Monitoring of hospital water supplies for Legionella

In order to determine the value of regular surveillance for Legionella in the prevention of hospital-acquired (nosocomial) legionellosis, water samples were obtained over a three-year period from 17 hospitals located in England and Scotland. Prior to the study, all of the hospitals had in operation defined protocols and maintenance schedules which followed national guidelines for the prevention of legionellosis in health care premises. Six samples, from key locations in the water system of each hospital, were taken at six-monthly intervals. Total viable bacterial count (TVC), coliform count and Tegionella cultures were performed on all the samples. No coliforms were detected in any of the samples, whereas the TVC was variable. Legionella pneumophila was isolated from both the hot and cold water supplies of two hospitals. The TVC was not related to the isolation of Legionella. Confirmation of the presence of Legionella was subsequently attributed to defects in the equipment and water maintenance programmes. It was concluded that the microbiological examination of water is an effective approach to the audit of the maintenance of hospital water systems in order to prevent legionellosis.