Treatment of a Legionella pneumophila-colonized water distribution system using copper-silver ionization and continuous chlorination.

  title={Treatment of a Legionella pneumophila-colonized water distribution system using copper-silver ionization and continuous chlorination.},
  author={A Biurrun and Luc{\'i}a Caballero and Carmen Pelaz and Elias Heimdal Leon and Ana Isabel Gago},
  journal={Infection control and hospital epidemiology},
  volume={20 6},
The detection in April 1997 of a case of nosocomial legionellosis in our hospital led to the discovery that both our hot- and cold-water circuits were heavily colonized with Legionella pneumophila. Conventional methods for eradication of the organisms were unsuccessful, so a copper-silver (Cu-Ag) ionization system and a continuous chlorination system were installed. Five months later, the number of colonized sites decreased from an initial 58.3% to 16.7%. 
Efficacy of Copper-Silver Ionization in Controlling Biofilm- and Plankton-Associated Waterborne Pathogens
At concentrations below the EPA limits, ionization has potential to control the three waterborne pathogens, in addition to Legionella, in hospital water systems for nosocomial infection control.
Use of copper-silver ionization for the control of legionellae in alkaline environments at health care facilities.
Control of legionellae in premise water systems may be a complex process requiring long-term assessments for adequate control, and the evidence suggests that Ag ions are responsible for the control of Legionella pneumophILA 1, L pneumophila 6, and L anisa under alkaline water conditions.
Persistence of chlorine‐sensitive Legionella pneumophila in hyperchlorinated installations
Aims:  To study the persistence of Legionella over time in different disinfected facilities and analysing whether failures in bacterial eradication could be the result of a decrease in the
Efficacy of Copper-Silver Ionization in Controlling Legionella in a Hospital Hot Water Distribution System: a German Experience
This chapter evaluates the efficacy of copper-silver ionization that is reported to be a useful tool to control growth of Legionella. Copper-silver ionization was tested over a period of 1 year as
Efficacy of point-of-entry copper--silver ionisation system in eradicating Legionella pneumophila in a tropical tertiary care hospital: implications for hospitals contaminated with Legionella in both hot and cold water.
Although Legionella was not completely eradicated during the study period, ionisation was effective in controlling Legionella for both hot and cold water, and may be an attractive alternative as a point-of-entry systematic disinfection solution for Legionella.
Legionella pneumophila in ospedale, un pr o blema superabile.
Chlorination with sodium hypochlorite or other chlorine compounds, superheathing, copper/silver ionization, UV radiation, ozone and other treatments of drinking and hot waters, if rationally used, may contribute substantially to avoiding this preventable pneumonia.
Control of Legionella in Drinking Water Systems: Impact of Monochloramine
Investigations indicate that it is possible to prevent 90% of drinking-water-associated Legionnaires' disease through the use of monochloramine for residual municipal water disinfection, and this finding is not just important for control of nosocomial infections.
Controlling Legionella in Hospital Drinking Water: An Evidence-Based Review of Disinfection Methods
This review evaluates systemic disinfection methods (copper-silver ionization, chlorine dioxide, monochloramine, ultraviolet light, and hyperchlorination), a focal disinfection method (point-of-use filtration), and short-term disinfections methods in outbreak situations (superheat-and-flush with or without hyperchlorinated).
BACKGROUND AND OBJECTIVES: Hospital-acquired legionnaires' disease can be prevented by disinfection of hospital water systems. This study assessed the long-term efficacy of copper-silver ionization
Control of Legionella in hospital potable water systems
This chapter describes long-term systemic disinfection methods (copper‑silver ionization, chlorine dioxide, monochloramine, ultraviolet light, hyperchlorination), a localized disinfection method (point-of-use filtration), and short-term disinfectant methods in outbreak situations (superheat-and-flush plus or minus hyperchlorinated).


Legionella disinfection of water distribution systems: principles, problems, and practice.
Progress in the field of disinfection directed at hospital water systems has been necessarily slow, and cases of nosocomial legionellosis continue to appear, increasing pressures for hospitals to find solutions.
Controlled evaluation of copper-silver ionization in eradicating Legionella pneumophila from a hospital water distribution system.
  • Z. Liu, J. Stout, +4 authors V. Yu
  • Environmental Science, Medicine
    The Journal of infectious diseases
  • 1994
Copper-silver ionization can eradicate L. pneumophila in a water distribution system because of its relatively low cost, straightforward installation, easy maintenance, nontoxic by-products and the presence of a disinfecting residual.
Controlling Legionella in hospital water systems: experience with the superheat-and-flush method and copper-silver ionization.
It is concluded that a properly maintained and monitored copper-silver ionization system was more effective than the superheat-and-flush method for reducing the recovery of Legionella from the hospital water distribution system.
Disinfection of water distribution systems for legionella: a review of application procedures and methodologies.
Hospital-acquired legionella pneumonia is emerging as a major problem; potable water distribution systems have been shown to be the primary reservoirs for the legionella organisms. As a result,
Efficacy of thermal treatment and copper-silver ionization for controlling Legionella pneumophila in high-volume hot water plumbing systems in hospitals.
Copper-silver ionization effectively controls L. pneumophila in high-volume plumbing systems and is superior to thermal treatment; however, high concentrations of copper and silver can accumulate at the bottom of hot water tanks.
Legionnaires' disease associated with a hospital water system. A five-year progress report on continuous hyperchlorination.
Continuous hyperchlorination of the hot and cold water began in January 1982, and chlorine levels of 3 to 5 mg/L have been maintained most recently, and water samples have been consistently negative for Legionella for more than five years.
Efficacy of copper and silver ions and reduced levels of free chlorine in inactivation of Legionella pneumophila
All disinfection systems, regardless of temperature or free chlorine concentration, showed increase inactivation rates when 400 and 40 micrograms of copper and silver per liter was added; however, this trend was significant only at 0.4 mg of free chlorine per liter.
LEGIONELLACEAE IN THE HOSPITAL WATER-SUPPLY Epidemiological Link with Disease and Evaluation of a Method for Control of Nosocomial Legionnaires' Disease and Pittsburgh Pneumonia
An epidemiological link was found between contamination of a hospital water-supply by Legionella pneumophila and by Pittsburgh pneumonia agent (PPA) and subsequent cases of nosocomial legionnaires'
Legionellae isolated from clinical and environmental samples in Spain (1983-90): monoclonal typing of Legionella pneumophila serogroup 1 isolates.
Characterization of samples from four outbreaks in which both clinical and environmental isolates had been recovered permitted the recognition of three Philadelphia 1 or Allentown 1 and one Knoxville 1 strains as the aetiological agents.
Guidelines for prevention of nosocomial pneumonia. Centers for Disease Control and Prevention.
  • Medicine
    MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports
  • 1997
This revised guideline is designed to reduce the incidence of nosocomial pneumonia and is intended for use by personnel who are responsible for surveillance and control of infections in acute-care hospitals; the information may not be applicable in long-term-care facilities because of the unique characteristics of such settings.