Risk of Hospital‐Acquired Legionnaires’ Disease in Cities Using Monochloramine Versus Other Water Disinfectants

• Published in: Infection control and hospital epidemiology 2003-08, Vol.24 (8), p.569-574
• Main Authors: Heffelfinger, James D., Kool, Jacob L., Fridkin, Scott, Fraser, Victoria J., Hageman, Jeffrey, Carpenter, Joseph, Whitney, Cynthia G.
• Format: Article
• Language: English
• Subjects: American Hospital Association; Antibiotics. Antiinfectious agents. Antiparasitic agents; Antiseptics; Bacterial diseases; Bacterial diseases of the respiratory system; Biological and medical sciences; Centers for Disease Control and Prevention (U.S.); Chloramines; Cohort Studies; Cross Infection - microbiology; Cross Infection - prevention & control; Cross Infection - transmission; Disease outbreaks; Disinfectants; Disinfection; Disinfection - methods; Drinking water; Epidemiology; Health Care Surveys; Hospital units; Hospitals; Human bacterial diseases; Humans; Infectious diseases; Legionella; Legionnaire's disease; Legionnaires disease; Legionnaires' Disease - prevention & control; Legionnaires' Disease - transmission; Legionnaires' Disease - urine; Maintenance and Engineering, Hospital; Medical sciences; Municipal water; Original Articles; Outbreaks; Pharmacology. Drug treatments; Public water supply; Residual neoplasm; Risk Assessment; Surveillance; United States - epidemiology; Water Microbiology; Water Pollutants - adverse effects; Water Purification - methods; Water supply; Water treatment; Water treatment plants
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1086/502256

To measure the association between the disinfection of municipal drinking water with monochloramine and the occurrence of hospital-acquired legionnaires' disease (LD). One hundred sixty-six U.S. hospitals. Survey of 459 members of the Society for Healthcare Epidemiology of America (SHEA) for hospital features; endemic- and outbreak-related, hospital-acquired LD; the source of the hospital water supply; and the methods of disinfection used by the hospitals and municipal water treatment plants. SHEA members representing 166 (36%) of 459 hospitals responded; 33 (20%) reported one or more episodes of hospital-acquired LD during the period from 1994 to 1998 and 23 (14%) reported an outbreak of hospital-acquired LD during the period from 1989 to 1998. Hospitals with an occurrence of hospital-acquired LD had a higher census (median, 319 vs 221; P = .03), more acute care beds (median, 500 vs 376; P = .04), and more intensive care unit beds (median, 42 vs 24; P = .009) than did other hospitals. They were also more likely to have a transplant service (74% vs 42%; P = .001) and to perform surveillance for hospital-acquired disease (92% vs 61%; P = .001). After adjustment for the presence of a transplant program and surveillance for legionnaires' disease, hospitals supplied with drinking water disinfected with monochloramine by municipal plants were less likely to have sporadic cases or outbreaks of hospital-acquired LD (odds ratio, 0.20; 95% confidence interval, 0.07 to 0.56) than were other hospitals. Water disinfection with monochloramine by municipal water treatment plants significantly reduces the risk of hospital-acquired LD.