particles generated from TSI Particle Generator would be contaminated with legionella, if sterile water is not used

[Sony SO]

Dear All,

We would like to report the captioned findings, and remedial measures should be taken as soon as possible to mitigate the risk of identified hazards, details are as follows.

Meanwhile, most hospitals should use the quantitative fit test i.e. by using PortaCount Fit Tester http://www.tsi.com/portacount-respirator-fit-tester-8038/. With refer to TSI recommended practices, Particle Generator Model 8026 may be used to supplement the naturally occurring particles in the air when performing quantitative respirator fit tests using the TSI PortaCount Respirator Fit Tester, because it would generate particles for fit test.

The recommended procedures of using TSI PARTICLE GENERATOR MODEL 8026 are addressed in the following TSI websites, however their recommended practices are conflicting. SO, we have reported our findings to TSI HQ for their clarification, details are as follows. Please note, if water is contaminated with legionella, Particle Generator will generate a lot of infectious aerosols.
online spec sheets, page 2, http://www.tsi.com/uploadedfiles/_site_root/products/literature/spec_sheets/particle_generator_8026-2980120-usa.pdf which state: the result is an aerosol of microscopic salt particles. simply fill the particle generators reservoir with clean tap water and let one of the supplied salt tablets (nacl) dissolve. turn the instrument on, and within about 15 minutes the ambient particle count will exceed the minimum levels necessary for your portacount pro+ respirator fit tester to operate
online operational manual 6, page 4, http://www.tsi.com/uploadedFiles/_Site_Root/Products/Literature/Manuals/Model_8026_Particle_Generator-1980319.pdf which status: Fill the reservoir jar with distilled water to the fill line.

To prevent healthcare-acquired infections of Legionnaires Disease (LD), sterile water should/shall be used to operate the respiratory devices2,3,5,6.

Please note, Legionellae are ubiquitous in aqueous environments including man-made water systems such as potable water supplies systems. Overseas studies have shown that legionella bacteria were found in about 10% to 60% of potable water systems.Based on the above mentioned information, our preliminary risk assessment results are as follows:
1.Hazards Identification: use of TSI Particle Generator would generate aerosols potential contaminated with legionella.
2.Exposed Persons: depending on fit test location, not only staffs would be exposed but others person (example patients, visitors or contractors) nearby the contaminated vicinity would be exposed1.
3.Outcome of Exposure: depending on the immune statues of exposed persons range from Minor to Catastrophic (if case is dead).
4.Probability of happening: It is Possible (if sterile water is NOT used or using contaminated container).

Lastly, for the recommended measures – we recommend fit test operators should be alerted for the identified hazards, and sterile water should be used to dissolve the salt tablet, if TSI Particle Generator Model 8026 is used.

We have reported our findings to TSI HQ for follow up.

For sharing.

Regards,

Sony SO
Nursing Officer, Infection Control Team
CND WTSH
office phone: +852 3517-3676; fax: +852 3517-3520
HA email sony@ha.org.hk
Please consider the environment before printing this e-mail

1.Benkel, D. H., McClure, E. M., Woolard, D., Rullan, J. V., Miller, G. B., Jenkins, S. R., Breiman, R. F. (2000). Outbreak of Legionnaires’ disease associated with a display whirlpool spa. International Journal of Epidemiology, 29(6), 1092-1098. doi:10.1093/ije/29.6.1092 Retrieved from http://ije.oxfordjournals.org/content/29/6/1092.full.pdf+html
2.CDC. (2003). Guidelines for Preventing Health-Care–Associated Pneumonia Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm
3.Centre for Health Protection. (n.d.). Prevention and control of Legionnaires’ Disease in Hong Kong. Commununicable Diseases Watch [Hong Kong SAR], p. 2. Retrieved from http://www.chp.gov.hk/files/pdf/cdw_v13_1.pdf
4.Cheng VC, Wong SS, Chen JH, et al. (2012). An unprecedented outbreak investigation for nosocomial and community-acquired legionellosis in Hong Kong. Chin Med J , 125(23), 4283-90.
5.Electrical and Mechanical Services Department. (2012). Code of Practices Prevention of Legionnaires Disease Retrieved from http://www.emsd.gov.hk/filemanager/en/content_296/COP-PLD_2012.pdf
6.HA Central Committee on Infectious Disease and Emergency Responses (CCIDER). (2012). Guideline on Prevention and Control of Nosocomial Legionnaires Disease http://ha.home/ho/ps/Legionnaires_Disease_2012.pdf

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