{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,4]],"date-time":"2026-10-04T13:41:51Z","timestamp":1791121311849,"version":"4.1.0"},"reference-count":30,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":4172,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2003,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0195941700081789_abs1\"><jats:title>Objective:<\/jats:title><jats:p>To measure the association between the disinfection of municipal drinking water with monochloramine and the occurrence of hospital-acquired legionnaires' disease (LD).<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700081789_abs2\"><jats:title>Setting:<\/jats:title><jats:p>One hundred sixty-six U.S. hospitals.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700081789_abs3\"><jats:title>Design:<\/jats:title><jats:p>Survey of 459 members of the Society for Healthcare Epidemiology of America (SHEA) for hospital features; endemic- and outbreak-related, hospital-acquired LD; the source of the hospital water supply; and the methods of disinfection used by the hospitals and municipal water treatment plants.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700081789_abs4\"><jats:title>Results:<\/jats:title><jats:p>SHEA members representing 166 (36%) of 459 hospitals responded; 33 (20%) reported one or more episodes of hospital-acquired LD during the period from 1994 to 1998 and 23 (14%) reported an outbreak of hospital-acquired LD during the period from 1989 to 1998. Hospitals with an occurrence of hospital-acquired LD had a higher census (median, 319 vs 221;<jats:italic>P<\/jats:italic>= .03), more acute care beds (median, 500 vs 376;<jats:italic>P<\/jats:italic>= .04), and more intensive care unit beds (median, 42 vs 24;<jats:italic>P<\/jats:italic>= .009) than did other hospitals. They were also more likely to have a transplant service (74% vs 42%;<jats:italic>P<\/jats:italic>= .001) and to perform surveillance for hospital-acquired disease (92% vs 61%;<jats:italic>P<\/jats:italic>= .001). After adjustment for the presence of a transplant program and surveillance for legionnaires' disease, hospitals supplied with drinking water disinfected with monochloramine by municipal plants were less likely to have sporadic cases or outbreaks of hospital-acquired LD (odds ratio, 0.20; 95% confidence interval, 0.07 to 0.56) than were other hospitals.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700081789_abs5\"><jats:title>Conclusion:<\/jats:title><jats:p>Water disinfection with monochloramine by municipal water treatment plants significantly reduces the risk of hospital-acquired LD.<\/jats:p><\/jats:sec>","DOI":"10.1086\/502256","type":"journal-article","created":{"date-parts":[[2006,3,14]],"date-time":"2006-03-14T16:59:36Z","timestamp":1142355576000},"page":"569-574","source":"Crossref","is-referenced-by-count":44,"title":["Risk of Hospital-Acquired Legionnaires' Disease in Cities Using Monochloramine Versus Other Water Disinfectants"],"prefix":"10.1017","volume":"24","author":[{"given":"James D.","family":"Heffelfinger","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob L.","family":"Kool","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Fridkin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victoria J.","family":"Fraser","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Hageman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Carpenter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia G.","family":"Whitney","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"Society for Healthcare Epidemiology of America","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700081789_ref013","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9343(93)90227-G"},{"key":"S0195941700081789_ref021","volume-title":"Optimizing Chloramine Treatment","author":"Kirmeyer","year":"1993"},{"key":"S0195941700081789_ref004","first-page":"R109","article-title":"Legionnaires' disease surveillance: England and Wales, 1993","volume":"4","author":"Joseph","year":"1994","journal-title":"Commun Dis Rep"},{"key":"S0195941700081789_ref018","volume-title":"ASHRAE Guideline 12-2000: Minimizing the Risk of Legionellosis Associated With Building Water Systems","year":"2000"},{"key":"S0195941700081789_ref014","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1996.00440140115011"},{"key":"S0195941700081789_ref010","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.302.6773.378"},{"key":"S0195941700081789_ref030","volume-title":"The Chlorination\/Chloramination Handbook","author":"Connell","year":"1996"},{"key":"S0195941700081789_ref012","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199201163260302"},{"key":"S0195941700081789_ref015","doi-asserted-by":"publisher","DOI":"10.2307\/30142014"},{"key":"S0195941700081789_ref008","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1985.03360040075028"},{"key":"S0195941700081789_ref024","doi-asserted-by":"publisher","DOI":"10.1086\/501587"},{"key":"S0195941700081789_ref001","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1997.00440360129015"},{"key":"S0195941700081789_ref003","doi-asserted-by":"publisher","DOI":"10.1093\/oxfordjournals.epirev.a036076"},{"key":"S0195941700081789_ref007","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/146.4.460"},{"key":"S0195941700081789_ref026","volume-title":"Legionella, Proceedings of the 5th International Conference","author":"Donlan","year":"2002"},{"key":"S0195941700081789_ref019","doi-asserted-by":"publisher","DOI":"10.2307\/30144266"},{"key":"S0195941700081789_ref022","doi-asserted-by":"crossref","first-page":"2492","DOI":"10.1128\/AEM.54.10.2492-2499.1988","article-title":"Inactivation of biofilm bacteria","volume":"54","author":"LeChevalier","year":"1988","journal-title":"Appl Environ Microbiol"},{"key":"S0195941700081789_ref020","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1002\/j.1551-8833.1985.tb05471.x","article-title":"Denver's seven decades of experience with chloramination","volume":"77","author":"Dice","year":"1985","journal-title":"Journal of the American Water Works Association"},{"key":"S0195941700081789_ref027","unstructured":"Shelton BG , Donegan N , Flanders WD , Kool J , Pic-Aluas L , Witherell L . 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