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Xi H, Ross KE, Hinds J, Molino PJ, Whiley H. Efficacy of chlorine-based disinfectants to control Legionella within premise plumbing systems. WATER RESEARCH 2024; 259:121794. [PMID: 38824796 DOI: 10.1016/j.watres.2024.121794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 05/14/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024]
Abstract
Legionella is an opportunistic waterborne pathogen that causes Legionnaires' disease. It poses a significant public health risk, especially to vulnerable populations in health care facilities. It is ubiquitous in manufactured water systems and is transmitted via inhalation or aspiration of aerosols/water droplets generated from water fixtures (e.g., showers and hand basins). As such, the effective management of premise plumbing systems (building water systems) in health care facilities is essential for reducing the risk of Legionnaires' disease. Chemical disinfection is a commonly used control method and chlorine-based disinfectants, including chlorine, chloramine, and chlorine dioxide, have been used for over a century. However, the effectiveness of these disinfectants in premise plumbing systems is affected by various interconnected factors that can make it challenging to maintain effective disinfection. This systematic literature review identifies all studies that have examined the factors impacting the efficacy and decay of chlorine-based disinfectant within premise plumbing systems. A total of 117 field and laboratory-based studies were identified and included in this review. A total of 20 studies directly compared the effectiveness of the different chlorine-based disinfectants. The findings from these studies ranked the typical effectiveness as follows: chloramine > chlorine dioxide > chlorine. A total of 26 factors were identified across 117 studies as influencing the efficacy and decay of disinfectants in premise plumbing systems. These factors were sorted into categories of operational factors that are changed by the operation of water devices and fixtures (such as stagnation, temperature, water velocity), evolving factors which are changed in-directly (such as disinfectant concentration, Legionella disinfectant resistance, Legionella growth, season, biofilm and microbe, protozoa, nitrification, total organic carbon(TOC), pH, dissolved oxygen(DO), hardness, ammonia, and sediment and pipe deposit) and stable factors that are not often changed(such as disinfectant type, pipe material, pipe size, pipe age, water recirculating, softener, corrosion inhibitor, automatic sensor tap, building floor, and construction activity). A factor-effect map of each of these factors and whether they have a positive or negative association with disinfection efficacy against Legionella in premise plumbing systems is presented. It was also found that evaluating the effectiveness of chlorine disinfection as a water risk management strategy is further complicated by varying disinfection resistance of Legionella species and the form of Legionella (culturable/viable but non culturable, free living/biofilm associated, intracellular replication within amoeba hosts). Future research is needed that utilises sensors and other approaches to measure these key factors (such as pH, temperature, stagnation, water age and disinfection residual) in real time throughout premise plumbing systems. This information will support the development of improved models to predict disinfection within premise plumbing systems. The findings from this study will inform the use of chlorine-based disinfection within premise plumbing systems to reduce the risk of Legionnaires disease.
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Affiliation(s)
- Hao Xi
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia; Enware Pty Ltd, Caringbah, NSW, Australia.
| | - Kirstin E Ross
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia
| | - Jason Hinds
- ARC Training Centre for Biofilm Research and Innovation, Flinders University, Bedford Park, SA, Australia; Enware Pty Ltd, Caringbah, NSW, Australia
| | | | - Harriet Whiley
- College of Science and Engineering, Flinders University, Bedford Park, SA, Australia; ARC Training Centre for Biofilm Research and Innovation, Flinders University, Bedford Park, SA, Australia
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Doménech-Sánchez A, Laso E, Albertí S. Prevalence and Control of Pseudomonas aeruginosa in Tourist Facilities across the Canary Islands, Spain. Pathogens 2024; 13:501. [PMID: 38921799 PMCID: PMC11207077 DOI: 10.3390/pathogens13060501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/07/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024] Open
Abstract
Pseudomonas aeruginosa is a common pathogen associated with recreational water facilities and poses risks to public health. However, data on the prevalence of P. aeruginosa in tourist destinations like the Canary Islands, Spain, remain limited. We assessed P. aeruginosa prevalence in 23 tourist facilities from 2016 to 2019. Compliance with water quality standards was evaluated, and 3962 samples were collected and analyzed. We examined different types of recreational water installations, including outer swimming pools, whirlpools, and cold wells. Of the sampled facilities, 31.2% did not comply with the current legislation's parametric values, mainly due to inadequate disinfectant levels, water temperature, and P. aeruginosa presence. The prevalence of P. aeruginosa was 4.8%, comparable to some European countries but lower than others. Cold wells displayed the highest non-compliance rate (89.2%) and yet exhibited a lower P. aeruginosa prevalence (1.9%) than outer swimming pools and whirlpools. Children's presence did not significantly impact P. aeruginosa contamination. Chlorine-based disinfectants are more effective than bromine-based ones in controlling P. aeruginosa. Regional variability in contamination was observed, with Fuerteventura showing lower colonization rates. Disinfectant levels play a critical role in P. aeruginosa control, and maintaining adequate levels is essential, particularly in bromine-treated installations. Our findings provide valuable insights into the prevalence and distribution of P. aeruginosa in recreational waters within tourist facilities. Tailored strategies are needed to ensure water safety in different Spanish regions. Continued monitoring and assessment, combined with artificial intelligence and machine learning, will enable the implementation of targeted interventions to protect the health of recreational water users.
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Affiliation(s)
- Antonio Doménech-Sánchez
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Universidad de las Islas Baleares, Carretera de Valldemossa km 7.5, 07122 Palma de Mallorca, Spain;
- Saniconsult Ibérica SL, Can Foradí 37 bajos, 07009 Palma de Mallorca, Spain;
- Instituto de Investigación Sanitaria de les Illes Balears (IdIsBa), Edificio S, Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain
| | - Elena Laso
- Saniconsult Ibérica SL, Can Foradí 37 bajos, 07009 Palma de Mallorca, Spain;
| | - Sebastián Albertí
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Universidad de las Islas Baleares, Carretera de Valldemossa km 7.5, 07122 Palma de Mallorca, Spain;
- Instituto de Investigación Sanitaria de les Illes Balears (IdIsBa), Edificio S, Hospital Universitario Son Espases, Carretera de Valldemossa 79, 07120 Palma de Mallorca, Spain
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Di Onofrio V, Pagano M, Santulli M, Rossi A, Liguori R, Di Dio M, Liguori G. Contamination of Hotel Water Distribution Systems by Legionella Species: Environmental Surveillance in Campania Region, South Italy. Microorganisms 2023; 11:1840. [PMID: 37513012 PMCID: PMC10385258 DOI: 10.3390/microorganisms11071840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/13/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic period was marked by the absence or reduced circulation of some infectious diseases. Legionellosis may have been affected by the prevention measures adopted to counter COVID-19. Legionellosis is a form of pneumonia interstitial that is normally transmitted via aerosol-containing bacteria (genus Legionella), that could be present in contaminated water sources and is often associated with travel and with staying in hotels. In this work, the data of the environmental surveys carried out by ARPA Campania in accommodation facilities since 2019 were analyzed for a better understanding of the dispersion patterns of L. pneumophila associated with the environment and to evaluate the variation of the data during the pandemic period. The aim was to provide a better understanding of Legionella at different geographic scales and to define a predictive epidemiological method. Results: In 2019, the Legionella genus contaminated 37.7% of all tourist facilities evaluated. In 2020, the Legionella genus contaminated 44.4% of all tourist facilities evaluated. In 2021, the Legionella genus contaminated 54.2% of all tourist facilities evaluated. Conclusions: Legionella pneumophila was the most prevalent species in our community, serogroup 1 was the most frequently isolated and the most implicated risk factor of contamination was the temperature of water in circulation.
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Affiliation(s)
- Valeria Di Onofrio
- International PhD Programme/UNESCO Chair "Environment, Resources and Sustainable Development", Department of Sciences and Technologies, University of Naples "Parthenope", Business District, Block C4, 80143 Naples, Italy
| | - Mariangela Pagano
- ARPA Campania-Salerno Department-Via Lanzalone, 54/56, 84100 Salerno, Italy
| | - Marco Santulli
- School of Medicine and Health Sciences, "G. d'Annunzio" University of Chieti-Pescara, Via dei Vestini 31, 66100 Chieti, Italy
| | - Annamaria Rossi
- ARPA Campania-Salerno Department-Via Lanzalone, 54/56, 84100 Salerno, Italy
| | - Renato Liguori
- International PhD Programme/UNESCO Chair "Environment, Resources and Sustainable Development", Department of Sciences and Technologies, University of Naples "Parthenope", Business District, Block C4, 80143 Naples, Italy
| | - Mirella Di Dio
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Via Medina n. 40, 80133 Naples, Italy
| | - Giorgio Liguori
- Department of Movement Sciences and Wellbeing, University of Naples "Parthenope", Via Medina n. 40, 80133 Naples, Italy
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Valciņa O, Pūle D, Ķibilds J, Lazdāne A, Trofimova J, Makarova S, Konvisers G, Ķimse L, Krūmiņa A, Bērziņš A. Prevalence and Genetic Diversity of Legionella spp. in Hotel Water-Supply Systems in Latvia. Microorganisms 2023; 11:microorganisms11030596. [PMID: 36985170 PMCID: PMC10055240 DOI: 10.3390/microorganisms11030596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 02/22/2023] [Accepted: 02/23/2023] [Indexed: 03/02/2023] Open
Abstract
Legionella is one of the most important waterborne pathogens that can lead to both outbreaks and sporadic cases. The majority of travel-associated Legionnaires’ disease (TALD) cases are contracted during hotel stays. The aim of this study was to evaluate the prevalence and genetic diversity of Legionella spp. in hotel water supply systems in Latvia. In total, 834 hot water samples were collected from the water systems of 80 hotels in Latvia. At least one Legionella spp. positive sample was detected in 47 out of 80 hotels (58.8%). Overall, 235 out of 834 samples (28.2%) were Legionella spp. positive. The average hot water temperature in Latvian hotels was 49.8 °C. The most predominant L. pneumophila serogroup (SG) was SG3 which was found in 113 (49.8%) positive samples from 27 hotels. For 79 sequenced L. pneumophila isolates, 21 different sequence types (ST) were obtained, including 3 new types—ST2582, ST2579, and ST2580. High Legionella contamination and high genetic diversity were found in the hotel water supply systems in Latvia, which, together with the insufficient hot water temperature, may indicate that the lack of regulation and control measures may promote the proliferation of Legionella.
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Affiliation(s)
- Olga Valciņa
- Institute of Food Safety, Animal Health and Environment “BIOR”, 1076 Rīga, Latvia
| | - Daina Pūle
- Institute of Food Safety, Animal Health and Environment “BIOR”, 1076 Rīga, Latvia
- Department of Water Engineering and Technology, Riga Technical University, 1048 Rīga, Latvia
| | - Juris Ķibilds
- Institute of Food Safety, Animal Health and Environment “BIOR”, 1076 Rīga, Latvia
| | - Andžela Lazdāne
- Department of Metabolic Genetics Laboratory, Children’s Clinical University Hospital, 1004 Rīga, Latvia
| | - Jūlija Trofimova
- National Reference Laboratory, Riga East University Hospital, 1038 Rīga, Latvia
| | - Svetlana Makarova
- Institute of Food Safety, Animal Health and Environment “BIOR”, 1076 Rīga, Latvia
| | - Genadijs Konvisers
- Institute of Food Safety, Animal Health and Environment “BIOR”, 1076 Rīga, Latvia
| | - Laima Ķimse
- Institute of Food Safety, Animal Health and Environment “BIOR”, 1076 Rīga, Latvia
| | - Angelika Krūmiņa
- Department of Infectology, Riga Stradiņš University, 1007 Rīga, Latvia
| | - Aivars Bērziņš
- Institute of Food Safety, Animal Health and Environment “BIOR”, 1076 Rīga, Latvia
- Correspondence: ; Tel.: +371-6780-8972
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Rakić A, Vukić Lušić D, Jurčev Savičević A. Influence of Metal Concentration and Plumbing Materials on Legionella Contamination. Microorganisms 2022; 10:1051. [PMID: 35630493 PMCID: PMC9147233 DOI: 10.3390/microorganisms10051051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/15/2022] [Accepted: 05/17/2022] [Indexed: 12/07/2022] Open
Abstract
Legionella colonization of water supply pipes is a significant public health problem. The objective of this work was to evaluate Legionella colonization in hotel hot water systems and to investigate the relationship between metal concentrations, piping materials (galvanized iron pipes and plastic pipes), and Legionella proliferation. Concentrations of calcium and magnesium ions and the presence of Legionella pneumophila were determined in a total of 108 water samples from the hot water systems of four hotels in Split-Dalmatia County over a 12-month period, and additional data on piping materials were collected. L. pneumophila was isolated in 23.1% of all samples-in 28.8% (15/52) of water samples from galvanized iron pipes and in 17.8% (10/56) of samples from plastic pipes. L. pneumophila serogroups 2-14 were isolated from all samples. This study found higher prevalence of L. pneumophila at higher concentrations of Ca and Mg ions (except for Mg and plastic pipes). The metal parts of the water supply may be important factors in Legionella contamination due to the possibility of lime scale or roughness of the pipes. Higher Ca and Mg ion concentrations increased the risk of Legionella colonization.
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Affiliation(s)
- Anita Rakić
- Public Health Institute of Split-Dalmatia County, Vukovarska 46, 21000 Split, Croatia;
| | - Darija Vukić Lušić
- Department of Environmental Health, Faculty of Medicine, University of Rijeka, Braće Branchetta 20, 51000 Rijeka, Croatia
- Department of Environmental Health, Teaching Institute of Public Health of Primorje-Gorski Kotar County, Krešimirova 52a, 51000 Rijeka, Croatia
- Center for Advanced Computing and Modeling, University of Rijeka, Radmile Matejčić 2, 51000 Rijeka, Croatia
| | - Anamarija Jurčev Savičević
- Public Health Institute of Split-Dalmatia County, Vukovarska 46, 21000 Split, Croatia;
- Department of Health Studies, University of Split, 35 P.P. 464, Ruđera Boškovića Street, 21000 Split, Croatia
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Doménech-Sánchez A, Laso E, Berrocal CI, Albertí S. Environmental surveillance of Legionella in tourist facilities of the Balearic Islands, Spain, 2006 to 2010 and 2015 to 2018. Euro Surveill 2022; 27:2100769. [PMID: 35621000 PMCID: PMC9137269 DOI: 10.2807/1560-7917.es.2022.27.21.2100769] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/20/2021] [Indexed: 06/15/2023] Open
Abstract
BackgroundLegionnaires' disease is a respiratory illness often associated with hotels and travel. Spain is a major tourist destination and one of the European countries with most cases of Legionnaires' disease , both community- and travel-associated. However, the prevalence of Legionella in tourist facilities is unknown.AimThe present investigation aimed to survey the tourist facilities in the Balearic Islands, Spain, for Legionella prevalence.MethodsWe visited tourist facilities in the Balearic Islands in two different periods (2006-2010 and 2015-2018) and took water samples following national and international guidelines. Legionella was investigated by culture methods following international standards (ISO 11731:1998).ResultsWe evaluated 13,472 samples from 465 facilities. Bacteria of the Legionella genus were detected in 65.4% of the surveyed facilities. Contamination of the facilities was significantly higher during the second decade (54.5 vs 78.6%). The most frequent colonisers were L. pneumophila serogroup 2-14. We detected the pathogen in 15.9% and 6.9% of hot and cold water distribution systems samples, respectively. The Legionella contamination rate in cold water systems samples was higher when free chlorine levels were < 0.2 mg/L and at > 25 °C temperatures, while in the hot water systems samples, the contamination rate was higher at < 50 °C. Of the samples from hot tubs, 10.9% were contaminated.ConclusionLegionella prevalence in hotels in the Balearic Islands was high but the contamination rates depended on the installations. Corrective measures are still needed to improve Legionella control.
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Affiliation(s)
- Antonio Doménech-Sánchez
- Saniconsult Ibérica SL, Palma de Mallorca, Spain
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Universidad de las Islas Baleares, Palma de Mallorca, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdIsBa), Palma de Mallorca, Spain
| | - Elena Laso
- Saniconsult Ibérica SL, Palma de Mallorca, Spain
| | | | - Sebastián Albertí
- Instituto Universitario de Investigación en Ciencias de la Salud (IUNICS), Universidad de las Islas Baleares, Palma de Mallorca, Spain
- Instituto de Investigación Sanitaria de les Illes Balears (IdIsBa), Palma de Mallorca, Spain
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