Ultraviolet light disinfection of hospital water for preventing nosocomial Legionella infection: a 13-year follow-up.
OBJECTIVE
CDC has estimated that 23% of Legionella infections are nosocomial. When a new hospital was being constructed and a substantial increase in transplantation was anticipated, an ultraviolet light apparatus was installed in the water main of the new building because 27% of water samples from taps in the old hospital contained Legionella. This study reports the rate of nosocomial Legionella infection and water contamination since opening the new hospital.


METHODS
Charts of all patients with positive Legionella cultures, direct immunofluorescent antibody (DFA), or urine antigen between April 1989 and November 2001 were reviewed. Frequencies of DFAs and urine antigens were obtained from the laboratory.


RESULTS
None of the 930 cultures of hospital water have been positive since moving into the new building. Fifty-three (0.02%) of 219,521 patients had a positive Legionella test; 41 had pneumonia (40 community acquired). One definite L. pneumophila pneumonia confirmed by culture and DFA in August 1994 was nosocomial (0.0005%) by dates. This patient was transferred after prolonged hospitalization in another country, was transplanted 11 days after admission, and developed symptoms 5 days after liver transplant. However, tap water from the patient's room did not grow Legionella. Seventeen (2.5%) of 670 urine antigens were positive for Legionella (none nosocomial). Thirty-three (1.2%) of 2,671 DFAs were positive, including 7 patients (21%) without evidence of pneumonia and 6 (18%) who had an alternative diagnosis.


CONCLUSIONS
Ultraviolet light usage was associated with negative water cultures and lack of clearly documented nosocomial Legionella infection for 13 years at this hospital.
Hall
Keri K
KK
University of Virginia Health System, Charlottesville, Virginia 22908-1337, USA.
Giannetta
Eve T
ET
Getchell-White
Sandra I
SI
Durbin
Lisa J
LJ
Farr
Barry M
BM
D000046:Academic Medical Centers; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D004203:Disinfection / Q000379:methods*; D019085:Fluorescent Antibody Technique, Direct; D005500:Follow-Up Studies; D006801:Humans; D016952:Legionella pneumophila / Q000302:isolation & purification / Q000472:pathogenicity / Q000528:radiation effects; D007877:Legionnaires' Disease / Q000175:diagnosis / Q000517:prevention & control* / Q000635:transmission; D008284:Maintenance and Engineering, Hospital / Q000379:methods*; D018571:Sentinel Surveillance; D014466:Ultraviolet Rays; D014768:Virginia / Q000453:epidemiology; D014871:Water Microbiology; D018508:Water Purification / Q000379:methods*; D014881:Water Supply / Q000032:analysis