Krankenhaushygiene up2date, Table of Contents Krankenhaushygiene up2date 2021; 16(01): 107-122DOI: 10.1055/a-1159-1895 Technische Hygiene, Umgebungshygiene Keine Legionellen in Verdunstungskühlanlagen! Teil 1: Funktionsweise, Anforderungen und Betrieb Authors Martin Scherrer Recommend Article Abstract Buy Article(opens in new window) All articles of this category(opens in new window) Verdunstungskühlanlagen dienen dem Abkühlen von Kühlwasser oder anderen Kühlmitteln. Oft sind sie Infektionsquelle für Ausbrüche der Legionärskrankheit. Der vorliegende Beitrag erklärt, wie diese Anlagen funktionieren und welche Anforderungen an sie gestellt werden. Außerdem geht es darum, wie sich Legionellen vermehren und verbreiten. Im zweiten Teil wird auf die dazugehörige Verordnung für Verdunstungskühlanlagen eingegangen. Full Text References Literatur 1 Orkis LT, Harrison LH, Mertz KJ. et al. Environmental sources of community-acquired legionnaires’ disease: A Review. Int J Hyg Environ Health 2018; 221: 764-774 2 Prussin AJ, Schwake DO, Marr LC. Ten Questions Concerning the Aerosolization and Transmission of Legionella in the Built Environment. Build Environ 2017; 123: 684-695 3 Hamilton KA, Prussin AJ, Ahmed W. et al. Outbreaks of Legionnaires’ Disease and Pontiac Fever 2006–2017. Curr Environ Health Rep 2018; 5: 263-271 4 Bentham RH. Environmental Factors Affecting the Colonization of Cooling Towers by Legionella spp. in South Australia. Int Biodeterior 1993; 31: 55-63 5 Werner HP, Pietsch M. Vorkommen und Bedeutung von Legionellen in Kraftwerkskühlsystemen. Schr.-Reihe Verein WaBoLu 91. Stuttgart: Gustav Fische; 1993: 231-240 6 Dubrou S, Guillotin L, Cabon S. et al. Cooling towers and legionellosis: A large urban area experience. In: Marre R, Abu Kwaik Y, Bartlett C. et al. Legionella. Washington: ASM press; 2002: 291-294 7 Verein Deutscher Ingenieure. VDI-Richtlinie 2047 Blatt 2 – Rückkühlwerke – Sicherstellung des hygienegerechten Betriebs von Verdunstungskühlanlagen vom Januar 2019. 8 Sinder C, Gringel M, Hardt H. et al. Legionellenrisiken in Verdunstungskühlanlagen und Kühltürmen. Berlin: VDE-Verlag; 2020 9 Sedighi AA, Bazargan M. A CFD analysis of the pollutant dispersion from cooling towers with various configurations in the lower region of atmospheric boundary layer. Sci Total Environ 2019; 696: 133939 10 Zweiundvierzigste Verordnung zur Durchführung des Bundes-Immissionsschutzgesetzes (Verordnung über Verdunstungskühlanlagen, Kühltürme und Nassabscheider – 42. BImSchV) vom 12. Juli 2017. Bundesgesetzblatt; 2017 47. 2379-2390 11 Eurovent. Eurovent 9/7: Recommended code of practice to keep your cooling system efficient and safe. Brüssel: Eurovent; 2011 12 European Working Group for Legionella Infections. EWGLI Technical Guidelines for the Investigation, Control and Prevention of Travel Associated Legionnaires´ Disease. European Working Group for Legionella Infections; 2011 Im Internet (Stand 02.12.2020): http://ecdc.europa.eu/en/activities/surveillance/ELDSNet/Documents/EWGLI-Technical-Guidelines.pdf 13 Bentham RH, Broadbent CR. A model for autumn outbreaks of Legionnaires' disease associated with cooling towers, linked to system operation and size. Epidemiol Infect 1993; 111: 287-295 14 Exner M, Pleischl S. Empfehlungen zur Gefährdungsbeurteilung und zur Prävention und Kontrolle von Legionellen in Rückkühlwerken. Umweltmed Forsch Prax 2010; 15: 193-201 15 Schulze-Röbbecke R, Richter M. Entstehung und Vermeidung von Legionelleninfektionen durch Kühltürme und Rückkühlwerke. Gesundheitsingenieur 1994; 115: 71-77 16 Kusnetsov JM, Tulkki AI, Ahonen HE. et al. Efficacy of three prevention strategies against legionella in cooling water systems. J Appl Microbiol 1997; 82: 763-768 17 Internationale Kommission zum Schutz des Rheins (IKSR). Fachbericht Nr. 243: Biozideinsatz zur Legionellenbekämpfung in Kühlsystemen von Kraftwerken und sonstigen Verdunstungskühlanlagen. 2017 Im Internet (Stand 02.12.2020): www.iksr.org/fileadmin/user_upload/DKDM/Dokumente/Fachberichte/DE/rp_De_0243.pdf 18 Verordnung über Anforderungen an das Einleiten von Abwasser in Gewässer (Abwasserverordnung - AbwV) vom 17. Juni 2004 (BGBl. I S. 1108, 2625), zuletzt geändert durch Artikel 1 der Verordnung vom 16. Juni 2020 (BGBl. I S. 1287). Im nternet (Stand 02.12.2020): www.gesetze-im-internet.de/abwv/AbwV.pdf 19 Cooling Technology Institute (CTI). Guideline: Best Practices for Control of Legionella. Houston, Texas: Cooling Technology Institute Houston; 2008 20 Carducci A, Verani M, Battistini R. Legionella in industrial cooling towers: monitoring and control strategies. Lett Appl Microbiol 2010; 50: 24-29 21 Mouchtouri VA, Goutziana G, Kremastinou J. et al. Legionella species colonization in cooling towers: risk factors and assessment of control measures. Am J Infect Control 2010; 38: 50-55 22 Garrison LE, Kunz JM, Cooley LA. et al. Vital Signs: Deficiencies in Environmental Control Identified in Outbreaks of Legionnaires' Disease - North America, 2000-2014. MMWR Morb Mortal Wkly Rep 2016; 65: 576-584 23 Bhopal RS, Fallon RJ, Buist EC. et al. Proximity of the home to a cooling tower and risk of non-outbreak Legionnaires' disease. BMJ 1991; 302: 378-383 24 Ricketts KD, Joseph CA, Lee JV. et al. Wet cooling systems as a source of sporadic Legionnaires' disease: a geographical analysis of data for England and Wales, 1996-2006. J Epidemiol Community Health 2012; 66: 618-623 25 Nguyen TMN, Ilef D, Jarraud S. et al. A Community-Wide Outbreak of Legionnaires Disease Linked to Industrial Cooling Towers – How Far Can Contaminated Aerosols Spread?. JID 2006; 193: 102-111 26 Nygård K, Werner-Johansen Ø, Rønsen S. et al. An outbreak of legionnaires disease caused by long-distance spread from an industrial air scrubber in Sarpsborg, Norway. Clin Infect Dis 2008; 46: 61-69 27 White PS, Graham FF, Harte DJ. et al. Epidemiological investigation of a Legionnaires' disease outbreak in Christchurch, New Zealand: the value of spatial methods for practical public health. Epidemiol Infect 2013; 141: 789-799 28 Russo A, Gouveia CM, Soares PMM. et al. The unprecedented 2014 Legionnaires’ disease outbreak in Portugal: atmospheric driving mechanisms. Int J Biometeorol 2018; 62: 1167-1179 29 Gleason JA, Kratz NR, Greeley RD. et al. Under the Weather: Legionellosis and Meteorological Factors. Ecohealth 2016; 13: 293-302 30 Hicks LA, Rose Jr. CE, Fields BS. et al. Increased rainfall is associated with increased risk for legionellosis. Epidemiol Infect 2007; 135: 811-817 31 Fisman DN, Lim S, Wellenius GA. et al. It's not the heat, it's the humidity: wet weather increases legionellosis risk in the greater Philadelphia metropolitan area. J Infect Dis 2005; 192: 2066-2073 32 Beauté J, Sandin S, Uldum SA. et al. Short-term effects of atmospheric pressure, temperature, and rainfall on notification rate of community-acquired Legionnaires' disease in four European countries. Epidemiol Infect 2016; 144: 3483-3493 33 Freudenmann M, Kurz S, von Baum H. et al. Interdisziplinäres Management eines länderübergreifenden Legionellenausbruchs. Bundesgesundheitsbl 2011; 54: 1161-1169 34 Walser SM, Gerstner DG, Brenner B. et al. Assessing the environmental health relevance of cooling towers - A systematic review of legionellosis outbreaks. Int J Hyg Environ Health 2014; 217: 145-154 35 Phares CR, Russell E, Thigpen MC. et al. Legionnaires' disease among residents of a long-term care facility: the sentinel event in a community outbreak. Am J Infect Control 2007; 35: 319-323 36 Jansà JM, Caylà JA, Ferrer D. et al. An outbreak of Legionnaires' disease in an inner city district: importance of the first 24 hours in the investigation. Int J Tuberc Lung Dis 2002; 6: 831-838 37 Borgen K, Aaberge I, Werner-Johansen O. et al. A cluster of Legionnaires disease linked to an industrial plant in southeast Norway, June-July 2008. Euro Surveill 2008; 13: 18985 38 Olsen JS, Aarskaug T, Thrane I. et al. Alternative routes for dissemination of Legionella pneumophila causing three outbreaks in Norway. Environ Sci Technol 2010; 44: 8712-8717 39 Blystad H, Brantsaeter AB, Løvoll Ø. Outbreak of community-acquired legionnairesʼ disease in southwest Norway, May 2005. Euro Surveill 2005; 10: 2709 40 Sala MR, Arias C, Oliva JM. et al. Community outbreak of Legionnaires disease in Vic-Gurb, Spain in October and November 2005. Euro Surveill 2007; 12: 48-50 41 Ragull S, Montenegro R, García-Núñez M. et al. Fluctuation in Legionella pneumophila counts in cooling towers over a 1-year-period. In: Cianciotto NP, Abu Kwaik Y, Edelstein PH. et al. Legionella: state of the art 30 years after its recognition. Washington: ASM press; 2006: 436-438 42 Lin H, Xu B, Chen Y. et al. Legionella pollution in cooling tower water of air-conditioning systems in Shanghai, China. J Appl Microbiol 2009; 106: 606-612 43 McCormick D, Thorn S, Milne D. et al. Public health response to an outbreak of Legionnairesʼ disease in Edinburgh, United Kingdom, June 2012. Euro Surveill 2012; 17: 20216 44 Burckhardt F, Brion A, Lahm J. et al. Confirming Legionnairesʼ Disease Outbreak by Genome-Based Method, Germany, 2012. Emerg Infect Dis 2016; 22: 1303-1304 45 Maisa A, Brockmann A, Renken F. et al. Epidemiological investigation and case-control study: a Legionnairesʼ disease outbreak associated with cooling towers in Warstein, Germany, August-September 2013. Euro Surveill 2015; 20 46 Quinn C, Demirjian A, Watkins LF. et al. Legionnaires' Disease Outbreak at a Long-Term Care Facility Caused by a Cooling Tower Using an Automated Disinfection System – Ohio, 2013. J Environ Health 2015; 78: 8-13 47 Shivaji T, Sousa Pinto C, San-Bento A. et al. A large community outbreak of Legionnaires disease in Vila Franca de Xira, Portugal, October to November 2014. Euro Surveill 2014; 19: 20991 48 Thornley CN, Harte DJ, Weir RP. et al. Legionella longbeachae detected in an industrial cooling tower linked to a legionellosis outbreak, New Zealand, 2015; possible waterborne transmission?. Epidemiol Infect 2017; 145: 2382-2389 49 Weiss D, Boyd C, Rakeman JL. et al. A Large Community Outbreak of Legionnaires' Disease Associated With a Cooling Tower in New York City, 2015. Public Health Rep 2017; 132: 241-250 50 Addiss DG, Davis JP, LaVenture M. et al. Community acquired Legionnairesʼ disease associated with a cooling tower: Evidence for longer-distance transport of Legionella pneumophila. Am J Epidemiol 1989; 130: 557-568 51 Dondero Jr. TJ, Rendtorff RC, Mallison GF. et al. An outbreak of Legionnaires' disease associated with a contaminated air-conditioning cooling tower. N Engl J Med 1980; 302: 365-370 52 Christopher PJ, Noonan LM, Chiew R. Epidemic of Legionnairesʼ disease in Wollongong. The medical journal of Australia 1987; 147: 127-128 53 Garbe PL, Davis BJ, Weisfeld JS. et al. Nosocomial Legionnaires' disease. Epidemiologic demonstration of cooling towers as a source. JAMA 1985; 254: 521-524 54 Conwill DE, Werner SB, Dritz SK. et al. Legionellosis – the 1980 San Francisco outbreak. Am Rev Respir Dis 1982; 126: 666-669 55 Cordes LG, Fraser DW, Skaliy P. et al. Legionnairesʼ disease outbreak at an Atlanta, Georgia, Country Club: evidence for spread from an evaporative condenser. Am J Epidemiol 1980; 111: 425-431 56 Timbury MC, Donaldson JR, McCartney AC. et al. Outbreak of Legionnairesʼ disease in Glasgow Royal Infirmary: microbiological aspects. J Hyg (Lond) 1986; 97: 393-403 57 Bell JC, Jorm LR, Williamson M. et al. Legionellosis linked with a hotel car park--how many were infected?. Epidemiol Infect 1996; 116: 185-192 58 Klaucke DN, Vogt RL, LaRue D. et al. Legionnairesʼ disease: the epidemiology of two outbreaks in Burlington, Vermont, 1980. Am J Epidemiol 1984; 119: 382-391 59 de Olalla PG, Gracia J, Rius C. et al. Brote comunitaro de neumonía por Legionella pneumophila: importancia del control de las torres de refrigeración en los centros sanitarios. (Community outbreak of pneumonia due to Legionella pneumophila: importance of monitoring hospital cooling towers.). Enferm Infecc Microbiol Clin 2008; 26: 15-22 60 Pastoris CM, Ciceroni L, Lo Monaco R. et al. Molecular epidemiology of an outbreak of Legionnairesʼ disease associated with a cooling tower in Genova-Sestri Ponente, Italy. Eur J Clin Microbiol Infect Dis 1997; 16: 883-892 61 Mitchell E, O'Mahony M, Watson JM. et al. Two outbreaks of Legionnairesʼ disease in Bolton Health District. Epidemiol Infect 1990; 104: 159-170 62 Fiore AE, Nuorti JP, Levine OS. et al. Epidemic Legionnairesʼ disease two decades later: old sources, new diagnostic methods. Clin Infect Dis 1998; 26: 426-433 63 Hunt DA, Cartwright KA, Smith MC. et al. An outbreak of Legionnairesʼ disease in Gloucester. Epidemiol Infect 1991; 107: 133-141 64 Brown CM, Nuorti PJ, Breiman RF. et al. A community outbreak of Legionnairesʼ disease linked to hospital cooling towers: an epidemiological method to calculate dose of exposure. Int J Epidemiol 1999; 28: 353-359 65 García-Fulgueiras A, Navarro C, Fenoll D. et al. Legionnairesʼ disease outbreak in Murcia, Spain. Emerg Infect Dis 2003; 9: 915-921 66 Telford D, Partridge S, Cumming I. et al. The legionnairesʼ outbreak in Barrow-in-Furness, summer 2002. J Epidemiol Community Health 2006; 60: 464-466 67 Greig JE, Carnie JA, Tallis GF. et al. An outbreak of Legionnairesʼ disease at the Melbourne Aquarium, April 2000: investigation and case-control studies. Med J Aust 2004; 180: 566-572 68 Sabria M, Alvarez J, Dominguez A. et al. A community outbreak of Legionnairesʼ disease: evidence of a cooling tower as the source. Clin Microbiol Infect 2006; 12: 642-647 69 Kirrage D, Reynolds G, Smith GE. et al. Investigation of an outbreak of Legionnairesʼ disease: Hereford, UK 2003. Respir Med 2007; 101: 1639-1644 70 Brown J, Hort K, Bouwman R. et al. Investigation and control of a cluster of cases of Legionnaires disease in western Sydney. Commun Dis Intell Q Rep 2001; 25: 63-66 71 Baird D, Barclay J, Jackson J. et al. Outbreak of legionellosis in a community. Report of an ad-hoc committee. Lancet 1986; 2: 380-383 72 Castilla J, Barricarte A, Aldaz J. et al. A large Legionnairesʼ disease outbreak in Pamplona, Spain: early detection, rapid control and no case fatality. Epidemiol Infect 2008; 136: 823-832 73 Gecewicz TE, Saravo L, Lett SM. et al. Legionnairesʼ Disease Associated with Cooling Towers -- Massachusetts, Michigan, and Rhode Island, 1993. MMWR Weekly 1994; 43: 491-499 74 Keller DW, Hajjeh R, DeMaria A. et al. Community outbreak of Legionnairesʼ disease: an investigation confirming the potential for cooling towers to transmit Legionella species. Clin Infect Dis 1996; 22: 257-261 75 Politi BD, Fraser DW, Mallison GF. et al. A major focus of Legionnairesʼ disease in Bloomington, Indiana. Ann Intern Med 1979; 90: 587-591 76 Nordström K, Kallings I, Dahnsjö H. et al. An outbreak of Legionnairesʼ disease in Sweden: report of sixty-eight cases. Scand J Infect Dis 1983; 15: 43-55 77 Band JD, LaVenture M, Davis JP. et al. Epidemic Legionnairesʼ disease. Airborne transmission down a chimney. JAMA 1981; 245: 2404-2407 78 Morton S, Bartlett CL, Bibby LF. et al. Outbreak of legionnairesʼ disease from a cooling water system in a power station. Br J Ind Med 1986; 43: 630-635 79 Anderson P, Bartlett C, Cook G. et al. Legionnaires disease in Reading--possible association with a cooling tower. Community Med 1985; 7: 202-207 80 Friedman S, Spitalny K, Barbaree J. et al. Pontiac fever outbreak associated with a cooling tower. Am J Public Health 1987; 77: 568-572 81 O'Mahony MC, Stanwell-Smith RE, Tillett HE. et al. The Stafford outbreak of Legionnairesʼ disease. Epidemiol Infect 1990; 104: 361-380 82 Brundrett GW. Outbreak of Legionnaires’ disease at Stafford District General Hospital. Building Serv Eng Res Technol 1991; 12: 53-64 83 O'Mahony M, Lakhani A, Stephens A. et al. Legionnairesʼ disease and the sick-building syndrome. Epidemiol Infect 1989; 103: 285-292 84 Addiss DG, Davis JP, Wand PJ. et al. Two cases of community-acquired Legionnairesʼ disease: evidence for association with a cooling tower. Infect Dis 1989; 159: 572-575 85 Watson JM, Mitchell E, Gabbay J. et al. Piccadilly Circus legionnairesʼ disease outbreak. J Public Health Med 1994; 16: 341-347 86 Levy M, Westley-Wise V, Blumer C. et al. Legionnairesʼ disease outbreak, Fairfield 1992: public health aspects. Aust J Public Health 1994; 18: 137-143 87 Heath TC, Roberts C, Jalaludin B. et al. Environmental investigation of a legionellosis outbreak in western Sydney: the role of molecular profiling. Aust N Z J Public Health 1998; 22: 428-431 88 Formica N, Tallis G, Zwolak B. et al. Legionnairesʼ disease outbreak: Victoria's largest identified outbreak. Commun Dis Intell 2000; 24: 199-202 89 Fernández JA, López P, Orozco D. et al. Clinical study of an outbreak of Legionnaireʼs disease in Alcoy, Southeastern Spain. Eur J Clin Microbiol Infect Dis 2002; 21: 729-735 90 Barrufet-Barqué MP, Sauca-Subias G, Force-Sanmartín L. et al. Estudio de un brote de infección por Legionella pneumophila. Med Clin (Barc) 2006; 126: 178-182 91 Rota MC, Pontrelli G, Scaturro M. et al. Legionnairesʼ disease outbreak in Rome, Italy. Epidemiol Infect 2005; 133: 853-859 92 Isozumi R, Ito Y, Ito I. et al. An outbreak of Legionella pneumonia originating from a cooling tower. Scand J Infect Dis 2005; 37: 709-711 93 Hugosson A, Hjorth M, Bernander S. et al. A community outbreak of Legionnairesʼ disease from an industrial cooling tower: assessment of clinical features and diagnostic procedures. Scand J Infect Dis 2007; 39: 217-224 94 Pérez de Agreda JP. Community outbreak of legionnaires’ disease related to hospital cooling towers in Zaragoza, Spain, May-June 2004. Euro Surveill 2004; 8: 2526 95 Gilmour MW, Bernard K, Tracz DM. et al. Molecular typing of a Legionella pneumophila outbreak in Ontario, Canada. J Med Microbiol 2007; 56: 336-341 96 Dejour Salamanca D, Henry S, Che D. Outbreak of community-acquired legionnaireʼs disease, July-September 2006, Paris, France. Euro Surveill 2006; 11: 3055 97 Sonder GJ, van den Hoek JA, Bovée LP. et al. Changes in prevention and outbreak management of legionnairesʼ disease in the netherlands between two large outbreaks in 1999 and 2006. Euro Surveill 2008; 13: 18983
