Recently, an article pointed to a motive force that is understood by many, litigation. The article points to possible scenarios where building owners could be taken to task for not addressing a serious threat to the public welfare, listing as authoritative sources The American Society of Heating, Refrigerating & Air-Conditioning Engineers, Inc., (ASHRAE) and The Centers for Disease Control & Prevention (CDC&P), However, the article only addressed cooling towers as a potential threat, neglecting potable H/W systems, suggesting that 10,000-15,000 cases/year are linked to open recirculating water systems. This number, a low estimate for total potential legionella deaths' by any standard, failed to address contributions by potable H/W systems. The article fell into the cooling tower/legionella connection and failed to grasp the implications of domestic or potable H/W systems.

Open recirculating water systems have been beaten to death in many articles. Most with a continued misinformation on the subject best left to another article. Let us address the other risk areas, hot water pools and potable hot water systems.

HOT TUBS, WHIRLPOOL SPAS, WHIRLPOOL BATHS & HYDROTHERAPY POOLS
We point to hot tubs' and/or whirlpool spas or baths as they are underscored by the worlds largest LD outbreak. This catastrophe occurred in 1999, in the Netherlands at a flower and garden show, with 133 confirmed cases - 55 probable and 28 deaths. Cruise ships, hotels, motels have all been stricken by LB and other pathogens in the water associated with these units.

Most units on the market use a myriad of methods for heating and circulating the water. The hoses, connections, piping, circulating pump, pump housing and water heaters are all areas where LB and other pathogens, such as, but not limited to, Pseudomonas aeruginosa, E. Coli, etc., amplify. The organisms lie within the piping, unaffected by common (and some not so common) cleaning materials, within biofilms. At the right moment they "bloom" into the water. Since the bather is submerged up to the chin or neck, the bacteria laden mist need not travel far to gain entry to the lungs and other body orifices. In health care facilities the hydrotherapy pools could be an excellent point of entry for MRSA and VRSA (pathogenic bacterial species resistant to antibiotics) infections. The risk is not just for the patient, the care taker is also placed at risk from the bacterial mist.

There is no denying that hydrotherapy is beneficial for some ills, but to have the cure place a loved one at greater risk is ridiculous! These units should be banned unless they address the issue of CLEANLINESS and the ability to be thoroughly cleaned, mechanically, in 100% of water wet surfaces. Draining a unit is not sufficient to eliminate the risk, all the wetted ends must be mechanically scrubbed. An at-risk patient falls ill, is taken to the hospital, dies of bilateral pneumonia - is an autopsy done to determine EXACT cause of death?

POTABLE H/W SYSTEMS
It is safe to assume, as have researchers at the University of Pittsburgh VA Medical Center, that most nosocomial (hospital acquired) outbreaks of Legionellosis are via the potable hot water system. This assumes, of course, that the victim did not check-in with the illness and it ran its' course over its' incubation period. We also assume that the Legionella sp. afflicting the victim is the same, via DNA test, as that found within the piping of the facility. The same reasoning applies to the victims' home hot water heater - rarely, if ever, checked by health authorities

So, what can be done to address the LB problem? Let's look at what we know about Legionella:

1. Legionella are small and cigar shaped (0.3 x 1.0 micron) with a "leg" that gives it motility
2. Legionella are resistant to those levels of chlorine used to kill some water borne pathogens such as cholera and E.coli, especially when pH levels of the water are above 7.2
3. Legionella exists as free swimming (planktonic) organisms and in clumps (sessile) or colonies
4. Legionella are devoured by protozoans - that are in-turn devoured by the Legionella (akin to the ALIEN - but 1000's plural) and then burst into the environment as conditions dictate
5. Legionella exist within biofilms in a symbiotic relationship with other organisms within DHW piping
6. Legionella are also found in compost material (L. Longbeachae) -
7. One does not "recover" from legionnaires' disease - ask survivors - one exists on a day-to-day basis (Consider, Legionella attacks the lungs = less oxygen to body & brain = ?)
8. Legionella attacks the newborn as well as the "aged"
9. Greater at-risk includes those with illness that predispose them to infection
10. Legionella can coexist with Mycobacterium tuberculosis within the lungs of an ill patient.Treatment for tuberculosis ONLY will lead to death of the victim.