Skip to main content

Safety and Efficacy of Chlorine Dioxide for Legionella Control in a Hospital Water System

  • Zhe Zhang (a1), Carole McCann (a2), Janet E. Stout (a1) (a3) (a4), Steve Piesczynski (a2), Robert Hawks (a2), Radisav Vidic (a1) and Victor L. Yu (a5)...

In a 30-month prospective study, we evaluated the efficacy of chlorine dioxide to control Legionella organisms in a water distribution system of a hospital with 364 patient beds and 74 skilled nursing beds. The number of hot water specimens positive for Legionella organisms decreased from 12 (60%) of 20 to 2 (10%) of 20. An extended time (18 months) was needed to achieve a significant reduction in the rate of Legionella positivity among hot water specimens. At the time of writing, no cases of hospital-acquired Legionnaires disease have been detected at the hospital since the chlorine dioxide system was installed in January 2003. Use of chlorine dioxide was safe, based on Environmental Protection Agency limits regarding maximum concentrations of chlorine dioxide and chlorite.

Corresponding author
Special Pathogens Laboratory, 1401 Forbes Avenue, Suite 209, Pittsburgh, PA 15219 (
Hide All
1. Sidari, FP, Stout, JE, VanBriesen, JM, et al. Keeping Legionella out of water systems. J Am Water Works Assoc 2004;96:111119.
2. Srinivasan, A, Bova, G, Ross, T, et al. A 17-month evaluation of a chlorine dioxide water treatment system to control Legionella species in a hospital water supply. Infect Control Hosp Epidemiol 2003;24:575579.
3. Bova, G, Sharpe, P, Keane, T. Evaluation of chlorine dioxide in potable water systems for Legionella control in an acute care hospital environment. In: Program and abstracts of the 65th Annual International Water Conference; October 17-21, 2004; Pittsburgh, PA. Abstract IWC-04-11.
4. US Environmental Protection Agency (EPA). Test Method: Determination of Inorganic Anions in Drinking Water by Ion Chromatography. Cincinnati, OH: EPA; 1997:300.1.
5. Lin, YE, Vidic, RD, Stout, JE, Yu, VL. Legionella in water distribution systems. J Am Water Works Assoc 1998;90:112121.
6. Stout, JE, Yu, VL. Experiences of the first 16 hospitals using copper-silver ionization for Legionella control: implications for the evaluation of other disinfection modalities. Infect Control Hosp Epidemiol 2003;24:563568.
7. Zhang, Z, Stout, JE, Vidic, RD. The impact of temperature and TOC on chlorine dioxide decay in drinking water. Paper presented at: American Water Works Association Annual Conference and Exposition; June 11 -15, 2006; San Antonio, TX.
8. Harris, A, Rendell, M. The elimination of Legionella in local hot and cold water systems using a novel chlorine dioxide technique. In: Program and abstracts of the 60th Annual International Water Conference; October 18-20, 1999; Pittsburgh, PA. Abstract IWC-99-18.
9. Hamilton, E, Seal, DV, Hay, J. Comparison of chlorine and chlorine dioxide disinfection for control of Legionella in a hospital water supply. J Hosp Infect 1996;32:156160.
10. Hood, J, Cheape, G, Mead, A, Curran, E. Six years' experience with chlorine dioxide in control of Legionella pneumophila in potable water supply of Glasgow Royal Infirmary. Am J Infect Control 2000;28:86.
11. Makin, T. Control of Legionella in domestic water systems and potential energy savings resulting from the control of legionellae with chlorine dioxide. In: Program and abstracts of the 15th International Federation of Hospital Engineering Congress; 1998; Edinburgh, Scotland.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *


Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed