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June 8, 2017

Why your hospital's plumbing systems might be an 'outbreak just waiting to happen'

Daily Briefing

Dozens of health care facilities reported cases of Legionnaires' disease in 2015, revealing the need for more facilities to implement effective water management systems to prevent such infections, according to CDC Morbidity and Mortality Weekly Report published Tuesday.

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Legionnaires' disease is a life-threatening and preventable lung infection that stems from waterborne pathogens known as Legionella bacteria. According to MedPage Today, Legionella organisms can be found in outdated water systems that allow the pathogens to spread.

Report details

For the report, CDC reviewed data from its National Notifiable Diseases Surveillance System. The agency identified a total of 6,079 cases of Legionnaires' disease reported in 2015 throughout the country.

CDC then analyzed 2,809 Legionnaires' cases that were reported in 20 states and New York City in 2015.  CDC assessed the data to determine whether the cases were definitely or possibly associated with a health care facility by reviewing symptom onset. The agency defined:

  • Definite health care association as a case in which symptoms emerged in an individual who was hospitalized or resided in a long-term care facility for the entire 10 days prior to the symptoms' onset; and
  • Possible health care association as a case in which symptoms emerged in an individual who had any exposure to a health care facility for a part of the 10 days prior to the symptoms' onset.


CDC found that out of the 2,809 confirmed cases it reviewed, 85 cases—or 3 percent—were definitely associated with health care facilities, and 468 cases—or 17 percent—were possibly associated with health care facilities. CDC said the other 2,256 cases were considered unrelated to health care.

Of all the health-care associated Legionnaires' infections CDC identified, the agency found that:

  • 80 percent were linked to long-term care facilities;
  • 18 percent were linked to hospitals; and
  • 2 percent were linked to both.

CDC said the majority of definite health-care associated infections occurred among individuals ages 60 and older. According to CDC, the fatality rate for definite health care-associated infections was 25 percent, compared with 10 percent for infections with a possible health care-association.


CDC wrote that the report "highlights the importance of case prevention and response activities, including implementation of effective water management programs and timely case identification."

Patient experience: An investment worth making

CDC Acting Director Anne Schuchat said the report "uncovered a problem that is happening every day in health care facilities around the country and something we can do a lot about." She added, "This report suggests that in many health care facilities, there's really just an outbreak waiting to happen." Schuchat noted that while Legionnaires' disease is deadly and widespread, health care facilities can prevent the disease by having "an effective water-management system."

Cynthia Whitney, who works for CDC's respiratory diseases branch, said the agency has developed a toolkit to help health care facilities develop water management systems that reduce the risk of spreading Legionnaires' disease.

Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association, said, "America's hospitals and health systems are committed to providing safe and healthy environments for the patients they serve," which "includes ensuring the development and use of an effective water management program to help prevent the outbreak of diseases, including Legionnaires' disease." She added that AHA's member hospitals and health systems "rely on effective guidance from trusted partners, such as CDC and [the America Society of Heating, Refrigerating, and Air-Conditioning Engineers], to provide a road map for their work" (Gever, MedPage Today, 6/6; Stein, "Shots," NPR, 6/6; AHA News, 6/6).

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