title: 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).
  
  
  METHODS
  One hundred sixty-six U.S. hospitals.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Water disinfection with monochloramine by municipal water treatment plants significantly reduces the risk of hospital-acquired LD.
authors.affiliation: Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
authors.forename: James D
authors.initials: JD
authors.lastname: Heffelfinger
authors.forename: Jacob L
authors.initials: JL
authors.lastname: Kool
authors.forename: Scott
authors.initials: S
authors.lastname: Fridkin
authors.forename: Victoria J
authors.initials: VJ
authors.lastname: Fraser
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hageman
authors.forename: Joseph
authors.initials: J
authors.lastname: Carpenter
authors.forename: Cynthia G
authors.initials: CG
authors.lastname: Whitney
mesh_terms: D000573:American Hospital Association; D002487:Centers for Disease Control and Prevention, U.S.; D002700:Chloramines; D015331:Cohort Studies; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control / Q000635:transmission*; D004203:Disinfection / Q000379:methods*; D019538:Health Care Surveys; D006801:Humans; D007877:Legionnaires' Disease / Q000517:prevention & control / Q000635:transmission* / Q000652:urine; D008284:Maintenance and Engineering, Hospital; D018570:Risk Assessment; D014481:United States / Q000453:epidemiology; D014871:Water Microbiology; D014873:Water Pollutants / Q000009:adverse effects; D018508:Water Purification / Q000379:methods*
chemical_list: D002700:Chloramines; D014873:Water Pollutants; C030816:chloramine