Korean J healthc assoc Infect Control Prev 2023; 28(1): 135-142
Published online June 30, 2023 https://doi.org/10.14192/kjicp.2023.28.1.135
Copyright © Korean Society for Healthcare-associated infection Control and Prevention
Suryeong Go1*, Su Young Kim2*, Myoung Jin Shin2, Eun Sil Lee2, Yoon Jung Kim2, Hong Bin Kim1,3, Kyoung-Ho Song1,2,3, Jeong Su Park3,4, Sug Bae Park5, Gun Young Park5, Eu Suk Kim1,2,3
Division of Infectious Disease, Department of Internal Medicine, Seoul National University Bundang Hospital1, Infection Control Center, Seoul National University Bundang Hospital2, Seongnam, Seoul National University College of Medicine3, Seoul, Department of Laboratory Medicine, Seoul National University Bundang Hospital4, Construction & Engineering Team, Seoul National University Bundang Hospital5, Seongnam, Korea
Correspondence to: Eu Suk Kim
E-mail: eskim@snubh.org
ORCID: https://orcid.org/0000-0001-7132-0157
*Suryeong Go and Su Young Kim contributed equally to this work.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0).
Background: Close surveillance of Legionella in the plumbing systems of medical institutions is required because of the higher morbidity and mortality of nosocomial legionellosis. We experienced an outbreak of legionellosis in a university hospital, managed with a chlorine dioxide infusion system.
Methods: Multiple contaminations with Legionella were reported in the annual water surveillance in June 2019. A task force was established to prevent the outbreak of legionellosis, and the entire plumbing system of the hospital was investigated. Initial measurement was done according to the action manual of the Korean Disease Control and Prevention Agency, including cleaning of hot water tanks, superheating and flushing, point-of-use management (change of showerheads and taps on washstands), and application of filters in higher-risk areas. Further shock hyperchlorination for the cooling tower and cleaning of the water tank were performed since persistent contamination was reported in these areas. Nevertheless, there was an outbreak of three presumable cases of in-hospital legionellosis. A continuous infusion of chlorine dioxide (ClO2) was planned to decontaminate the hospital’s plumbing. Equipment for ClO2 infusion was installed by May 2020, with terminal monitors of residual chlorine and a feedback system. A repeated environmental culture study was also planned. Furthermore, a preemptive surveillance system including active monitoring for patients tested with Legionella urinary antigen was developed, and a newer response manual for legionellosis was distributed.
Results: Isolation of Legionella in hospital water was first noted in June 2019. Since then, Legionella has been identified in 6 out of 47 samples in five surveillances by the public health center. Furthermore, 6 out of 85 samples were reported to be positive for Legionella by inhospital water cultures. Two patients were diagnosed with nosocomial legionellosis within 3 months of the initial response. After the installation of the ClO2 continuous infusion system in May 2020, no isolation of Legionella was reported in the next two whole environmental surveillance. No further cases of bacterial inoculation or Legionella infections have been reported so far.
Conclusion: The outbreak of nosocomial legionellosis was successfully terminated with the continuous infusion of ClO2 into the premise plumbing system of the hospital. Sporadic outbreaks of hospital-acquired legionellosis have continued; therefore, individualized reinforcement of the response system to prevent nosocomial legionellosis is required.
Keywords: Legionella, Chlorine dioxide, Outbreak, Infection control
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