{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:51:55Z","timestamp":1788976315144,"version":"build-2803163510"},"reference-count":28,"publisher":"Cambridge University Press (CUP)","issue":"11","license":[{"start":{"date-parts":[[2016,5,10]],"date-time":"2016-05-10T00:00:00Z","timestamp":1462838400000},"content-version":"unspecified","delay-in-days":556,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2014,11]]},"abstract":"<jats:sec id=\"S0899823X0019333X_ab1\"><jats:title>Objective.<\/jats:title><jats:p>To evaluate the efficacy of a new monochloramine generation system for control of<jats:italic>Legionella<\/jats:italic>in a hospital hot water distribution system<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X0019333X_ab2\"><jats:title>Setting.<\/jats:title><jats:p>A 495-bed tertiary care hospital in Pittsburgh, Pennsylvania. The hospital has 12 floors covering approximately 78,000 m<jats:sup>2<\/jats:sup>.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X0019333X_ab3\"><jats:title>Methods.<\/jats:title><jats:p>The hospital hot water system was monitored for a total of 29 months, including a 5-month baseline sampling period prior to installation of the monochloramine system and 24 months of surveillance after system installation (postdisinfection period). Water samples were collected for microbiological analysis (<jats:italic>Legionella<\/jats:italic>species,<jats:italic>Pseudomonas aeruginosa, Stenotrophomonas maltophilia, Acinetobacter<\/jats:italic>species, nitrifying bacteria, heterotrophic plate count [HPC] bacteria, and nontuberculous mycobacteria). Chemical parameters monitored during the investigation included monochloramine, chlorine (free and total), nitrate, nitrite, total ammonia, copper, silver, lead, and pH.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X0019333X_ab4\"><jats:title>Results.<\/jats:title><jats:p>A significant reduction in<jats:italic>Legionella<\/jats:italic>distal site positivity was observed between the pre- and postdisinfection periods, with positivity decreasing from an average of 53% (baseline) to an average of 9% after monochloramine application (<jats:italic>P<\/jats:italic>&gt; .05). Although geometric mean HPC concentrations decreased by approximately 2 log colony-forming units per milliliter during monochloramine treatment, we did not observe significant changes in other microbial populations.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X0019333X_ab5\"><jats:title>Conclusions.<\/jats:title><jats:p>This is the first evaluation in the United States of a commercially available monochloramine system installed on a hospital hot water system for<jats:italic>Legionella<\/jats:italic>disinfection, and it demonstrated a significant reduction in<jats:italic>Legionella<\/jats:italic>colonization. Significant increases in microbial populations or other negative effects previously associated with monochloramine use in large municipal cold water systems were not observed.<\/jats:p><jats:p><jats:italic>Infect Control Hosp Epidemiol<\/jats:italic>2014;35(11):1356\u20131363<\/jats:p><\/jats:sec>","DOI":"10.1086\/678418","type":"journal-article","created":{"date-parts":[[2014,9,19]],"date-time":"2014-09-19T21:29:17Z","timestamp":1411162157000},"page":"1356-1363","source":"Crossref","is-referenced-by-count":35,"title":["Evaluation of a New Monochloramine Generation System for Controlling<i>Legionella<\/i>in Building Hot Water Systems"],"prefix":"10.1017","volume":"35","author":[{"given":"Scott","family":"Duda","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheena","family":"Kandiah","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janet E.","family":"Stout","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julianne L.","family":"Baron","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohamed","family":"Yassin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie","family":"Fabrizio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juliet","family":"Ferrelli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahman","family":"Hariri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marilyn M.","family":"Wagener","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Goepfert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Bond","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Hannigan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denzil","family":"Rogers","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2016,5,10]]},"reference":[{"key":"S0899823X0019333X_ref692","doi-asserted-by":"publisher","DOI":"10.1086\/664047"},{"key":"S0899823X0019333X_ref684","doi-asserted-by":"publisher","DOI":"10.1264\/jsme2.ME12205"},{"key":"S0899823X0019333X_ref687","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1002\/j.1551-8833.2009.tb09894.x","article-title":"Legionella control by chlorine dioxide in hospital water systems","volume":"101","author":"Zhang","year":"2009","journal-title":"JAWWA"},{"key":"S0899823X0019333X_ref673","author":"Gao","year":"2000"},{"key":"S0899823X0019333X_ref668","year":"2014"},{"key":"S0899823X0019333X_ref680","unstructured":"US Environmental Protection Agency (EPA). National primary drinking water regulations. EPA 816-F-09\u2013004. May 2009. http:\/\/water.epa.gov\/drink\/contaminants\/upload\/mcl-2.pdf. Accessed February 14, 2013."},{"key":"S0899823X0019333X_ref674","doi-asserted-by":"publisher","DOI":"10.1086\/502256"},{"key":"S0899823X0019333X_ref686","doi-asserted-by":"crossref","first-page":"83","DOI":"10.2166\/wst.2004.0025","article-title":"Investigation of opportunistic pathogens in municipal drinking water under different supply and treatment regimes","volume":"50","author":"Pryor","year":"2004","journal-title":"Water Sci Tech"},{"key":"S0899823X0019333X_ref672","doi-asserted-by":"publisher","DOI":"10.1128\/9781555817985.ch82"},{"key":"S0899823X0019333X_ref666","first-page":"1083","article-title":"Legionellosis\u2014United States, 2000\u20132009","volume":"60","year":"2011","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"S0899823X0019333X_ref675","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)06394-6"},{"key":"S0899823X0019333X_ref683","doi-asserted-by":"publisher","DOI":"10.1016\/j.watres.2011.11.071"},{"key":"S0899823X0019333X_ref681","doi-asserted-by":"publisher","DOI":"10.1086\/518754"},{"key":"S0899823X0019333X_ref671","doi-asserted-by":"crossref","first-page":"649","DOI":"10.1128\/AEM.54.3.649-654.1988","article-title":"Factors promoting survival of bacteria in chlorinated water supplies","volume":"54","author":"LeChevallier","year":"1988","journal-title":"Appl Microbiol"},{"key":"S0899823X0019333X_ref677","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2011.03.008"},{"key":"S0899823X0019333X_ref693","doi-asserted-by":"publisher","DOI":"10.1086\/502251"},{"key":"S0899823X0019333X_ref667","year":"1997"},{"key":"S0899823X0019333X_ref670","doi-asserted-by":"publisher","DOI":"10.1086\/657934"},{"key":"S0899823X0019333X_ref669","first-page":"110","article-title":"Guidelines for preventing health-care-associated pneumonia, 2003","volume":"53","year":"2004","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"S0899823X0019333X_ref682","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajic.2010.02.002"},{"key":"S0899823X0019333X_ref679","doi-asserted-by":"crossref","first-page":"2118","DOI":"10.1128\/JCM.33.8.2118-2123.1995","article-title":"Comparison of culture methods for monitoring Legionella species in hospital potable water systems and recommendations for standardization of such methods","volume":"33","author":"Ta","year":"1995","journal-title":"J Clin Microbiol"},{"key":"S0899823X0019333X_ref685","doi-asserted-by":"publisher","DOI":"10.1017\/S095026880800099X"},{"key":"S0899823X0019333X_ref691","doi-asserted-by":"publisher","DOI":"10.1053\/jhin.2002.1336"},{"key":"S0899823X0019333X_ref688","first-page":"19","author":"Hicks","year":"2009"},{"key":"S0899823X0019333X_ref689","doi-asserted-by":"publisher","DOI":"10.1086\/502333"},{"key":"S0899823X0019333X_ref690","doi-asserted-by":"publisher","DOI":"10.1053\/jhin.2001.1060"},{"key":"S0899823X0019333X_ref678","doi-asserted-by":"publisher","DOI":"10.1086\/675280"},{"key":"S0899823X0019333X_ref676","doi-asserted-by":"publisher","DOI":"10.3201\/eid1204.051101"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0899823X0019333X","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,8,24]],"date-time":"2020-08-24T18:27:49Z","timestamp":1598293669000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0899823X0019333X\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,11]]},"references-count":28,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2014,11]]}},"alternative-id":["S0899823X0019333X"],"URL":"https:\/\/doi.org\/10.1086\/678418","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,11]]}}}