Prevention of Legionella infections from toilet flushing cisterns

Published on 02/21/2024 | by Waterline Admin

Bechmann L, Bauer K, Zerban P, Esser T, Tersteegen A, Fuchs SA, Kaasch AJ, Wolleschak D, Schalk E, Fischer T, Mougiakakos D, Geginat G. J Hosp Infect. 2024 Jan 13:S0195-6701(24)00010-0. doi: 10.1016/j.jhin.2023.12.016. Epub ahead of print. PMID: 38224856.


  • This study reports an investigation following a fatal case of hospital-acquired legionellosis linked to contaminated water from a toilet-flushing cistern.
  • Legionella spp. were monitored in the building’s hot and cold-water systems using culture. Molecular typing of L. pneumophila isolates was also performed on samples from the infected patient and the water.
  • Legionella contamination in the hospital building’s cold-water system was significantly higher than in the hot water system and significantly higher in toilet flushing cistern’s water compared to cold water from bathroom sinks and showers.
  • Isolates from the patient and from the flushing cistern of the patient’s bathroom were identical by molecular typing.
  • In an experimental setting, daily toilet flushing for a period of 21 days resulted in a 67% reduction in the growth of Legionella spp. in the water of toilet flushing cisterns.
  • A one-time disinfection of cisterns with peracetic acid, followed by daily flushing, decreased legionella growth to less than 1% over a period of at least 7 weeks in these settings.
  • The paper can be sourced here

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