title: Abbreviated duration of superheat-and-flush and disinfection of taps for Legionella disinfection: lessons learned from failure.
abstract: One medical center in southern Taiwan faced an outbreak of nosocomial Legionnaires' disease; a total of 81 suspected cases were detected during an 8-month period. Baseline environmental surveillance showed that 80% of the distal sites in intensive care units (ICUs) were positive for Legionella pneumophila. Superheat-and-flush was selected for hospital water supply disinfection because it required no special equipment, and it can be initiated expeditiously. We conducted 2 episodes of superheat-and-flush based on the published recommendations from the Department of Health, Taiwan; US Centers for Disease Control and Prevention; and American Society of Heating, Refrigerating, and Air-Conditioning Engineers. Both flushes failed to control colonization of Legionella in the hospital water supply. The rate of distal sites positive for Legionella in wards and ICUs was 14% and 66%, respectively, 10 days after the second flush. The effect of replacement of faucets and showerheads in ICUs appeared to be insignificant in colonization of Legionella. The application of superheat-and-flush for flush duration of 5 minutes was ineffective. Superheat-and-flush may not be economic for a large medical center because it could be costly and labor intensive.
authors.affiliation: Section of Infectious Diseases of the Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China.
authors.forename: Yao-shen
authors.initials: YS
authors.lastname: Chen
authors.forename: Yung-ching
authors.initials: YC
authors.lastname: Liu
authors.forename: Susan Shin-jung
authors.initials: SS
authors.lastname: Lee
authors.forename: Hung-chin
authors.initials: HC
authors.lastname: Tsai
authors.forename: Shue-ren
authors.initials: SR
authors.lastname: Wann
authors.forename: Chih-hsiang
authors.initials: CH
authors.lastname: Kao
authors.forename: Chiao-Lin
authors.initials: CL
authors.lastname: Chang
authors.forename: Wen-kuei
authors.initials: WK
authors.lastname: Huang
authors.forename: Tsi-shu
authors.initials: TS
authors.lastname: Huang
authors.forename: Hsueh-lan
authors.initials: HL
authors.lastname: Chao
authors.forename: Ching-hsien
authors.initials: CH
authors.lastname: Li
authors.forename: Chin-mei
authors.initials: CM
authors.lastname: Ke
authors.forename: Yu-sen Eason
authors.initials: YS
authors.lastname: Lin
mesh_terms: D000046:Academic Medical Centers; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D006361:Heating; D006801:Humans; D017053:Infection Control / Q000379:methods; D016952:Legionella pneumophila / Q000302:isolation & purification; D007877:Legionnaires' Disease / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000635:transmission; D008284:Maintenance and Engineering, Hospital / Q000379:methods*; D013624:Taiwan / Q000453:epidemiology; D014871:Water Microbiology; D014881:Water Supply