Monochloramine in the water supply and the need for hospital monitoring for Legionella?

What would you recommend as a monitoring program for our hospital given the fact that our municipality is using monochloramine. We perform environmental cultures for Legionella on a regular basis. Our distal water sites are consistently negative. Our laboratory also has Legionella culture and the urinary antigen test to be used for both community-acquired and hospital-acquired pneumonia.

Regarding your Legionella monitoring program, we congratulate you on having diagnostic capability in-house. Many hospitals still send these tests out to reference labs and as a consequence, the physicians do not use the tests, because it takes too long to get a result. Given that your municipality is using monochloramine and that you have a history of negative culture results from your distal outlets, we would recommend that you revert to performing environmental monitoring once a year.