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Occurrence and parameters of frequency of Legionella in warm water systems of hospitals and hotels in Lower Saxony.

A total of 1241 water samples was investigated from 103 hospitals and 62 hotels in Lower Saxony 1985-87. 331 of 949 samples from hospitals and 26 of 292 samples from hotels were Legionella positive. All together 70% of the hospitals and 18% of the hotels investigated were Legionella positive, and 836 strains of Legionella were isolated (Table 1). As they could be diagnosed they belong to L. pneumophila SG1 306 strains, SG2 36 strains, SG3 127 strains, SG4 45 strain, SG5 29 strain, SG6 106 strains, SG9 13 strains and SG10 13 strains. Further 134 strains belonging to L. pneumophila but not to SG1-SG12 show cross reactions with serogroups 5, 8, and 10. Finally, 16 strains belong to L. dumoffii and 1 strain to L. anisa (Table 2). The following parameters of water samples were studied, too: temperature, pH value, conductivity, concentration of iron, of organic matter, of other bacteria, occurrence of amoebas, and the materials of water plumbing systems. Most samples contained concentrations of Legionella in the range of 10(1)-10(3) CFU/ml, highest concentrations were 10(5) CFU/ml (Fig. 1). Most frequently, Legionella were isolated within the range of temperature of 35-45 degrees C. However, a few of the water samples were positive for Legionella even up to 66 degrees C (Fig. 3). The conductivity has no and the pH value (Fig. 2) has only little influence on the occurrence of Legionella. There is a positive correlation between concentration of iron and frequency of Legionella (Fig. 4). Also organic matter (Fig. 6) and amoebas (Table 3) seem to enhance the occurrence of Legionella. Plumbing systems consisting of copper showed an inhibitory effect on Legionella during the first five years, whereas no effect could be detected in older systems (Fig. 5).