A bronchoscopy-associated pseudo-outbreak of and associated with contaminated ice machine water and ice.

A pseudo-outbreak of bronchoscopy-associated and was traced to contaminated ice machine water and ice. A nonsterile ice bath was used to cool uncapped, sterile, saline syringes used to slow procedural bleeding. Joining the growing evidence of bronchoscopy pseudo-outbreaks, our investigation describes several lessons for future prevention.

Evaluation of a new culture medium for isolation of nontuberculous mycobacteria from environmental water samples.

Nontuberculous mycobacteria (NTM) are waterborne pathogens commonly found in building water systems where they are a primary concern to vulnerable patient populations and can cause severe disease. The recovery of NTM from environmental samples can be a laborious undertaking and current pre-treatment methods and selective media lack sensitivity. We explored the use of the highly selective Rapidly Growing Mycobacteria (RGM) medium for culturing NTM from environmental water samples compared to existing methods.

Evaluation of Recommended Water Sample Collection Methods and the Impact of Holding Time on Recovery and Variability from Healthcare Building Water Systems.

Water safety and management programs (WSMP) utilize field measurements to evaluate control limits and monitor water quality parameters including presence. This monitoring is important to verify that the plan is being implemented properly. However, once it has been determined when and how to sample for , it is important to choose appropriate collection and processing methods.

Water Quality as a Predictor of Positivity of Building Water Systems.

Testing drinking water systems for the presence of colonization is a proactive approach to assess and reduce the risk of Legionnaires' disease. Previous studies suggest that there may be a link between positivity in the hot water return line or certain water quality parameters (temperature, free chlorine residual, etc.) with distal site positivity.

Point-of-use filters for prevention of health care-acquired Legionnaires' disease: Field evaluation of a new filter product and literature review.

Background: The Centers for Medicare & Medicaid Services requires that health care facilities assess their building water systems and minimize the risk of growth and spread of Legionella and other waterborne pathogens. Increasingly, point-of-use (POU) filters are being used to prevent exposure to these pathogens. This study provides efficacy and performance specifications (membrane size, pore size, and use restrictions), which will aid in selecting POU filters.

Environmental sources of community-acquired legionnaires' disease: A review.

Background: Most Legionnaires' disease in the US and abroad is community-acquired and believed to be sporadic, or non-outbreak associated. Most patients are exposed to numerous water sources, thus making it difficult to focus environmental investigations. Identifying known sources of sporadic community-acquired Legionnaires' disease will inform future sporadic Legionnaires' disease investigations as well as highlight directions for research.

Diagnostic testing for Legionnaires' disease.

Legionnaires' disease is commonly diagnosed clinically using a urinary antigen test. The urinary antigen test is highly accurate for L. pneumophila serogroup 1, however other diagnostic tests should also be utilized in conjunction with the urinary antigen as many other Legionella species and serogroups are pathogenic.

Lack of correlation between Legionella colonization and microbial population quantification using heterotrophic plate count and adenosine triphosphate bioluminescence measurement.

This investigation compared biological quantification of potable and non-potable (cooling) water samples using pour plate heterotrophic plate count (HPC) methods and adenosine triphosphate (ATP) concentration measurement using bioluminescence. The relationship between these measurements and the presence of Legionella spp. was also examined.

Effect of monochloramine treatment on the microbial ecology of Legionella and associated bacterial populations in a hospital hot water system.

Opportunistic pathogens, including Legionella spp. and non-tuberculous mycobacteria, can thrive in building hot water systems despite municipal and traditional on-site chlorine disinfection. Monochloramine is a relatively new approach to on-site disinfection, but the microbiological impact of on-site chloramine use has not been well studied.

Fungal diversity and presence of potentially pathogenic fungi in a hospital hot water system treated with on-site monochloramine.

Currently, our knowledge of fungal ecology in engineered drinking water systems is limited, despite the potential for these systems to serve as a reservoir for opportunistic pathogens. In this study, hot water samples were collected both prior to and following the addition of monochloramine as an on-site disinfectant in a hospital hot water system. Fungal ecology was then analyzed by high throughput sequencing of the fungal ITS1 region.

Evaluation of a new monochloramine generation system for controlling Legionella in building hot water systems.

Objective: To evaluate the efficacy of a new monochloramine generation system for control of Legionella in a hospital hot water distribution system.

Setting: A 495-bed tertiary care hospital in Pittsburgh, Pennsylvania. The hospital has 12 floors covering approximately 78,000 m(2).

Field evaluation of a new point-of-use faucet filter for preventing exposure to Legionella and other waterborne pathogens in health care facilities.

Background: Opportunistic waterborne pathogens (eg, Legionella, Pseudomonas) may persist in water distribution systems despite municipal chlorination and secondary disinfection and can cause health care-acquired infections. Point-of-use (POU) filtration can limit exposure to pathogens; however, their short maximum lifetime and membrane clogging have limited their use.

Methods: A new faucet filter rated at 62 days was evaluated at a cancer center in Northwestern Pennsylvania.

Shift in the microbial ecology of a hospital hot water system following the introduction of an on-site monochloramine disinfection system.

Drinking water distribution systems, including premise plumbing, contain a diverse microbiological community that may include opportunistic pathogens. On-site supplemental disinfection systems have been proposed as a control method for opportunistic pathogens in premise plumbing. The majority of on-site disinfection systems to date have been installed in hospitals due to the high concentration of opportunistic pathogen susceptible occupants.

Monochloramine and chlorine dioxide for controlling Legionella pneumophila contamination: biocide levels and disinfection by-product formation in hospital water networks.

Legionella colonization in hospital hot water distribution networks was evaluated following 36 months of continuous treatment with monochloramine and compared with chlorine dioxide. Nitrite, nitrate, chlorite, chlorate, bromide, trihalomethanes and haloacetic acids as well as the biocide concentration at sampled points were measured. Only 8/84 samples treated with monochloramine were found contaminated and after the first 8 months of treatment no Legionella was isolated.

Computer keyboard covers impregnated with a novel antimicrobial polymer significantly reduce microbial contamination.

Background: Contaminated computer keyboards have been acknowledged as a potential source for bacterial transmission between health care providers and patients. Biosafe HM 4100 is an antimicrobial polymer that can be incorporated into the polyurethane material used to make keyboard covers. This study aimed to determine whether plastic keyboard covers containing HM 4100 effectively minimize the survival of bacterial species commonly present on health care environmental surfaces.

Prevention of hospital-acquired legionellosis.

Purpose Of Review: The incidence of hospital-acquired legionellosis appears to be increasing. Presence of Legionella in the hospital drinking water is the only risk factor known with certainty to be predictive of risk for contracting Legionnaires' disease.

Recent Findings: Given the high frequency of infection by nonpneumophila and nonserogroup 1 species, both Legionella respiratory culture on selective media and urine antigen testing should be available in the hospital clinical microbiology laboratory.

Controlling Legionella in hospital drinking water: an evidence-based review of disinfection methods.

Hospital-acquired Legionnaires' disease is directly linked to the presence of Legionella in hospital drinking water. Disinfecting the drinking water system is an effective preventive measure. The efficacy of any disinfection measures should be validated in a stepwise fashion from laboratory assessment to a controlled multiple-hospital evaluation over a prolonged period of time.

Revisiting the hand wipe versus gel rub debate: is a higher-ethanol content hand wipe more effective than an ethanol gel rub?

Background: The Centers for Disease Control and Prevention's guidelines for hand hygiene state that the use of alcohol-based hand wipes is not an effective substitute for the use of an alcohol-based hand rub or handwashing with an antimicrobial soap and water. The objective of this study was to determine whether a hand wipe with higher ethanol content (65.9%) is as effective as an ethanol hand rub or antimicrobial soap in removing bacteria and spores from hands.

Rapid diagnostic testing for community-acquired pneumonia: can innovative technology for clinical microbiology be exploited?

Two nonsynchronous events have affected the management of community-acquired pneumonia (CAP): spiraling empiricism for CAP and the "golden era" of clinical microbiology. The development of broad-spectrum antibiotics has led to widespread empiric use without ascertaining the etiology of the infecting microbe. Unfortunately, this approach clashes with the second event, which is the advent of molecular-based microbiology that can identify the causative pathogen rapidly at the point of care.

Effect of pipe corrosion scales on chlorine dioxide consumption in drinking water distribution systems.

Previous studies showed that temperature and total organic carbon in drinking water would cause chlorine dioxide (ClO(2)) loss in a water distribution system and affect the efficiency of ClO(2) for Legionella control. However, among the various causes of ClO(2) loss in a drinking water distribution system, the loss of disinfectant due to the reaction with corrosion scales has not been studied in detail. In this study, the corrosion scales from a galvanized iron pipe and a copper pipe that have been in service for more than 10 years were characterized by energy dispersive spectroscopy (EDS) and X-ray diffraction (XRD).