Intermittent use of copper-silver ionization for Legionella control in water distribution systems: a potential option in buildings housing individuals at low risk of infection.

One copper-silver ionization system was sequentially installed onto the hot-water recirculation lines of two hospital buildings colonized with Legionella pneumophila, serogroup 1. A third building with the same water supply and also colonized with Legionella served as a control. Four weeks after activation of the system, distal site positivity for Legionella in the first test building dropped to zero. After operating for 16 weeks, the system was disconnected and installed onto the second test building. Twelve weeks of disinfection reduced the distal site positivity for Legionella in the second test building to zero. Legionella recolonization did not occur in the first test building for 6-12 weeks and in the second test building for 8-12 weeks after inactivation of the system. The control building remained Legionella-positive throughout the experimental period. A significantly higher copper concentration was found in the biofilm taken from a sampling device than in that from water. This is likely to be the reason that the copper-silver ionization system had the residual effect of preventing early recolonization. Our study raises the possibility that one copper-silver unit could be rotated among several buildings to maintain a Legionella-free environment. Such an approach may be cost-effective for buildings housing individuals at low risk for contracting legionnaires' disease.