Hostname: page-component-586b7cd67f-l7hp2 Total loading time: 0 Render date: 2024-11-28T00:42:18.822Z Has data issue: false hasContentIssue false
  • English
  • Français

Nosocomial Legionellosis Traced to a Contaminated Ice Machine

Published online by Cambridge University Press:  02 January 2015

Paul S. Graman ,
Gail A. Quinlan  and
June A. Rank
Paul S. Graman*
Affiliation:
Infectious Diseases Unit and Infection Control Program, Department of Medicine, Strong Memorial Hospital, and the University of Rochester School of Medicine and Dentistry, Rochester, New York
Gail A. Quinlan
Affiliation:
Infectious Diseases Unit and Infection Control Program, Department of Medicine, Strong Memorial Hospital, and the University of Rochester School of Medicine and Dentistry, Rochester, New York
June A. Rank
Affiliation:
Infectious Diseases Unit and Infection Control Program, Department of Medicine, Strong Memorial Hospital, and the University of Rochester School of Medicine and Dentistry, Rochester, New York
*
Infectious Diseases Unit, University of Rochester Medical Center, 601 Elmwood Ave, Box 689, Rochester, NY 14642
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate a case of nosocomial legionellosis, identify pathways of transmission, and effect control of the environmental source.

Design:

Case investigation and environmental culture surveillance.

Setting:

A 720-bed university teaching hospital.

Case Patient:

A ventilator-dependent 66-year-old male developed nosocomial pneumonia due to Legionella pneumophila serogroup 6 after 3 months in an intensive-care unit (ICU). The patient had no intake of potable water except for ice chips from an ice machine in the ICU.

Results:

Cultures revealed L pneumophila serogroup 6 in the ice (4.3 colony-forming units/mL) and ice machine cold water (too numerous to count). Cultures from adjacent hot and cold taps, plus taps located near the patient, all were negative; ice machines and cold water on seven other patient units also were negative. Only sterile water had been used for tube feedings, mouth care, suctioning, and ventilator humidification. Hospital hot water previously had been colonized with L pneumophila serogroup 6, but all surveillance water cultures had been negative since chlorination of the hot-water system began the previous year; cold-water cultures had never before grown Legionella.

The ice machine was disinfected with a 2-hour flush of 2.625% sodium hypochlorite. The supply line to the ice machine was replaced, and the cold-water pipe from the floor below was treated with 83 ppm sodium hypochlorite for 48 hours. All follow-up surveillance cultures of the ice machine remained negative through mid-1996. No additional cases of nosocomial legionellosis occurred.

Conclusions:

Ice machines may be reservoirs of L pneumophila in hospitals. Both ice and water dispensed from these machines may be contaminated, and nosocomial transmission may occur. Successful long-term decontamination and control can be accomplished with shock chlorination.

Type
Originals Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 9 , September 1997 , pp. 637 - 640
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Estein, PH. Legionnaires' disease. Clin Infect Dis 1993;16:741–747.Google Scholar
2. Mastro, TD, Fields, BS, Breiman, RF, Campbell, J, Plikaytis, BD, Spika, JS. Nosocomial legionnaires' disease and use of medication nebulizers. J Infect Dis 1991;163:667–671.CrossRefGoogle ScholarPubMed
3. Blatt, SP, Parkinson, MD, Pace, E, et al. Nosocomial legionnaires' disease: aspiration as a primary mode of disease acquisition. Am J Med 1993;95:16–22.CrossRefGoogle ScholarPubMed
4. Stout, JE, Yu, VL, Muraca, P. Isolation of Legionella pneumophila from the cold water of hospital ice machines: implications for origin and transmission of the organism. Infect Control 1985;6:141–146.CrossRefGoogle ScholarPubMed
5. Bangsborg, JM, Uldum, S, Jensen, JS, Bruun, BG. Nosocomial legionellosis in three heart-lung transplant patients: case reports and environmental observations. Eur J Clin Microbiol Infect Dis 1995;14:99–104.CrossRefGoogle ScholarPubMed
6. Gahrn-Hansen, B, Uldum, SA, Schmidt, J, Nielsen, B, Birkeland, SA, Jorgensen, KA. Nosocomial Legionella pneumophila infection in a nephrology department. Ugesfrift for Laeger 1995;157:590–594.Google Scholar
7. Urban, MA, Graman, PS, Hardy, DJ, Menegus, MA. Prospective surveillance for Legionella pneumophila in respiratory specimens in a university hospital. In: Program and Abstracts of the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy; New Orleans, LA; American Society for Microbiology; 10 17-20, 1993. Abstract 864.Google Scholar
8. Muraca, PW, Yu, VL, Goetz, A. Disinfection of water distribution systems for Legionella: a review of application procedures and methodologies. Infect Control Hosp Epidemiol 1990;11:79–88.CrossRefGoogle ScholarPubMed
9. Helms, CM, Massanari, RM, Wenzel, RP, Pfaller, MA, Moyer, NP Hall, N. Legionnaires' disease associated with a hospital water system: a five-year progress report on continuous hyperchlo-rination. JAMA 1988;259:2423–2427.CrossRefGoogle Scholar
10. Snyder, MB, Siwicki, M, Wireman, J, et al. Reduction in Legionella pneumophila through heat flushing followed by continuous supplemental chlorination of hospital hot water. J Infect Dis 1990;162:127–132.CrossRefGoogle ScholarPubMed
11. Marrie, TJ, Haldane, D, MacDonald, S, et al. Control of endemic nosocomial legionnaires' disease by using sterile potable water for high risk patients. Epidemiol Infect 1991;107:591–605.CrossRefGoogle ScholarPubMed