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Healthcare-related Legionnaires’ disease has a devastating impact on high risk patients, with a case fatality rate of 30–50%.  Legionella  prevention and control in hospitals is therefore crucial. To control  Legionella  water colonisation in a hospital setting we evaluated the effect of pipeline improvements and temperature increase, analysing 237 samples over a 2-year period (first year: 129, second year: 108). In the first year, 25.58% of samples were positive for  Legionella  and 16.67% for amoeba. Assessing the distance of the points analysed from the hot water tank, the most distal points presented higher proportion of  Legionella  colonisation and lower temperatures (nearest points: 6.4% colonised, and temperature 61.4 °C; most distal points: 50% and temperature 59.1 °C). After the first year, the hot water system was repaired and the temperature stabilised. This led to a dramatic reduction in  Legionella  colonisation, which was negative in all the samples analysed; however, amoeba colonisation remained stable. This study shows the importance of keeping the temperature stable throughout the circuit, at around 60 °C. Special attention should be paid to the most distal points of the circuit; a fall in temperature at these weak points would favour the colonisation and spread of  Legionella , because amoeba (the main  Legionella  reservoir) are not affected by temperature.

The impact of pipeline changes and temperature increase in a hospital historically colonised with Legionella