Controlling Legionella in hospital water systems: experience with the superheat-and-flush method and copper-silver ionization

Infect Control Hosp Epidemiol. 1998 Dec;19(12):911-4.


Objective: To evaluate the effect of copper-silver ionization on Legionella colonization and nosocomial legionnaires' disease and to compare the efficacy of metal ions versus the superheat-and-flush method of disinfection.

Design: Prospective determination over a 36-month period of copper and silver ion concentrations in the recirculating hot-water system, Legionella colonization of the hospital water distribution system, and cases of nosocomial legionnaires' disease. Retrospective comparison of results with the previous 13 years, during which the superheat-and-flush method was used.

Setting: The Pittsburgh Veterans' Affairs Health Care System (University Drive Division) acute-care hospital.

Intervention: Three copper-silver ionization systems were installed on the hot-water distribution system in November 1994.

Results: The average number of cases of legionnaires' disease per year and the percentage of distal sites positive for Legionella pneumophila for the superheat-and-flush method versus the copper-silver ionization method was six cases with 15% positivity versus two cases with 4% positivity, respectively. The reduction in Legionella colonization after copper-silver ionization was significant (P<.05) compared to the superheat and flush. Mean copper and silver ion concentrations (mg/L) were 0.29 and 0.054 from hot-water tanks, and 0.17 and 0.04 from distal outlets, respectively.

Conclusions: We conclude 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.

MeSH terms

  • Copper
  • Cross Infection / epidemiology
  • Cross Infection / prevention & control*
  • Cross Infection / transmission
  • Disinfection / methods*
  • Heating
  • Hospitals, Veterans
  • Humans
  • Infant, Newborn
  • Infection Control / methods
  • Ions
  • Legionella pneumophila / growth & development*
  • Legionnaires' Disease / epidemiology
  • Legionnaires' Disease / prevention & control*
  • Legionnaires' Disease / transmission
  • Maintenance and Engineering, Hospital / methods*
  • Pennsylvania
  • Retrospective Studies
  • Silver
  • Water Microbiology*
  • Water Supply*


  • Ions
  • Silver
  • Copper