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071 - The puzzle Legionella

Autor(s): L. Fabbri, M. Schinella

Issue: RIMeL - IJLaM, Vol. 5, N. 3-S1, 2009 (MAF Servizi srl ed.)

Page(s): 71-74

Summary
Background. It is well known and widely reported in the literature that if you carefully examine the water and air systems of hospitals you can find, almost always, Legionella and that bacterial contamination can not be completely eliminated. The Provincial Health Services of Trento (APSS) has developed a specific organization for combating and controlling this complex phenomenon. One of these organization is the experimental application of methods disinfection of water systems and health of the towers and evaporative air conditioning/ventilation. Materials and methods. The Group for the Surveillance of Legionellosis has carried-on a comprehensive strategy of intervention aimed at controlling the proliferation of bacteria in all the hospitals business. This strategy is based on a series of measures and technologies designed to ensure maximum safety Technically feasible (MSTP), a condition that, if reached, could lead minimizing the risk of infection from legionella. The application of bacterial growth control systems to the plumbing, which release disinfectant substances, is integrated with a range of other interventions, which together constitute the “multiple barriers” strategy; described in detail in Water Safety Plan. Results. Nosocomial cases have been recorded only in the Hospital S. Chiara di Trento, although the contamination of the water is present in all hospitals and cooling towers are also present at the Hospital of Rovereto and Borgo Valsugana. There is no correlation between the occurrence of Legionella cases and levels environmental contamination at the hospital S. Chiara. We continue to record new cases of definite or suspected nosocomial Legionnaires disease (5 cases certain and 2 alleged in 2008) despite the acceptable levels of possible disease-risk (<=1000). This is true even achieving a greater reduction in the levels of contaminant loads to higher levels (% of ufc > 1000), compared to a decrease of contamination with lower levels (% of ufc <1000). Discussion. The cross-analysis on the number of cases of bacterial contamination in domestic hot water, highlighted the lack of correlation between the occurrence of cases and the levels of the presence of Legionella. In this context, it becomes extremely important to maintain a condition of minimization of environmental risk basis and implement a program of continuous surveillance of the infection (micro-organism alert) implemented by the Laboratory of Microbiology. It is also important to carry out an action for achieving the highest awareness of clinicians regarding the diagnosis of this particular pulmonary pathology.
Key-words: legionella, surveillance, contamination, risk.

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