Transcript Power Point Presentation Describing Legionella History, Locations

Legionella Analysis & Reporting Services
AIHA EMLAP Accredited Laboratory #162952
State of Virginia Department of Minority Business Enterprise: Certificate Number: 652931
State of Texas Department of State Health Services: License Number: LAB0166
Consulting Member – Association of Water Technologies (AWT)
Core Services
SANAIR TECHNOLOGIES LABORATORY operates a
state-of-the-art microbiological analysis laboratory, based in
Powhatan, Virginia, specializing in full service
environmental microbial analyses for indoor air quality (IAQ)
investigations.
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CUSTOM SAMPLING PROTOCOLS
VIABLE AIR SAMPLE ANALYSIS
VIABLE, BULK/SWAB ANALYSIS
LEGIONELLA ANALYSIS
NON-VIABLE AIR ANALYSIS
DIRECT MICROSCOPY ANALYSIS
Major Market Segments
 Segment 1 – Chemical Processing/Industrial Plants
 Segment 2 – Hospitals/Healthcare
 Segment 3 – Commercial/Residential Complexes
 Segment 4 - Hospitality Industry
Investigating the Source
Segment 1 - Chemical Processing/Industrial Plants
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Cooling Towers
Process Water Systems
Piping Dead Legs
Potable Water Systems
Air Conditioning Systems
Evaporative Cooling Systems
Other Aerosolizing Devices & Equipment
Investigating the Source
Segment 2 - Hospitals/Healthcare
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Cooling Towers
Air Conditioning Systems
Potable Water Systems
Decorative Fountains
Ice Makers
Respiratory Care Equipment
Dialysis Equipment
Whirlpool Bath Treatment Systems
Carpet Cleaning Equipment
Humidifiers
Cafeteria Water & Ice Systems
Investigating the Source
Segment 3 - Commercial/Residential Complexes
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Cooling Towers
Potable Water Systems
Air Conditioning Systems
Humidifiers
Whirlpool Spas
Decorative Fountains
Ice Makers
Carpet Cleaning Equipment
Investigating the Source
Segment 4 – Hospitality Industry
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Cooling Towers
Potable Water Systems
Air Conditioning Systems
Humidifiers
Whirlpool Spas
Decorative Fountains
Ice Makers
Carpet Cleaning Equipment
Legionella: Where is it commonly found?
Cooling Towers: Evaporative Condensers / Heat-Transfer
Associated Water Systems & Municipal/Potable/Process Water
Systems.
 Legionella occurs naturally in aquatic habitats
 Low levels occur in Municipal Water Systems
This occurrence may seed your Make-Up Water
 Legionella may colonize & amplify in hot water
tanks, dead legs in distribution systems, etc…
Legionella-Legionnaires Disease
(Cause & Effect)
 Causative Agent: a bacterium named Legionella
pneumophila – an old bacteria that was finally recognized and
named.
 Forty-eight identified species currently - more than half
being linked to human disease.
 LD is an acute bacterial infection of the lower
respiratory tract - bacterial pneumonia.
 LD is potentially fatal - multi-system respiratory illness with an
average mortality rate of 15-20%.
 Legionella dispersion can extend over a distance of 6
kilometers, that’s more than 3.7 miles - Journal of Infectious
Diseases 193:102-11, 2006
Legionnaires’ Disease …a common & serious illness
 American Society of Microbiology reports that 15-20% of
patients admitted to intensive care units with pneumonia had
LD.
 Legionella bacteria are among the top three causes of
sporadic, community acquired pneumonias.
 The CDC has estimated that the disease infects 8,000 – 18,000
persons annually in the US alone.
 OSHA estimates up to 50,000 cases of the illness occur each
year causing more than 4000 deaths.
Sampling & Testing for Legionella:
A Proactive Approach
 Water Analysis for Legionella - useful in
assessing risks and in determining whether
preventive and corrective measures are
working.
 An Action Plan based on Sampling Results
- will signal increased risks and trigger implementation
of disinfection procedures.
 Without Sampling – First trigger → a case of LD.
Testing has been proven to save lives…
According to Dr. Victor Yu, chief of the VA's Infectious Disease
Section, “CDC is failing Americans.” Between 1978 and 1998, Dr.
Yu contends an estimated 35,000 people died needlessly from the
disease. "They could have been cured. They didn't even have to
have it."
Although its proven that testing saves lives, Yu said hospitals are reluctant
to look for Legionnaires' and even more afraid to find it. "The perception is
that it's a matter of national shame if you find it in your water supply. But it
happens. And you can kill it," he said.
By 1993, Pittsburgh hospitals saw Legionnaires' disease more often than
anywhere else in the country, but only because they were actively looking
for it. In 1994, the county Health Department began advocating routine
testing in hospital systems. According to Dr. Bruce Dixon, director of the
Allegheny County Health Department, "It's been reduced in the hospital
setting here to an extremely low number. People need to think about
Legionella: test for it, find it, and then treat it."
Excerpt from an article in Engineered Systems Magazine by
Mr. Jack Springston, CIH, CSP….
It's been almost a quarter century since a then-mysterious disease killed 34 convention attendees.
Unfortunate its legacy is still going strong.
Legionella bacteria tend to be an unwanted occupant of the building environment.
Their ability to contaminate domestic water systems, coupled with their potential to
cause severe health complications, presents a very real concern to building owners
and managers. Fortunately, there are methods readily available for both the detection
of Legionella and its control. Establishing a proactive approach of periodic
testing, along with proper water treatment in both cooling towers and hot water
systems, is the best way to avoid disease outbreaks and potential lawsuits.
Complying with JCAHO EC 1.7 *
 Health Care Facilities accredited by the Joint Commission on
Accreditation of Healthcare Organizations (JCAHO) must have a
management program to "reduce the potential for organizationalacquired illness." The standard, EC 1.7, holds health care facilities
responsible for "managing pathogenic biological agents in cooling
towers, domestic hot water, and other aerosolizing water systems."
 The American Society for Healthcare Engineering (ASHE), in
technical reports on managing waterborne pathogens per
JCAHO EC 1.7, has recommended that health care facilities conduct a
an assessment of potential sources of Legionella and develop a
management plan for maintenance and operation of water systems.
*HC Information Resources Inc.
Waterborne Pathogens -
Compliance with JCAHO Requirements
 Introduction The Joint Commission's accreditation manuals for 2001
includes a new standard that appears in the Environment of Care - Utility
Systems Management standards and require health care facilities to
develop programs that will reduce organization-acquired illness. Since its
introduction the standard has been a source of frequent discussion among
hospital engineers, facility managers, infection control practitioners,
ASHE and JCAHO staff members. As a means to respond to the
questions regarding the expectations of these new standards (particularly
the waterborne pathogen requirements) and to provide clarification to the
confusing and somewhat contradictory literature ASHE provides
information to develop a briefing to clearly state the issues and provide
guidance for assessing the potential risk and dealing with compliance
issues.
 Visit our website for a complete copy of this article: www.sanair.com
Who’s Ultimately Responsible…YOU?
You can Detect
You can Disinfect
You can Control
You can Monitor
You can be Responsible
You can also Ignore
You can be held Accountable!
Case Study
Legionnaire's Disease Outbreak
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A $600 million class action lawsuit was filed in October 2005 on behalf of
residents at a Toronto, Ontario nursing home as a result of a deadly outbreak of
Legionnaires' disease (LD).
At least 20 residents died and dozens were hospitalized after the residents of the
nursing home became ill. The infection remained undiagnosed for a number of
days because of false-negative results.
The defendants named in the action included the Public Health Department, the
Board of Health, the Ontario Public Health Laboratory, the Homes for the Aged
Division of Toronto Community and Neighborhood Services and the Seven Oaks
Home for the Aged.
The allegations stated that the defendants were negligent in the collection,
sampling, testing, diagnosing and evaluating of the bacterium Legionella
Pneumophillia.
The Lab you chose is of the Greatest Concern… all labs are not equal.
Choose Wisely…
Choose: SanAir Technologies Laboratory
Partnering Programs…
 Water Hygiene Consulting Services
 Risk Management Procedures
 Energy Efficiency Upgrade Programs
 LEED Credit Generation Protocols
 Water Hygiene Program Implementation
 Autonomous Monitoring & Control
 Solutions Guaranteed…
SanAir Technologies Laboratory offers…
 Industry Knowledge – we know your needs
Staff Engineer: 20 years in process/hospital industries
 Commitment to Excellence – we have the expertise
Lab Staff: all degreed and advanced degreed scientists
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Lab Equipment - utilize proven technology
State-of-the-art in Microbial Analysis
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Reporting Format – offer quality, defensible reports
Web-based, remote access, near real time
Legionella Analysis…
PCR-Polymerase Chain Reaction & DNA Sequencing Technology
Traditional Culture→ subculture to purify isolate [cfu/ml or cfu/L]→
DNA Acquisition with Polymerase Chain Reaction→ DNA
Sequencing
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Truly Quantitative – with Culture Based Accuracy
Truly Qualitative - with Genomics Based Accuracy
Speciation of 45 Legionella Species
Serogroup ID for L. pneumophila (1 & 2/14)
97, 2489-2494, Vol 63, No. 7
Copyright © 1997, American Society for Microbiology
Development of a new seminested PCR method for
detection of Legionella species and its application to
surveillance of legionellae in hospital cooling tower
water
H Miyamoto, H Yamamoto, K Arima, J Fujii, K Maruta, K Izu, T Shiomori and S
Yoshida
Department of Microbiology, School of Medicine, University of Occupational and Environmental Health,
Kitakyushu, Japan. [email protected]
The presence of PCR inhibitors in water samples is well known and contributes to the fact
that a practical PCR assay has not been developed for legionella surveillance. In this
study, we devised a new seminested PCR assay for detection of Legionella spp. in water
samples as a means of overriding the PCR inhibitors without loss of sensitivity. The
seminested PCR assay utilized primers to amplify the 16S rRNA gene (LEG primers) of
39 Legionella spp. The assay was specific to legionellae, and the sensitivity was 1 fg of
extracted Legionella DNA in laboratory examination. To evaluate the feasibility and
sensitivity of the PCR assay in identifying the presence of legionellae, it was used to
survey Legionella contamination in the water of 49 cooling towers of 32 hospitals. A
commercially available EnviroAmp Legionella kit and a culture method were also used in
the survey for comparison with the seminested PCR assay. The detection rates of
legionellae in the samples were 91.8% (45 of 49) by the PCR assay and 79.5% (39 of 49)
by the culture method. The EnviroAmp kit revealed that 30.6% of the water samples (15
of 49) contained inhibitors of the PCR amplification. However, the seminested PCR assay
could produce the Legionella-specific DNA bands in 14 of the 15 samples. Although 8 of
the 14 samples were positive in the first-step PCR, 6 of the 14 samples became positive in
the second-step PCR. These results suggest that the effect of PCR inhibitors in samples, if
any, can be reduced because of the dilution of the sample in the second-step PCR and that
sensitivity of detection can be increased by the second- step PCR. Thus, the
seminested PCR assay with LEG primers to amplify the 16S rRNA gene of
39 Legionella spp. was a practical and sensitive method to detect
Legionella spp. in water samples.
SanAir’s Web Based Reporting Format
Reporting format to include:
Site specific cooling tower (ID) - Color coded indicating status of analysis.
Color Coding indicates numerical groupings of Colony Forming Units/liter (cfu/liter)
Color Coding as indicated:
Green: no colonies detected – no action required
Blue:
colonies detected - range: 1 – 9… Action Level One Mandate
Orange: colonies detected – range: 10 – 99… Action Level Two Mandate
Yellow: colonies detected – range: 100 – 999… Action Level Three Mandate
Red:
colonies detected – range: 1000 +… Action Level Four Mandate
Action Level Mandates per Client Corporate Standards… Action Level Mandates listed on
Summary Page of Report.
Notes:
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SanAir Technologies Laboratory will report each Cooling Tower’s actual number of
CFUs on Summary page.
SanAir Technologies Laboratory will report additional Bacterial Findings on
Summary page.
Client will have access code to view and download data from remote locations.
SanAir Technologies Laboratory will archive sample data for 5 years
ISO standards require 1 liter sample/location.
Samples should be received by mid-week in order to facilitate proper lab
procedures
All samples will follow strict Microbiology Chain of Custody protocols customized
for Client
SanAir Technologies Laboratory’s QC, SOPs & C of C protocols are available via
website
SanAir Technologies Laboratory procedures based on ISO 1173.1 part 1: 1998.
Sample: Web Based Reporting Format
When to Sample for Bacteria ?
Total Bacterial Sampling is not enough. Specific tests for Legionella is required for a good maintenance program. If
there is a suspicion or presumption that water sources are contaminated or if a single case of Legionnaires’ disease
exists, a thorough study of the water system is warranted. After the water systems have been systematically
evaluated and control actions have been taken, water should be sampled. Water should be collected under the
guidance of an accredited lab. The laboratory will analyze the bacteria under controlled conditions. Contamination is
expressed in number of colony forming units per milliliter of water (CFU/ml). The limit of detection for this analysis is
200-1000 CFU/liter. The following table should be used to interpret lab results and develop action plans.
A
C
T
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N
Cooling
Tower
Domestic
Water
Humidifier
1
100
10
1
2
1,000
100
10
Action 1: Prompt cleaning and/or biocide treatment of the system.
Action 2: Immediate cleaning and/or biocide treatment. Take prompt steps to prevent
employee exposure.
Health and Safety
UAW members can draw upon the resources and expertise of the largest health and safety department of any American union.
The UAW Health and Safety Department educates UAW members, local union leaders, and staff about ways to prevent and eliminate
safety and health hazards.
Legionella sp. under UV illumination
Legionella pneumophila
Legionella Analytical Management Staff:
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John H. Keene, Dr. P.H., CBSP, Director of Technical Development
Stephen N. Hayes, BSMT (ASCP), VP, Technical Operations
L. Claire Macdonald, BS, CMI, Laboratory Director
William J. Kokolis, MS, (ASCP-M) Special Pathogens Technical
Manager
Legionella Sampling Kit
Shown: Kit – 1 # SA – LS – 4 – 2
Kit – 1 (4Pak) - # SA - LS – 4 – 2: 1 cooler, 4 sample bottles, 2 scoops, 4 swabs, ice pack
Kit – 2 (6Pak) - # SA – LS – 6 – 2: 1 cooler, 6 sample bottles, 2 scoops, 4 swabs, ice pack
Kit – 3 (8Pak) - # SA – LS – 8 – 2: 1 cooler, 8 sample bottles, 2 scoops, 4 swabs, ice pack
Custom kits per client need:
Summation:
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Absence of Legionella = no risk for Legionnaires’ Disease.
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Only practical way to determine the presence of Legionella →
test for it.
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Routine testing is a proven, logical, and proactive choice.
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Detection is not the end of the world… Solutions are available.
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When taking preventative measures to control Legionella in water, then
you should periodically test to insure the preventative measures are
working.
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Please, remember the results of sampling may provide life-saving
information.
Additional Case Studies on Legionnaire's Disease are available on our website:
www.sanair.com