Patients in Health Care Facilities at Risk for Legionnaires’ Disease

On June 6, 2017, the CDC published the report of a study that found that people got Legionnaires’ disease from a health care facility in 76% of locations reporting exposures. This is a concerning finding because Legionnaires’ disease acquired from health care facilities can be particularly severe. The findings highlight a possibly deadly risk to patients from exposure to Legionella in health care facilities.


Approximately one out of every ten people who get sick with Legionnaires’ disease will die due to complications from the illness. For those who get Legionnaires’ disease during a stay in a healthcare facility, approximately one out of every four will die.


The CDC report found that, among the Legionnaires’ disease cases definitely associated with health care facilities, 80% were associated with long-term care facilities, 18% with hospitals, and 2% with both. Cases were reported from 72 unique facilities, with the number of cases ranging from one to six per facility. Of the studied health care facility cases of Legionnaires’ disease, 88% were in people 60 years of age or older.


Legionella is a type of bacterium found naturally in freshwater environments, like lakes and streams. It can become a health concern when it grows and spreads in human-made water systems. People can be exposed to Legionella when they breathe in small droplets of water in the air that contain the bacteria. Less commonly, people can be exposed to Legionella by aspiration of drinking water. People at increased risk of aspiration include those with swallowing difficulties.


People who get sick after being exposed to Legionella can develop two different illnesses: Legionnaires’ disease and Pontiac fever. Legionnaires’ disease is very similar to other types of pneumonia (lung infection), with symptoms that include cough, shortness of breath, fever, muscle aches, and headaches. Legionnaires’ disease can also be associated with other symptoms such as diarrhea, nausea, and confusion. Symptoms usually begin two to ten days after being exposed to the bacteria, but it can take longer.


Most healthy people do not get Legionnaires’ disease after being exposed to Legionella. People at increased risk of Legionnaire’s disease are 50 years of age or older or have certain risk factors, such as being a current or former smoker, having a chronic disease, or having a weakened immune system.


“Legionnaires’ disease in hospitals is widespread, deadly, and preventable. These data are especially important for health care facility leaders, doctors, and facility managers because it reminds them to think about the risks of Legionella in their facility and to take action,” said CDC Acting Director Anne Schuchat, M.D. “Controlling these bacteria in water systems can be challenging, but it is essential to protect patients.”


Legionella growth occurs in building water systems that are not managed adequately and where disinfectant levels are low, water is stagnant, or water temperatures are ideal for growth of bacteria. In 2016, the CDC released a toolkit for building owners and managers: Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings: A Practical Guide to Implementing Industry Standards. Based on ASHRAE Standard 188, a document for building engineers, the toolkit provided a checklist to help identify when a water management program was needed, examples to help identify where Legionella could grow and spread in a building, and ways to reduce the risk of Legionella contamination. The toolkit also included examples relevant for health care facilities.


“Safe water at a health care facility might not be on a physician’s mind, but it’s an essential element of health care quality,” said Nancy Messonnier, M.D., director of the CDC’s National Center for Immunization and Respiratory Diseases. “Having a water management program that focuses on keeping facility water safe can help prevent Legionnaires’ disease.”


A new measure was put in place on June 2, 2017, to encourage implementation of water management programs. The Centers for Medicare and Medicaid Services released a Survey and Certification Memo stating that health care facilities are expected to develop and adhere to policies and procedures to reduce the risk of Legionella and other waterborne pathogens.


See the CDC Announcement


See the CDC Report


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See the Medical Law Perspectives Blog: Pneumonia in the News, in the Law, But Hopefully Not in Your Lungs