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Peracetic Acid in the Disinfection of a Hospital Water System Contaminated With Legionella Species

Published online by Cambridge University Press:  21 June 2016

Savina Ditommaso*
Affiliation:
Dipartimento di Sanitá Pubblica e di Microbiologia, Universitá degli Studi di Torino, Torino, Italy
Cinzia Biasin
Affiliation:
Dipartimento di Sanitá Pubblica e di Microbiologia, Universitá degli Studi di Torino, Torino, Italy
Monica Giacomuzzi
Affiliation:
Dipartimento di Sanitá Pubblica e di Microbiologia, Universitá degli Studi di Torino, Torino, Italy
Carla Maria Zotti
Affiliation:
Dipartimento di Sanitá Pubblica e di Microbiologia, Universitá degli Studi di Torino, Torino, Italy
Alberto Cavanna
Affiliation:
Presidio Sanitario San Camillo, Torino, Italy
Angela Ruggenini Moiraghi
Affiliation:
Dipartimento di Sanitá Pubblica e di Microbiologia, Universitá degli Studi di Torino, Torino, Italy
*
Via Santena 5 bis, 10126 - Torino, Italiasavina.ditommaso@unito.it

Abstract

Objective:

To assess the efficacy of an alternative disinfection method for hospital water distribution systems contaminated with Legionella.

Methods:

Disinfection with peracetic acid was performed in a small hospital contaminated with L. pneumophila serotype 1. The disinfectant was used at concentrations of 50 ppm (first three surveillance phases) and 1,000 ppm (fourth surveillance phase) for 30 minutes.

Results:

Environmental monitoring revealed that disinfection was maintained 1 week after treatment; however, levels of recontamination surpassing baseline values were detected after approximately 1 month. Comparison of water temperatures measured at the distal outlets showed a statistically significant association between temperature and bacterial load. The circulating water temperature was found to be lower in the two wards farthest away from the hot water production plant than in other wards. It was thought that the lower water temperature in the two wards promoted the bacterial growth even after disinfection.

Conclusion:

Peracetic acid may be useful in emergency situations, but does not provide definitive protection even if used monthly.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Shands, K, Ho, J, Meyer, R, et al. Potable water as a source of Legionnaires' disease. JAMA 1985;253:14121416.Google Scholar
2.Kool, JL, Fiore, AE, Kioski, CM, et al. More than ten years of unrecognized nosocomial transmission of Legionnaires' disease among transplant patients. Infect Control Hosp Epidemiol 1998;19:898904.Google Scholar
3.Yu, VL. Nosocomial legionellosis. Curr Opin Infect Dis 2000;13:385388.CrossRefGoogle ScholarPubMed
4.Craven, DE. Progress in the battle against nosocomial Legionnaires' disease: shedding light on shades of gray. Infect Control Hosp Epidemiol 2003;24:560562.CrossRefGoogle ScholarPubMed
5.Stout, JE, Yu, VL. Legionella in the hospital water supply: a plea for decision making based on evidence-based medicine. Infect Control Hosp Epidemiol 2001;22:670672.Google Scholar
6.Lin, YS, Stout, JE, Yu, VL, et al. Disinfection of water distribution systems for Legionella. Semin Respir Infect 1998;13:147159.Google Scholar
7.Liu, Z, Stout, JE, Tedesco, L, et al. Efficacy of ultraviolet light in preventing Legionella colonization of a hospital water distribution system. Water Res 1995;29:22752280.Google Scholar
8.Best, MG, Goetz, A, Yu, VL. Heat eradication measures for control of hospital-acquired Legionnaires' disease: implementation, education, and cost analysis. Am J Infect Control 1984;12:2630.Google Scholar
9.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;162:127132.Google Scholar
10.Patterson, WJ, Hay, J, Seal, DV, et al. Colonization of transplant unit water supplies with Legionella and protozoa: precautions required to reduce the risk of legionellosis. J Hosp Infect 1997;37:717.CrossRefGoogle ScholarPubMed
11.Direction Générate De La Santé. Circulaire DGS/SD7A/SD5C-DHOS/E4 n°2002/243 du 24 avril 2002 relative á la prevention du risque lié aux legionetles dans les établissements de santé. Bulletin Officiel 2002;18.Google Scholar
12.Health and Safety Commission. The Control of Legionella Bacteria in Water System: Approved Code of Practice and Guidance. Norwich, United Kingdom: Her Majesty's Stationery Office; 2000.Google Scholar
13.Linee guida per la prevenzione ed il controllo della legionellosi. Conferenza permanente per i rapporti tra lo stato le regioni e le province autonome di Trento e Bolzano. Gazzetta Ufflciale della Repubblica Italiana n° 103, 5 maggio 2000.Google Scholar
14.Centers for Disease Control and Prevention. Guidelines for prevention of nosocomial pneumonia. MMWR 1997;46(RR-1):179.Google Scholar
15.Centers for Disease Control and Prevention, Infectious Diseases Society of America, and American Society of Blood and Marrow Transplantation. Guidelines for preventing opportunistic infections (OIs) in hematopoietic stem cell transplant recipients (HSCT). MMWR 2000;49(RR-1):1128.Google Scholar
16.Allegheny County Health Department. Approaches to Prevention and Control of Legionella Infection in Allegheny County Health Care Facilities, ed. 2. Pittsburgh, PA: Allegheny County Health Department; 1997:115.Google Scholar
17.American Society of Heating, Refrigerating, and Air-Conditioning Engineers, Inc. ASHRAE Guideline: Minimizing the Risk of Legionellosis Associated With Building Water System. Atlanta, GA: American Society of Heating, Refrigerating, and Air-Conditioning Engineers, Inc.; 2000.Google Scholar
18.Centers for Disease Control and Prevention. Guidelines for prevention of healthcare-associated pneumonia. MMWR 2004;53(RR-3):136.Google Scholar
19.Stout, JE, Yu, VL. Experiences of the first 16 hospitals using copper-silver ionization for Legionella control: implications for the evaluation of other disinfection modalities. Infect Control Hosp Epidemiol 2003;24:563568.CrossRefGoogle ScholarPubMed
20.Srinivasan, A, Bova, G, Ross, T, et al. A 17-month evaluation of a chlorine dioxide water treatment system to control Legionella species in a hospital water supply. Infect Control Hosp Epidemiol 2003;24:575579.Google Scholar
21.Heffelfinger, JD, Kool, JL, Fridkin, S, et al. Risk of hospital-acquired Legionnaires' disease in cities using monochloramine versus other water disinfectants. Infect Control Hosp Epidemiol 2003;24:569574.Google Scholar
22.Hall, KK, Giannetta, ET, Getchell-White, SI, et al. Ultraviolet light disinfection of hospital water for preventing nosocomial Legionella infection: a 13-year follow-up. Infect Control Hosp Epidemiol 2003;24:580583.Google Scholar
23.Stampi, S, De Luca, G, Onorato, M, et al. Peracetic acid as an alternative wastewater disinfectant to chlorine dioxide. J Appl Microbiol 2002;93:725731.Google Scholar
24.Gehr, R, Wagner, M, Veerasubramanian, P, et al. Disinfection efficiency of peracetic acid, UV and ozone after enhanced treatment of municipal wastewater. Water Res 2003;37:78941.Google Scholar
25.Veschetti, E, Cutilli, D, Bonadonna, L, et al. Pilot-plant comparative study of peracetic acid and sodium hypochlorite wastewater disinfection. Water Res 2003;37:45734586.Google Scholar
26.European Committee for Standardization (CEN TC/216). EN 1276: Quantitative Suspension Test for Evaluation of Bactericidal Activity of Chemical Disinfectants and Antiseptic Used in Food, Industrial, Domestic and Institutional Areas. Bruxelles: European Committee for Standardization; 1997. UNI EN 12762000.Google Scholar
27.International Standard Organization. Water Quality: Detection and Enumeration Legionella. Geneva: International Standard Organization; 1998. 117311998.Google Scholar
28.Guidetti, L, Ditommaso, S, Giacomuzzi, M, et al. Valutazione dell'efficacia di interventi di disinfezione di impianti idrici ospedalieri contaminati da Legionella. Giornale Italiano delle Infezioni ospedaliere 2000;7:97103.Google Scholar
29.Monarca, S, Ferretti, D, Zerbini, I, et al. Studies on mutagenicity and disinfection by-products in river drinking water disinfected with peracetic acid or sodium hypochlorite. Presented at the International Water Association World Conference; October 1519, 2001; Berlin, Germany.Google Scholar
30.Monarca, S, Richardson, SD, Ferretti, D, et al. Mutagenicity and disinfection by-products in surface drinking water disinfected with peracetic acid. Environ Toxicol Chem 2002;21:309318.Google Scholar
31.Baldry, MGC, Fraser, JAL. Disinfection with peroxygens. In: Payne, KR, ed. Industrial Biocides. New York: Wiley; 1988:91116.Google Scholar
32.Fraser, JAL, Godfree, AF, Jones, F. Use of peracetic acid in operational sewage sludge disposal to pasture. Water Sci Technol 1984,17:451466.CrossRefGoogle Scholar
33.Schroder, W. Peracetic acid: disinfectant for the food industry. Brauwelt lnt 1984;115120.Google Scholar