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An Outbreak of Legionnaires Disease Associated with a Decorative Water Wall Fountain in a Hospital

Published online by Cambridge University Press:  02 January 2015

Thomas E. Haupt ,
Richard T. Heffernan ,
James J. Kazmierczak ,
Henry Nehls-Lowe ,
Bruce Rheineck ,
Christine Powell ,
Kathryn K. Leonhardt ,
Amit S. Chitnis  and
Jeffrey P. Davis
Thomas E. Haupt*
Affiliation:
Wisconsin Division of Public Health, Madison, Wisconsin
Richard T. Heffernan
Affiliation:
Wisconsin Division of Public Health, Madison, Wisconsin
James J. Kazmierczak
Affiliation:
Wisconsin Division of Public Health, Madison, Wisconsin
Henry Nehls-Lowe
Affiliation:
Wisconsin Division of Public Health, Madison, Wisconsin
Bruce Rheineck
Affiliation:
Wisconsin Division of Public Health, Madison, Wisconsin
Christine Powell
Affiliation:
Wisconsin State Laboratory of Hygiene, Madison, Wisconsin
Kathryn K. Leonhardt
Affiliation:
Aurora Health Care, Milwaukee, Wisconsin
Amit S. Chitnis
Affiliation:
Wisconsin Division of Public Health, Madison, Wisconsin
Jeffrey P. Davis
Affiliation:
Wisconsin Division of Public Health, Madison, Wisconsin
*
Wisconsin Division of Public Health, 1 West Wilson Street, Madison, WI 53701 (thomas.haupt@wi.gov)
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Abstract

Objective.

To detect an outbreak-related source of Legionella, control the outbreak, and prevent additional Legionella infections from occurring.

Design and Setting.

Epidemiologic investigation of an acute outbreak of hospital-associated Legionnaires disease among outpatients and visitors to a Wisconsin hospital.

Patients.

Patients with laboratory-confirmed Legionnaires disease who resided in southeastern Wisconsin and had illness onsets during February and March 2010.

Methods.

Patients with Legionnaires disease were interviewed using a hypothesis-generating questionnaire. On-site investigation included sampling of water and other potential environmental sources for Legionella testing. Case-finding measures included extensive notification of individuals potentially exposed at the hospital and alerts to area healthcare and laboratory personnel.

Results.

Laboratory-confirmed Legionnaires disease was diagnosed in 8 patients, all of whom were present at the same hospital during the 10 days prior to their illness onsets. Six patients had known exposure to a water wall-type decorative fountain near the main hospital entrance. Although the decorative fountain underwent routine cleaning and maintenance, high counts of Legionella pneumophila serogroup 1 were isolated from cultures of a foam material found above the fountain trough.

Conclusion.

This outbreak of Legionnaires disease was associated with exposure to a decorative fountain located in a hospital public area. Routine cleaning and maintenance of fountains does not eliminate the risk of bacterial contamination. Our findings highlight the need to evaluate the safety of water fountains installed in any area of a healthcare facility.

Infect Control Hosp Epidemiol 2012;33(2):185-191

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 33 , Issue 2 , February 2012 , pp. 185 - 191
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2012

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References

1.Stout, JE, Brennen, C, Muder, RR. Legionnaires' disease in a newly constructed long-term care facility. J Am Geriatr Soc 2000;48(12):1589–1592.CrossRefGoogle Scholar
2.Buchholz, U, Stöcker, P, Brodhun, B. Legionnaires disease—reordered. Infect Control Hosp Epidemiol 2010;31(1):104–105.Google Scholar
3.Graman, PS, Quinlan, GA, Rank, JA. Nosocomial legionellosis traced to a contaminated ice machine. Infect Control Hosp Epidemiol 1997;18(9):637–640.Google Scholar
4.Palmore, T, Stock, F, White, M, et al. A cluster of cases of nosocomial Legionnaires disease linked to a contaminated hospital decorative water fountain. Infect Control Hosp Epidemiol 2009;30(8):764–768.Google Scholar
5.Hlady, WG, Mullen, RC, Mintz, CS, Shelton, BG, Hopkins, RS, Daikos, GL. Outbreak of Legionnaire's disease linked to a decorative fountain by molecular epidemiology. Am J Epidemiol 1993;138(8):555–562.Google Scholar
6.O'Loughlin, RE, Kightlinger, L, Werpy, MC, et al. Restaurant outbreak of Legionnaires' disease associated with a decorative fountain: an environmental and case-control study. BMC Infect Dis 7:93, dok10.1 186/1471-2334-7-93.Google Scholar
7.Veronesi, L, Capbianco, E, Affanni, P, Pizzi, S, Vitali, P, Tanzi, ML. Legionella contamination in the water system of hospital dental settings. Acta Biomed 2007;78(2):117–122.Google ScholarPubMed
8.Singh, T, Coogan, MM. Isolation of pathogenic Legionella species and legionella-laden amoebae in dental unit waterlines. J Hosp Infect 2005;61(3):257–262.Google Scholar
9.Straus, WL, Plouffe, JF, File, TM Jr, et al. Risk factors for domestic acquisition of Legionnaires disease. Arch Intern Med 1996;156(15):1685–1692.Google Scholar
10.Environmental assessment of water systems. Centers for Disease Control and Prevention Web site. http://www.cdc.gov/legionella/files/EnvironmentalAssessmentlnstrument.pdf. Accessed March 9, 2010.Google Scholar
11.Centers for Disease Control and Prevention. Procedures for the Recovery of Legionella from the Environment. Atlanta: Centers for Disease Control and Prevention, 1994.Google Scholar
12.American Public Health Association. Standard Methods for the Examination of Water and Wastewater. 21st edition. Washington, DC: American Public Health Association, 2005.Google Scholar
13.ASHRAE Standard Project Committee 12-2000. Minimizing the Risk of Legionellosis Associated with Building Water Systems. Atlanta: American Society of Heating, Refrigerating and Air-Conditioning Engineers, 2000:4.Google Scholar
14.Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Morb Mortal Wkly Rep 2003;52(RR-10):1–44.Google Scholar
15.Facility Guidelines Institute. Guidelines for Design and Construction of Health Care Facilities. Chicago: American Society for Healthcare Engineering (ASHE) of the American Hospital Association, 2010:16, appendix Al.2–2.2.2.5 (8).Google Scholar