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Monochloramine and chlorine dioxide for controlling Legionella pneumophila contamination: biocide levels and disinfection by-product formation in hospital water networks.
J Water Health. 2013 Dec; 11(4):738-47.JW

Abstract

Legionella colonization in hospital hot water distribution networks was evaluated following 36 months of continuous treatment with monochloramine and compared with chlorine dioxide. Nitrite, nitrate, chlorite, chlorate, bromide, trihalomethanes and haloacetic acids as well as the biocide concentration at sampled points were measured. Only 8/84 samples treated with monochloramine were found contaminated and after the first 8 months of treatment no Legionella was isolated. Chlorine dioxide was associated with a strong reduction in Legionella contamination compared to pre-treatment, but differences according to the device were observed. Monochloramine between 2 and 3 mg l(-1) and chlorine dioxide between 0.50 and 0.70 mg l(-1) were needed to control Legionella colonization. Comparing no- and post-flush samples, a higher frequency of no-flush positive samples was noted using chlorine dioxide, suggesting an increased risk for patients when they open the tap. No increase in chlorite levels and no water nitrification occurred by using monochloramine. Chlorite at levels exceeding the limit requested for drinking water was measured when chlorine dioxide was applied. In conclusion, we highlight that continuous injection of monochloramine should be considered as an effective alternative to chlorine dioxide in controlling legionellae contamination inside hospital water distribution systems.

Authors+Show Affiliations

Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via Campi 287, I-41125 Modena, Italy E-mail: isabella.marchesi@unimore.it.Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via Campi 287, I-41125 Modena, Italy E-mail: isabella.marchesi@unimore.it.Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via Campi 287, I-41125 Modena, Italy E-mail: isabella.marchesi@unimore.it.University Hospital Policlinico of Modena, Via del Pozzo 71, I-41124 Modena, Italy.Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via Campi 287, I-41125 Modena, Italy E-mail: isabella.marchesi@unimore.it.Special Pathogens Laboratory, 1401 Forbes Ave. Suite 209, Pittsburgh, PA 15219, USA and Swanson School of Engineering, University of Pittsburgh, 3700 O'Hara Street, Pittsburgh, PA 15261, USA.Department of Diagnostic, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Via Campi 287, I-41125 Modena, Italy E-mail: isabella.marchesi@unimore.it.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

24334848

Citation

Marchesi, Isabella, et al. "Monochloramine and Chlorine Dioxide for Controlling Legionella Pneumophila Contamination: Biocide Levels and Disinfection By-product Formation in Hospital Water Networks." Journal of Water and Health, vol. 11, no. 4, 2013, pp. 738-47.
Marchesi I, Ferranti G, Bargellini A, et al. Monochloramine and chlorine dioxide for controlling Legionella pneumophila contamination: biocide levels and disinfection by-product formation in hospital water networks. J Water Health. 2013;11(4):738-47.
Marchesi, I., Ferranti, G., Bargellini, A., Marchegiano, P., Predieri, G., Stout, J. E., & Borella, P. (2013). Monochloramine and chlorine dioxide for controlling Legionella pneumophila contamination: biocide levels and disinfection by-product formation in hospital water networks. Journal of Water and Health, 11(4), 738-47. https://doi.org/10.2166/wh.2013.079
Marchesi I, et al. Monochloramine and Chlorine Dioxide for Controlling Legionella Pneumophila Contamination: Biocide Levels and Disinfection By-product Formation in Hospital Water Networks. J Water Health. 2013;11(4):738-47. PubMed PMID: 24334848.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Monochloramine and chlorine dioxide for controlling Legionella pneumophila contamination: biocide levels and disinfection by-product formation in hospital water networks. AU - Marchesi,Isabella, AU - Ferranti,Greta, AU - Bargellini,Annalisa, AU - Marchegiano,Patrizia, AU - Predieri,Guerrino, AU - Stout,Janet E, AU - Borella,Paola, PY - 2013/12/17/entrez PY - 2013/12/18/pubmed PY - 2014/2/28/medline SP - 738 EP - 47 JF - Journal of water and health JO - J Water Health VL - 11 IS - 4 N2 - Legionella colonization in hospital hot water distribution networks was evaluated following 36 months of continuous treatment with monochloramine and compared with chlorine dioxide. Nitrite, nitrate, chlorite, chlorate, bromide, trihalomethanes and haloacetic acids as well as the biocide concentration at sampled points were measured. Only 8/84 samples treated with monochloramine were found contaminated and after the first 8 months of treatment no Legionella was isolated. Chlorine dioxide was associated with a strong reduction in Legionella contamination compared to pre-treatment, but differences according to the device were observed. Monochloramine between 2 and 3 mg l(-1) and chlorine dioxide between 0.50 and 0.70 mg l(-1) were needed to control Legionella colonization. Comparing no- and post-flush samples, a higher frequency of no-flush positive samples was noted using chlorine dioxide, suggesting an increased risk for patients when they open the tap. No increase in chlorite levels and no water nitrification occurred by using monochloramine. Chlorite at levels exceeding the limit requested for drinking water was measured when chlorine dioxide was applied. In conclusion, we highlight that continuous injection of monochloramine should be considered as an effective alternative to chlorine dioxide in controlling legionellae contamination inside hospital water distribution systems. SN - 1477-8920 UR - https://www.unboundmedicine.com/medline/citation/24334848/Monochloramine_and_chlorine_dioxide_for_controlling_Legionella_pneumophila_contamination:_biocide_levels_and_disinfection_by_product_formation_in_hospital_water_networks_ DB - PRIME DP - Unbound Medicine ER -