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Open AccessArticle

Prevention and Control of Legionella and Pseudomonas spp. Colonization in Dental Units

Department of Translational Research, N.T.M.S., University of Pisa, 56123 Pisa, Italy
Department of Health Sciences, University of Genova, Via Pastore 1, 16132 Genova, Italy
Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
Author to whom correspondence should be addressed.
Pathogens 2020, 9(4), 305;
Received: 24 February 2020 / Revised: 16 April 2020 / Accepted: 17 April 2020 / Published: 21 April 2020
(This article belongs to the Special Issue Legionella Contamination in Water Environment)
Introduction: Dental Unit Waterlines (DUWLs) have shown to be a source of Legionella infection. We report the experience of different dental healthcare settings where a risk management plan was implemented. Materials and methods: In a Hospital Odontostomatology Clinic (HOC) and three Private Dental Clinics (PDCs) housing 13 and six dental units (DUs), respectively, an assessment checklist was applied to evaluate staff compliance with guideline recommendations. DUWLs microbial parameters were investigated before and after the application of corrective actions. Results: In the HOC a poor adherence to good practices was demonstrated, whereas protocols were carefully applied in PDCs. L. pneumophila sg 2–15 was isolated in 31% (4/13) and 33% (2/6) of DUs in HOC and PDCs, respectively, mainly from handpieces (32%, 6/19) with counts >102 colony-forming units per milliliter (CFU/L), often associated with P. aeruginosa (68%, 13/19). The shock disinfection with 3% v/v hydrogen peroxide (HP) showed a limited effect, with a recolonization period of about 4 weeks. Legionella was eradicated only after 6% v/v HP shock disinfection and filters-installation, whilst P. aeruginosa after the third shock disinfection with a solution of 4% v/v HP and biodegradable surfactants. Conclusions: Our data demonstrate the presence and persistence of microbial contamination within the DUWLs, which required strict adherence to control measures and the choice of effective disinfectants. View Full-Text
Keywords: Dental unit waterlines; Legionella spp.; risk management; disinfection Dental unit waterlines; Legionella spp.; risk management; disinfection
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Tuvo, B.; Totaro, M.; Cristina, M.L.; Spagnolo, A.M.; Di Cave, D.; Profeti, S.; Baggiani, A.; Privitera, G.; Casini, B. Prevention and Control of Legionella and Pseudomonas spp. Colonization in Dental Units. Pathogens 2020, 9, 305.

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