A 2017 report from the Centers for Disease Control and Prevention (CDC) said Legionnaires’ disease, a serious lung infection caused by Legionella bacteria, is widespread in long-term care facilities – and 75 percent of hospital-acquired Legionnaires could be prevented with better water management.
The most recent example is occurring at University Hospital in Madison, Wisconsin, where an outbreak of Legionnaires’ disease has resulted in 14 sickened patients – and three deaths. A change in the hospital’s hot-water system, which had been adjusted to save water, is the primary suspect in the outbreak.
“The flow was altered in the system,” Nasia Safdar, medical director of infection control for UW Health, said when the outbreak first made headlines on Nov. 28. “So, instead of being at a consistent high flow, it was altered to be more flexible to be on demand.”
Hospital-acquired Legionnaires: 2015 information used
The 2017 CDC report, using data from 2015, showed that Legionnaires’ disease kills 10 percent of those diagnosed in the general population. In a hospital or long-term care facility, however, that rate increases to 25 percent.
A total of 2,809 confirmed Legionnaires’ disease cases were reported in the United States in 2015, including 85 (3 percent) considered “definite” and 468 (17 percent) considered “possible” health-care-associated cases. (The study used information only from long-term-care patients – that is, anyone who had been hospitalized or in a facility for at least 10 days.)
“In health-care facilities, people are more vulnerable and more likely to get sick if they are exposed to the pathogen,” said Anne Schuchat, then-acting director of the CDC, during a 2017 media telebriefing. “Everything from shower heads, to decorative fountains, to respiratory equipment, could house Legionella.”
Hospital-acquired Legionnaires: patients vulnerable
The three patients who passed away at University Hospital all had “serious, life-limiting health conditions,” UW Health officials said, underscoring the vulnerability of bed-ridden hospital patients.
UW Health officials reported that test results from three patients confirmed that the strain of Legionella was identical to the strain found in University Hospital’s water system. (The other 11 patients did not provide samples.)
To combat the problem, University Hospital officials said the water system has been flushed with high levels of chlorine to eliminate Legionella, and the procedure has been successful. “Testing completed so far continues to show the expected reduction in the bacteria,” a hospital statement read. “UW Health will continue intensive monitoring of its water system to ensure patient safety.”
University Hospital officials also said they have been working with CDC investigators on their response to the outbreak, and a review and analysis from the CDC is expected in about three months.
Hospital-acquired Legionnaires: disease facts
Legionnaires’ disease is also called Legionella pneumonia and legionellosis. The CDC estimates that there are about 25,000 yearly cases in the U.S., although only 5,000 are reported because of the disease’s nonspecific symptoms.
Those symptoms, which develop from two to 10 days after exposure to Legionella, generally begin with:
- fever, which can be as high as 104 degrees Fahrenheit or higher
- muscle aches.
By day 2 or day 3, symptoms can start to include:
- shortness of breath (dyspnea)
- pluerisy, or pleuritic chest pain, which occurs when the lungs’ lining is inflamed
- coughing, which can produce blood and mucus
- gastrointestinal symptoms (diarrhea, nausea, vomiting)
- mental confusion.
Hospital-acquired Legionnaires: high-risk groups
In addition to hospital patients with weakened immune systems, people most susceptible to infection include:
- anyone over the age of 50
- organ-transplant recipients
- anyone on a specific drug protocol, such as corticosteroids
- anyone with a chronic lung disease or COPD (bronchitis or emphysema)
- smokers, both current and former
Hospital-acquired Legionnaires: Legionella hosts
Legionella are contracted by inhaling microscopic water droplets in the form of mist or vapor. The bacteria grow best in warm water and are found most commonly in human-made environments.
In addition to large water systems like those in hospitals or nursing homes, Legionella can be found in:
- large plumbing systems
- hot-water tanks and heaters
- physical-therapy equipment
- bathroom showers and faucets
- decorative fountains
- swimming pools, whirlpools, hot tubs
- mist machines: produce sections of grocery stores
- hand-held sprayers
- cooling towers of air conditioning systems.
Elliot Olsen has decades of experience representing people harmed by Legionnaires’ disease. You can contact him for a free consultation by filling out the following form and submitting it: