What am I really drinking in my soup of hot or cold water– a microbiome conundrum?

Mrs Marija Juraja1,2

1Infection Prevention and Control Unit, Adelaide, Australia, 2Infectious Diseases Service, Adelaide, Australia


Water heating/cooling systems for potable water have been around for many years. As part of our new hospital build, new systems were installed and intermittently used. With commissioning, the systems (which provides both chilled water at 4 degrees and hot water at above 90 degrees for patient and staff use) were tested and 43% of them grew Legionella pneumophilia. Where to from here???


Prior to the new hospital build another site with a similar system had returned a positive Legionella pneumophila result, including installed carbon filters. As part of commissioning the site stakeholders undertook a variety of tasks to ensure we met our national Legionella guidelines. Even with this process, 43% (17/40) was contaminated (counts were between a 100 to 600 cfu/mL) with predominantly Legionella species (not L. pneumophila) from the cold section of the system.

Further actions taken included isolating the cold system whilst leaving the hot water functional (this has remained permanently in the inpatient areas). 10 new systems were installed in office spaces and monitored monthly for legionella and chlorine levels. No Legionella detected. Subsequently the refurbished systems are slowly being rolled out across all the office space areas only.


System designs can create their own infection control issues, and this is what we found with this system. It can be challenging when you work with stakeholders to get them to understand the risks, when the risks were real and potentially could have opened us to litigation and adverse patient outcomes.


Marija Juraja RN, Grad Cert IC, CICP-E

Marija has previously held the position of President of the Australasian College for Infection Prevention and Control (ACIPC), including state and national appointments to the Healthcare Associated Infection’s Implementation Advisory Committee at the Australian Commission on Safety & Quality in Health Care and Joanna Briggs Institute (JBI) Infection Control Node Expert Reference Group. She currently is member of the ACIPC Low-Middle Income Special Interest group and Co-chair of the ACIPC South Australian Special Interest Group.

Marija also works in the position of Nurse Unit Manager for Central Adelaide Local Health Network, Infection Prevention and Control Unit. She holds an adjunct teaching position at The University of South Australia. She has published and co-authored several articles and guidelines and presented at both national and international conferences.

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