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Healthcare-acquired Legionnaires’ disease is caused by exposure to Legionella in hospital drinking water. Disinfecting the drinking water system is an effective preventive measure. The efficacy of any disinfection measures should be validated in a step-wise fashion from laboratory assessment to a controlled multihospital evaluation over a prolonged period of time. In this chapter, we describe 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 disinfection methods in outbreak situations (superheat-and-flush plus or minus hyperchlorination). Controlled evaluations by other hospitals with experience with the system under consideration are the strongest evidentiary demonstration of efficacy. We also discuss the importance of risk assessment and infection preventionists in the selection of hospital disinfection strategies. The infection preventionist should be consulted in the selection of a commercial disinfection system. Their input will assure that healthcare facilities personnel make an evidence-based selection. Regulations and guidelines pertaining to Legionella control and Legionnaires’ disease prevention can affect the need for and choice of disinfectant. These disinfectant technologies have also demonstrated efficacy against other problematic waterborne pathogens. Routine surveillance cultures of water for Legionella and monitoring of disinfectant concentrations are necessary for long-term efficacy. |
