Heffelfinger James D, Kool Jacob L, Fridkin Scott, Fraser Victoria J, Hageman Jeffrey, Carpenter Joseph, Whitney Cynthia G
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Infect Control Hosp Epidemiol. 2003 Aug;24(8):569-74. 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.
测定城市饮用水用一氯胺消毒与医院获得性军团病（LD）发生之间的关联。
166家美国医院。
对美国医疗保健流行病学学会（SHEA）的459名成员进行调查，内容包括医院特征；与地方流行和暴发相关的医院获得性LD；医院供水来源；以及医院和城市水处理厂使用的消毒方法。
代表459家医院中166家（36%）的SHEA成员做出了回应；33家（20%）报告在1994年至1998年期间发生了1起或多起医院获得性LD，23家（14%）报告在1989年至1998年期间发生了医院获得性LD暴发。发生医院获得性LD的医院比其他医院有更高的普查人数（中位数，319对221；P = 0.03）、更多的急性护理病床（中位数，500对376；P = 0.04）和更多的重症监护病房病床（中位数，42对24；P = 0.009）。它们也更有可能设有移植服务（74%对42%；P = 0.001）并对医院获得性疾病进行监测（92%对61%；P = 0.001）。在对移植项目的存在情况和军团病监测进行调整后，由城市水厂用一氯胺消毒饮用水的医院发生散发性病例或医院获得性LD暴发的可能性低于其他医院（比值比，0.20；95%置信区间，0.07至0.56）。
城市水处理厂用一氯胺对水进行消毒可显著降低医院获得性LD的风险。
