Nosocomial and healthcare-related infections: Edited by Marc J. StruelensPrevention of hospital-acquired legionellosisLin, Yusen E.a; Stout, Janet E.b,c; Yu, Victor L.b,c Author Information aNational Kaohsiung Normal University, Taiwan, ROC bSpecial Pathogens Laboratory cUniversity of Pittsburgh, Pittsburgh, Pennsylvania, USA Correspondence to Victor L. Yu, MD, Special Pathogens Laboratory, 1401 Forbes Avenue, Suite 208, Pittsburgh, PA 15219, USA E-mail: [email protected] Current Opinion in Infectious Diseases: August 2011 - Volume 24 - Issue 4 - p 350-356 doi: 10.1097/QCO.0b013e3283486c6e Buy Metrics Abstract Purpose of review The incidence of hospital-acquired legionellosis appears to be increasing. Presence of Legionella in the hospital drinking water is the only risk factor known with certainty to be predictive of risk for contracting Legionnaires’ disease. Recent findings Given the high frequency of infection by nonpneumophila and nonserogroup 1 species, both Legionella respiratory culture on selective media and urine antigen testing should be available in the hospital clinical microbiology laboratory. If the drinking water is contaminated by nonpneumophila or nonserogroup 1 species, Legionella culture on selective media must be available for patients with hospital-acquired pneumonia. The impact of PCR application for environmental water specimen remains to be elucidated. Its advantage is that it is a rapid test and its weakness is its low specificity. Copper–silver ionization disinfection and point-of-use (POU) filters have proved effective. Chlorine dioxide and monochloramine are under evaluation and their ultimate role remains to be elucidated. Routine Legionella cultures in concert with disinfectant levels are the best indicators for ensuring long-term efficacy. Percentage distal site positivity for Legionella in drinking water is accurate in predicting risk. Quantitative criteria (CFU/ml) have proven inaccurate and should be abandoned. Summary Infection control professionals, not healthcare facility personnel or engineers, should play the leadership role in selecting and evaluating the specific disinfection modality. Proactive measures of routine environmental cultures for hospital water and disinfection modalities allow for effective prevention of this high-profile hospital-acquired infection. © 2011 Lippincott Williams & Wilkins, Inc.