title: Efficacy of thermal treatment and copper-silver ionization for controlling Legionella pneumophila in high-volume hot water plumbing systems in hospitals.
abstract: BACKGROUND
  Thermal treatment and copper-silver ionization are often used for controlling Legionella pneumophila in high-volume hospital plumbing systems, although the comparative efficacies of these measures in high-volume systems are unknown.
  
  
  METHODS
  Thermal treatment of a hot water circuit was accomplished by flushing hot water (> 60 degrees C) through distal fixtures for 10 minutes. Copper-silver ionization was conducted in three circuits by installing units into return lines immediately upstream from hot water tanks. Recovery rates of L. pneumophila were monitored by culturing swab samples from faucets. Concentrations of copper and silver in water samples were determined by atomic absorption spectrophotometry.
  
  
  RESULTS
  Four heat-flush treatments failed to provide long-term control of L. pneumophila. In contrast, ionization treatment reduced the rate of recovery of L. pneumophila from 108 faucets from 72% to 2% within 1 month and maintained effective control for at least 22 months. Only three samples (1.9%) of hot water from faucets exceeded Environmental Protection Agency standards for silver, and none exceeded the standards for copper. Of 24 samples obtained from hot water tanks, 42% and 50% exceeded the silver and copper standards, respectively.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Children's Hospital of Pittsburgh, PA 15213, USA.
authors.forename: S
authors.initials: S
authors.lastname: Mietzner
authors.forename: R C
authors.initials: RC
authors.lastname: Schwille
authors.forename: A
authors.initials: A
authors.lastname: Farley
authors.forename: E R
authors.initials: ER
authors.lastname: Wald
authors.forename: J H
authors.initials: JH
authors.lastname: Ge
authors.forename: S J
authors.initials: SJ
authors.lastname: States
authors.forename: T
authors.initials: T
authors.lastname: Libert
authors.forename: R M
authors.initials: RM
authors.lastname: Wadowsky
authors.forename: S
authors.initials: S
authors.lastname: Miuetzner
mesh_terms: D003300:Copper; D003428:Cross Infection / Q000517:prevention & control*; D004203:Disinfection / Q000379:methods*; D004566:Electrodes; D006801:Humans; D007477:Ions; D016952:Legionella pneumophila / Q000302:isolation & purification; D007877:Legionnaires' Disease / Q000517:prevention & control*; D008284:Maintenance and Engineering, Hospital; D010414:Pennsylvania; D012498:Sanitary Engineering; D012834:Silver; D018709:Statistics, Nonparametric; D014871:Water Microbiology; D014881:Water Supply
chemical_list: D007477:Ions; D012834:Silver; D003300:Copper