From a unique perspective as the former CEO of a company that provided infection surveillance software to hospitals, Adam Boris observed the impact of numerous hospital-acquired infections. However, he was startled by his recent experience with the overlooked and escalating issue of Legionnaires’ disease. There has been a rise in outbreaks, including significant cases across major cities such as New York, Cleveland, Denver, Detroit, Illinois, and California.
Unlike with dangerous superbugs like MRSA or outbreaks like the Ebola scare, these increases in Legionnaires’ cases did not prompt significant action from national and state authorities. Even though healthcare regulations demand testing and public data reporting for superbugs, there are no such requirements for Legionella, the bacteria that cause Legionnaires’ disease. Remarkably, most cases of Legionnaires’ can be prevented by routine tests on building plumbing, fountains, hot tubs, and cooling towers.
Each year, it is estimated that between 56,000 and 113,000 people in the United States are infected with Legionella. Resulting fatalities vary from 15% to 30% of infections, thereby making prevention a crucial point of attention for public health and hospitals. Since Legionnaires’ disease is often misdiagnosed as common pneumonia and its incubation period can span days to weeks, tracing the source of the infection becomes challenging.
Hospitals account for more than half of the reported Legionnaire’s disease outbreaks mainly due to their large water systems and the vulnerability of already ill patients. Despite the stated goal by the CDC to prevent Legionella infections by keeping the bacteria out of water, no requirement exists for routine bacteria testing. Such an omission seems puzzling considering the available inexpensive tests and techniques to control Legionella in potable water systems and cooling towers.
Europe offers a stark contrast, with long-established specific guidelines for Legionella testing and remediation, while U.S. public health agencies have yet to establish such standards. The American Society of Heating, Refrigerating, and Air-Conditioning Engineers made a positive move recently by publishing ASHRAE 188, introducing minimum Legionnaires’ risk management requirements for building water systems. If this is adopted as the local building code, like the case in New York City, it could set a significant step toward limiting Legionnaire’s disease.
It has become apparent that fighting Legionella outbreaks also requires education, especially directed at environmental building engineers, about the ideal conditions for bacterial growth such as warm, stagnant water. The time is ripe for the U.S. to take decisive action to protect its citizens from these preventable Legionella outbreaks and exercise due diligence in policy, education, surveillance, and enforcement.