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A 17-Month Evaluation of a Chlorine Dioxide Water Treatment System to Control Legionella Species in a Hospital Water Supply

Published online by Cambridge University Press:  02 January 2015

Arjun Srinivasan ,
Gregory Bova ,
Tracy Ross ,
Karen Mackie ,
Nicholas Paquette ,
William Merz  and
Trish M. Perl
Arjun Srinivasan
Affiliation:
Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland Hospital Epidemiology and Infection Control, Johns Hopkins Medical Institutions, Baltimore, Maryland
Gregory Bova
Affiliation:
Facilities Engineering, Johns Hopkins Medical Institutions, Baltimore, Maryland
Tracy Ross
Affiliation:
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
Karen Mackie
Affiliation:
Hospital Epidemiology and Infection Control, Johns Hopkins Medical Institutions, Baltimore, Maryland
Nicholas Paquette
Affiliation:
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
William Merz
Affiliation:
Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, Maryland
Trish M. Perl*
Affiliation:
Department of Medicine, Division of Infectious Diseases, Johns Hopkins Medical Institutions, Baltimore, Maryland Hospital Epidemiology and Infection Control, Johns Hopkins Medical Institutions, Baltimore, Maryland
*
Johns Hopkins Hospital, 600 N. Wolfe St., Osler Building, Room 425, Baltimore, MD 21287
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Abstract

Objective:

To assess the safety and efficacy of a chlorine dioxide water treatment system in controlling Legionella in a hospital water supply.

Design:

For 17 months following installation of the system, we performed regular water cultures throughout the building, assessed chlorine dioxide and chlorite levels, and monitored metal corrosion.

Results:

Sites that grew Legionella species decreased from 41% at baseline to 4% (P = .001). L. anisa was the only species recovered and it was found in samples of both hot and cold water. Levels of chlorine dioxide and chlorite were below Environmental Protection Agency (EPA) limits for these chemicals in potable water. Further, enhanced carbon filtration effectively removed the chemicals, even at chlorine dioxide levels of more than twice what was used to treat the water. After 9 months, corrosion of copper test strips exposed to the chlorine dioxide was not higher than that of control strips. During the evaluation period, there were no cases of nosocomial Legionella in the building with the system, whereas there was one case in another building.

Conclusions:

Our results indicate that operation of a chlorine dioxide system effectively removed Legionella species from a hospital water supply. Furthermore, we found that the system was safe, as levels of chlorine dioxide and chlorite were below EPA limits. The system did not appear to cause increased corrosion of copper pipes. Our results indicate that chlorine dioxide may hold promise as a solution to the problem of Legionella contamination of hospital water supplies.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 8 , August 2003 , pp. 575 - 579
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Stout, JE, Yu, VL. Nosocomial Legionella infection. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Philadelphia: Lippincott, Williams and Wilkins; 1999.Google Scholar
2.Johnson, JT, Yu, VL, Best, MG, et al.Nosocomial legionellosis in patients with head and neck cancer: implications for epidemiological reservoir and mode of transmission. Lancet 1985;2:298–300.CrossRefGoogle ScholarPubMed
3.Kool, JL, Fiore, AE, Kioski, CM, et al.More than 10 years of unrecognized nosocomial transmission of legionnaires' disease among transplant patients. Infect Control Hosp Epidemiol 1998;19:898–904.CrossRefGoogle ScholarPubMed
4.Lepine, L, Jernigan, DB, Butler, JC, et al.A recurrent outbreak of nosocomial legionnaires' disease detected by urinary antigen testing: evidence for long-term colonization of a hospital plumbing system. Infect Control Hosp Epidemiol 1998;19:905–910.CrossRefGoogle ScholarPubMed
5.Her Majesty's Stationery Office. Second Report of the Committee of Inquiry Into the Outbreak of Legionnaire's Disease in Stafford in April 1985, London, England. London: Her Majesty's Stationery Office; 1987.Google Scholar
6.Yu, VL, Nguyen, MLT. Legionnaire's disease: new insights. Clin Chest Med 1991;12:257–268.Google Scholar
7.Yu, VL. Resolving the controversy on environmental cultures of Legionella: a modest proposal. Infect Control Hosp Epidemiol 1998;19:893–897.Google Scholar
8.Lin, YE, Vidic, RD, Stout, JE, Yu, VL. Legionella in water distribution systems. Journal of the American Water Works Association 1998;90:112–121.Google Scholar
9.Stout, JE, Yu, VL. Legionellosis. N Engl J Med 1997;337:682–687.Google Scholar
10.Joseph, CA, Watson, JM, Harrison, TG, Bartlett, CLR. Nosocomial legionnaires' disease in England and Wales, 1980-1992. Epidemiol Infect 1994;112:329–345.Google Scholar
11.Environmental Protection Agency. National primary drinking water regulations. Federal Register 2002;67:14502. Codified at 40 CFR §141.Google Scholar
12.Chang, SL. The safety of water disinfection. Ann Rev Public Health 1982;3:393–418.CrossRefGoogle ScholarPubMed
13.Kallen, BA, Robert, E. Drinking water chlorination and delivery outcome: a registry based study in Sweden. Reprod Toxicol 2000;14:303.Google Scholar
14.Wondergem, E, van Dijk-Looijaard, AM. Chlorine dioxide as a post-disinfectant for Dutch drinking water. Sci Total Environ 1991;102:101–112.Google Scholar
15.Kanitz, S, Franco, Y, Patrone, V, et al.Association between drinking water disinfection and somatic parameters at birth. Environ Health Perspect 1996;104:516–520.Google Scholar
16.Hamilton, E, Seal, DV, Hay, J. Comparison of chlorine dioxide and chlorine for control of Legionella in a hospital potable water supply. J Hosp Infect 1996;32:156–160.Google Scholar
17.Hood, J, Cheape, G, Mead, A, Curran, E. Six years' experience with chlorine dioxide in the control of Legionella pneumophila in the potable water supply of Glasgow Royal Infirmary. Presented at 4th Decennial Conference on Nosocomial and Healthcare Associated Infections; March 7, 2000; Atlanta, GAGoogle Scholar
18.Environmental Protection Agency. Standard Methods for the Examination of Water and Wastewater, 20th ed. Washington, DC: Environmental Protection Agency.Google Scholar
19.Environmental Protection Agency. National primary drinking water regulations. Federal Register 2002;67:14502. Codified at 40 CFR §141.53 and §141.54.Google Scholar
20.Moore, GS, Calabrese, EJ, Ho, SC. Groups at potentially high risk from chlorine dioxide treated water. J Environ Pathol Toxicol 1980;4:465–470.Google Scholar
21.Calabrese, EJ, Moore, G, Brown, R. Effects of environmental oxidant stressors on individuals with a G6PD deficiency with particular reference to an animal model. Environ Health Perspect 1979;29:49–55.CrossRefGoogle ScholarPubMed
22.Ames, RG, Stratton, JW. Effect of chlorine dioxide disinfection on hematologic and serum parameters of renal dialysis patients. Arch Environ Health 1987;42:280–285.Google Scholar
23.Smith, RP, Willhite, CC. Chlorine dioxide and hemodialysis. Regul Toxicol Pharmacol 1990;11:42–62.Google Scholar
24.Rohr, U, Senger, M, Selenka, F, Turley, R, Wilhelm, M. Four years of experience with silver-copper ionization for control of Legionella in a German university hospital hot water system. Clin Infect Dis 1999;29:1507–1511.Google Scholar