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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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References

1. Vickers, RM, Yu, VL, Hanna, SS, et al. Determinants of Legionella pneumophilu contamination of water distribution systems: 15-hospital prospective study. Infect Control 1987;8:357–363.CrossRefGoogle ScholarPubMed
2. Alary, M, Joly, JR. Factors contributing to the contamination of hospital water distribution systems by Legionellae . J Infect Dis 1992;165:565–569.Google Scholar
3. Bezanson, G, But-bridge, S, Haldane, D, et al. Diverse populations of Legionella pneumophilu present in the water of geographically clustered institutions served by the same water reservoir. J Clin Microbiol 1992;30:570–576.CrossRefGoogle ScholarPubMed
4. Blatt, SR Parkinson, MD, Pace, E, et al. Nosocomial Legionnaires' disease: aspiration as a primary mode of disease acquisition. Am J Med 1993;95:16–22.Google Scholar
5. States, JS, Conley, LF, Kuchta, JM, et al. Survival and multiplication of Legionella pneumophila in municipal drinking water systems. Appl Environ Microbiol 1987;53:979–986.CrossRefGoogle ScholarPubMed
6. 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
7. Sanden, GN, Fields, BS, Barbaree, JM, et al. Viability of Legionella pneumophilu in chlorine-free water at elevated temperatures. Current Microbiol 1989;18:61–65.CrossRefGoogle Scholar
8. Hoge, CW, Breiman, RF, Advances in the epidemiology and control of Legionella infections. Epidemiologic Reviews 1991;13:329–340.Google Scholar
9. Edelstein, PH. Legionnaires' disease. Clin Infect Dis 1993;16:741–749.Google Scholar
10. Marrie, TJ, Haldane, D, Macdonald, S, et al. Control of nosocomial Legionnaires' disease by using sterile potable water for high risk patients. Epidemiol Infect 1991;107:591–605.Google Scholar
11. Bopp, CA, Sumner, JW, Morris, GK, et al. Isolation of Legionella spp. from environmental water samples by low-pH treatment and use of selective medium. J Clin Microbiol 1981;13:714–719.CrossRefGoogle ScholarPubMed
12. Schoonmaker, D, Heimberger, T, Birkhead, G. Comparison of ribotyping and restriction enzyme analysis using pulsed-field gel electrophoresis for distinguishing Legionella pneumophilu isolates obtained during a nosocomial outbreak. J Clin Microbiol 1992;30:1491–1498.CrossRefGoogle ScholarPubMed
13. Matulonis, U, Rosenfeld, CS, Shadduck, RK. Prevention of Legionella infections in a bone marrow transplant unit: multifaceted approach to decontamination of a water system. Infect Control Hospital Epidemiol 1993;14:571–575.Google Scholar