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Comment published on 4 August 2017, see Int. J. Environ. Res. Public Health 2017, 14(8), 876.

Reply published on 11 August 2017, see Int. J. Environ. Res. Public Health 2017, 14(8), 906.

Open AccessArticle
Int. J. Environ. Res. Public Health 2017, 14(7), 670; doi:10.3390/ijerph14070670

Evaluation of Legionella Air Contamination in Healthcare Facilities by Different Sampling Methods: An Italian Multicenter Study

1
Department of Biomedical Science and Human Oncology, University of Bari “Aldo Moro”, Piazza G. Cesare 11, 70124 Bari, Italy
2
Department of Health Sciences, University of Genoa, Via Pastore 1, 16132 Genova, Italy
3
Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Roma, Via di Grottarossa 1035, 00189 Roma, Italy
4
Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Sofia 87, 95123 Catania, Italy
5
Department of Cardiac, Thoracic and Vascular Sciences, Hygiene and Public Health Unit, University of Padova, Via Loredan 18, 35131 Padova, Italy
6
Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Via San Zeno 35/39, 56127 Pisa, Italy
7
Department of Biomedical Sciences and Public Health, Polytechnic University of Marche, via Tronto, 10/a Torrette di Ancona, 60020 Ancona, Italy
8
Department of Biomedical Science and Morphological and Functional Images, University of Messina, Via C.Valeria snc, 98125 Messina, Italy
9
Department of Biomedical Science-Hygiene Section, University of Sassari, Via Padre Manzella 4, 07100 Sassari, Italy
10
Department of Biology, University of Napoli “Federico II”, Via Cinthia 26, 80126 Napoli, Italy
11
Department of Movement Sciences and Wellbeing, University “Parthenope”, Via Medina 40, 80133 Napoli, Italy
12
IRCCS San Raffaele Scientific Institute, Via Olgettina 60, 20132 Milano, Italy
13
Department of Public Health, University of Napoli “Federico II”, Via S.Pansini 5, 80131 Napoli, Italy
14
Department of Movement, Human and Health Sciences, Public Health Unit, University of Roma “Foro Italico”, P.zza Lauro De Bosis 6, 00135 Roma, Italy
15
Department of Diagnostic and Public Health, University of Verona, Strada le Grazie 8, 37134 Verona, Italy
16
Department of Medicine and Surgery, University of Parma, Medical Immunology Unit, University Hospital of Parma, Via Gramsci 14, 43126 Parma, Italy
17
Department of Medicine and Surgery, University of Parma, Via Volturno 39, 43125 Parma, Italy
*
Author to whom correspondence should be addressed.
Academic Editor: Jason K. Levy
Received: 26 May 2017 / Revised: 16 June 2017 / Accepted: 19 June 2017 / Published: 22 June 2017
View Full-Text   |   Download PDF [927 KB, uploaded 22 June 2017]   |  

Abstract

Healthcare facilities (HF) represent an at-risk environment for legionellosis transmission occurring after inhalation of contaminated aerosols. In general, the control of water is preferred to that of air because, to date, there are no standardized sampling protocols. Legionella air contamination was investigated in the bathrooms of 11 HF by active sampling (Surface Air System and Coriolis®μ) and passive sampling using settling plates. During the 8-hour sampling, hot tap water was sampled three times. All air samples were evaluated using culture-based methods, whereas liquid samples collected using the Coriolis®μ were also analyzed by real-time PCR. Legionella presence in the air and water was then compared by sequence-based typing (SBT) methods. Air contamination was found in four HF (36.4%) by at least one of the culturable methods. The culturable investigation by Coriolis®μ did not yield Legionella in any enrolled HF. However, molecular investigation using Coriolis®μ resulted in eight HF testing positive for Legionella in the air. Comparison of Legionella air and water contamination indicated that Legionella water concentration could be predictive of its presence in the air. Furthermore, a molecular study of 12 L. pneumophila strains confirmed a match between the Legionella strains from air and water samples by SBT for three out of four HF that tested positive for Legionella by at least one of the culturable methods. Overall, our study shows that Legionella air detection cannot replace water sampling because the absence of microorganisms from the air does not necessarily represent their absence from water; nevertheless, air sampling may provide useful information for risk assessment. The liquid impingement technique appears to have the greatest capacity for collecting airborne Legionella if combined with molecular investigations. View Full-Text
Keywords: Coriolis®μ; Surface Air System; settle plates; index microbial air Coriolis®μ; Surface Air System; settle plates; index microbial air
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MDPI and ACS Style

Montagna, M.T.; De Giglio, O.; Cristina, M.L.; Napoli, C.; Pacifico, C.; Agodi, A.; Baldovin, T.; Casini, B.; Coniglio, M.A.; D’Errico, M.M.; Delia, S.A.; Deriu, M.G.; Guida, M.; Laganà, P.; Liguori, G.; Moro, M.; Mura, I.; Pennino, F.; Privitera, G.; Romano Spica, V.; Sembeni, S.; Spagnolo, A.M.; Tardivo, S.; Torre, I.; Valeriani, F.; Albertini, R.; Pasquarella, C. Evaluation of Legionella Air Contamination in Healthcare Facilities by Different Sampling Methods: An Italian Multicenter Study. Int. J. Environ. Res. Public Health 2017, 14, 670.

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