Infection Control & Hospital Epidemiology (2018), 39, 1470–1472 doi:10.1017/ice.2018.240
Concise Communication
Preventing hospital-acquired Legionnaires’ disease: A snapshot of clinical practices and water management approaches in US acute-care hospitals
Karen M. Ehret MSPH1, Allison T. Chamberlain PhD1, Ruth L. Berkelman MD1 and Scott K. Fridkin MD1,2 1Rollins School of Public Health, Emory University, Atlanta, Georgia and 2Department of Medicine, Emory University School of Medicine, Emory University,
Atlanta, Georgia Abstract
In 2017, we surveyed 101 SHEA Research Network hospitals regarding Legionnaires’ disease (LD). Of 29 respondents, 94% have or are developing a water management plan with varying characteristics and personnel engaged. Most LD diagnostic testing is limited to urine antigen testing. Many opportunities to improve LD prevention and diagnosis exist.
(Received 5 July 2018; accepted 19 August 2018; electronically published October 8, 2018)
Legionnaires’ disease (LD) is a type of pneumonia caused by Legionella pneumophila. These bacteria thrive in warm water with stagnant flow, commonly present in hospital plumbing systems.1 Infections occur when water containing Legionella is inhaled. Risk factors for LD include comorbid conditions common among hospitalized patients: older age, immunosuppression, and chronic lung disease. For these reasons, LD prevention deserves particular attention from the infection control community. With the proliferation of LD reports in recent years, the
healthcare epidemiology community has received new informa- tion to reduce the risk of Legionella growth in potable and non- potable water systems.2 In 2015, ASHRAE (formerly the American Society of Heating, Refrigerating and Air-Conditioning Engineers) released ASHRAE 188, an industry standard intended to minimize Legionella growth and transmission through the implementation of facility water management programs.3 In June 2016, the Centers for Disease Control and Prevention (CDC) published a tool kit to translate ASHRAE 188 for audiences with less technical expertise.4 In June 2017, the Centers for Medicare and Medicaid Services also issued a requirement for all Medicare- certified healthcare facilities to establish a water management plan.5 In this study, we sought to understand variations in LD pre-
vention strategies including clinical practices for diagnosing LD and characterization of water management plans within the Society for Healthcare Epidemiology of America Research Network (SRN) hospitals.
Author for correspondence: Allison T. Chamberlain PhD, 1518 Clifton Road,
Atlanta, GA 30318. E-mail:
allison.chamberlain@
emory.edu PREVIOUS PRESENTATION: These data were presented at the SHEA Spring Conference on March 19, 2018, in Portland, Oregon.
Cite this article: Ehret KM, et al. (2018). Preventing hospital-acquired Legionnaires’
disease: A snapshot of clinical practices and water management approaches in US acute- care hospitals. Infection Control & Hospital Epidemiology 2018, 39, 1470–1472. doi: 10.1017/ice.2018.240
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. Methods
A 24-item electronic survey was e-mailed to SRN principal investigators on October 17, 2017. Up to 3 reminders were sent to nonrespondents until survey closure on November 30, 2017. Any US-based acute-care hospital within the SRN was eligible. For questions requiring nonepidemiologic expertise, consultation with colleagues was strongly encouraged. Respondents were asked questions on clinical protocols for diagnosing cases of LD, maintenance practices of potable and nonpotable water systems, Legionella-specific prevention strate- gies, and knowledge of recent guidelines and regulations. Facility names, respondents and locations were not disclosed to the research team; responses were limited to 1 per facility. Results were analyzed using descriptive statistics in SAS version 9.4 software (Cary, North Carolina). The Emory University Institu- tional Review Board deemed this study to be nonhuman subjects research.
Results
In total, 29 respondents from 101 (29%) eligible facilities com- pleted the survey. Respondents represented mostly academic medical centers (59%), and 93% were from facilities where the SRN principal investigator was registered with the SRN as having “hospital epidemiologist” or “infection committee chair” listed as a primary professional activity. Facilities were large (ie, 80% had >250 beds), and 83% had transplant or inpatient dialysis units. Most facilities (79%) had cooling towers; 28% reported having operational indoor decorative fountains or aesthetic water fea- tures; and 10% had whirlpool therapy spas. Among the 29 respondents, 24 (83%) reported diagnosing LD
cases at their facility in the previous 5 years, of which 9 (38%) suspected or confirmed at least 1 case to be healthcare-associated. Regarding diagnostic capacity, 25 respondents (86%) reported an
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