Legionnaires’ Disease

Legionnaires’ disease can occur in your health care facility

Health care facilities may put people at risk for LD when they do not have an effective water management program. These limit germ growth by:

• Keeping hot water temperatures high enough.
• Making sure disinfectant amounts are right.
• Keeping water flowing (preventing stagnation).
• Operating and maintaining equipment to prevent slime (biofilm), organic debris, and corrosion.
• Monitoring factors external to buildings, such as construction, water main breaks, and changes in municipal water quality.

Contaminated water droplets can be spread by:

• Showerheads and sink faucets.
• Hydrotherapy equipment, such as jetted therapy baths.
• Medical equipment, such as respiratory machines, bronchoscopes, and heater-cooler units.
• Ice machines.
• Cooling towers (parts of large air-conditioning systems).
• Decorative fountains and water features.

Health care facility leaders and providers should be aware that some people are at increased risk for LD:

• Adults 50 years or older.
• Current or former smokers.
• People with a weakened immune system or chronic disease.

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The Federal government is

• Promoting LD prevention practices and providing tools on how to develop water management programs for health care facilities and other at-risk buildings.
• Requiring LD prevention programs at Veterans Health Administration health care facilities. http://bit.ly/2pIRrhL
• Providing information on technologies for Legionella control in building plumbing systems. http://bit.ly/2cA7w3L
• Tracking LD and providing guidance in responding to outbreaks to find the source and help prevent more infections.

Health care facility leaders can

• Build a team focused on keeping their facility’s water safe.
• Create and use a water management program to limit Legionella and other waterborne germs from growing and spreading. https://www.cdc.gov/legionella/WMPtoolkit
• Work with healthcare providers to identify LD cases early and determine if the cases may be associated with a health care facility.
• Report LD cases to local public health authorities quickly and work with them to investigate and prevent additional infections.

Health care providers can

• Test for LD in people with health care-associated pneumonia, especially those with severe pneumonia or in facilities where other LD cases have been identified or Legionella has been found in the water.
• Test for LD in people with pneumonia who have a weakened immune system or chronic disease, fail outpatient treatment, require intensive care, or report recent travel.
• Order a culture specific for Legionella from a lower respiratory specimen (e.g., sputum), preferably before giving antibiotics. Also order a urinary antigen test.
• Talk to their laboratories to make sure they do Legionella tests on site or have another way to quickly get results.

State and local officials can

• Improve monitoring for LD in health care facilities (including reviewing previous cases to look for patterns), and respond promptly to reports of cases.
• Understand capacity of laboratories to process Legionella specimens, and encourage laboratories to save patient isolates for public health investigations.
• Report details, including visits to health care facilities, for all LD cases to CDC. http://bit.ly/2pyjn7j
• Report details for all LD outbreaks to CDC’s National Outbreak Reporting System. www.cdc.gov/nors
• Provide tools and information to help health care facility leaders create and use Legionella water management programs.