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Nosocomial Legionellosis Associated with Aspiration of Nasogastric Feedings Diluted in Tap Water

Published online by Cambridge University Press:  02 January 2015

Richard A. Venezia ,
Marjorie D. Agresta ,
Eileen M. Hanley ,
K. Urquhart  and
D. Schoonmaker
Richard A. Venezia*
Affiliation:
Department of Epidemiology, Albany Medical Center, Albany, New York
Marjorie D. Agresta
Affiliation:
Department of Epidemiology, Albany Medical Center, Albany, New York
Eileen M. Hanley
Affiliation:
Department of Epidemiology, Albany Medical Center, Albany, New York
K. Urquhart
Affiliation:
Department of Environmental Health, Albany Medical Center, Albany, New York
D. Schoonmaker
Affiliation:
The Wadsworth Laboratories, The New York State Department of Health, Albany, New York
*
Department of Epidemiology, A-45, Albany Medical Center, Albany, NY 12208. 94-OA-02
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Abstract

Problem:

Two cases of nosocomial legionellosis due to Legionella pneumophila serogroup 6 (Lp6) were identified in the intensive care unit. Both patients had a history of aspiration of nasogastric tube feedings, developed pulmonary infiltrates, had positive cultures for Lp6, had serological titer rises to Legionella, were treated, and recovered.

Method:

Isolates of Lp6 from the potable water system and patients were characterized by DNA restriction enzyme analyses using pulsed-field gel electrophoresis (PFGE).

Results:

Water samples grew >1O4 CFU/L of Lp6, and the same PFGE pattern was observed with the patient and water isolates. Potable water was used only for delivering medications and diluting feeding solutions given through the nasogastric tubes of the patients. Heat shock of the hot water system (140° to 160°F or 60° to 7O°C, 4 hours) was performed and the temperature was maintained between 131° to 140°F (55° to 60°C). Surveillance over 18 months revealed a reduction in Legionella to <102 CFU/L.

Conclusion:

We speculate that nosocomial Legionella pneumonia occurred due to aspiration of nasogastric tube solutions diluted with tap water. A nursing practice change to use only sterile water to dilute feedings and flush medications for nasogastric administration was instituted. The hot water temperature at the faucet was increased to ≥131°F (≥60°C) to control Legionella. No further nosocomial cases have occurred.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 15 , Issue 8 , August 1994 , pp. 529 - 533
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1994

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