WHAT IS LEGIONNAIRES' DISEASE?
Legionnaires' disease is a serious lung infection caused by a bacterium called Legionella. Legionnaires' disease is not transmitted through person-to-person contact. Instead, most people get bacteria through respiration. Legionnaires' disease was first seen as an epidemic in 1976 at a meeting of American legionnaires. Scientists first identified the disease in 1977, six months after the outbreak, in which 29 people died.
Most people exposed to bacteria don't get the disease. However, especially the elderly, smokers and those with weak immune systems are at risk for the occurrence of infection. It is monitored with symptoms such as high fever, chills, headaches and shortness of breath. Antibiotics are used in the treatment. Starting treatment at an early period is effective in preventing the development of complications and can be lifesaving.
Throughout human history, infectious diseases have been the main health problem affecting people's health and living standards. One of the most important indicators of the development of countries is the incidence of infectious diseases and their achievements in combating them. Developed and developing countries are working effectively to minimize the incidence of infectious diseases and provide all kinds of support to ensure their extinction. The Republic of Turkey has always carried and will carry risks for infectious diseases due to its growing population, economic, social structure and geographical location in the world.
Today, due to the multiplicity and variety of transportation facilities, infectious diseases have become an international problem due to increased travel. One of these problems is Travel Related Legionnaires' Disease, which has been followed in our country since 1996.
It is known that legionnaires' disease is not only travel-related due to its associatedness with water, but also in other living areas where water is used in society. Therefore, within the scope of the "Legionnaires' Disease Control Program", the disease has been revised as procedures and principles regarding the prevention of the disease in all accommodations, especially hotels and hospitals, and the measures to be taken within the legal framework, to be prepared for Legionnaires' disease, to be prepared for the disease and to fight the disease, and to "Legionnaires' Disease Control Procedures and Principles regarding the notification of the disease" About Its Merits" regulation has been published.
"Legionnaires' Disease Control Program Guide" has been developed to ensure the standardization of the studies to be carried out within the scope of the regulation. In the light of the arrangements made with this guide; It is aimed to ensure the diagnosis of Legionnaires' Disease within the framework of certain standards, to obtain accurate notifications, to organize the studies to be carried out in accommodation units within the scope of environmental surreality and to reveal the dimensions of the disease in our country.
Risk Factors Legionnaires' disease is also considered an "opportunistic" infection; because individuals with a distinctly underlying disease or weak immune system become ill. Even if healthy individuals with a normal immune system are exposed to the factor, infection often does not develop. In order for the disease to develop, the individual must have some risk factors. Risk factors: - Advanced age (>50 years) - Masculinity - Chronic lung disease - Smoking - Alcohol addiction - Having any disease that suppresses the immune system or using medications that will cause immunosuppression (organ transplantation, use of corticosteroids and similar drugs, malignancies, diabetes mellitus, etc.). In addition, the size of the accommodations such as hospitals, hotels, etc., the age of the water system and the growth of Legionella in the system before are considered important risk factors.
The most common colonization environments of Legionella bacteria are as follows: - Building hot water systems – The temperature of water in hot water tanks is below 60°C and the temperature of the water flowing at the expiration point (shower, etc.) is below 50°C, - Building cold water system – Due to climate conditions or indirect heating of cold water pipes close to hot water system pipes, the temperature of the water in the installation is usually above 20 °C, - Cooling towers, steam capaciors and coolers that operate with the mechanism of evaporation of liquid, - Hot springs, hot pools, - irrigation pools, fish breeding pools, decorative pools and fountains, - Respiratory therapy equipment in hospitals – The likelihood of colonization of bacteria increases, especially when using tap water in water tanks, - Water pipes of dental units – Water is usually above 20°C, some of which may be heated up to 37°C for patient comfort, - Stagnant water remaining inside eye wash taps and showers and "sprinkler" type fire extinguishing systems related to working safety, - Other resources.
It is accepted that there are two ways for the bacterium to infect an individual and reach the lungs. The widely accepted route is the inhalation of water aerosols containing Legionella emitted from environmental sources into the respiratory air. It is thought that under the influence of force (cooling-tower fans, jacuzzi and shower heads, spray humidifiers, decorative fountains...) water is dispersed into the air as aerosols, and aerosols smaller than 5µm containing Legionella are taken through the respiratory tract and reach the alveoli. Another important mode of transmission is the aspiration of water containing Legionella or the passage of bacteria located in the oropharynx into the respiratory tract. Human-to-human transmission has not been demonstrated to date.
Transmission Route in Legionnaires' Disease
- Cooling towers,
- Hot and cold water systems
- SPA pools
- Thermal pools/resources
- Decorative fountains
- Ice machines, water dispensers
- Humidifiers
- Respiratory therapy equipment
- Medical treatment devices
- Industrial areas
- Shopping malls, restaurants, clubs
- Holiday centers
- Sports clubs
- Hotels
- Campgrounds
- Hospitals
PREVENT LEGIONELLA CARE FROM SETTLING IN THE PLANT LIST OF "ROUTINE CONTROL MEASURES"
- In the hospital/operation, a staff member who is trained in Legionella and can identify the risks should be permanently assigned.
- Hot and cold water tanks must have drain taps at a suitable point; thus, it should be possible to empty, clean and remove the bottom sediment at regular intervals.
- To reduce the sediment at the bottom, hot water tanks should be emptied, cleaned and disinfected every 3 months and cold water tanks every 6 months; the frequency of the procedure is decided according to the speed of sediment accumulation.
- If a hot water tank or part of the hot water system has been disabled for maintenance and similar reasons for a week or more; the temperature of the water should be kept above 70 C for at least one day from the moment it is put back into use.
- The temperature of the water in hot water tanks should be kept at least 60C throughout the year. The temperature of the water returning to hot water tanks should be at least 50 C.
- The temperature of the water poured from the tap or shower heads at almost every point of the building should reach a temperature between 50-60C in 1 minute.
- In hot water tanks; if the connection of cold water inlet or hot return water is not done correctly, there may be stagnation; this stagnation should be eliminated by replacing the ports.
- The water distribution system must be regulated so that it does not contain parts (any dead connection/cavity) where there is no water flow or where it is very slow; all detected dead cavities should be immediately destroyed, unused branches should be removed.
- The most important dead cavity formations are water pipes that fall behind unused taps; dead gaps behind the faucets and shower heads can easily occur in rooms that remain empty for a while when there are no occupants; to prevent this, water should be poured from the taps and shower heads of unused rooms for 3-5 minutes each day.
- Shower heads and tap filters cause the development of lime layer; or regenerated with descaling agents at regular intervals (on average once a month).
- If not in use, cooling towers must be emptied and cleaned. Cooling towers in use should be mechanically cleaned at least 2 times a year, sediment and sediment should be completely removed, and appropriate BIOIDS should be used regularly to prevent the reproduction of organisms.
- The heating system should be cleaned and disinfected at least once a year.
- If the accommodations is closed for a week or more, the guest must carry out the following precautions before accepting: (During these procedures, all necessary measures and measures must be taken by the accommodation authorities to ensure that guests staying in the accommodations do not use the water for drinking and use purposes.)
- The temperature of the water in all hot water tanks should be raised up to 70 C (heating) and this level should be maintained for at least 24 hours.
- Water should be drained from all hot water taps and shower heads for at least 5-10 minutes (flushing); in this way, the temperature of the water flowing from the tap should be at least 60 C.
- The temperature of the water flowing from the taps should be kept above 60 C for at least 24 hours.
- In addition, hyperchlorination should be performed in the entire hot and cold water system with a balance chlorine amount of at least 3 ppm; this level must be maintained for at least 24 hours.
- Shower heads and taps should be cleaned and the lime layers formed should be removed.
- Cooling towers should be emptied with all of them, all sediment and pollution should be removed. Internal surfaces should be cleaned and disinfected. Effective biocides should be applied when re-entering the system.
- From the reception of guests, the above mentioned items should be applied regularly.
- Su samples should be analyzed routinely monthly. Effective biocides should be used regularly.
