ABSTRACT
The risk of Legionella transmission in built environments remains a significant concern. Legionella can spread within buildings through aerosol transmission, prompting the exploration of airborne transmission pathways and proposing corresponding prevention and control measures based on building characteristics. To this end, a comprehensive literature review on the transmission risk of Legionella in built environments was performed. Four electronic databases (PubMed, Web of Science, Google Scholar, and CNKI) were searched from inception to March 2024 for publications reporting the risk of Legionella transmission in built environments. Relevant articles and gray literature reports were hand-searched, and 96 studies were finally included. Legionella pollution comes from various sources, mainly originates in a variety of built environments in which human beings remain for extended periods. The sources, outbreaks, national standards, regulations, and monitoring techniques for Legionella in buildings are reviewed, in addition to increases in Legionella transmission risk due to poor maintenance of water systems and long-distance transmission events caused by aerosol characteristics. Air and water sampling using various analytical methods helps identify Legionella in the environment, recognize sources in the built environments, and control outbreaks. By comparing the standard regulations of national organizations globally, the authors further highlight gaps and deficiencies in Legionella surveillance in China. Such advancements offer essential insights and references for understanding and addressing Legionella transmission risk in the built environment, with the potential to contribute to safeguarding public health and building environment safety.
Subject(s)
Built Environment , Legionella , Legionella/isolation & purification , Humans , Legionellosis/transmission , Legionellosis/prevention & control , Air Microbiology , Disease Outbreaks/prevention & control , Environmental Monitoring , Water Microbiology , China/epidemiologyABSTRACT
BACKGROUND: Infection by Legionella bacteria is a risk to elderly individuals in health care facilities and should be managed by preventing bacterial proliferation in internal water systems. Norwegian legislation calls for a mandatory Legionella-specific risk assessment with the subsequent introduction of an adapted water management programme. The present study investigates adherence to legislation and guidelines on Legionella control and prevention in Norwegian nursing homes. METHODS: A cross-sectional survey was distributed to Norwegian municipalities to investigate the status of Legionella specific risk assessments of internal water distribution systems and the introduction of water management programmes in nursing homes. RESULTS: A total of 55.1% (n = 228) of the participating nursing homes had performed Legionella-specific risk assessments, of which 55.3% (n = 126) stated that they had updated the risk assessment within the last year. 96.5% introduced a water management programme following a risk assessment, whereas 59.6% of the ones without a risk assessment did the same. Nursing homes with risk assessments were more likely to monitor Legionella levels than those without (61.2% vs 38.8%), to remove dead legs (44.7% vs 16.5%), and to select biocidal preventive treatment over hot water flushing (35.5% vs 4.6%). CONCLUSIONS: This study presents novel insight into Legionella control in Norway, suggesting that adherence to mandatory risk assessment in nursing homes is moderate-low. Once performed, the risk assessment seems to be advantageous as an introduction to future Legionella prevention in terms of the scope and contents of the water management programme.
Subject(s)
Guideline Adherence , Nursing Homes , Water Microbiology , Norway , Cross-Sectional Studies , Nursing Homes/standards , Nursing Homes/legislation & jurisprudence , Humans , Guideline Adherence/statistics & numerical data , Water Microbiology/standards , Legionella , Risk Assessment , Legionellosis/prevention & control , Water Supply/standards , Water Supply/legislation & jurisprudence , AgedABSTRACT
INTRODUCTION: Immunocompromised patients are at an increased risk of severe legionella infections. We present the results of an outbreak investigation initiated following a fatal case of hospital-acquired legionellosis linked to contaminated water from a toilet-flushing cistern. Additionally, we provide experimental data on the growth of Legionella spp. in flushing cisterns and propose a straightforward protocol for prevention. METHODS: We monitored the growth of Legionella spp. in the building's hot- and cold-water systems using quantitative bacterial culture on selective agar. Molecular typing of Legionella pneumophila isolates from the infected patient and the water system was conducted through core-genome multi-locus sequence typing (cgMLST). RESULTS: Legionella contamination in the hospital building's cold-water system was significantly higher than in the hot-water system and significantly higher in toilet flushing cistern's water compared with cold water from bathroom sinks and showers. Isolates from the patient and from the flushing cistern of the patient's bathroom were identical by cgMLST. In an experimental setting, daily toilet flushing for a period of 21 days resulted in a 67% reduction in the growth of Legionella spp. in the water of toilet flushing cisterns. Moreover, a one-time disinfection of cisterns with peracetic acid, followed by daily flushing, decreased legionella growth to less than 1% over a period of at least seven weeks in these setting. CONCLUSIONS: One-time disinfection of highly contaminated cisterns with peracetic acid and daily toilet flushing as short-term measure can significantly reduce legionella contamination in flushing cisterns. These measures may aid in preventing legionella infection among immunocompromised patients.
Subject(s)
Bathroom Equipment , Legionella pneumophila , Legionella , Legionellosis , Humans , Legionellosis/prevention & control , Multilocus Sequence Typing , Peracetic Acid , Water , Water Microbiology , Water Supply , GermanyABSTRACT
La enfermedad de los legionarios es un importante problema de salud pública particularmente por su frecuente presentación en forma de brotes, tanto comunitarios como nosocomiales, y por su letalidad, especialmente en personas de edad avanzada o con otras enfermedades. La notificación oportuna de casos y/o brotes de enfermedad y la investigación epidemiológica permiten la identificación de la/s fuentes de exposición y la adopción de medidas de prevención y control adecuadas. Las infecciones por Legionella son más frecuentes entre adultos mayores de 50 años, hombres, fumadores y huéspedes inmunocomprometidos o con ciertas enfermedades crónicas subyacentes. La infección en niñas/os es rara, con ≤ 1% de los casos de neumonía causada por Legionella, y puede ser asintomática o leve y no detectada. La Legionella puede multiplicarse si el agua no es tratada de manera adecuada o si los sistemas de agua no son mantenidos adecuadamente.
Subject(s)
Legionellosis/prevention & control , Legionellosis/drug therapy , Disease Outbreaks , Epidemiological MonitoringABSTRACT
Introducción: La legionelosis es una enfermedad de declaración obligatoria en España. Uno de sus mecanismos de prevención y control es el sistema de vigilancia epidemiológica y, en particular, la investigación epidemiológica. Entre 2005 y 2010 se reportó en Europa un aumento de la carga de la enfermedad no descrita en España. Objetivo: Determinar la evolución de los casos de legionelosis en España en la serie 2005-2015. Métodos: Estudio descriptivo de series temporales relativo al recuento de casos notificados a través del Centro Nacional de Epidemiología de España. Se incluyeron variables sociodemográficas del paciente, antecedentes personales y clínicos, síntomas y signos, datos de laboratorio y epidemiológicos. Se determinó la tasa de incidencia por 100 000 habitantes (2005-2010) y la tasa ajustada (población europea) por 100 000 habitantes según sexo (2005-2015), así como según grupo de edad y sexo para la serie 2010-2015. Resultados: España mantiene una tendencia estable respecto a la tasa de incidencia por 1100 000 habitantes (3,5 a 2,5), se produce un incremento relevante en la tasa ajustada a partir de los 50 años, con mayor impacto en los hombres. Conclusión: se evidencia la necesidad de la vigilancia epidemiológica de la legionelosis, la mejora en las medidas de prevención y control, y la consideración de nuevos factores de riesgo(AU)
Introduction: Legionellosis is a notifiable disease in Spain. One of its prevention and control mechanisms is epidemiological surveillance, particularly epidemiological research. An increase in legionellosis disease burden was reported in Europe from 2005 to 2010 which was not described in Spain. Objectives: Determine the evolution of legionellosis cases in Spain in the period 2005-2015. Methods: A descriptive time series analysis was performed based on the cases notified to the Spanish National Epidemiology Center. The variables considered were the patients' sociodemographic characteristics, personal and clinical antecedents, signs and symptoms, laboratory results and epidemiological data. Determination was made of the incidence rate per 100 000 inhabitants (2005-2010) and the adjusted rate per 100 000 inhabitants (European population) by sex (2005-2015) and by age group and sex for the series (2010-2015). Results: Incidence per 100 000 inhabitants has remained stable (3.5 to 2.5) in Spain, which has led to a relevant increase in the adjusted rate as of age 50 years, with a higher impact among men. Conclusion: Evidence was found of the need for epidemiological surveillance of legionellosis, improvement of prevention and control measures, and consideration of new risk factors(AU)
Subject(s)
Humans , Legionellosis/prevention & control , Legionellosis/epidemiology , Risk Factors , Spain , Time Series Studies , Disease NotificationABSTRACT
Legionella spp. es una bacteria ambiental capaz de sobrevivir en un amplio intervalo de condiciones fisicoquímicas y puede colonizar los sistemas de distribución y almacenamiento del agua potable. Legionella pneumophila es el principal patógeno trasmitido por el agua y produce el 90% de los casos de legionelosis. El objetivo del presente trabajo fue detectar por cultivo la presencia de Legionella spp. en depósitos domiciliarios de agua potable de la ciudad de Resistencia, Chaco. La detección de Legionella en las muestras de agua se realizó por cultivo según lo establecido en la norma ISO 11731:1998. Se analizaron 32 muestras de agua y de 12 (37,5%) de ellas se recuperaron cepas de Legionella spp. La vigilancia de este microorganismo en el agua de consumo humano representa el primer paso para controlar su diseminación hacia huéspedes susceptibles.
Legionella spp. is an environmental bacterium that can survive in a wide range of physicochemical conditions and may colonize distribution systems of drinking water and storage tanks. Legionella pneumophila is the major waterborne pathogen that can cause 90% of Legionnaires' disease cases. The aim of this study was to detect the presence of Legionella spp. in household drinking water tanks in the city of Resistencia, Chaco. The detection of Legionella in water samples was performed by culture methods as set out in ISO 11731:1998. Thirty two water samples were analyzed and Legionella spp. was recovered in 12 (37.5%) of them. The monitoring of this microorganism in drinking water is the first step towards addressing the control of its spread to susceptible hosts.
Subject(s)
Drinking Water/analysis , Legionellosis/prevention & control , Legionella pneumophila/isolation & purification , Legionella pneumophila/pathogenicity , Water Pollution/analysis , Drinking Water/microbiology , Surveillance in DisastersABSTRACT
La legionelosis es una enfermedad respiratoria con origen en sistemas que formen aerosol y que contenga el agente biológico Legionella sp. En las últimas décadas se ha desarrollado en España un marco normativo para su prevención y control. El presente artículo expone la epidemiología de la legionelosis y la importancia del control de la transmisión de la bacteria en la lucha contra la enfermedad. Para ello, se hace patente la revisión de las instalaciones críticas y la inclusión de otras nuevas en la legislación preventiva así como la estimación del riesgo, la mejora en los procesos de diagnóstico y el avance en nuevos protocolos de prevención.
Legionellosis is a respiratory disease originating in systems that produce aerosol and contain Legionella sp. In recent decades, Spain has developed a regulatory framework for prevention and control of legionellosis. This article describes the epidemiology of legionellosis and the importance of controlling the transmission of bacteria in the fight against the disease. In that regard, it becomes clear the role of reviewing critical facilities and the inclusion of new ones in the preventive legislation, the estimation of risk, and the improvement in the diagnostic processes and progress in new prevention protocols.
Subject(s)
Humans , Legionellosis/prevention & control , Public Health , Legionellosis/diagnosis , Legionellosis/epidemiology , Public Health/legislation & jurisprudence , Risk Assessment , Spain/epidemiologyABSTRACT
No disponible
Subject(s)
Humans , Legionellosis/prevention & control , Sprinkle Irrigation/adverse effects , Legionella/pathogenicity , Facility Regulation and Control/standardsABSTRACT
Las múltiples medidas que se han de tomar para prevenir la aparición de Legionella, en instalaciones tan complejas como las hospitalarias, son múltiples y suponen un importante impacto sobre el medioambiente. Por lo tanto, lo que propone este artículo es el de revisar qué medidas, de las obligadas por la normativa, pueden ser modificadas para causar el menor daño posible en el entorno, y cómo un Sistema de Gestión Ambiental ayuda claramente a alcanzar este objetivo (AU)
The many measures taken to prevent the occurrence of Legionella, in such complex installations such as hospitals, are numerous and represent a significant impact on the environment. Therefore, this article proposes what is to review what measures, if required by the regulations may be changed to cause the least harm to the environment, and how an Environmental Management System clearly help to achieve this objective (AU)
Subject(s)
Environmental Management , Legionellosis/prevention & control , Legionella/pathogenicity , Cross Infection/prevention & control , Asepsis/methodsABSTRACT
En España se ha producido un considerable desarrollo legislativo preventivo. En referencia al agente biológico Legionella pneumophila y la legionelosis, enfermedad producida por aquél, las implicaciones legislativas han sido fruto de una constante evolución. El objeto del estudio es la contribución al conocimiento genérico preventivo y epidemiológico de la legionelosis, tanto desde el punto de vista nacional como de la Comunidad Autónoma de Andalucía. Se abordan aspectos básicos para el acercamiento al control higiénico preventivo, incluyendo referencias médicas y legislativas. El análisis combinado de criterios conducirá al posicionamiento actual reflexivo referido a la eliminación, control y dispersión de la bacteria (AU)
In Spain, a considerable preventive legislative development has taken place. In reference to the biological agent Legionella pneumophila and the legionnaires disease, certain amount of legislative implications has been a constant evolution result. The object of the study is the contribution to the preventive generic and epidemiological knowledge of the disease, as much from the national point of view like of the Autonomous Community of Andalucía. Basic aspects for the preventive hygieniccontrol, including medical and legislative references, are approached. The combined analysis of criteria will lead to the reflexive present positioning referred to the elimination, control and dispersion of the bacterium (AU)
Subject(s)
Humans , Legionellosis/prevention & control , Epidemiological Monitoring , Occupational Health Services/methods , Legionella pneumophila/pathogenicity , Communicable Disease Control/methods , Occupational RisksABSTRACT
No disponible
No disponible
Subject(s)
Humans , Legionellosis/prevention & control , Legionella/isolation & purification , 24966/methods , Communicable Disease Control/methodsABSTRACT
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Subject(s)
Humans , Legionellosis/prevention & control , Communicable Disease Control/methods , Sanitation/methods , Legionellosis/epidemiology , Legionella/pathogenicity , Military Facilities , Military PersonnelABSTRACT
A pesar de la extensa reglamentación, las actuaciones en materia de seguridad alimentaria realizadas por los órganos sanitarios del Ministerio de Defensa no han sido en absoluto reguladas en el ámbito del Estado. Asi, las competencias de inspección sanitaria han sido trasferidas a las Comunidades Autónomas, sin que se tuvieran en cuenta las particularidades y el funcionamiento de los órganos de la Defensa. Con el fin de subsanar esta falta, la Jefatura de Apoyo Veterinario de Inspección General de Sanidad, trabaja actualmente en la redacción de un proyecto del Real Decreto en el que se contempla la figura de una Autoridad Sanitaria competente en materia de Seguridad Alimentaria en el ámbito del Ministerio de Defensa, similar a la que aparece reflejada en la orden Ministerial nº 143/2006 de 30 de noviembre, para la aplicación de la Ley de Sanidad Animal o en la Orden Ministerial nº 87/2004 de 31 de Marzo, sobre la inspección de instalaciones para la prevención y control de la legionelosis (AU)
No disponible
Subject(s)
Humans , Food Supply , Legionellosis/prevention & control , Food Contamination/prevention & control , 51708 , Veterinary Service, Military/organization & administration , Legionella/pathogenicityABSTRACT
Las actuaciones inspectoras sobre prevención de legionelosis en el Ministerio de Defensa, son efectuadas por Oficiales de Sanidad, al menos una vez al año, sobre instalaciones que puedan producir aerosoles contaminantes.Los preámbulos incluyen la elaboración de un cronograma, las notificaciones correspondientes, la solicitud de apoyo logístico y la preparación de documentación y material necesarios. Tras la oportuna presentación, se procede a la revisión documental (con especial interés en instalaciones, programas, certificados e informes, y libro general de mantenimiento), seguida de la comprobación visual y la toma de muestras. Finalmente se concluye con la redacción del acta y la indicación de recomendaciones, y la redacción del informe, cuando proceda
The inspector actions on legionelosis prevention, in Defence's Ministry, are carried out by Sanitary Officers, at least once on year, about facilities that can produce contaminate aerosols.The preambles include the chronogram elaboration, the correspondingly notifications, the logistics support solicitude and the needy documentation and materials preparation. After the appropriate presentation, it proceeds to the documentary revision (with special interest on facilities, programmes, certificates and reports, and the general maintenance book), straight of the visual comprobation and the sample taking. Finally it concludes with acta wording and the recommendations manifestation, and the report wording, when it proceed