Legionellae Control In Health Care Facilities


Legionnellae Control BookLegionellae Control in Health Care Facilities
A Guide for Minimizing Risk

by Matthew R.Freije

James M. Barbaree, Ph.D., Technilcal Editor
Foreword by Alfred P. Dufour, Ph.D.

•  Reviewed or highlighted in more than 50 professional journals worldwide
•  Distributed in more than 30 countries

Softcover, 144 pages, 1996  |  ISBN 0-9649926-4-7 or 978-0-9649926-4-1  |  $79 USD


This book is sold out. Find other up-to-date resources appropriate for your job.


  • Test questions for your facility to help evaluate your risk
  • Lawsuit data: strength of a plaintiff’s case, verdict and settlement amounts
  • Ways to prevent legionellae growth: checklists for domestic water systems and cooling towers
  • Water sampling guidance: if, how often, how many, where, how to, interpreting results, costs
  • Disinfecting domestic water: solving problems without overspending, advantages and disadvantages of various methods
  • Costs of equipment and procedures
  • Getting the best laboratories, consultants, and equipment manufacturers: screening questions to ask
  • Outbreaks: being prepared, investigating
  • Source directory listing experienced individuals willing to give advice by telephone, consultants, laboratories worldwide that specialize in Legionella, government agencies, suppliers, attorneys experienced in Legionnaires’ disease cases, and professional societies.

What the experts say

“The publication, Legionellae Control in Health Care Facilities, is a practical, well-written, and thoroughly researched review of particular value for infection control practitioners, hospital epidemiologists and hospital engineering departments. The book is well organized and well referenced and will serve as a valuable reference for all of us involved in health care institutional management and planning. As a clinician with little mechanical background, I found it particularly useful in understanding how to effectively recommend engineering strategies for environmental control.” Michael F. Parry, MD, Director of Infectious Diseases and Microbiology, The Stamford (USA) Hospital; Associate Clinical Professor of Medicine, Columbia University College of Physicians and Surgeons

“Legionnaires’ disease can be a serious liability challenge to any facility operator. Freije meets the issue head on and provides the system administrator with straightforward methods to minimize the risk. A fine contribution to industry.” Larry Staples, Consultant, and 1996 Vice President of American Society of Heating, Refrigerating and Air-Conditioning Engineers, Inc. (ASHRAE)

“Legionellae Control in Health Care Facilities: A Guide for Minimizing Risk is the first comprehensive, multi-disciplinary publication to address the prevention, identification and control of legionellae. We have litigated and investigated many legionellae outbreak claims in the United States, and it is our belief that this publication should go a long way to reduce the incidence of claims if the hospital community utilizes this manual in its management structure.” Ronnie Penton, attorney, Wimberly & Penton, Bogalusa, La., USA

“I wish I had had this book before our hospital began its battle with Legionella–it would have saved us a lot of time and money. Legionella is a major problem in hospitals, but many hospitals don’t even know a problem exists. This book gives health care professionals a quick overview of the potential problem and lists action steps in an easy-to-use format. Highly recommended.” Dennis Criggar, Director of Facilities, Community Hospital East, Indianapolis, USA

“This guide is thorough and full of useful information. The information is presented in a balanced and practical way. I particularly like the emphasis on communication between engineering and infection control.” Janet Stout, Ph.D., Microbiologist, Special Pathogens Laboratory, VA Medical Center, Pittsburgh, USA

“This book contains valuable information for health care professionals for the prevention and control of Legionellae, presented in a practical format.” I. Campbell, MD, Microbiology and M. Garcia, Infection Control, The Toronto (Ontario) Hospital, Canada

“The issue of Legionellae control in hospitals is topical and important, but also controversial. Much of the book is devoted to specific approaches that engineers and microbiologists will find useful and feasible; the focus is on pragmatic approaches that are cost-effective. However, health care professionals including infection control chiefs and hospital directors can also benefit from the overview of this provocative disease (that can engender so much adverse publicity for a hospital) and review the strategies for protecting both the patient and the hospital’s reputation. I disagree with some of the views presented in this book, but, certainly, it is the most comprehensive and probably best balanced book on the subject.” Victor L. Yu, MD, Chief, Infectious Diseases, VA Medical Center, Pittsburgh; Professor of Medicine, University of Pittsburgh, USA

“This guide is both timely and practical. Education handouts and sample logs are timesavers. The definitions in the guide enable widely divergent disciplines to communicate accurately with each other thereby promoting a concerted approach to control. Such communication is critical since the approach to control of Legionella is an interdepartmental affair!” Jeanne A. Linquist, MD, Medical Director of Infection Control; Mills-Peninsula Hospitals, San Mateo, Calif, USA


About the author and technical editor

matt_freije_web-smMatt Freije is president of HC Information Resources Inc. He is a consultant, author, and course instructor specializing in Legionella and other waterborne pathogens. He earned a B.S. degree in mechanical engineering from Purdue University, a Water Treatment Plant Operations Specialist certificate from California State University, Sacramento, and is a Certified Water Specialist. He is a member of the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE), International Water Association (IWA), Water Quality Association (WQA), and Association of Water Technologists (AWT). He is the author of several articles, a frequent guest speaker, and the editor of Legionella E-news, an international newsletter that covers outbreaks and new technology. Freije has been interviewed on radio and TV and by many newspapers and magazines.

Dr. James Barbaree is a Professor of Microbiology, Associate Director of the Detection and Food Safety Center, and former Chair of the Biological Sciences Department at Auburn University.  He retired from the Public Health Service Commissioned Corps and the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia before going to Auburn.  His experience includes being the Chief of the Bacterial Respiratory Diseases Epidemic Investigations Laboratory at the CDC and participating in a number of Legionnaires’ Disease epidemic investigations.  He has been an expert witness or consultant in over forty litigation cases concerning Legionnaires’ Disease, and has authored or co-authored over one hundred scientific papers and six patents.

Technical/Peer Review: The manuscript of this book was peer reviewed for technical accuracy and practicality by 21 individuals including health care facility engineers, infectious disease specialists, epidemiologists, microbiologists, consultants, attorneys (regarding risk management information), public health officials, and industrial hygienists.

Foreword by Alfred P. Dufour, Ph.D.: Much has been learned about Legionnaires’ disease and its causative agent, Legionella, in the twenty years that have passed since the outbreak associated with the 1976 meeting of the American Legion in Philadelphia. Because of the dedication and diligence of scientists worldwide, we now have advanced knowledge of the clinical and epidemiologic aspects of Legionnaires’ disease. We now know the sources and reservoirs for Legionella organisms and the environmental conditions under which they grow and die. We also have state-of-the-art technology to detect Legionella and we know how to control Legionella organisms in water systems. To date, most of this knowledge has not been disseminated beyond the scientific community in a form that provides specific guidance for the recognition and management of problems associated with Legionella. This book addresses the issue by providing a timely compilation of information, based on the scientific data that has been generated over the last twenty years, in the form of action steps that those in responsible positions can implement to prevent the disease. The clear, concise guidance will lead to more effective management and safety practices in health care facilities.

The information in this book applies primarily to hospitals and other health care facilities. It is in these environments that Legionella organisms pose the greatest risk because of the high probability of the presence of immunocompromised persons and other highly susceptible individuals. These circumstances require the need to exercise extreme surveillance and control measures to prevent the occurrence of Legionnaires’ disease. The book’s usefulness, however, should not be limited only to health care situations. The proposed principles and practices can be applied to any building or environment where high levels of Legionella in the water system may pose a health risk to its occupants. The suggested action-based approach to minimizing the proliferation of Legionella organisms in building water systems will undoubtedly diminish the risk for contracting Legionnaires’ disease wherever it is used.


Published Reviews

Some of the reviews (if we have received permission) are posted in full.

“Mr. Freije’s approach to the subject is…that of the risk manager. He appears to have done his homework fairly thoroughly and gives thoughtful consideration to conflicting views. …It will be useful to hospital epidemiologists and infection control personnel needing an introduction to the topic, as well as to hospital management and engineering personnel.” Infection Control and Hospital Epidemiology (July 1997), published by Slack Inc. for the Society for Healthcare Epidemiology of America. Reviewed by Robert R. Muder, MD.

“written for an international audience…present[s] a practical step-by-step approach to risk assessment and management that can be understood by both administrators and engineers.” The Medical Journal of Australia (20 Apr. 1998), published by the Australasian Medical Publishing Company Ltd. for the Australian Medical Association. Reviewed by A Scott Cameron, Dept. of Public Health, University of Adelaide, South Australia.

“Quite frankly, the approach and application of science in this text represents some of the best industrial (occupational) hygiene that I have ever seen in print! …Get this book if you have responsibility for occupational health in a hospital/healthcare facility or if you want to read and learn a true-to-life approach to the industrial hygiene triad of recognition, evaluation, and control. You won’t be sorry.” Applied Occupational and Environmental Hygiene (Dec 1996), Applied Industrial Hygiene, Inc., a subsidiary of the American Conference of Governmental Industrial Hygienists (ACGIH). Reviewed by Lawrence Stilwell Betts, MD, Ph.D., CIH; Oakland, Calif., USA

“This is an excellent reference book for any facility (healthcare or otherwise) that either is concerned about legionellae in its water systems or wants to establish a proactive program to reduce the risk of legionellae. The book provides enough information to permit the reader to develop his/her own program and, thus, is a valuable resource whether the program is developed in-house or by an outside consultant.” Professional Safety (July 1997), The American Society of Safety Engineers. Reviewed by Cherryl M. Crouch, CSP  

“This book offers a practical, ‘Action-based’ approach to one of the more insidious problems that a health care facility could ever face. The information is presented in a clear and concise manner, and the book is easy to read and follow and has quite a few appropriate references for further reading. With a usefulness that goes beyond just health care facilities, the book is well worth reading. I recommend it.” Science Books & Films (Nov. 1996), American Association for the Advancement of Science. Reviewed by Zafar M. Iqbal, Toxicology-Cancer, TCCI, Chicago, USA.

“Matt has really tackled the thorny problem issues head on. …I like the book because it is very much a ‘what to do’ book. There’s no beating around the bush and it’s written in a very chatty style. Although written by an American, the book is well suited to the Australian scene. Implementing the safety recommendations in this book should greatly diminish the risk of disease.” AIRAH Journal, (Aug. 96), Australian Institute of Refrigeration Air Conditioning & Heating. Reviewed by Clive Broadbent, Weetangera, ACT, Australia  

“…an easy read with well-defined topic areas. I would want to have a copy of this publication if I were involved in health and safety at a health care facility.” American Industrial Hygiene Association Journal ( May 1997). Reviewed by Edward L. Tapley, CIH, CSP, Salt Lake City, USA

“This is a very useful resource work for operating and maintenance staffs of health-care facilities and professionals designing the water and HVAC systems for such facilities.” CHOICE (Dec. 1996), Association of College and Research Libraries, A Division of the American Library Association. Reviewed by J. T. Pfeffer, University of Illinois at Urbana-Champaign, USA

“Legionellae Control in Health Care Facilities: A Guide for Minimizing Risk, is a must-read not only for health care facility directors and operators, but for engineers, architects and contractors involved in hospital projects. …The theme of the book is that of efficiency–how to minimize exposure and financial expenditure in a timely fashion. …All plumbing engineers involved in hospital projects should have access to a copy of this book.” ASPE Report (Jun 97), American Society of Plumbing Engineers. Reviewed by Timothy Allinson, PE

“…a lot of useful information in a compact and conveniently presented form.” SGM Quarterly (May 1997), Society for General Microbiology (UK). Reviewed by John V. Lee, Public Health Laboratory, Nottingham (UK)

“Shows how to evaluate risk at a particular facility, and offers step-by-step instructions on implementing risk reduction and preventive measures for domestic water systems and cooling towers, and on water sampling and disinfection procedures.” SciTech Book News (Sep.-Oct. 1996), Book News, Inc., Portland, Ore., USA

“…if, as an environmental professional, you are looking for a great manual focusing on controlling legionellae in your facility or your clients’ facilities, this is a very valuable book to have.” Environmental Choices (Spring 1997), Environmental Information Association, Bethesda, Md., USA. Reviewed by Nick Gannick and Pamela Harvey Hogue