CDC Report: Patients in Health Care Facilities at Risk for Legionnaires’ Disease

Bacteria in water systems can cause deadly pneumonia

A new analysis from the Centers for Disease Control and Prevention (CDC) has found that among the 21 U.S. jurisdictions studied, 76% reported health care-associated cases of Legionnaires’ disease––a concerning finding, the agency says, since 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, according to the CDC’s latest Vital Signs report.

Legionnaires’ disease is a serious lung infection (pneumonia) that people can get by breathing in small droplets of water containing Legionella bacteria. While most cases of Legionnaires’ disease are not associated with health care facilities, one in four people who develop the infection from a health care facility will die. This death rate is higher than for people who get the infection elsewhere.

All 50 states and two large cities report basic data on Legionnaires’ disease cases to the CDC, but not all report information on where those people might have been exposed to Legionella, including in health care facilities, hotels, and the community. During 2015, approximately 6,000 cases of Legionnaires’ disease were reported to the CDC; only about half of these cases included exposure data.

The Vital Signs findings are based on exposure data from 20 states and New York City. The analysis was limited to these 21 jurisdictions because they reported exposure information for most of their cases. These details were used to see how often Legionnaires’ disease was associated with health care facilities. The findings indicated that 3% of Legionnaires’ disease cases were definitely associated with a health care facility (inpatient stays of 10 days or more before the symptoms began) and that an additional 17% were possibly associated with a health care facility (exposure to a health care facility for less than 10 days before symptoms begin).

“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, MD. “Controlling these bacteria in water systems can be challenging, but it is essential to protect patients.”

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
  • 88% of cases involved people 60 years of age or older

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

Legionella growth occurs in buildings’ water systems that are not managed adequately and where disinfectant levels are low, water is stagnant, or water temperatures are ideal for the growth of bacteria.

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.

Source: CDC; June 6, 2017.