{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T20:22:09Z","timestamp":1778876529314,"version":"3.51.4"},"reference-count":29,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2009,5,15]],"date-time":"2009-05-15T00:00:00Z","timestamp":1242345600000},"content-version":"unspecified","delay-in-days":5462,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":["journals.cambridge.org"],"crossmark-restriction":true},"short-container-title":["Epidemiol. Infect."],"published-print":{"date-parts":[[1994,6]]},"abstract":"<jats:title>SUMMARY<\/jats:title><jats:p>The investigation, epidemiology, and effectiveness of control procedures during an outbreak of Legionnaires' disease involving three immunosuppressed patients are described. The source of infection appeared to be a network of fire hydrant spurs connected directly to the incoming hospital mains water supply. Removal of these hydrants considerably reduced, but failed to eliminate, contamination of water storage facilities. As an emergency control procedure the incoming mains water was chlorinated continuously. Additional modifications to improve temperature regulation and reduce stagnation also failed to eliminate the legionellae.<\/jats:p><jats:p>A perspex test-rig was constructed to model the pre-existing hospital water supply and storage system. This showed that through the hydraulic mechanism known as \u2018temperature buoyancy\u2019, contaminated water could be efficiently and quickly exchanged between a stagnant spur pipe and its mains supply. Contamination of hospital storage tanks from such sources has not previously been considered a risk factor for Legionnaires' disease. We recommend that hospital water storage tanks are supplied by a dedicated mains pipe without spurs.<\/jats:p>","DOI":"10.1017\/s0950268800051219","type":"journal-article","created":{"date-parts":[[2009,5,15]],"date-time":"2009-05-15T08:44:25Z","timestamp":1242377065000},"page":"513-525","update-policy":"https:\/\/doi.org\/10.1017\/policypage","source":"Crossref","is-referenced-by-count":25,"title":["Fatal nosocomial Legionnaires' disease: relevance of contamination of hospital water supply by temperature-dependent buoyancy-driven flow from spur pipes"],"prefix":"10.1017","volume":"112","author":[{"given":"W. J.","family":"Patterson","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"D. V.","family":"Seal","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E.","family":"Curran","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"T. M.","family":"Sinclair","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"J. C.","family":"McLuckie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2009,5,15]]},"reference":[{"key":"S0950268800051219_ref007","unstructured":"7. Mitchell K . Rapid diagnosis of legionella infections and identification of Legionella species isolated from man and the environment [PhD thesis]. Glasgow University. 1991."},{"key":"S0950268800051219_ref013","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.aje.a112517"},{"key":"S0950268800051219_ref009","doi-asserted-by":"publisher","DOI":"10.1017\/S0022172400062641"},{"key":"S0950268800051219_ref008","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1128\/JCM.14.3.298-303.1981","article-title":"Improved semi-selected medium for isolation of Legionella pneumophlia from contaminated clinical and environmental specimens","volume":"14","author":"Edelstein","year":"1981","journal-title":"J Clin Microbiol"},{"key":"S0950268800051219_ref003","volume-title":"A code of practice","year":"1988"},{"key":"S0950268800051219_ref017","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268800054492"},{"key":"S0950268800051219_ref002","doi-asserted-by":"crossref","first-page":"447","DOI":"10.1128\/AEM.53.2.447-453.1987","article-title":"Comparative assessment of chlorine, heat, ozone, and UV light for killing Legionella pneumophila","volume":"53","author":"Muraca","year":"1987","journal-title":"Appl Environ Microbiol"},{"key":"S0950268800051219_ref020","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(83)90290-8"},{"key":"S0950268800051219_ref015","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268800047385"},{"key":"S0950268800051219_ref011","unstructured":"11. DHSS and Welsh Office. Accommodation for pharmaceutical services. Health Building Note 1988; No 29: Para 8.44."},{"key":"S0950268800051219_ref016","first-page":"380","article-title":"Report of an Ad-Hoc committee","volume":"ii","year":"1986","journal-title":"Lancet"},{"key":"S0950268800051219_ref014","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(81)92803-8"},{"key":"S0950268800051219_ref010","unstructured":"10. The building services research and information association. Investigation of the extent of water exchange between pipe and spur. Report 66850\/1. 1991."},{"key":"S0950268800051219_ref018","doi-asserted-by":"publisher","DOI":"10.1017\/S0022172400063580"},{"key":"S0950268800051219_ref012","doi-asserted-by":"publisher","DOI":"10.1016\/0196-6553(91)90040-J"},{"key":"S0950268800051219_ref004","unstructured":"4. The hospital infection manual. Including a code of practice for the Scottish health service. Scottish Home and Health Department. 1988."},{"key":"S0950268800051219_ref019","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.282.6263.573"},{"key":"S0950268800051219_ref001","unstructured":"1. Public Health Laboratory Service Collaborative Study of Legionella Species in Water Systems. HAC 1985."},{"key":"S0950268800051219_ref025","doi-asserted-by":"crossref","first-page":"221","DOI":"10.1128\/AEM.49.1.221-228.1985","article-title":"Ecology of Legionelia pneumophila within water distribution systems","volume":"49","author":"Stout","year":"1985","journal-title":"Appl Environ Microbiol"},{"key":"S0950268800051219_ref024","first-page":"49","article-title":"Legionella pneumophila in residential water supplies: environmental surveillance with clinical assessment for Legionnaires' disease","volume":"109","author":"Stout","year":"1992","journal-title":"Epidemiol Infect"},{"key":"S0950268800051219_ref027","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.282.6263.515"},{"key":"S0950268800051219_ref028","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268800050731"},{"key":"S0950268800051219_ref029","doi-asserted-by":"publisher","DOI":"10.1016\/0195-6701(86)90037-X"},{"key":"S0950268800051219_ref006","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1128\/JCM.20.4.605-607.1984","article-title":"Onset and duration of urinary antigen excretion in Legionnaires disease","volume":"20","author":"Kohler","year":"1984","journal-title":"J Clin Microbiol"},{"key":"S0950268800051219_ref005","unstructured":"5. Surveillance definitions for Legionnaires' disease. Respiratory Diseases Section. Communicable Diseases Surveillance Centre. 09 1992."},{"key":"S0950268800051219_ref023","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/152.1.145"},{"key":"S0950268800051219_ref022","doi-asserted-by":"publisher","DOI":"10.1080\/02508068908692051"},{"key":"S0950268800051219_ref021","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(86)90809-0"},{"key":"S0950268800051219_ref026","unstructured":"26. Legionnaires' disease surveillance: England and Wales 1991. Communicable Disease Report 1992: 2: No 11."}],"container-title":["Epidemiology and Infection"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0950268800051219","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,5,18]],"date-time":"2020-05-18T05:03:21Z","timestamp":1589778201000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0950268800051219\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1994,6]]},"references-count":29,"journal-issue":{"issue":"3","published-print":{"date-parts":[[1994,6]]}},"alternative-id":["S0950268800051219"],"URL":"https:\/\/doi.org\/10.1017\/s0950268800051219","relation":{},"ISSN":["0950-2688","1469-4409"],"issn-type":[{"value":"0950-2688","type":"print"},{"value":"1469-4409","type":"electronic"}],"subject":[],"published":{"date-parts":[[1994,6]]},"assertion":[{"value":"Cambridge University Press 1994","name":"license","label":"License","group":{"name":"copyright_and_licensing","label":"Copyright and Licensing"}}]}}