Integrated legionella risk assessment framework for thermal spa healthcare facilities

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Abstract

As a result of modern anthropogenic activities and urbanized lifestyles, the incidence and prevalence of respiratory diseases have risen significantly in the 20th and 21st centuries, primarily due to the deterioration of air quality. As part of these processes, the spread of the use of spas and rheumatology treatment centers carries new, invisible exposure risks, among which Legionnaires' disease caused by Legionella spp. stands out. The aim of this research is to identify the risks associated with Legionella exposure in a Hungarian spa, to determine the groups of people at risk, and to formulate technical and operational recommendations to reduce exposure and increase occupational safety. During the study, we mapped the indoor areas associated with aerosol formation, analyzed the operating practices of water and air treatment systems, and reviewed current control protocols.