Risk of hospital-acquired legionnaires' disease in cities using monochloramine versus other water disinfectants.

Abstract

OBJECTIVE:

To measure the association between the disinfection of municipal drinking water with monochloramine and the occurrence of hospital-acquired legionnaires' disease (LD).

SETTING:

One hundred sixty-six U.S. hospitals.

DESIGN:

Survey of 459 members of the Society for Healthcare Epidemiology of America (SHEA) for hospital features; endemic- and outbreak-related, hospital-acquired LD; the source of the hospital water supply; and the methods of disinfection used by the hospitals and municipal water treatment plants.

RESULTS:

SHEA members representing 166 (36%) of 459 hospitals responded; 33 (20%) reported one or more episodes of hospital-acquired LD during the period from 1994 to 1998 and 23 (14%) reported an outbreak of hospital-acquired LD during the period from 1989 to 1998. Hospitals with an occurrence of hospital-acquired LD had a higher census (median, 319 vs 221; P = .03), more acute care beds (median, 500 vs 376; P = .04), and more intensive care unit beds (median, 42 vs 24; P = .009) than did other hospitals. They were also more likely to have a transplant service (74% vs 42%; P = .001) and to perform surveillance for hospital-acquired disease (92% vs 61%; P = .001). After adjustment for the presence of a transplant program and surveillance for legionnaires' disease, hospitals supplied with drinking water disinfected with monochloramine by municipal plants were less likely to have sporadic cases or outbreaks of hospital-acquired LD (odds ratio, 0.20; 95% confidence interval, 0.07 to 0.56) than were other hospitals.

CONCLUSION:

Water disinfection with monochloramine by municipal water treatment plants significantly reduces the risk of hospital-acquired LD.

• Authors: James D Heffelfinger, Jacob L Kool, Scott Fridkin, Victoria J Fraser, Jeffrey Hageman, Joseph Carpenter, Cynthia G Whitney, Society for Healthcare Epidemiology of America
• Journal: Infection control and hospital epidemiology (Infect Control Hosp Epidemiol) Vol. 24 Issue 8 Pg. 569-74 (Aug 2003) ISSN: 0899-823X [Print] United States
• PMID: 12940576 (Publication Type: Comparative Study, Journal Article)

Chemical References

• Chloramines
• Water Pollutants
• chloramine

Topics

• American Hospital Association
• Centers for Disease Control and Prevention, U.S.
• Chloramines
• Cohort Studies
• Cross Infection (microbiology, prevention & control, transmission)
• Disinfection (methods)
• Health Care Surveys
• Humans
• Legionnaires' Disease (prevention & control, transmission, urine)
• Maintenance and Engineering, Hospital
• Risk Assessment
• United States (epidemiology)
• Water Microbiology
• Water Pollutants (adverse effects)
• Water Purification (methods)