June 06, 2017
People are getting Legionnaires' disease from healthcare facilities — primarily long-term care facilities — in most parts of the country, Anne Schuchat, MD (RADM, USPHS), acting director of the Centers for Disease Control and Prevention (CDC), told reporters on a conference call Tuesday.
Reports from 2015 in 20 states and New York City were studied and the CDC found that 16 of the jurisdictions reported residents who had Legionnaires' disease definitely acquired from a stay in a hospital or a long-term care facility, she said.
Numbers were reported Tuesday in the CDC's Morbidity and Mortality Weekly Report ( MMWR ).
Of all 2809 Legionnaires' cases reported, 3% have been confirmed as acquired from a healthcare facility (meaning symptoms showed up after 10 full days in the hospital), with 17% possibly healthcare-associated (symptoms appeared when the patient had been hospitalized less than 10 days).
"We know that Legionnaires is underreported and that the numbers we report each year are just the tip of the iceberg," Dr Schuchat said. She says the 10-day bar may skew the risk because most hospitalizations are shorter than 10 days, so "many people considered possible Legionnaires disease, healthcare-associated, probably got their disease in a healthcare facility." The 10-day bar may also make it easier to confirm the cases in long-term care facilities, she noted.
In those 16 jurisdictions, cases occurred in 72 facilities, with cases ranging from one to six per site. Most (80%) occurred in long-term care, 18% in hospitals, and 2% were linked to both.
"Legionnaires disease at healthcare facilities is widespread, deadly and preventable," she said, adding that most of the infections can be prevented with better water management programs at these sites.
The CDC has a toolkit for help with such programs.. But recent data show more is needed, she said.
Reducing the Risk
In previous outbreaks, the CDC has reported that "effective water management could have prevented the problems leading to four out of five healthcare-associated outbreaks," Dr Schuchat added.
Most healthy people do not get Legionnaires' disease after exposure to Legionella, Dr Schuchat emphasized. Those most likely to develop the disease are those aged at least 50 years, current or former smokers, and those with chronic disease or weakened immune systems.
About one in 10 people who get the infection die from it, but the numbers are higher (25%) for those in healthcare facilities because they are already ill when they contract the disease.
Patients can inhale water droplets from shower heads, cooling towers, fountains, water therapy spas, and certain medical equipment, Dr Schuchat noted.
Previous analyses have shown the high cost of the disease — in 1 year, insurers paid an estimated $434 million in claims and total cost per patient averaged $38,000, Dr Schuchat said.
The Centers for Medicare and Medicaid Services recently announced that facilities are expected to develop and adhere to policies to reduce the risk for Legionella and other pathogens in water.
"So this is essentially a warning to healthcare facilities that if you don't have a good water management plan, this is a time to study up and develop one," Dr Schuchat said.
Cynthia Whitney, MD, MPH, chief of the CDC's respiratory diseases branch, said that providers have a key role in suspecting Legionnaires' in certain patients with healthcare-associated pneumonia and using the right tests to confirm because failing to order the right tests is leading to underreporting.
Local health authorities should be notified of one definite case or two possible cases within a year so they can stem outbreaks together, Dr Schuchat explained.
"This is a big culture change for infection control and hospital facilities," she said. She noted that while there have been big improvements in hand hygiene and antibiotics use, "most infection control practitioners haven't even heard that Legionnaires can be a hospital-acquired infection."
"Each single healthcare-associated case could be considered an outbreak waiting to happen," she said. "We also think for consumers, it's a great reminder that if someone you love is hospitalized or in a nursing home and develops pneumonia to ask about whether this could be Legionnaires disease."
Dr Schuchat and Dr Whitney report no relevant financial relationships.
MMWR. Published online June 6, 2017. Full text