Outbreaks of Legionnaires’ disease receive significant media attention especially when a large number of people become ill or die. In contrast to highly publicized outbreaks, single infections with Legionella bacteria often go unnoticed. According to the Centers for Disease Control and Prevention (CDC), between 8,000 and 18,000 people are hospitalized with Legionnaires’ disease in the United States each year. Legionnaires’ disease is a legitimate public health concern as its fatality rate during an outbreak ranges from 5% to 30% in those who contract the disease. The immediate consequences for the building owner or manager faced with liability claims and negative publicity can be devastating and extremely costly. Many experts agree that proactively managing the risk of Legionella bacteria in cooling towers and water systems is more cost effective than responding to an outbreak retroactively.
While a few states and municipalities have instituted guidelines for monitoring Legionella, there are no federal or state regulations that require routine monitoring of buildings with susceptible individuals. We recommend building owners and hospitals establish a Legionella control and management program, including routine monitoring and testing, in areas where the risk of Legionella infection is high. This accomplishes two tasks:
1) It indicates the effectiveness of control measures already in place, and
2) It provides an early warning of potential problems.
Although some species of Legionella can be found in the soil, most species live in water. The Gram-negative Legionella bacterium thrives in warm, stagnant water but it can survive under a wide range of temperatures (68° to 122°F), pH and dissolved oxygen levels. Legionella pneumophila has been isolated and associated with outbreaks stemming from air-conditioning cooling towers, whirlpool spas and showers. Other water devices can include potable water systems, whirlpool baths, respiratory care equipment, humidifiers and faucets. As water from these sources is aerosolized, individuals inhale the Legionella-containing droplets and the organism is aspirated into the lungs. Smokers and individuals with weakened immune systems have a higher risk of developing Legionellosis (Legionnaires’ disease or Pontiac fever).
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