唐代崑嵛山无染院碑及相关问题

山东崑嵛山无染院是一座历史悠久的佛教寺院,联结着中国南北海上及海外商贸经济与佛教文化交流的历史文脉,但长期未受学界重视。近些年来,因唐光化四年无染院碑文中提到新罗人金清,引起中韩学者们的关注,但已有研究未对无染院碑文及其相关问题作全面考察,因而影响了对无染院历史面貌的全面认识。

北宋名臣范仲淹的用人之道

范仲淹是北宋名臣,他在政治、经济、军事和文化教育等方面均有卓越建树。在从政近四十年的时间里,他知人善任,荐举和培养了大批人才,其中的胡瑗、孙复、狄青、富弼、种世衡等,后来成为北宋政治、军事、文化教育等领域的杰出人物,为北宋社会的稳定和文化的发展作出了巨大贡献。

北宋名将种世衡的管理谋略

范仲淹经略西北时发现并使用了种世衡,使得其杰出的军事才能和管理谋略得以施展。种世衡（985—1045年）,字仲平,深受儒家思想文化的影响,注重气节养成和文化修养。他在治理边地时政绩突出,是一位声誉卓著、文武兼备、具备高超领导才能的将领,其杰出的军事才能和管理谋略令后人景仰。

General Characteristics of HIV/AIDS Patients in Ditan Hospital

Objective: To elucidate general characteristics of HIV/AIDS patients seeking care at Ditan Hospital in an attempt to guide early diagnosis in routine medical care. Materials and methods: A retrospective analysis of 185 HIV/AIDS cases from January 1990 to June 2002 was completed using SPSS statistical analysis. Results: Male to female ratio was 1.8 :1. Subjects ranged in age from 1 year old to 64 years old. 16 cases were younger than 20 years old with the median age among the younger subset at 7.7 years. 169 cases were older than 20 years old with a median age of 36 years old. 29% of the subjects were peasants. The remaining 71%, were of other unspecified occupations. 90.8% of individuals were of Han descent while 3.7% of individuals were of a minority heritage. 50.3% of subjects were married; 23.8% have never married; 8.1% were divorced; and the remaining 17.8% were of unknown marital status. Of those represented in this study, 36.8% came from the Henan province; 17.8% were from Beijing; 8.6% were from Shanxi; 31.4% from the other 20 provinces of China; and 5.4% from outside of China. Mode of transmission: 40.0% (74/185) contracted HIV through unprotected sexual contact; 29.2% (54/185) through receiving blood or plasma transfusions; 21.1%(39/185) through donating plasma; 7 cases were intravenous drug users; 7 cases were vertically transmitted. Mode of transmission was unknown in 4 cases. Clinical categories: An included 45 cases; B included 85 cases: C consisted of 76 cases. 12 cases were deceased. Initial presentation: 39 cases presented with fever ,cough and diarrhea. 37 cases had fever and cough only. 38 cases presented with chronic diarrhea. 16 cases were discovered incidentally at time of operation. 8 cases presented with fungal infection of the oral cavity or in esophagus. The common HIV associated symptoms and opportunistic infections were: weight loss and diarrhea, respiratory diseases, der-matologic diseases, anemia , neutropenia. Diseases of other organ systems were less common. Common misdiagnoses included pneumonia, the common cold, and enteritis. Conclusion: The majority of cases were of middle age (between 30-40 years old) and had contracted HIV/ AIDS sexually.Receiving contaminated blood or plasma via a transfusion accounted for the second most common mode of transmission. Donating plasma was the third most likely mode of transmission. Initial presenting symptoms were various and complicated. Even though the majority of HIV/AIDS cases present to the general hospital, many doctors working at the general hospital are still unable to recognize the symptoms of HIV/AIDS. Thus, it is imperative to identify general characteristics of the HIV/AIDS population in order to diagnose the disease at an earlier stage and halt further transmission.

Effect of TYLCV Infection on Leaf Anatomical Structure and Protective Enzyme System of Tomato

[Objective] The aim was to study the effect of tomato yellow leaf curl virus （TYLCV） infection on leaf anatomical structure and protective enzyme system of tomato. [Method] The anatomical structure of infected and healthy leaves of tomato were observed and compared by using paraffin section method. The activity changes of SOD, POD and CAT in the infected leaves of tomato were determined. [ Result] The results revealed that there were some differences in anatomical structure between healthy and infected leaves. Some cells of infected leaves were damaged so that the leaves curled and became yellow, which affected the normal function of organs. Compared with control, enzyme activities in the tomato plants infected by TYLCV were enhanced at the early periods and higher than that in control, then started to decline at the middle and late periods but lower than that in control.[ Conclusion] After infection by TYLCV, the leaf anatomical structure of tomato was changed greatly and the protective enzyme system was damaged severely, and affected the normal physJological metabolic functions of tissues and organs in tomato in further.

Nosocomial spontaneous bacterial peritonitis antibiotic treatment in the era of multi-drug resistance pathogens: A systematic review

To systematically review literature upon aetiology of nosocomial spontaneous bacterial peritonitis (N-SBP) given the rising importance of multidrug-resistant (MDR) bacteria. METHODSA literature search was performed on MEDLINE and Google Scholar databases from 2000 to 15th of November 2016, using the following search strategy: “spontaneous” AND “peritonitis”. RESULTSThe initial search through electronic databases retrieved 2556 records. After removing duplicates, 1958 records remained. One thousand seven hundred and thirty-five of them were excluded on the basis of the screening of titles and abstract, and the ensuing number of remaining articles was 223. Of these records, after careful evaluation, only 9 were included in the qualitative analysis. The overall proportion of MDR bacteria turned out to be from 22% to 73% of cases across the studies. CONCLUSIONN-SBP is caused, in a remarkable proportion, by MDR pathogens. This should prompt a careful re-assessment of guidelines addressing the treatment of this clinical entity.

Clostridium diffi cile associated infection,diarrhea and colitis

A new, hypervirulent strain of Clostridium difficile, called NAP1/BI/027, has been implicated in C. difficile outbreaks associated with increased morbidity and mortality since the early 2000s. The epidemic strain is resistant to fluoroquinolones in vitro, which was infrequent prior to 2001. The name of this strain reflects its characteristics, demonstrated by different typing methods： pulsed-field gel electrophoresis （NAP1）, restriction endonuclease analysis （BI） and polymerase chain reaction （027）. In 2004 and 2005, the US Centers for Disease Control and Prevention （CDC） emphasized that the risk of C. difficile-associated diarrhea （CDAD） is increased, not only by the usual factors, including antibiotic exposure, but also gastrointestinal surgery/manipulation, prolonged length of stay in a healthcare setting, serious underlying illness, immune-compromising conditions, and aging. Patients on proton pump inhibitors （PPIs） have an elevated risk, as do peripartum women and heart transplant recipients. Before 2002, toxic megacolon in C. dif/icile-associated colitis （CDAC）, was rare, but its incidence has increased dramatically. Up to two- thirds of hospitalized patients may be infected with C. difficile. Asymptomatic carriers admitted to healthcare facilities can transmit the organism to other susceptible patients, thereby becoming vectors. Fulminant colitis is reported more frequently during outbreaks of C. difficile infection in patients with inflammatory bowel disease （IBD）. C. diff/cile infection with IBD carries a higher mortality than without underlying IBD. This article reviews the latest information on C. difficile infection, including presentation, vulnerable hosts and choice of antibiotics, alternative therapies, and probiotics and immunotherapy. We review contact precautions for patients with known or suspected C. difficile- associated disease. Healthcare institutions require accurate and rapid diagnosis for early detection of possible outbreaks, to initiate specific therapy and implement effective control measures. A comprehensive C. difficile infection control management rapid response team （RRT） is recommended for each health care facility. A communication network between RRTs is recommended, in coordination with each country＇s department of health. Our aim is to convey a comprehensive source of information and to guide healthcare professionals in the difficult decisions that they face when caring for these oftentimes very ill patients.

A shield against a monster:Hepatitis C in hemodialysis patients

Hepatitis C virus(HCV)infection is highly prevalent among patients on hemodialysis(HD).The prevalence of HCV infection in HD patients varies markedly from country to country.Some factors are especially related to these high prevalence rates,such as blood transfusions and length of dialysis time. Nosocomial routes of transmission including the use of contaminated equipment and patient-to-patient exposure is considered more important.Several prophylactic measures have been suggested to avoid infection by HCV in the HD environment.

Respiratory Virus Multiplex RT-PCR Assay Sensitivities and Influence Factors in Hospitalized Children with Lower Respiratory Tract Infections

Multiplex RT-PCR assays have been widely used tools for detection and differentiation of a panel of respiratory viral pathogens. In this study, we evaluated the Qiagen ResPlex lI V2.0 kit and explored factors influencing its sensitivity. Nasopharyngeal swab （NPS） specimens were prospectively collected from pediatric inpatients with lower respiratory tract infections at the time of admission in the Shenzhen Children＇s Hospital from May 2009 to April 2010. Total nucleic acids were extracted using the EZ1 system （Qiagen, Germany） and 17 respiratory viruses and genotypes including influenza A virus （FluA）, FluB, parainfluenza virus 1 （PIV1）, PIV2, PIV3, PIV4, respiratory syncytial virus （RSV）, human metapneumovirus （hMPV）, rhinoviruses （RhV）, enteroviruses （EnV）, human bocaviruses （hBoV）, adenoviruses （AdV）, four coronaviruses （229E, OC43, NL63 and HKU1）, and FluA 2009 pandemic H1NI（H1NI-p） were detected and identified by the ResPlex II kit. In parallel, 16 real-time TaqMan quantitative RT-PCR assays were used to quantitatively detect each virus except for RhV. Influenza and parainfluenza viral cultures were also performed. Among the total 438 NPS specimens collected during the study period, one or more viral pathogens were detected in 274 （62.6%） and 201（45.9%） specimens by monoplex TaqMan RT-PCR and multiplex ResPlex, respectively. When results from monoplex PCR or cell culture were used as the reference standard, the multiplex PCR possessed specificities of 92.9-100.0%. The sensitivity of multiplex PCR for PIV3, hMPV, PIV1 and BoV were 73.1%, 70%, 66.7% and 55.6%, respectively, while low sensitivities （11.1%-40.0%） were observed for FluA, EnV, OC43, RSV and H1N1. Among the seven viruses/genotypes detected with higher frequencies, multiplex PCR sensitivities were correlated significantly with viral loads determined by the TaqMan RT-PCR in FluA, H 1N 1-p and RSV （p=0.011-0.000） The Qiagen ResPlex II multiplex RT-PCR kit possesses excellent specificity for simultaneous detection of 17 viral pathogens in NPS specimens in pediatric inpatients at the time of admission. The sensitivity of multiplex RT-PCR was influenced by viral loads, specimen process methods, primer and probe design and amplification condition.

Healthcare utilization and costs associated with gastroparesis

To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis. METHODSWe analyzed the National Inpatient Sample Database (NIS) for all patients in whom gastroparesis (ICD-9 code: 536.3) was the principal discharge diagnosis during the period, 1997-2013. The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by regression analysis. RESULTSIn 1997, there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to 16460 in 2013 (P < 0.01). The mean length of stay for gastroparesis decreased by 20 % between 1997 and 2013 from 6.4 d to 5.1 d (P < 0.001). However, during this period the mean hospital charges increased significantly by 159 % from $13350 (after inflation adjustment) per patient in 1997 to $34585 per patient in 2013 (P < 0.001). The aggregate charges (i.e., “national bill”) for gastroparesis increased exponentially by 1026 % from $50456642 ± 4662620 in 1997 to $568417666 ± 22374060 in 2013 (P < 0.001). The percentage of national bill for gastroparesis discharges (national bill for gastroparesis/total national bill) has also increased over the last 16 years (0.0013% in 1997 vs 0.004% in 2013). During the study period, women had a higher frequency of gastroparesis discharges when compared to men (1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000 vs 3/10000 in 2013). There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period (P < 0.001). CONCLUSIONThe number of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years. Inpatient costs associated with gastroparesis contribute significantly to the national healthcare bill. Further research on cost-effective evaluation and management of gastroparesis is required.

High Prevalence of Multidrug-Resistance MRSA and VRSA of Different Infections from AI-Jumhuory Teaching Hospital Patients in Mosul

Staphylococcus aureus is major human pathogen causing large variety of infections worldwide. This study carried out to isolate S. aureus from different clinical cases, also detection of MRSA prevalence and VRSA emergence, in addition to shedding light on strains that have to be multidrug resistance against various antibiotics, The clinical samples were collected from AI-Jumhuory Teaching Hospital patients in Mosul, isolates identification were achieved by conventional procedures including biochemical and physiological tests, and the specific latex agglutination test. The sensitivity pattern achieved by using disk diffusion technique, for MRSA and VRSA detection oxacillin-disk （1 μg） and vancomycin-disk （30 μg） were used respectively. Results revealed, among 17 S. aureus isolates, 7 （41%） were mostly isolated from patients with wound and burn infections. Isolates had high resistance rate against ampicillin （100%） and cefotaxime （81%）, and lower resistance rate against several antibiotics. MRSA was 88% of total isolates, 93.3% of MRSA were multidrug resistance to 3-9 of antibiotics. Six isolates （40%） of MRSA were VRSA. It is concluded that antibiotics other than vancomycin can be used as anti-MRSA agents after a sensitivity test to prevent the prevalence of VRSA, the major cause of this chemotherapy problems maybe irrational and indiscriminate use of broad-spectrum antibiotics.

Different outcomes of nosocomial infection with hepatitis C virus from the same origin

The outcome of infection with hepatitis C virus （HCV） varies substantially from self-limiting infection to chronic hepatitis, liver cirrhosis, and hepatocellular carcinoma among the individuals. The mechanisms that determine the clearance or the persistence of HCV have not yet been clarified. Here, we experienced two cases of hospital-related infection with HCV from the same origin but with quite different outcomes. One case resolved after an episode of acute hepatitis, while the other case developed a chronic hepatitis although they were infected with HCV of the same origin. Although infected with the virus of the same origin, the clinical and virological courses were completely different. This suggests that host factors play a major role in conditioning the outcome of acute HCV infection.

Universal precaution practice and barriers to compliance among nurses in Aseer public Hospitals, Saudi Arabia

Background:Studies have shown that for every 100 hospitalized patients at any given time,10 in developing,and 7 in the developed countries would eventually develop at least one episode of healthcare associated infections.This highlights the imperativeness of adherence to Universal Precautions(Ups)for prevention of infections.Proper compliance with standard would lead to a decrease in rate of HAI.Aim:The aim of the study is to determine the perception of nurses toward compliance with universal precautions in Aseer region hospitals,Saudi Arabia and factors that may hinder the nurses from complying with those standards.Methods:A cross sectional study was performed.Data collected using validated questionnaire of universal precautions from convenience sample of 302 respondents’nurses across four public hospitals in Aseer region.Analysis was performed through descriptive statistics and chi square tests of association.Results:The overall compliance toward universal precautions among nurses was high at 88%.The results reveal that all constructs that define the actions of the nurses to have a statistically significant association at 99%with the extent to which nurses utilized the universal precautions.Discussion:The results indicate that nursing staff adhere to the universal precautions for prevention of infection.However,the hospitals should solve the main barriers including lack of personal protective clothing,challenges during emergencies,and lack of training on how to use.

一次性医疗废物的管理

随着医疗卫生事业的发展,一次性医疗用具广泛应用于医院临床诊疗及卫生保健,因此一次性医疗废物管理尤为重要。按照《医疗废物管理条例》把医疗废物分为五大类,并分类处理。感染性医疗废物必须做到日产日清,

Effect of Vacuum Sealed Drainage on Recovery of Gastrointestinal Function in Gastric Cancer Patients after Radical Gastrectomy

Objective This study aims to explore the effect of vacuum sealed drainage on the recovery of gastrointestinal function in gastric patients after radical gastrectomy. Methods One hundred and twenty patients who received radical gastrectomy for gastric cancer were randomly divided into two groups.Patients in the control group received continuous gastrointestinal decompression to drain the gastric juices after radical gastrectomy,whereas patients in the treatment group received vacuum sealed drainage.The postoperative variables between the two groups were compared,including time of bowel sound reoccurrence,time of the first flatus,indwelling time of gastric tube,days of hospitalization,and complications,such as anastomotic leakage,intestinal obstruction,wound infection,pulmonary infection,fever, and pharyngitis.SPSS 13.0 was used to analyze the data. Results Significant differences in the following variables were observed in patients between the two groups:time of bowel sound reoccurrence,time of the first flatus,indwelling time of gastric tube,and length of hospitalization of the patients.The value of each of these variables was much smaller in the treatment group than in the control group(P<0.05).No significant difference was found in the incidence of anastomotic leakage,intestinal obstruction,and wound infection among patients between the two groups(P>0.05). However,a significant differences were observed in the incidence of pulmonary infection,fever,and pharyngitis among the patients between the two groups(P<0.05),with much lower incidence of the variables in the treatment group than in the control group. Conclusions Vacuum sealed drainage used in gastric cancer patients after radical gastrectomy can accelerate the recovery of gastrointestinal function and reduce postoperative complications.Moreover,it shortens the indwelling time of the gastric tube, thereby making the patients feel comfortable without the disturbance from the gastric tube.

Evaluation of Risk Management of Foodborne Infection in Hospital

As being at the head of the establishment, the hospital manager＇s major concern is food safety in his hospital. Unfortunately, because of their health weaknesses, patients are more susceptible to foodborne illness than any other population group As match as food prepared according to less stringent hygiene＇s rules can infect or intoxicate more than it would be in a healthy population, as hygiene＇s rules must be observed in a particularly strict way, at the kitchen where meals are prepared for health care facilities. In fact, hospitals＇ food hygiene＇s rules are those who defined catering. They are made to avoid food contamination and microbial growth throughout the food chain from raw materials＇ delivery to the consumer. The main objective of taking the meal as a patients＇ tracer is to detect and study the infection＇s risk associated with feeding at hospital, and to provide practical tools to better manage this risk. Methodology was based on an analysis of the last six years＇ work concerning hygiene＇s audits and bacteriological analyses. The results showed that the food infectious risk has an important frequency, on one side; on another, they were used as a standard model of such risk＇s management.

Surgical Site Infection Prevention Practices and Associated Factors among Nurses Working in Government Hospitals of Harari Regional State and Dire Dawa City Administration, Eastern Ethiopia

Background:Surgical site infections are the most frequent type of preventable hospital acquired infections with a serious and undesirable outcome of surgery associated with increase morbidity,mortality rate,hospital stay,readmission and excess cost.Surgical site infection prevention is one of the most important challenge in delivering optimal nursing care.Studies suggest that the nurses’practices of surgical site infection prevention is not well addressed.Moreover,there is clearly paucity of information,in Africa including the study area.Objective:The aim of this study was to assess surgical site infection prevention practices and associated factors among nurses working in government hospitals of Harari Regional State and Dire Dawa City Administration,Eastern Ethiopia from March 01 to 28,2019.Method and Materials:An institutional based cross-sectional study design was employed for a total of 515 nurses.Simple random sampling method was used to select study participants.Data were collected using pretested structured self-administered questionnaire supplemented by observation.Data were checked,coded,entered and cleaned using Epi-data version 3.1 and exported to SPSS version 20 for analysis.Bivariate and multivariate analysis were undertaken and P values less than 0.05 at 95%confidence interval were considered as statistically significant.Result:The overall self-reported level of SSI prevention practice was found to be 40.8%(95%CI:36.9%,45.4%).Nurses with BSc and above[Adjusted odds ratio(AOR)=2.52,95%CI(1.14,5.54)],trained on infection prevention[AOR=2.22,95%CI(1.29,3.82)],good knowledge[AOR=2.21,95%CI(1.32,3.71)],good attitude[AOR=5.11,95%CI(3.05,8.57)],got supply of personal protective equipment[AOR=2.57,95%CI(1.46,4.49)],had management support[AOR=3.41,95%CI(1.90,6.12)],experience of 5 to 10 years[AOR=5.38,95%CI(2.82,10.27)]and≥11 years[AOR=3.48,95%CI(1.47,8.25)],were found to be statistically and positively associated with nurses SSI prevention practice.Conclusion:In this study,the level of surgical site infection prevention practice was poor.Being BSc and above,being knowledgeable and good attitude,got personal protective equipment,had management support,serving for≥5 years and trained on infection prevention were found to be significantly associated with surgical site infection prevention practice.Updating knowledge and practice of nurses through in-service education and training on latest evidence-based practice,regularly supplying of personal protective equipment,developing hospital policy and procedures for surgical site infection prevention practice is recommended.

Evaluation of the Appropriateness of Gastrointestinal Prophylaxis in the Critically III

The aim of this study was to determine the utilization of SRMD （stress related mucosal disease） prophylaxis in the ICU （intensive care unit） of a large teaching institution based on duration and defined adverse effects. Patients were reviewed for appropriateness of SRMD prophylactic therapy based on the presence of two independent risk factors （coagulopathy and mechanical ventilation greater than 48 hours） versus presence of any one risk factor from a list developed by the study investigator. Data was collected into spreadsheets and outcomes were analyzed using descriptive statistics. When evaluating patients based on the presence of any risk factor, 84 percent of patients had at least one risk factor present, while 16 percent did not have any. In patients who received famotidine, there was one occtLrrence of Clostridium difficile and 6 cases of electrolyte abnormalities. In patients who received a PPI, there was one documented case of HAP, two cases of ventilator-associated pneumonia, three cases of Clostridium difficile, and 14 patients who developed electrolyte abnormalities. Data does not show an association between acid suppression therapy and incidence of nosocomial infections. The number of patients whose therapy exceeded the appropriate stop-date compared with the number of patients in which SRMD prophylaxis was discontinued when risk factors diminished was greater when evaluating patients based upon the two independent risk factors.

Lack of Association between fbe Gene with Adherence and Biofilm Formation in Staphylococcus epidermidis Clinical Isolates

Biofilm formation plays a major role in the pathogenesis of nosocomial infections caused by Staphylococcus epidermidis ( S.epidermidis ). It has been suggested that protein encoded by the fbe (fibrinogen binding protein) gene of S.epidermidis enhances bacterial adherence to medical devices and biofilm formation by binding to host fibrinogen (Fg). In this study, a 1.7 kb fbe gene fragment was amplified in 111 of 115 strains of S.epidermidis clinical isolates using PCR. Contrary to expectations, only 14 strains showed marginally increased adherence to Fg-coated polystyrene wells compared with BSA coated wells. Quantitative real-time PCR revealed no statistically significant difference in Fbe expression between Fg binding strains and Fg non-binding strains. Furthermore, in the presence of soluble Fg, S.epidermidis biofilm formation decreased in a dose-dependent manner. In contrast, the Staphylococcus aureus ( S.aureus ) strain Cowan Ⅰ and other 5 S.aureus clinical isolates showed a substantial increase in both adherence and biofilm formation in the presence of Fg. The results suggest that in S.epidermidis the fbe gene may not be associated with bacterial adherence and biofilm formation.

Risk of Getting Nosocomial Water-Borne Infections from the Main Water Systems in Hospitals

Drinking water may be a risk factor for human infections if the water supply is contaminated with biofilm producing bacteria such as Legionella pneumophilae or Pseudomonas aeruginosa. Several situations have to be considered when water supply to new buildings is planned. The aim of this paper is to review situations that have to be considered in new buildings and give an example on a new water supply contaminated with biofilm producing water bacteria and the precautions introduced to eliminate the contamination. When new buildings are planned it should be considered where to get the water and what is the microbiological quality of the water. If the water is contaminated there will be troubles from the beginning. The material for the pipes should be considered as biofilm which is produced in greater amounts and faster in PEG pipes than in stainless steel pipes. The choice of material depends on the expected lifetime of the building, the dimensions of the pipes, and the choice of forceps, how often the taps are used and thereby the flow in the system. The higher flow the less and slower biofilm formation. It is important to reduce the number of taps to a minimum to ovoid ＂dead ends＂ if they are not or only seldom used. Alternatively all taps could be opened automatically regularly. It is important to establish precautions to ovoid contamination of the water system in the period from when it is established until the building is taken in use. The period can be several months during which the system can act as a ＂dead end＂ if no precautions, such as regularly opening of all taps, are taken. The microbiological quality of the water in the system should be controlled before the building is taken in use. In a new building, where the water supply and the water in the building was not controlled before the building was taken in use, extremely high total and Legionella germ counts were found. The water was disinfected with low concentrations of chloride with very little effect. After disinfection with high concentrations of chloride for few hours and placing a sterile filter at the water entrance both the total and Legionella germ count decreased to an acceptable level.