Legionnaires' Disease - Legionella

“Legionnaires' Disease z is called pneumonia caused by Legionella bacteria.

In 1976, the American Legion meeting was held in a hotel in Phidelphia was detected by an outbreak.

Legionella spp. proliferates in water systems;

Large buildings - hotels, hospitals, business and shopping centers, nursing homes, etc. places, cooling tower air-conditioning systems, shower heads, taps, whirlpools, baths, sprinklers used for garden irrigation, breathing equipment in hospitals is spread by spreading into the air. It occurs as a result of the bacteria in the water particles entering the body by breathing and settling in the lungs, the number of inhaled bacteria and contact time are important factors in the severity of the disease. 3 km with water particles. can spread over an area of ​​diameter.

In 71-85% of legionella-related infections, L.pneumophila is the causative agent.

There are 2 different clinical manifestations:

1- Pontiac Fever: Creates a flu-like picture. The incubation period is 2-5 days. It starts with fever and muscle pains. Does not cause pneumonia. Heals spontaneously within a week without treatment.

2- Legionnaires' Disease: Especially in people with low immune system, the disease causes atypical pneumonia and death risk varies between 5-30%. Legionella causative bacteria enter the body, from the onset of the symptoms of the disease is between 2-10 days. Legionnaires' disease usually begins with general complaints such as fever, weakness, dry cough, muscle and headache, more rarely diarrhea may be seen, and the picture becomes more severe. Diagnosis of atypical pneumonia is made by lung film (X-ray). Laboratory tests should be performed to determine the presence of Legionnaires bacteria in pneumonia.

Legionella diseases resulting from water systems in accommodation facilities and hotels are defined as ”TRAVEL RELATED LEGIONARY DISEASE.. EWGL of 34 European countries, including Turkey's (The European Working Group for Legionella Infections) cases and controls by implementing sanctions and travel agencies to follow.

Turkey according to 2001 data, 65.2 / 10,000,000 (case / number of tourists) are the first in Europe.

In order to determine the effectiveness of the disinfectant used in water systems, periodical water analyzes should be carried out regularly to laboratories accredited by TURKAK TS ISO EN 17025, accredited from Legionella analyzes ([url] www.saniter.com.tr [/ url]) and by whom , how it is made, daily controls of water temperature, the use of disinfectants in the recommended doses and analysis should be held in detail.

Things to do for Leyjonella Control

Ministry of Health - Implementation Control Measures of Legionella-Free Facilities:

1. The facility should be staffed by Legionella-trained personnel who can identify risks.

2. Hot water tanks must have drain taps at a suitable point; thus, it should be possible to discharge, clean and remove the bottom sediment from the hot water tanks at regular intervals,

3. Hot water tanks should be emptied, cleaned and disinfected every 3 months to reduce sludge deposits at the bottom; the frequency of this process can be decided according to the rate of sediment accumulation (2-6 times per year).

4. Cold water tanks should also be emptied, cleaned and disinfected at least once a year.

5. If a hot water tank or part of the hot water system is maintained for a week or longer, etc. has been disabled for reasons; the temperature of the water should be kept above 70 ° C for at least one day after it is re-used.

6. Hot water heater tanks; if cold water inlet or hot return water connection is not made correctly, there may be stagnation; this stagnation must be eliminated by changing the connection points.

7. The water distribution system shall be arranged in such a way that there are no dead-connections / spaces (parts where the water flow is absent or very slow); All dead gaps detected should be eliminated immediately and unused branches removed.

8. The most important dead cavities are the water pipes behind the unused taps; such dead spaces can easily occur behind the faucets and shower heads in rooms that are left empty for a while when the customer is absent; The most effective way to prevent this is to drain water from the faucets and shower heads in unused rooms for 3-5 minutes every day.

9. The heat of the hot water flowing from the faucets or shower heads at almost every point of the building should reach a temperature of 50-60 C within 1 minute.

10. The temperature of the hot water tanks should be kept at least 60 ° C throughout the year

11. The temperature of the hot water returned to the hot water tanks should be at least 50 ° C.

12. Shower heads and faucet filters cause sediment build-up; should be avoided or regenerated with descaling agents at regular intervals (on average once a month).

13. If not in use, the cooling towers must be drained and cleaned.

14. Cooling towers in use should be mechanically cleaned 4 times a year, sediment and sediment should be completely removed, and appropriate biocides should be used regularly to prevent the growth of organisms.

15. The heating system should be cleaned and disinfected at least once a year.

16. If the accommodation is closed during certain periods of the year, at the beginning of the season the customer must comply with the following precautions before accepting:

The temperature of the water in all hot water tanks should be increased to 70 ° C (heating) and this level should be maintained for at least 24 hours.

b.Flowing of all hot water taps and shower heads for at least 30 minutes; in this way the temperature of the water flowing from the faucet should be at least 60 ° C, since this temperature is sufficient to kill legionellaes located in the faucets and shower heads.

c. The hot water flowing from the taps for at least 24 hours should be kept above 60C. Alternatively, hyperchlorination is carried out in the entire hot and cold water system such that the amount of free residual chlorine is at least 3 ppm; This level is maintained for at least 24 hours.

D. Dead gaps and blockages in the system must be detected and canceled.

e Shower heads and taps should be cleaned, lime layer formed should be cleaned.

Cooling towers should be completely emptied and all sediment and pollution should be removed. Internal surfaces are cleaned and disinfected, necessary repairs are made and effective apparatus is installed to prevent sediment accumulation. Effective biocides (quaternary ammonium compounds, etc. disinfectants) are applied when the system is re-used.