Cleanliness and maintenance for LD in hospitals?

I am a health protection practitioner working in the UK’s Health Protection Agency. I specialise in investigating and managing cases of Legionnaires’ disease. I am one of thousands who benefit from your work and regularly see your names when researching the subject.


This morning I found an old reference book in our library and was interested by your comments about the gap between intention to control and actual control. This is what you wrote: “It should be emphasized that appearance, degree of cleanliness, and regular preventative maintenance measures of the system were not associated with Legionella contamination. Thus, recent engineering guidelines and building codes directed at Legionella, although well-intentioned, are unlikely to affect Legionella colonization.”


(Yu, V.L., 1995. Legionella pneumophila(Legionnaires’ disease). INMandell, G.L., Bennett, J.E. and Dolin, R.Principles and Practice of Infectious Diseases,4th Ed. London: Churchill Livingstone.)


Given the long time since this was written I was wondering, has your current position on this changed?


Our position has not changed. However, more studies have been performed that show that many commonly recommended measures for Legionella prevention are not only non-evidence-based, but may actually increase the risk of Legionnaires’ disease.

See Publications for recent articles as well as the articles below.

Lin YE, Stout JE, Yu VL. Prevention of Hospital-Acquired Legionellosis. Curr Opin Infect Dis. 2011. 24(4):350-6

Lin YE, Stout JE, Yu VL. Controlling Legionella in Hospital Drinking Water: An Evidence-Based Review of Disinfection Methods. Infect Control Hosp Epidemiol. 2011;32(2):166-173.

Stout JE, Yu VL. Environmental culturing for Legionella: Can we build a better mouse trap? Am J Infect Control 2010;38:341-3.