Lin Y S, Stout J E, Yu V L, Vidic R D
Department of Civil & Environmental Engineering, University of Pittsburgh, PA, USA.
Semin Respir Infect. 1998 Jun;13(2):147-59.
Hospital-acquired legionnaires' disease arises from the presence of Legionella in hospital water systems. Legionella not only persists in hot water tanks but is also found in the biofilm throughout the entire water distribution system. Conditions within water systems that promote Legionella colonization include water temperature, configuration and age of the hot water tank, physicochemical constituents of the water, plumbing materials, and commensal microflora. Hospital-acquired legionnaires' disease has been prevented by instituting control measures directed at the water distribution system. These include superheat-and-flush, copper/silver ionization, ultraviolet light, instantaneous heating systems, and hyperchlorination. Each of the above disinfection methods has been proven to be effective in the short-term, but long-term efficacy has been difficult due to limitations associated with each method. The complexities of Legionella disinfection, including advantages and disadvantages of each method, are reviewed. A successful Legionella prevention program requires cooperation and communication among hospital administrative personnel, engineers, and infection control staff. Routine environmental surveillance cultures for Legionella are the critical component for successful long-term disinfection. Culture results document the efficacy of the disinfection method and alert the hospital staff to consider Legionella in hospitalized patients with pneumonia.
医院获得性军团菌病源于医院供水系统中存在军团菌。军团菌不仅在热水箱中持续存在，还存在于整个供水系统的生物膜中。促进军团菌定殖的供水系统内部条件包括水温、热水箱的结构和使用年限、水的物理化学成分、管道材料以及共生微生物群落。通过针对供水系统采取控制措施，已预防了医院获得性军团菌病。这些措施包括过热冲洗、铜/银离子化、紫外线、即时加热系统和高氯消毒。上述每种消毒方法在短期内均已被证明有效，但由于每种方法存在局限性，长期效果一直不佳。本文综述了军团菌消毒的复杂性，包括每种方法的优缺点。成功的军团菌预防计划需要医院行政人员、工程师和感染控制人员之间的合作与沟通。对军团菌进行常规环境监测培养是长期成功消毒的关键组成部分。培养结果记录了消毒方法的有效性，并提醒医院工作人员在患有肺炎的住院患者中考虑军团菌感染。
