Legionnaires’ disease is a severe pneumonia caused by Legionella, a waterborne bacteria. Legionella species, found naturally in freshwater environments. Legionella is of concern when it grows and spreads in water systems, such as showers, faucets, cooling towers, decorative fountains, and hot tubs that are not drained after each use. It can flourish in complex building water systems that are not well maintained.
The following conditions promote Legionella growth:
• Low level of disinfectant: Inadequate disinfection cannot kill or inactivate Legionella species.
• Stagnation: Allows biofilm growth, reducing the effectiveness of disinfection and providing protection from heat.
• Biofilm: Provides food and shelter to waterborne organisms.
• Sediment: Promotes growth of water commensal microflora.
• Algae and Pseudomonas can supply nutrients for Legionella growth.
• Temperature between 20 and 50°C (68– 122°F) (optimal growth temperature range is 35–46°C [95–115°F]).
• pH between 5.0 and 8.5.
Those most susceptible to the disease are people age 50 or over; those with a history of smoking, chronic disease, immunosuppression, or cancer; or people with underlying illnesses such as diabetes, kidney failure, or liver failure. While about 10 percent of cases are fatal, mortality associated with healthcare-associated Legionnaires’ disease is reported to be as high as 46 percent. Being proactive is the only approach to take when fighting agains Legionella bacteria.
This CMS regulatory memorandum is mandatory. Healthcare facility leadership needs to know that this memorandum is pertinent to the for hospitals. The hospital must provide a sanitary environment to avoid sources and transmission of infections and communicable diseases. There must be an active program for the prevention, control, and investigation of infections and communicable diseases. Noncompliance may carry severe consequences (e.g., losing CMS reimbursement or a CMS citation). In response, healthcare facilities should create compliant Water Management Programs.