On-site availability of Legionella testing in acute care hospitals, United States.

We surveyed 399 US acute care hospitals regarding availability of on-site Legionella testing; 300 (75.2%) did not offer Legionella testing on site. Availability varied according to hospital size and geographic location. On-site access to testing may improve detection of Legionnaires disease and inform patient management and prevention efforts.

Legionnaires' disease--risk management.

Steve Mount, an independent Legionella management consultant and trainer with over 25 years' previous experience in microbiology and UKAS-accredited Legionella analysis, underlines the rising number of nosocomial cases of Legionnaires' disease in recent years, and explains the key risk assessment, management, and monitoring steps that must be taken by those responsible for hospital water systems to comply with legislation governing the 'control and management' of Legionella risk.

[Experience with prevention and control of legionellosis in Germany : plea for proactive risk management]. / Erfahrungen zur Prävention und Kontrolle von Legionellosen in Deutschland : Plädoyer für ein proaktives Risikomanagement.

Legionellosis is meanwhile the most important specific water-associated infectious disease in developed countries, which is completely preventable, if water distribution systems are correctly planned and operated. This assumes clear criteria for risk regulation and for verification, including microbiological monitoring for Legionella. There are different reactive and proactive strategies in the USA and in Europe. The common premises for prevention and control of legionellosis in Germany, relevant facts for risk regulation, experience in Germany toward proactive risk regulation, and the current approach of the amended drinking water ordinance are discussed. The article concludes with a short discussion of the controversial approaches for the prevention of legionellosis in Germany.

A preliminary assessment of the occupational risk of acquiring Legionnaires' disease for people working in telephone manholes, a new workplace environment for Legionella growth.

BACKGROUND: Telephone manholes (TMs) are underground wells, used in Italy by the telecommunication companies to locate telephone networks. Following a fatal case of Legionnaires' disease (LD), acquired during working activity in a TM, we investigated whether Legionella was present in TMs and could be a risk for manhole workers (MWs). METHODS: Three hundred fifty-three environmental samples were collected from 100 TMs, and serum antibody titer against Legionella pneumophila and Legionella species non-pneumophila was determined from both MWs and control non-manhole workers. RESULTS: L pneumophila and Legionella species non-pneumophila were detected in 28% of water samples, in 8% of the biofilm, and in 6% of sediment matrices taken in TMs, in a concentration range of 10(2) to 10(4) colony-forming units/L. No Legionella was found in TM air samples. Although there was a statistically significant difference (P = .027) in antibody titer to L pneumophila serogroup 1 (Lp1) between MWs and non-manhole workers, a multivariate logistic regression analysis showed a significant association between antibody against Lp1 and both age group and the practice of aquatic sports. CONCLUSION: Although further investigations will be performed to quantify the risk of acquiring legionellosis, this preliminary study demonstrates for the first time the presence of Legionella, including human pathogenic species, in a working environment such as TM.

[Best practices in prevention public health]. / Risultati eccellenti e nuovi problemi.

It describes the ten best practices implemented by the Department for Prevention dell'AUSL 7 of Ragusa in Sicily, with particular reference to the draft coverage against chickenpox vaccine made in two cohorts: new born to 15 months of age (80%) and adolescents at 12 years of age (50%).

Public health and economic costs of investigating a suspected outbreak of Legionnaires' disease.

This paper provides one of the first assessments of the burden of both the public health investigation and the economic costs associated with an apparent outbreak of Legionnaires' disease (LD) in South East London. In addition to epidemiological, microbiological and environmental investigations, we collected data on the staff time and resources committed by the 11 main organizations responsible for managing the outbreak. Of the overall estimated costs of 455,856 pounds, only 14% (64,264 pounds) was spent on investigation and control of the outbreak compared with 86% (391,592 pounds) spent on the hospital treatment of the patients. The time and money spent on public health services in this investigation appear to represent good value for money considering the potential costs of a major outbreak, including the high case-fatality rate in LD generally and the high health-care costs. Further research is needed to determine optimum strategies for the cost-effective use of health system resources in investigations of LD. Whether the threshold for investigation of cases should be based on observed incidence rates or the cost-effectiveness of investigations, or both, should be debated further.

Incidence and completeness of notification of Legionnaires' disease in The Netherlands: covariate capture-recapture analysis acknowledging regional differences.

To estimate incidence and completeness of notification of Legionnaires' disease (LD) in The Netherlands in 2000 and 2001, we performed a capture-recapture analysis using three registers: Notifications, Laboratory results and Hospital admissions. After record-linkage, 373 of the 780 LD patients identified were notified. Ascertained under-notification was 52.2%. Because of expected and observed regional differences in the incidence rate of LD, alternatively to conventional log-linear capture-recapture models, a covariate (region) capture-recapture model, not previously used for estimating infectious disease incidence, was specified and estimated 886 LD patients (95% confidence interval 827-1022). Estimated under-notification was 57.9%. Notified, ascertained and estimated average annual incidence rates of LD were 1.15, 2.42 and 2.77/100 000 inhabitants respectively, with the highest incidence in the southern region of The Netherlands. Covariate capture-recapture analysis acknowledging regional differences of LD incidence appears to reduce bias in the estimated national incidence rate.

[Active clinical surveillance for detection of Legionnaires' disease: implications for health care structures]. / Sorveglianza clinica attiva per la ricerca di polmoniti da Legionella: risultati e considerazioni per le strutture sanitarie.

In an university hospital of about 900 beds, a clinical surveillance was activated to detect cases of Legionnaires' disease in patients affected by community and/or nosocomial-acquired pneumonia. In the hospital Legionella spp was detected in the hot water distribution system and various disinfecting and control procedures were adopted to reduce contamination. Contemporary, the clinical surveillance began with the systematic detection of Legionella urinary antigen among recovered pneumonia, seroconversion as confirmation test and the collection of respiratory secretions or other biological materials to isolate the microorganism in patients positive to the urinary antigen. From September 2003 to May 2005, 486 pneumonia were followed, 98 of which considered of nosocomial origin. In total, 15 cases of community-acquired Legionnaires' disease were detected by the urinary test, whereas no cases of nosocomial origin were found. The characteristics of the detected cases are described in comparison with the other pneumonia and the surveillance cost was evaluated. The systematic clinical surveillance for Legionella infections is feasible with limit costs, allows to detect community-acquired cases otherwise unknown and to ascertain the absence/presence of nosocomial-acquired pneumonia, irrespective of the environment contamination.

Legionnaire's disease avoidance planning.

Hospital-acquired infection is the cause of about 5,000 deaths a year in the UK. In New Zealand, there are more than three times as many such deaths as from the annual road toll. The costs in loss of income, in pain and suffering and in direct costs to hospitals are staggering.

Combating a rising incidence of Legionnaire's disease.

A statement released last week by the Health Protection Agency highlighted a recent increase in the incidence of Legionnaire's disease in England and Wales. Although an upsurge in cases is common at this time of year due to people returning from holidays abroad, only a small proportion of the recent cases can be attributed to foreign travel. Nurses need to be aware of the symptoms and what health measures they can take.

Legionellosis: epidemiology, management and prevention.

Legionellosis is an acute bacterial pneumonia, which is associated with a mortality rate of approximately 10-15 per cent in healthy individuals. It was first identified in the USA following an outbreak of pneumonia among delegates at a legionnaires' convention. Antibiotics provide effective treatment. Outbreaks continue to occur and have the most significant effects on older people and other vulnerable groups.

Eight deadly blunders. Common mistakes in protecting against Legionella.

A year has passed since the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), under EC 1.7, began requiring all accredited hospitals to "reduce the potential for organizational-acquired illness ... managing pathogenic biological agents in cooling towers, domestic hot water and other aerosolizing water systems."