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Assessment of the risk of Legionella pneumophila in water distribution systems in hospitals of Tehran city

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Abstract

When a sensitive host inhales aerosols containing these bacteria, Legionella infection occurs. Therefore, monitoring and assessing Legionella in the environment and water distribution systems of such places are critical due to the prone population in hospitals. However, the health risks of Legionella bacteria in the environment are not adequately evaluated. In this study, for hospitalized patients, we performed a quantitative health risk assessment of Legionella in selected hospitals in Tehran city using two scenarios of shower and toilet faucet exposure. This study identified Legionella in 38 cases (38%) out of 100 samples collected from toilet faucets and showers in 8 hospitals. The information gathered was used for quantitative microbial risk assessment (QMRA). The microbial load transmitted by inhalation was calculated using the concentration of Legionella in water. Other exposure parameters (inhalation rate and exposure time) were obtained using information from other studies and the median length of hospital stay (3.6 days). The exponential model was used to estimate the risk of infection (γ = 0.06) due to Legionella pneumophila (L. pneumophila) inhalation for each exposure event. For the mean concentration obtained for Legionella (103 CFU/L), the risk of infection for toilet faucets and showers was in the range of 0.23–2.3 and 3.5–21.9, respectively, per 10,000 hospitalized patients. The results were compared with the tolerable risk level of infection determined by the US EPA and WHO. The risk values exceeded the WHO values for waterborne pathogens in hospitals in both exposure scenarios. As a result, our QMRA results based on monitoring data showed that despite using treated water (from distribution networks in the urban areas) by hospitals, 38% of the samples were contaminated with Legionella, and faucets and showers can be sources of Legionella transmission. Hence, to protect the health of hospitalized patients, the risk of Legionella infection should be considered.

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Acknowledgements

The authors would like to thank the Iran University of Medical Sciences for the financial support of this research.

Funding

This article is the result of Grant No. 98–4-99–16883, which Iran University had approved.

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Authors and Affiliations

  1. Research Center for Environmental Health Technology, Iran University of Medical Sciences, Tehran, Iran

    Majid Kermani & Samira Norzaee

  2. Department of Environmental Health Engineering, School of Public Health, Iran University of Medical Sciences, Tehran, Iran

    Majid Kermani & Samira Norzaee

  3. Department of Microbiology, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

    Zahra Chegini

  4. Department of Microbiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran

    Shiva Mirkalantari

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  1. Majid Kermani
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  2. Zahra Chegini
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Contributions

Conceptualization, methodology supervision, and writing—original draft preparation: Samira norzaee, Zahra Chegini, and Majid Kermani; investigation, software, data curation: Samira norzaee; resources, formal analysis, and validation: Shiva Mirkalantari and Majid Kermani; writing—review and editing: Samira norzaee and Zahra Chegini; visualization, funding acquisition, project administration: Majid Kermani and Samira norzaee. The authors read and approved the final manuscript.

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Correspondence to Shiva Mirkalantari or Samira Norzaee.

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Kermani, M., Chegini, Z., Mirkalantari, S. et al. Assessment of the risk of Legionella pneumophila in water distribution systems in hospitals of Tehran city. Environ Monit Assess 194, 842 (2022). https://doi.org/10.1007/s10661-022-10469-y

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