Copper-silver ionisation is gaining popularity worldwide as a water disinfection method. We review the literature that supports the effectiveness and safety of the copper-silver ionisation pertaining to legionella control in water distribution systems. A search between January 1997 and January 2007 was conducted in relevant health databases: Medline, Embase, NHS CRD, Cochrane Library Plus, Web of Knowledge, IME (Spanish Medical Index) and IBECS (Health Sciences Bibliographic Index). Ten published studies were selected according to inclusion and exclusion criteria previously established; most of these were experimental. Legionella levels decrease with the application of any of the procedures used in these studies and the procedures can be combined to obtain better outcomes. No studies containing an economic evaluation were found. We conclude that copper-silver ionisation is an effective method to control legionella, bearing in mind that eradication cannot be achieved by any method in isolation. Maintaining high temperatures in the water system can maximise effectiveness of the method. Copper-silver appears to be safe, as long as ion levels are monitored and kept within international recommended levels. More studies with concurrent control group, long follow-up and economic evaluation are required to properly assess this procedure.