{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T17:52:02Z","timestamp":1788976322962,"version":"build-2803163510"},"reference-count":35,"publisher":"Cambridge University Press (CUP)","issue":"8","license":[{"start":{"date-parts":[[2015,1,2]],"date-time":"2015-01-02T00:00:00Z","timestamp":1420156800000},"content-version":"unspecified","delay-in-days":4172,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2003,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0195941700081777_abs1\"><jats:title>Background and Objectives:<\/jats:title><jats:p>Hospital-acquired legionnaires' disease can be prevented by disinfection of hospital water systems. This study assessed the long-term efficacy of copper-silver ionization as a disinfection method in controlling<jats:italic>Legionella<\/jats:italic>in hospital water systems and reducing the incidence of hospital-acquired legionnaires' disease. A standardized, evidence-based approach to assist hospitals with decision making concerning the possible purchase of a disinfection system is presented.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700081777_abs2\"><jats:title>Design:<\/jats:title><jats:p>The first 16 hospitals to install copper-silver ionization systems for<jats:italic>Legionella<\/jats:italic>disinfection were surveyed. Surveys conducted in 1995 and 2000 documented the experiences of the hospitals with maintenance of the system, contamination of water with<jats:italic>Legionella<\/jats:italic>, and occurrence of hospital-acquired legionnaires' disease. All were acute care hospitals with a mean of 435 beds.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700081777_abs3\"><jats:title>Results:<\/jats:title><jats:p>All 16 hospitals reported cases of hospital-acquired legionnaires' disease prior to installing the copper-silver ionization system. Seventy-five percent had previously attempted other disinfection methods including superheat and flush, ultraviolet light, and hyperchlorination. By 2000, the ionization systems had been operational from 5 to 11 years. Prior to installation, 47% of the hospitals reported that more than 30% of distal water sites yielded<jats:italic>Legionella<\/jats:italic>. In 1995, after installation, 50% of the hospitals reported 0% positivity, and 43% still reported 0% in 2000. Moreover, no cases of hospital-acquired legionnaires' disease have occurred in any hospital since 1995.<\/jats:p><\/jats:sec><jats:sec id=\"S0195941700081777_abs4\"><jats:title>Conclusions:<\/jats:title><jats:p>This study represents the final step in a proposed 4-step evaluation process of disinfection systems that includes (1) demonstrated efficacy of<jats:italic>Legionella<\/jats:italic>eradication in vitro using laboratory assays, (2) anecdotal experiences in preventing legionnaires' disease in individual hospitals, (3) controlled studies in individual hospitals, and (4) validation in confirmatory reports from multiple hospitals during a prolonged time (5 to 11 years in this study). Copper-silver ionization is now the only disinfection modality to have fulfilled all four evaluation criteria.<\/jats:p><\/jats:sec>","DOI":"10.1086\/502251","type":"journal-article","created":{"date-parts":[[2006,3,14]],"date-time":"2006-03-14T21:59:36Z","timestamp":1142373576000},"page":"563-568","source":"Crossref","is-referenced-by-count":116,"title":["Experiences of the First 16 Hospitals Using Copper-Silver Ionization for<i>Legionella<\/i>Control: Implications for the Evaluation of Other Disinfection Modalities"],"prefix":"10.1017","volume":"24","author":[{"given":"Janet E.","family":"Stout","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor L.","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2015,1,2]]},"reference":[{"key":"S0195941700081777_ref003","first-page":"1","article-title":"Guidelines for prevention of nosocomial pneumonia","volume":"46","year":"1997","journal-title":"MMWR"},{"key":"S0195941700081777_ref020","doi-asserted-by":"publisher","DOI":"10.1016\/S0043-1354(01)00124-5"},{"key":"S0195941700081777_ref033","doi-asserted-by":"publisher","DOI":"10.1093\/infdis\/169.4.919"},{"key":"S0195941700081777_ref016","unstructured":"Bowler WA , Bresnahan J , Bradfish A , A \u201cvitriolic\u201d solution to the problem of Legionella contamination of a hospital water system. Presented at the Ninth Annual Meeting of the Society for Healthcare Epidemiology of America; April 19-21, 1999; San Francisco, CA Abstract 53."},{"key":"S0195941700081777_ref006","doi-asserted-by":"publisher","DOI":"10.1097\/00001648-199803000-00005"},{"key":"S0195941700081777_ref030","doi-asserted-by":"publisher","DOI":"10.1128\/AEM.68.6.2711-2715.2002"},{"key":"S0195941700081777_ref027","unstructured":"Modol JM , Pedro-Botet ML , Sabria M , et al. Environmental and clinical legionellosis in hospitals in Catalonia, Spain. Presented at the 38th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; September 24-27, 2002; San Diego, CA."},{"key":"S0195941700081777_ref032","doi-asserted-by":"publisher","DOI":"10.1086\/317431"},{"key":"S0195941700081777_ref022","unstructured":"Reynaga E , Garcia-Nunez M , Pedro-Botet M , et al. Copper-silver ionization system water disinfection, and nosocomial legionellosis. Presented at the 41st Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; December 16-19, 2001; Chicago, IL."},{"key":"S0195941700081777_ref024","doi-asserted-by":"publisher","DOI":"10.1097\/00000441-198708000-00007"},{"key":"S0195941700081777_ref005","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.82.7.955"},{"key":"S0195941700081777_ref028","first-page":"1","volume-title":"Approaches to Prevention and Control of Legionella Infection in Allegheny County Health Care Facilities","year":"1997"},{"key":"S0195941700081777_ref013","first-page":"16","article-title":"Installation of metal ionization system for the reduction of Legionella pneumophila at a university hospital: black water and other complications","volume":"17","author":"Nouri","year":"1996","journal-title":"Infect Control Hosp Epidemiol"},{"key":"S0195941700081777_ref011","volume-title":"Proceedings of the Annual Meeting of the American Society for Microbiology (Anaheim, CA)","author":"Thompson","year":"1990"},{"key":"S0195941700081777_ref017","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-6553(97)90066-3"},{"key":"S0195941700081777_ref034","doi-asserted-by":"publisher","DOI":"10.1086\/516283"},{"key":"S0195941700081777_ref035","doi-asserted-by":"publisher","DOI":"10.1128\/9781555817985.ch84"},{"key":"S0195941700081777_ref009","doi-asserted-by":"publisher","DOI":"10.1016\/0043-1354(96)00077-2"},{"key":"S0195941700081777_ref029","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1997.03540480027018"},{"key":"S0195941700081777_ref018","first-page":"292","article-title":"Studies on reducing the Legionella load of a hospital warm-water system by using the Tarn-Pure procedure","volume":"20","author":"Selenka","year":"1995","journal-title":"Hygiene Medicine"},{"key":"S0195941700081777_ref010","first-page":"514","article-title":"Effect of silver and copper ions on survival of Legionella pneumophila in tap water [in German]","volume":"198","author":"Rohr","year":"1996","journal-title":"Zentralblatt Hyg Umweltmedizin"},{"key":"S0195941700081777_ref021","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1002\/j.1551-8833.1998.tb08504.x","article-title":"Controlling Legionella using copper-silver ionization","volume":"90","author":"States","year":"1998","journal-title":"Journal of the American Water Works Association"},{"key":"S0195941700081777_ref023","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(85)90349-6"},{"key":"S0195941700081777_ref007","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(83)90290-8"},{"key":"S0195941700081777_ref025","first-page":"39","volume-title":"Current Status and Emerging Perspectives","author":"Joly","year":"1994"},{"key":"S0195941700081777_ref014","doi-asserted-by":"publisher","DOI":"10.1086\/501645"},{"key":"S0195941700081777_ref004","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1002\/j.1551-8833.1998.tb08503.x","article-title":"Legionella in water distribution systems","volume":"90","author":"Lin","year":"1998","journal-title":"Journal of the American Water Works Association"},{"key":"S0195941700081777_ref008","doi-asserted-by":"crossref","first-page":"3045","DOI":"10.1128\/AEM.55.12.3045-3050.1989","article-title":"Efficacy of copper and silver ions and reduced levels of free chlorine in inactivation of Legionella pneumophila","volume":"55","author":"Landeen","year":"1989","journal-title":"Appl Environ Microbiol"},{"key":"S0195941700081777_ref012","unstructured":"Lumish RM , Stout JE , Fleming J , et al. New approach to controlling nosocomial Legionnaires' disease: copper\/silver ionization treatment in hot water system. Presented at the 11th Annual Interscience Conference on Antimicrobial Agents and Chemotherapy; October 1720, 1993; New Orleans, LA."},{"key":"S0195941700081777_ref019","doi-asserted-by":"publisher","DOI":"10.2307\/30142016"},{"key":"S0195941700081777_ref002","doi-asserted-by":"publisher","DOI":"10.1086\/501642"},{"key":"S0195941700081777_ref031","doi-asserted-by":"publisher","DOI":"10.1086\/313512"},{"key":"S0195941700081777_ref015","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268800050731"},{"key":"S0195941700081777_ref026","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-6553(98)70054-9"},{"key":"S0195941700081777_ref001","first-page":"147","article-title":"Disinfection of water distribution systems for Legionella","volume":"13","author":"Lin","year":"1998","journal-title":"Semin Respir Infect"}],"container-title":["Infection Control &amp; Hospital Epidemiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0195941700081777","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2020,4,13]],"date-time":"2020-04-13T05:33:55Z","timestamp":1586756035000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0195941700081777\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2003,8]]},"references-count":35,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2003,8]]}},"alternative-id":["S0195941700081777"],"URL":"https:\/\/doi.org\/10.1086\/502251","relation":{},"ISSN":["0899-823X","1559-6834"],"issn-type":[{"value":"0899-823X","type":"print"},{"value":"1559-6834","type":"electronic"}],"subject":[],"published":{"date-parts":[[2003,8]]}}}