Monochloramine for Remediation of Legionella Only in Domestic Hot Water Systems: An Iron Fist in a Velvet Glove

Abstract

Monochloramine is a well-known disinfectant for drinking water with several advantages over chlorine and chlorine dioxide. With these two biocides, monochloramine is included in the US-EPA list of disinfectants for drinking water. At the beginning of XXI century, epidemiological studies demonstrated its superior ability to control Legionella in hot water health-care premises. In 2005 a research program started to set up a reliable and effective method to produce monochloramine directly in domestic hot water systems, at the safest concentration and without accumulation of by-products. Results of these researches, which has been carried out with the collaboration of Italian and American Institutions showed that monochloramine can be safely and reliably prepared and that it is the best approach to Legionella remediation in health-care facilities.

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Melada, S. and Coniglio, M. (2015) Monochloramine for Remediation of Legionella Only in Domestic Hot Water Systems: An Iron Fist in a Velvet Glove. Open Journal of Preventive Medicine, 5, 143-150. doi: 10.4236/ojpm.2015.53017.

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1] Marston, B.J., Plouffe, J.F., File Jr., T.M., Hackman, B.A., Salstrom, S.J., Lipman, H.B., et al, (1997) Incidence of Community Acquired Pneumonia Requiring Hospitalization—Results of a Population-Based Active Surveillance Study in Ohio. Archives of Internal Medicine, 15, 1709-1718.
http://dx.doi.org/10.1001/archinte.1997.00440360129015
[2] Zhan, X.Y., Hu, C.H. and Zhu, Q.Y. (2010) Research Advances of Legionella and Legionnaires’ Disease. Frontiers of Medicine in China, 2, 166-176.
http://dx.doi.org/10.1007/s11684-010-0036-3
[3]
http://water.epa.gov/drink/contaminants/basicinformation/disinfectants.cfm
[4] Coniglio, M.A., Melada, S. and Yassin, M.H. (2015) Monochlorammine for Controlling Legionella in Biofilms: How Much We Know? Journal of Nature and Science, 1, e44.
[5] Helms, C.M., Massanari, M., Wenzel, R.P., Pfaller, M.A., Moyer, N.P. and Hall, N. (1988) Legionnaires’ Disease Associated With a Hospital Water System. A Five-Year Progress Report on Continuous Hyperchlorination. JAMA, 16, 2423-2427.
[6] Snyder, M.B., Siwicki, M., Wireman, J., Pohlod, D., Grimes, M., Bowman-Riney, S., et al. (1990) Reduction in Legionella pneumophila through Heat Flushing Followed by Continuous Supplemental Chlorination of Hospital Hot Water. Journal of Infectious Disease, 1, 127-132.
http://dx.doi.org/10.1093/infdis/162.1.127
[7] Ditommaso, S., Biasin, C., Giacomuzzi, M., Zotti, C.M., Arione, M., Guglielmi, E., et al. (2006) Colonization of a Water System by Legionella Organisms and Nosocomial Legionellosis: A 5-Year Report from a Large Italian Hospital. Infection Control Hospital Epidemiology, 5, 532-535.
http://dx.doi.org/10.1086/504454
[8] Hamilton, E., Seal, D.V. and Hay, J. (1996) Comparison of Chlorine and Chlorine Dioxide Disinfection for Control of Legionella in a Hospital Potable Water Supply. Journal of Hospital Infection, 32, 156-160.
http://dx.doi.org/10.1016/S0195-6701(96)90058-4
[9] Srinivasan, A., Bova, G., Ross, T., Mackie, K., Paquette, N. Merz, W., et al. (2003) A 17-Month Evaluation of a Chlorine Dioxide Water Treatment System to Control Legionella Species in a Hospital Water Supply. Infection Control Hospital Epidemiology, 24, 575-579.
http://dx.doi.org/10.1086/502254
[10] Ricci, M.L., Dell’Eva, I., Scaturro, M., et al. (2005) A Four-Year Experience of a Chlorine Dioxide Treatment for the Control of Legionella in a Hospital Water System. ISTISAN Congressi, 05, 18.
[11] Casini, B., Valentini, P., Baggiani, A., Torracca, F., Frateschi, S., Nelli, L.C., et al. (2008) Molecular Epidemiology of Legionella pneumophila Serogroup 1 Isolates Following Long-Term Chlorine Dioxide Treatment in a University Hospital Water System. Journal of Hospital Infection, 69, 141-147.
http://dx.doi.org/10.1016/j.jhin.2008.03.003
[12] Hosein, I.K., Hill, D.W., Tan, T.Y., Butchart, E.G., Wilson, K., Finlay, G., et al. (2005) Point-of-Care Controls for Nosocomial Legionellosis Combined with Chlorine Dioxide Potable Water Decontamination: A Two-Year Survey at a Welsh Teaching Hospital. Journal of Hospital Infection, 61, 100-106.
http://dx.doi.org/10.1016/j.jhin.2005.02.008
[13] Zhang, Z., McCann, C., Hanrahan, J., Jencson, A., Joyce, D., Fyffe, S., et al. (2009) Legionella Control by Chlorine Dioxide in Hospital Water Systems. Journal-American Water Works Association, 101, 117-127.
[14] Sidari, F.P., Stout, J.E., VanBriesen, J.M., Bowman, A.M., Grubb, D., Neuner, A., et al. (2004) Keeping Legionella out of Water Systems. Journal-American Water Works Association, 96, 111-119.
[15] Di Marino, O., Valentini, P., Cosentina, R. and Melada, S. (2007) Chlorine Dioxide for Legionellosis Prevention in an Italian Hospital: A Success Story. 22nd Meeting EWGLI, Stockholm, 2-5 June 2007.
[16] Marchesi, I., Cencetti, S., Marchegiano, P., Frezza, G., Borella, P. and Bargellini, A. (2012) Control of Legionella Contamination in a Hospital Water Distribution System by Monochloramine. American Journal of Infection Control, 40, 279-281.
http://dx.doi.org/10.1016/j.ajic.2011.03.008
[17] Kandiah, A., Yassin, M.H., Hariri, R., Ferrelli, J., Fabrizio, M., Porter, L., et al. (2012) Control of Legionella Contamination with Monochloramine Disinfection in a Large Urban Hospital Hot Water System. American Journal of Infection Control, 40, e84.
http://dx.doi.org/10.1016/j.ajic.2012.04.149
[18] Chien, S.H., Chowdhury, I., Hsieh, M.K., Li, H., Dzombak, D.A. and Vidic, R.D. (2012) Control of Biological Growth in Recirculating Cooling Systems Using Treated Secondary Effluent as Makeup Water with Monochloramine. Water Research, 46, 6508-6518.
http://dx.doi.org/10.1016/j.watres.2012.09.027
[19] Marchesi, I., Ferranti, G., Bargellini, A., Marchegiano, P., Predieri, G., Stout, J.E. and 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, 738-747.
http://dx.doi.org/10.2166/wh.2013.079
[20] Kandiah, A., Yassin, M.H. and Stout, J. (2013) Monochloramine Use for Prevention of Legionella in Hospital Water System. Infectious Disorders-Drug Targets, 13, 184-190.
http://dx.doi.org/10.2174/1871526511313030006
[21] Casini, B., Buzzigoli, A., Cristina, M.L., Spagnolo, A.M., Del Giudice, P., Brusaferro, S., et al. (2014) Long-Term Effects of Hospital Water Network Disinfection on Legionella and Other Waterborne Bacteria in an Italian University Hospital. Infection Control and Hospital Epidemiology, 35, 293-299.
http://dx.doi.org/10.1086/675280
[22] Duda, S., Kandiah, S., Stout, J.E., Baron, J.L., Yassin, M., Fabrizio, M., et al. (2014) Evaluation of a New Monochloramine Generation System for Controlling Legionella in Building Hot Water Systems. Infection Control and Hospital Epidemiology, 35, 1356-1363.
http://dx.doi.org/10.1086/678418
[23] Alleron, L., Khemiri, A., Koubar, M., Lacombe, C., Coquet, L., Cosette, P., et al. (2013) VBNC Legionella pneumophila Cells Are Still Able to Produce Virulence Proteins. Water Research, 47, 6606-6617.
http://dx.doi.org/10.1016/j.watres.2013.08.032
[24] Coniglio, M.A., Andolfi, N., Faro, G., Pellegrino, M.B., Sgalambro, A., D’Aquila, G., et al. (2014) Monochloramine for the Control of Legionella Contamination of Domestic Hot Water Systems of Health-Care Facilities. A Six Months Experience from Sicily (Italy). 2nd ESGLI Congress, Barcelona, 17-19 September 2014.

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