legionarska bolezen<\/strong>.<\/p>\nLegionele so prisotne v naravnih vodnih okoljih kot so reke, jezera in druge stoje\u010de vode. \u0160tevilo bakterij v naravnem okolju je majhno, kar pomeni, da naravno okolje obi\u010dajno ne predstavlja tveganja za ljudi.<\/p>\n
<\/p>\n
Legionele iz naravnega okolja zaidejo v vodne sisteme, ki so namenjeni za oskrbo s pitno vodo, hlajenje (hladilni stolpi), v bazene s kopalno vodo, bazene z industrijsko vodo itd. Legionele se najbolje razmno\u017eujejo v topli vodi.<\/p>\n
V nenaravnem, umetnem okolju se legionele ob primerni temperaturi in drugih dejavnikih okolja mo\u010dno namno\u017eijo in za\u010dnejo predstavljati nevarnost za zdravje ljudi.<\/p>\n
Pojav legioneloze prepre\u010dujemo predvsem z ustreznim vzdr\u017eevanjem vodovodnih in drugih sistemov, ki predstavljajo tveganje za izbruh legioneloze. Potrebno je:<\/p>\n
– redno \u010di\u0161\u010denje, kamor sodi tudi odstranjevanje vodnega kamna, ki se nabira na pipah in tu\u0161ih<\/p>\n
– \u010di\u0161\u010denje kotlov in odstranjevanje oblog, kjer se bakterije najraje razmno\u017eujejo,<\/p>\n
– odstranjevanje t.i. slepih rokavov v vodovodnih sistemih, kjer ni pretoka, kar omogo\u010da razra\u0161\u010danje bakterij,<\/p>\n
– nadzor nad temperaturo vode v sistemu, ki mora biti primerno visoka (od 50\u00b0C do 60\u00b0C, da prepre\u010di razra\u0161\u010danje legionel ali pa ni\u017eja kot 20\u00b0C. V hladni vodi legionele ne rastejo.<\/p>\n
V posebno tveganih sistemih je na mestu ob\u010dasno vzor\u010denje – to pomeni pregledovanje vode na prisotnost legionel in izvajanje dodatnih ukrepov kot je hiperkloriranje sistema in izvajanje toplotnega \u0161oka, \u010de je potrebno.<\/p>\n
POTI OKU\u017dBE<\/h4>\n
Oku\u017eba z legionelo je navadno rezultat vdihovanja aerosola, ki vsebuje bakterije in lahko izvira iz kateregakoli obmo\u010dja kontaminirane vode. S pitjem kontaminirane vode se \u010dlovek navadno ne more oku\u017eiti zaradi uni\u010denja patogenov s klorovodikovo kislino v \u017eelodcu, razen izjemoma v primeru mo\u010dno oslabljenega imunskega sistema kot del oku\u017ebe dihal (npr. aspiracija \u017eelod\u010dne vsebine).<\/p>\n
Predispozicijski faktorji za legionarsko bolezen so predvsem oslabljeni imunski sistem zaradi starosti, transplantacije organov, kirur\u0161kih posegov ali bolezenskih stanj (npr. rak in posledi\u010dno kemoterapija ter AIDS) ter kajenje in spremljajo\u010de bolezni, kot npr. kroni\u010dne plju\u010dne bolezni, sladkorna bolezen in odpoved ledvic. Za pontia\u0161ko vro\u010dico lahko zbolijo ljudje vseh starostnih skupin, medtem ko pri legionarski bolezni ve\u010dinoma nad 40 let, \u0161e posebej ljudje s starostjo od 60-70 let; povpre\u010dna starost bolnikov je 55 let. Bolj ogro\u017eeno skupino predstavljajo tudi alkoholiki in novorojen\u010dki.<\/p>\n
<\/p>\n
NA\u010cINI PRENOSA <\/strong><\/p>\nInhalacija vodnega aerosola oku\u017eenega z legionelami je najbolj obi\u010dajna pot prenosa. Ku\u017eni aerosol nastaja v hladilnih stolpih, tu\u0161ih , pipah, opremi za respiratorno terapijo, sobnih vla\u017eilcih zraka itd. Tudi moramo paziti na sedimente ali obloge( vodni kamen, usedline, biofilmi) , ki se najraj\u0161e zadr\u017eujejo na plasti\u010dnih\u00a0 materialih, kjer klor ni u\u010dinkovit.<\/p>\n
Mo\u017ena je tudi kolonizacija \u017erela ob u\u017eivanju vode, ki vsebuje legionele in aspiracija v spodnja dihala.<\/p>\n
Bolezen se ne prena\u0161a s \u010dloveka na \u010dloveka. Legionele povzro\u010dajo bolezni tudi pri doma\u010dih \u017eivalih, kot so konji, svinje, drobnica in psi.<\/p>\n
![\"legionela](\"https:\/\/www.zdravstvena.info\/preventiva\/wp-content\/uploads\/2010\/06\/legionela-prevencija-1024x448.jpg\")
<\/p>\n
REDNI PREVENTIVNI UKREPI<\/strong><\/p>\n–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Zagotavljanje pravilnega delovanja, rednega \u010di\u0161\u010denja in dobrega vzdr\u017eevanja notranjega vodovodnega sistema.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Temperatura tople vode na vseh pipah in prhah, tudi na najbolj oddaljenih, naj bo nad 50’C, bolje 55’C.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Temperatura hladne vode naj bo pod 20’C.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Temperatura v grelcu (kotlu) naj bo ve\u010d kot 60’C, vsaj eno uro na dan tudi na dnu grelca.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Na mestih, kjer voda zastaja, naj se izvaja tedensko spiranje do stabilizacije temperature vode.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Mre\u017eice na pipah in glavah prh redno \u010distimo najmanj 4 krat letno oz. po potrebi (usedline, smeti, kamen)\u00a0 oz. .\u00a0 je koristno odstraniti mre\u017eice na vseh pipah<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Redno pregledujemo in po potrebi \u010distimo grelce \u2013 najmanj enkrat letno.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Po vsakem posegu v notranjem vodovodnem sistemu izvedemo \u010di\u0161\u010denje, spiranje in klorni \u0161ok.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Izbiramo naprave, ki ne tvorijo velikih koli\u010din aerosola, razen, \u010de jih dnevno steriliziramo ali podvr\u017eemo visoki stopnji razku\u017eevanja ter izpiramo in polnimo s sterilno vodo.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Vla\u017eilce zraka polnimo s sterilno vodo.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Respiratorno opremo po razku\u017eevanju izpiramo s sterilno vodo.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Pri gradnji hladilnih stolpov upo\u0161tevamo, da mora biti zajem zraka v prezra\u010devalni sistem dovolj oddaljen od samega hladilnega stolpa, da prepre\u010dimo vdor aerosolov v prezra\u010devalni sistem.<\/p>\n
–\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0\u00a0 Redni odvzem vzorcev vode za preiskavo na L. pneumophilla.<\/p>\n
<\/p>\n
UKREPI<\/strong><\/p>\nZdravnik, ki je postavil utemeljen sum ali potrdil primer bolni\u0161ni\u010dne legionarske bolezni, mora v skladu z zakonodajo primer prijaviti epidemiolo\u0161ki slu\u017ebi obmo\u010dnega zavoda za zdravstveno varstvo(ZZV).<\/p>\n
Naloga KOBO je, da v najkraj\u0161em \u010dasu seznani zdravnike in druge zdravstvene delavce na oddelku, kjer je bil dokazan primer bolni\u0161ni\u010dne legionarske bolezni.<\/p>\n
Pristojna epidemiolo\u0161ka slu\u017eba skupaj z zdravstveno in\u0161pekcijo ugotavlja stopnjo tveganja za pojav legioneloze:<\/strong><\/p>\nTveganje, ki izhaja iz okolja:<\/strong><\/p>\n-izmeri se temperatura vode na izlivkah in grelnih napravah<\/p>\n
-izmeri se koli\u010dina rezidualnega klora v vodovodnem omre\u017eju ob vstopu v bolni\u0161ni\u010dni objekt oz.\u00a0 na objekte in na izlivkah<\/p>\n
-skupaj s tehni\u010dno slu\u017ebo, ki mora posredovati podatke o vodovodnem omre\u017eju, ugotavlja prisotnost mrtvih rokavov oz. Dele vodovodnega omre\u017eja, ki trenutno ni v uporabi<\/p>\n
-podatek o opravljenih \u010di\u0161\u010denjih, dezinfekciji sistema, vzdr\u017eevanju in merjenju temperature vode<\/p>\n
-pridobi podatek o zdravstveni ustreznosti pitne vode<\/p>\n
-ugotovi, ali se hladilne naprave redno vzdr\u017eujejo, \u010distijo in razku\u017eujejo v skladu z navodili proizvajalca<\/p>\n
-ugotovi, ali se medicinske naprave in pripomo\u010dki, ki tvorijo aerosol, polnijo s sterilno vodo<\/p>\n
-izmeri se \u010das pretoka od vstopa vode v grelec do distalne izlivke v primeru, da se na izlivki ne dosega zahtevana temperatura.<\/p>\n
Literatura:
\n<\/strong><\/p>\nBetreff: Medelpflicht fur Legionarskrankenheit. Bundesministerium Fur Soziale Sicherheit und Generationen. GZ: 21.700\/177-VIII\/D\/2\/01<\/p>\n
In\u0161titut za varovanje zdravja RS, Legioneloza, 2007<\/p>\n
Joseph C, Lee J, van Wijngaarden J, Drasar V, Castellani-Pastoris M. European Guidelines for the control and prevention of travel associated legionnaires’ disease (Draft). EWGLI \u2013 EC DG Health and Consumer Protection. Junij 2001:1-66.<\/p>\n
Legioneloza, pridobljeno iz http:\/\/sl.wikipedia.org\/wiki\/Legioneloza<\/a> )<\/p>\nLikar M., Ljubljana, Legionarska bolezen, 2002<\/p>\n
Maja So\u010dan, Ljubljana, Ukrepi ob pojavu legionarske bolezni v\u00a0 bolni\u0161nicah (sekundarna prevencija)<\/p>\n
Muraca p. Yu VL, Goetz A. Disinfection of water distribution systems for legionella: A review of application procedures and methodologies. Infect Control Hospital Epidemiol; 1990;11: 79-88<\/p>\n
Tatjana Remec, dr.med., Ingrid Jakli\u010d, dipl.san.in\u017e., Novo Mesto, Primarna in sekundarna preventiva legionarske bolezni v SB NM, 2007<\/p>\n
Zbornik predavanj, Roga\u0161ka slatina, Sterilizacija ni igra, 2009<\/p>\n","protected":false},"excerpt":{"rendered":"
Legioneloza je bolezen, ki jo povzro\u010da bakterija legionela. Poznamo dve obliki obolenja: – bla\u017ejo vro\u010dinsko bolezen, ki jo imenujemo Pontia\u0161ka vro\u010dica – te\u017ejo obliko legioneloz, ki jo imenujemo legionarska bolezen. Legionele so prisotne v naravnih vodnih okoljih kot so reke, jezera in druge stoje\u010de vode. \u0160tevilo bakterij v naravnem okolju je majhno, kar pomeni, da […]<\/p>\n","protected":false},"author":7,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[52,101],"tags":[328,325,324,323,326,327],"class_list":["post-441","post","type-post","status-publish","format-standard","hentry","category-izobrazevanje","category-preventiva","tag-izobrazevanje-legionela","tag-legionela","tag-legionele","tag-legioneloza","tag-preentiva-legionele","tag-preventiva-legionel"],"yoast_head":"\n
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Legioneloza je bolezen, ki jo povzro\u010da bakterija legionela.<\/p>\n