Evaluation of A New Monochloramine Generation System for Controlling Legionella in Building Hot Water Systems. Scott Duda, MS; Sheena Kandiah, MD, PhD; Janet E. Stout, PhD; et al. Infection Control and Hospital Epidemiology vol. 35, no. 11 (November 2014) pp. 1356-1363.
Biological control in cooling water systems using nonchemical treatment devices. Scott Duda, Janet E. Stout & Radisav Vidic HVAC&R Research, 17(5): 872–890, 2011.
Controlling Legionella in Hospital Drinking Water: An Evidence-Based Review of Disinfection Methods. Lin YE, Stout JE and Yu VL. Infect Control Hosp Epidemiol 2011; 32(2):166–173.
Summary: The efficacy of any disinfection measures should be validated in a stepwise fashion from laboratory assessment to a controlled multiple-hospital evaluation over a prolonged period of time. In this review, we evaluate systemic disinfection methods (copper-silver ionization, chlorine dioxide, monochloramine, ultraviolet light, and hyperchlorination), a focal disinfection method (point-of-use filtration), and short-term disinfection methods in outbreak situations (superheat-and-flush with or without hyperchlorination.) The infection control practitioner should take the lead in selection of the disinfection system and the vendor. Formal appraisals by other hospitals with experience of the system under consideration is indicated. Routine performance of surveillance cultures of drinking water to detect Legionella and monitoring of disinfectant concentrations are necessary to ensure long-term efficacy.
Environmental Culturing for Legionella: Can We Build a Better Mouse Trap? . Janet E. Stout and Victor L. Yu. Am J Infect Control, 2010; 38:341-3.
This report discusses best practices for Legionella detection in water systems and reviews guidelines for Legionella prevention. The direct link between drinking water colonization by Legionella and hospital-acquired legionellosis has prompted healthcare organizations to recommend proactive culturing for Legionella as a preventative measure (see Legionella guidelines table).
Role of Environmental Surveillance in Determining the Risk of Hospital-Acquired Legionellosis: A National Surveillance Study with Clinical Correlations. Infect Control Hosp Epidemiol 2007;28:818–24, Stout JE, Muder RR, Mietzner S, Wagener MM, et al.
Conclusion: Environmental monitoring followed by clinical surveillance was successful in uncovering previously unrecognized cases of hospital-acquired Legionella pneumonia.
Safety and Efficacy of Chlorine Dioxide for Legionella Control in a Hospital Water System. Infection Control and Hospital Epidemiology, August 2007, vol. 28, no. 8.
Effect of flow regimes on the presence of Legionella within the biofilm of a model plumbing systems. Liu Z, Lin YE, Stout JE, Hwang CC, Vidic RD, Yu VL. J Appl Microbiol. 2006 Aug;101(2):437-42.
Stagnation is widely believed to predispose water systems to colonization by Legionella, but this long-held belief may be incorrect.
A Proactive Approach to Prevention of Healthcare-Acquired Legionnaires' Disease: The Allegheny County (Pittsburgh) Experience. Squire, CL., Stout, JE., et al. Am J Infect Control 2005; 33: 360–367.
Experiences of the first 16 Hospitals Using Copper-Sliver Ionization for Legionella Control: Implications for the Evaluation of Other Disinfection Modalities. Stout, JE; Yu, VL. Infect Control Hosp Epidemiol 2003;24:563–568.
Potable Water Supply as the Hospital Reservoir for Pittsburgh Pneumonia Agent. Stout J, Yu VL, Vickers RM, Shonnard J. Lancet 1982; 1:471472.
Ubiquitousness of Legionella Pneumophila in the Water Supply of a Hospital with Endemic Legionnaires' Disease. Stout, JE, Yu VL, Vickers, RM. et al. New England Journal of Medicine. 306: 466-468 (February) 1982.