Legionella is a pathogenic waterborne disease. It causes some infections called legionellosis, the most severe one being Legionnaires’. Legionella bacteria are mainly found in little numbers in natural aquatic surroundings like the rivers, groundwater, and lakes making its prevention from entering human-made water structures virtually difficult. Legionnaires’ disease is supposedly a fatal type of pneumonia (Bennett, 2014).
People usually contract Legionnaires’ disease due to inhaling of Legionella bacteria, in tiny water droplets up in the air referred to as aerosols. It can also infect a person through micro-aspiration of unclean water from respiratory therapy equipment.
Legionella is mainly prevalent in workplaces such as thermal baths, hospitals, Spa baths dental surgeries and thalassotherapy centers. Employees who are in these professions and their patients or consumers have higher risks of contracting the disease (Acton, 2012).
In Rome, Italy, an 83-year-old Italian woman was established to have died from Legionnaire’s disease. She is said to have caught the disease from dental practice water lines. The situation was quickly analyzed, and the cause of the infection is unquestioned. The lady was suffering from fever and breathing problems. She was taken into the intensive care unit with respiratory distress and persistent fever.
Chest radiography exhibited extents of lung consolidation. She had no underlying conditions or diseases (Miller & Palenik, 2016). Legionnaires’ infection was promptly affirmed by a pneumophila urinary antigen test. For the microbiological examination, bronchial aspirate was used, and oral ciprofloxacin began immediately. Nonetheless, the patient still passed away as she developed fulminant and irretrievable septic shock. An investigation to find the source of infection was started. After testing, the presence of legionnaire disease was detected.
This above case study ascertains dental treatment as the direct cause of the death of the patient. (Yin, 2009)This is because within the twelve days of the incubation period the woman left her house only twice. Those were direct visits to the dental healthcare and back. As such, it, therefore, necessitates the need to conduct a risk assessment.
Various methods can be applied while conducting a risk assessment. Some of these include what-if method, the checklist method, a combination of the two methods, and fault tree analysis (FTA) among others (Rausand, 2013). In my assessment of the occupational risk of the Legionella in the healthcare industry. I will use the fault tree analysis method because it assists responsible persons to be aware of what they should put emphasis on during assessment. It also helps in the quantification of impacts. It involves looking at and identifying all things that could possibly cause a hazardous occurrence.
A number of authors have ascertained the presence of Legionella spp. In the waterlines of the dental unit, prevalence rates are around 69.7 percent in some instances. There have been evident scenarios of employees in the dental health-care and dental patients contracting Legionella infection as illustrated earlier. This, therefore, necessitates the need for efficient disinfection experiments to be conducted where necessary and inspection of the microbiological quality of dental waterlines be executed (Kaye, 2011).
The Legionella infection risk among dental healthcare workers is conjectured because of the risk of routine inhalation of supposedly contaminated aerosols produced by the dental equipment (Santosh & Ogle, 2017). Both the Patients and dental physicians are exposed to an effective risk of infection during dental practice to which mainly derives from microorganisms suspended in aerosols.
Biological aspects are persistently present during dental processes. They are main sources of cross-infection in a dental office, comprising occupational hazards for the dental staff exposed to them for significantly longer periods of time. These bacterial factors present in the dental workspace office spread infections through direct contact of contaminated tools with a patient, blood-borne route and aerosols released from both the dental office and mouth of the patient (Bartram, 2007).
Among dental patient, there are those at higher risk of contracting Legionella disease. These are middle-aged persons and the elderly especially those that suffer from chronic lung disease and smokers. Also, dental patients who consequently suffer from other conditions such as kidney failure and undertaking dialysis, diabetes, cancer, and AIDs are at higher risk to contract this disease.
Taking into consideration the risk that doctors and patients in the dental unit could be exposed to as a result of legionella in the dental water units, there should be regular checks to control pollution of the air in the dental unit (Capolongo, Settimore, & Gola, 2017). Mostly the living space of a doctor who is exposed to aerosol air droplets that may cause legionella. Studies carried out by scholars on the presence of legionella in dental staff blood serum showed a positive result compared to individuals who are not exposed to dental procedures.
The doctors in the dental unit’s practices are connected to high levels of infection which affects both the health professionals and the patients. The surrounding may have a significant role in the transportation of infectious diseases. For instance, a study was conducted on six dental health care units. The contamination of the air, surfaces, and water were observed for a period of five working days in each of the clinics before, during and after treatments (Guidotti, 2011).
They showed a wide variation in the microbial environmental condition in each of the participating clinics and the difference in time between before and after treatments Contamination of water in the health clinics water system reached the highest value during treatment. Microbial contamination of air was high during dental procedures and treatments and later decreases when working activities reduce. Surface contamination was also seen to be higher during working hours.
In dental practice, there exist occupational hazards since the staff is at risk or exposure of legionella. This necessitates the need to minimize the risk associated with dental practice unit. Conducting research on microbial environmental contamination and associated risk factors in the dental units could be useful in controlling the disease (Percival, 2014). The research should be widened and expanded so as to contain an in-depth analysis of details about the disease while based on present data collection. This will lead to the birth of significant knowledge which could be useful in the prevention of legionella in the dental clinics.
In addition, delivery of water through turbines and syringes in dental operating units should be closely monitored so as to ensure that legionella bacteria lack their way in (Noble, 2012). Previous research showed that legionella bacteria’s were reduced by fifty-four percent while conducting continuous treatment of water output in the dental clinics with disinfection products (Freije, 2010). Also ensuring deionized water outputs in all dental units are supplied in all dental treatment units can be helpful.
Another control measure that can be adopted is inhibition of favorable temperatures that support the growth of Legionella bacteria are not maintained. These temperatures range between 22oC and 37oC. Also, the surfaces that the dental units’ use during treatment should always be kept net. This will help in limiting the growth of the bacteria within the dental clinics.
Dental clinic management should continuously carry out a risk assessment on the prevalence of legionella in their institution. This will help each institution to adopt the appropriate preventive measures depending on prevalence levels. The institution should also ensure that the equipment required to manage the risks effectively is readily available (McCoy, 2005).
In order to ensure proper management of the condition, the dental clinics should also assign some individuals with the responsibility of risk management. Their roles and responsibility should be clearly understood and defined. They should be offered training should ensure high levels of competence hence efficient results.
These individuals should ensure that proper equipment and the right quantity of disinfection products are put in place and done at the right time. They should also ensure that they keep a record of the written scheme of controlling the bacteria. The institution should also ensure that there are no information lags. That is, the persons responsible are always updated and receives the appropriate information.
A study conducted by researchers on sampling of water in 129 health care centers involving both the private and public health care facilities (56 private and 73 public). Microbiological and water sampling were carried out. A risk analysis method was applied to all the facilities by using a standardized report (Heuner & Swanson, 2008). The results were categorized as either good, medium, or bad. Legionella was evident in 102 health facilities out of the total 129 healthcare facilities. The contamination percentage was 43.3% in the health centers. There was a significant relation between medium and the bad score in the risk analysis of Legionella and microbiological results (Brunette & Control, 2017). The methods used for diagnosis in the laboratory were single antibody titer, urinary antigen, sero conversion, and other diagnostic methods.
Although Legionella bacteria are evident in the distribution water system in both the private and public sectors, the risk it causes or its effect on workers is little known. Also, some scholars argue that although the bacteria exist in the distribution systems of water, legionella bacteria does not lead to infection in humans. Other authors argue that the dental unit water distribution systems cause no harm to the patient. Despite the fact that lower contamination of water in the dental units lowers patient’s risk, patient exposure to contaminated water goes against the clinical infection control principles.
Data gap is an analysis that deals with the examination of present data to establish where an institution is not yielding or examining information that would be helpful for the operation of the organization. This analysis is useful in improving efficiency. While gathering information during the risk assessment process data gaps may arise. Dental healthcare facilities may create the data gaps by failing to reveal information that may implicate their organization negatively. This, therefore, would lead to inefficiency in the process and recommended solutions. As such then it is necessary to do an in-depth analysis of data provided to ensure its accuracy.
Conclusion
In conclusion, Legionella is a pathogenic waterborne disease and causes a number of infections called legionellosis, the most severe one being Legionnaires’. It is a threat to the healthcare industry at large. In the dental industry, both the patients and dental physicians are exposed to an effective risk of infection. This can be attributed to the presence of microorganisms suspended in aerosols.
This calls for the need for a risk assessment to enhance coming up with possible solutions. Such interventions could be useful in controlling the disease include inhibition of favorable temperatures that support the growth of Legionella bacteria, monitoring delivery of water through turbines and syringes in dental operating units, conducting research on microbial environmental contamination and associated risk factors in the dental units among others.
References
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