Control of Legionella pneumophila contamination in a respiratory hydrotherapy system with sulfurous spa water

OBJECTIVE. To evaluate the effectiveness of different disinfection treatments in a spa water system contaminated by Legionella pneumophila and associated with a case of Legionella pneumonia. DESIGN. During an 18-month period, the spa water was analyzed by taking samples from the well, the recirculation line, and the final distribution devices ( nebulizers and nasal irrigators). Various attempts were made to eradicate Legionella organisms by chemical and thermal shock. The final protocol consisted of heat shock treatment at 70 degrees C- 75 degrees C for 3 hours, 2 nights per week, followed by a lowering of the water temperature to 30 degrees C +/- 1 degrees C for use in the plant. In addition, 3 times a week superheated steam ( at a pressure of 1 atmosphere) was introduced for 1 hour into the nebulization machines. SETTING. A spa at which sulfurous water was used for hydrotherapy by means of aerosol and nasal irrigation. PATIENT. A 74-year-old woman with legionnaires disease. RESULTS. After the case of infection occurred, L. pneumophila was isolated from the recirculation line at a concentration of 400,000 cfu/ L and from the nebulizers and nasal irrigators at levels ranging from 3,300 to 1,800,000 cfu/ L. The colonizing organisms consisted of a mixture of L. pneumophila serogroup 1 ( 12%) and serogroup 5 ( 88%). The shock treatment with chlorine dioxide and peracetic acid resulted in the eradication of Legionella organisms from the recirculation line but not from the water generated from the final distribution devices. After the restructuring of the plant and the application of thermal shock protocol, an evaluation after 12 months revealed no evidence of Legionella contamination. CONCLUSION. To prevent Legionella colonization, disinfection treatment is effective if associated with carefully selected materials, good circuit design, and good maintenance practices.