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AbstractObjective:To evaluate the effect of copper-silver ionization on Legionellacolonization and nosocomial legionnaires' disease and to compare the efficacy of metal ions versus the super-heat-and-flush method of disinfection.Design:Prospective determination over a 36-month period of copper and silver ion concentrations in the recirculating hot-water system, Legionellacolonization of the hospital water distribution system, and cases of nosocomial legionnaires' disease. Retrospective comparison of results with the previous 13 years, during which the superheat-and-flush method was used.Setting:The Pittsburgh Veterans' Affairs Health Care System (University Drive Division) acut-care hospital.Intervention:Three copper-silver ionization systems were installed on the hot-water distribution system in November 1994.Results:The average number of cases of legionnaires‘ disease per year and the percentage of distal sites positive for Legionella pneumophilafor the superheat-and-flush method versus the copper-silver ionization method was six cases with 15% positivity versus two cases with 4% positivity, respectively. The reduction in Legionellacolonization after copper-silver ionization was significant (P<.05) compared to the superheat and flush. Mean copper and silver ion concentrations (mg/L) were 0.29 and 0.054 from hot-water tanks, and 0.17 and 0.04 from distal outlets, respectively.Conclusions:We conclude that a properly maintained and monitored copper-silver ionization system was more effective than the superheat-and-flush method for reducing the recovery of Legionellafrom the hospital water distribution system.

AbstractObjective:To describe the spectrum of clinical infection caused bymethicillin-resistant Staphylococcus aureus(MRSA) in healthcare workers.Design:Case series.Setting:Two Veterans Affairs hospitals in which methicillin-resistant S aureus(MRSA) is endemic.Patients:Five employees presenting to employee health or infectious disease clinic.Results:All employees had had direct exposure to patients colonized with MRSA. Employee infections included cellulitis, impetigo, folliculitis, paronychia, and conjunctivitis. MRSA was isolated from all clinically infected sites and from the anterior nares of two employees. Three employees received a variety of ineffective oral antimicrobials before MRSA was recognized as the causative agent. All infections responded to appropriate therapy.Conclusions:Employees of hospitals with endemic MRSA may acquire MRSA infection. Presentation in our employees was that of relatively uncomplicated soft tissue infection, but several employees received inappropriate therapy before bacteriologic diagnosis. We recommend that culture and susceptibility testing be obtained prior to institution of therapy when hospital employees present with soft tissue infection.