title: Legionella prevalence and risk of legionellosis in Hungarian hospitals.
abstract: Nosocomial legionellosis is a growing concern worldwide. In Hungary, about 20% of the reported cases are health-care associated, but in the absence of legal regulation, environmental monitoring of Legionella is not routinely performed in hospitals. In the present study, 23 hospitals were investigated. The hot water distribution system was colonized by Legionella in over 90%; counts generally exceeded the public health limit value. Hot water temperature was critically low in all systems (<45 °C), and large differences (3-38 °C temperature drop) were observed within buildings, indicating insufficient circulation. Most facilities were older than 30 years (77%); however, new systems (n = 3) were also shown to be rapidly colonized at low hot water temperature. Vulnerable source of drinking water, complex distribution system, and large volume hot water storage increased the risk of Legionella prevalence (OR = 28.0, 27.3, 27.7, respectively). Risk management interventions (including thermal or chemical disinfection) were only efficient if the system operation was optimized. Though the risk factors were similar, in those hospitals where nosocomial legionellosis was reported, Legionella counts and the proportion of L. pneumophila sg 1 isolates were significantly higher. The results of environmental prevalence of legionellae in hospitals suggest that the incidence of nosocomial legionellosis is likely to be underreported. The observed colonization rates call for the introduction of a mandatory environmental monitoring scheme.
authors.affiliation: National Public Health Center, Directoriate of Environmental Health , Albert Flórián út 2-6, H-1097 Budapest , Hungary.
authors.forename: Zsófia
authors.initials: Z
authors.lastname: Barna
authors.affiliation: National Public Health Center, Directoriate of Environmental Health , Albert Flórián út 2-6, H-1097 Budapest , Hungary.
authors.forename: Mihály
authors.initials: M
authors.lastname: Kádár
authors.affiliation: National Public Health Center, Directoriate of Environmental Health , Albert Flórián út 2-6, H-1097 Budapest , Hungary.
authors.forename: Emese
authors.initials: E
authors.lastname: Kálmán
authors.affiliation: National Public Health Center, Directoriate of Environmental Health , Albert Flórián út 2-6, H-1097 Budapest , Hungary.
authors.forename: Eszter
authors.initials: E
authors.lastname: Róka
authors.affiliation: National Public Health Center, Directoriate of Environmental Health , Albert Flórián út 2-6, H-1097 Budapest , Hungary.
authors.forename: Anita Sch
authors.initials: AS
authors.lastname: Szax
authors.affiliation: National Public Health Center, Directoriate of Environmental Health , Albert Flórián út 2-6, H-1097 Budapest , Hungary.
authors.forename: Márta
authors.initials: M
authors.lastname: Vargha
mesh_terms: D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D004783:Environmental Microbiology; D006761:Hospitals / Q000706:statistics & numerical data; D006814:Hungary / Q000453:epidemiology; D007875:Legionella / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D007876:Legionellosis / Q000453:epidemiology / Q000382:microbiology*; D015995:Prevalence
keywords: Hungary; Legionella spp.,; hospital acquired legionnaires’ disease; risk assessment