 2015;22(2):195–201.
https://doi.org/10.5604/123219....
38.
Stojek NM, Szymanska J, Dutkiewicz J. Gram-negative bacteria in water distribution systems of hospitals. Ann Agric Environ Med. 2008;15(1):135–42.
39.
Patterson WJ, Hay J, Seal DV, McLuckie JC. Colonization of transplant unit water supplies with Legionella and protozoa: precautions required to reduce the risk of legionellosis. J Hosp Infect. 1997;37(1): 7–17.
https://doi.org/10.1016/s0195-....
40.
Deiana G, Arghittu A, Dettori M, Masia MD, Deriu MG, Piana A, Muroni MR, Castiglia P, Azara A. Environmental Surveillance of Legionella spp. in an Italian University Hospital Results of 10 Years of Analysis. Water. 2021;13(16):2304.
https://doi.org/10.3390/w13162....
41.
Abdalla AI, Saidan MN, Al Alami N, Al-Naimat H. Comparative assessment of Legionella pneumophila prevalence among hospitals and hotels water systems. Desalination Water Treat. 2020;193:432–41.
http://dx.doi.org/10.5004/dwt.....