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Nosocomial Legionnaires' disease and use of medication nebulizers
T D Mastro1, B S Fields, R F Breiman
1Respiratory Diseases Branch, Division of Bacterial Diseases, Centers for Disease Control, Atlanta, GA 30333.
Abstract:
Guidelines for the prevention of nosocomial pneumonia specify that only sterile fluids should be used for aerosol therapy; however, this recommendation may not be uniformly followed. Thirteen patients with nosocomial pneumonia due to Legionella pneumophila serogroup 3 (Lp3) were identified at a community hospital in the period from 1984 through 1988; 12 patients (92%) had chronic obstructive pulmonary disease; and 9 patients (69%) died. An epidemiologic investigation suggested that the use of nebulizers to deliver medication was associated with acquiring legionnaires' disease. The hospital potable water system was contaminated with Lp3, and a survey indicated that tap water was commonly used to wash medication nebulizers. Lp3 in respirable-size droplets was isolated from aerosols generated by a nebulizer containing Lp3 at one-tenth the concentration found in the hospital potable water. These findings support the recommendation that only sterile fluids be used for filling or cleaning respiratory care equipment and suggest that this guideline is not universally followed.
Insights
Using non-sterile fluids in nebulizers can lead to hospital-acquired Legionnaires' disease. This study found Legionella pneumophila contamination in hospital water, linked to patient deaths from pneumonia.
Area of Science:
- Infectious Diseases
- Hospital Epidemiology
- Respiratory Medicine
Background:
- Nosocomial pneumonia guidelines recommend sterile fluids for aerosol therapy.
- Non-compliance with sterile fluid recommendations may occur.
- Legionnaires' disease poses a significant risk in healthcare settings.
Purpose of the Study:
- To investigate a cluster of Legionnaires' disease cases.
- To identify the source and transmission route of Legionella pneumophila serogroup 3 (Lp3).
- To assess the role of respiratory care equipment in disease transmission.
Main Methods:
- Epidemiologic investigation of nosocomial pneumonia cases.
- Microbiologic analysis of patient samples and hospital water system.
- Aerosol generation studies using contaminated nebulizers.
Main Results:
- Thirteen cases of Legionnaires' disease occurred, with 69% mortality.
- Contamination of the hospital potable water system with Lp3 was confirmed.
- Tap water was used to clean nebulizers, leading to aerosolized Lp3.
Conclusions:
- Contaminated tap water used in nebulizers is a likely source of Legionnaires' disease.
- Reinforces the critical importance of using only sterile fluids in respiratory equipment.
- Highlights the need for adherence to infection control guidelines in healthcare facilities.