Also, in a supplement to a new journal called "Filtration", edited by Professor Gourlay of the Hammersmith Hospital in England, VP Scientific Affairs for Pall Medical, Dr. Jerry Ortolano co-authored an article titled: "Hospital Water Point-of Use Filtration: A Complementary Strategy to Reduce the Risk of Noscomial Infection". The article reviews significant documentation of hospital water as a source of infection in patients.

In fact, Ortolano said that Pall Medical has recently sent a letter to the CDC regarding their new Guidelines for Isolation Precautions. The letter highlights the fact that both France and Germany have considered water contamination in hospitals to be a major issue, and while the problem may be underreported in the U.S., the CDC should consider stressing the importance of the issue in its recommendations.

Gunner Lyslo, director of Liquitech Inc.’s Medical Division (Bolingbrook, IL), advised: "Legionella surfaces in healthcare facilities because they generally have large, complicated water distribution systems that often have poor flow or stagnating water, and local codes often dictate that medical centers maintain their hot water at about 110º-140ºF, the ideal temperature for Legionella to proliferate."

The Liquitech system plays on the natural biocidal qualities of metals. "The Liquitech system kills Legionella by introducing copper-silver ions into the water distribution system," Lyslo said. "The real advantage of the Liquitech system is its ability to form residual protection throughout the entire hot- or cold-water distribution system." This claim is confirmed in a study of the first 16 hospitals to use copper-silver ionization for Legionella control (Infect Control Hosp Epidemiol 2003;24:563-568). The copper-silver ionization systems were installed in these hospitals between 1989 and 1995. Authors Stout and Yu, recognized as worldwide experts on Legionella, reported, ". . . all 16 hospitals reported cases of nosocomial legionnaires’ disease before installing the copper-silver ionization system; no cases have occurred in any of the hospitals since 1995. . . . Advantages of copper-silver ionization are that it is more cost-effective than hyperchlorination, is easier to maintain, and does not corrode piping or plumbing fixtures, and in the event of mechanical failure, recontamination is delayed for weeks, allowing a safety buffer."

Once installed, Liquitech works fast, but they make no claims of eradication, simply because it isn’t realistic. But the performance is impressive. Mark DeSanto, Vice President, Liquitech, said, "Typically within 2 to 4 weeks, cultures show 0 positivity." Lyslo noted that, "generally the IC committee determines the frequency of surveillance, but we advise, depending on the facility, that cultures be obtained once every 6 months to once per year. We guarantee the performance. If for any reason the customer is not satisfied in the first 6 months, they may return the equipment. In the 15 years we’ve provided that guarantee, we’ve never had a customer return the equipment."

And then there’s cost, always a concern. DeSanto said, "The electronic control unit draws very little power, about as much as a 200-watt light bulb. The copper-silver electrodes are sacrificial, they wear out after a period of time. Typically this happens during the third or fourth year. If you amortize the cost of the electrodes over 3 to 4 years, it costs about $1,000 to $1,500 per year to operate the system for a 200- to 400-bed hospital. It varies according to hospital design, but this is typical."

What about retrofitting? "It’s not a problem at all," said Lyslo. "In fact, the majority of our customers are retrofitting the equipment." Again, what’s the cost? DeSanto maintained, "If the work is done internally, it takes about $500 in parts; if they use an outside contractor, the cost is typically between $2,000 to $3,000 for complete installation. It’s pretty simple and it’s relatively inexpensive."

Another option to prevent decontamination is a point-of-use water filtration system, such as the ones offered by Pall Medical. Ortolano describes the system as a complementary method to be used in conjunction with more conventional disinfection strategies.

He points out that methods described in the "Filtration" journal mentioned above, such as the use of chlorination, heat-shock treatment, chlorine dioxide, monochloramines, copper-silver ionization and UV light, are all acceptable methods. However, he does note that an often overlooked element in water contamination is "biofilm". Over time, microorganisms present in the water stream will build up a biofilm or "slimy" coat which serves to protect them. As concentrations of disinfectants in the water system wax and wane, and the disinfectants cannot effectively penetrate the biofilm, there may be occasions when viable pathogens are shed or slough off into the flow of water.

Ortolano explains that Pall’s point-of-use filtration system can be easily affixed to any sink or showerhead, and will prove particularly valuable in areas where patients are at highest risk. The filters that Pall currently sells in the U.S. are 0.2 micron sterilization grade filters, designed for seven-day effectiveness against all appropriately sized bacteria. The filter provides an instant remedy, and simply requires a quick, 5-second, filter change after seven days.

Ortolano concludes that hospital water contamination is "not a trivial issue", but notes, "with point-of-use filtration we have a new tool to target the areas in the hospital where patients are at highest risk of infection."HPN