title: Disconnecting central hot water and using electric showers to avoid colonization of the water system by Legionella pneumophila: an 11-year study.
abstract: Legionella spp. can be difficult to control in hospitals. The objective of this study was to describe an 11-year experience with the use of electric showers in the control of Legionella pneumophila. From June 1989 to March 1990 there was an outbreak of pneumonia caused by L. pneumophila in a 20-bed renal transplant unit in a university-associated tertiary-care hospital. Control measures included hyperchlorination, heating and flushing of the water system with limited results. In November 1993 the central hot water was disconnected and water for bathing was heated using electric showers. From January 1992 to June 1995 water was collected from showers and water faucets and cultured for L. pneumophila every two weeks. Surveillance cultures were then collected every month until May 1999. During this seven-year surveillance period, 1115 samples of water were cultured. Water cultures were positive on 24 of 429 occasions (without cases of legionellosis) during the pre-shower period (22 months). In the post-shower period (67 months) only one of 686 cultures was positive. Subsequently there have been no new cases of nosocomial pneumonia by L. pneumophila although surveillance continues. In conclusion, disconnecting the central hot water was effective in avoiding colonization of the water system by L. pneumophila. Heating was possible by using electric showers, which are effective, easy to maintain and cheap.
authors.affiliation: Department of Infection Control, Hospital das Clínicas, Faculdade de Medicina, University of São Paulo, São Paulo, Brazil.
authors.forename: M S
authors.initials: MS
authors.lastname: Oliveira
authors.forename: F R
authors.initials: FR
authors.lastname: Maximino
authors.forename: R D
authors.initials: RD
authors.lastname: Lobo
authors.forename: S
authors.initials: S
authors.lastname: Gobara
authors.forename: S I
authors.initials: SI
authors.lastname: Sinto
authors.forename: L E
authors.initials: LE
authors.lastname: Ianhez
authors.forename: C L
authors.initials: CL
authors.lastname: Warschauer
authors.forename: A S S
authors.initials: AS
authors.lastname: Levin
mesh_terms: D001938:Brazil; D003428:Cross Infection / Q000517:prevention & control*; D004784:Environmental Monitoring; D005618:Fresh Water / Q000382:microbiology; D006361:Heating / Q000295:instrumentation*; D006785:Hospitals, University; D006801:Humans; D007877:Legionnaires' Disease / Q000517:prevention & control*; D008137:Longitudinal Studies; D018571:Sentinel Surveillance; D014881:Water Supply