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Legionella pneumophila, regularly found within premise plumbing distribution systems of many large and complex buildings, is responsible for 90% of legionellosis cases. When properly applied and maintained, onsite water treatment offers options for pathogen inactivation and health protection. The addition of copper and silver ions by copper–silver ionization (CSI) is reviewed here. A literature survey was conducted to assess current knowledge about the biocidal mechanisms of copper and silver ions against Legionella spp. and their survival responses and resistance mechanisms. Understanding how copper and silver ions affect bacteria, how bacteria defend against metal ions, and environmental conditions that affect CSI efficacy may help better define conditions under which CSI, alone or in combination with other treatment(s), might offer reliable control of Legionella. Elevated dissolved oxygen, the sodium content of the water, combined disinfectants, and higher temperature may provide conditions under which Legionella spp. may be more susceptible to metal ions.

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