By Phillip Maloy / Special to Healthcare Facilities Today

Legionnaires’ disease can be prevented and treated — but it starts with identifying the problem. The best way to identify and monitor for Legionella is to culture the water. It is also the method for ensuring effective long-term treatment. 

Culturing is the process of collecting water samples and testing them for the genus species Legionella pneumophila. To be effective, hospital staff needs to collect a representative amount of samples from the cooling towers and potable water systems. In a 200 bed hospital, for example, it is recommended that samples be taken from 10 to 12 hospital rooms and units on various floors. Not all rooms should be treated equally – neonatal, transplant and intensive care units pose higher risks than waiting rooms or janitorial areas.

Results from culturing can often be confusing, making hospital administrators hesitant to engage in this process. One common issue is that culturing may produce multiple negative results, before producing a positive reading. When retesting after a positive culture, it is not uncommon to receive another negative reading, prompting hospital administrators to question whether the investment of their time and resources is worthwhile. A second reason hospitals are hesitant to culture is due to not having a plan in place to respond if Legionella is present in their facility. In fact, in the past the CDC has recommended that hospitals only culture if they see one or two cases of Legionellosis that appear or if the hospital has a transplant center. A positive result does not always mean a problem, and once hospital administrators are aware of what the results mean, it helps demystify the process and highlight how culturing can be a tool for prevention.

What do my culture readings mean?

• Less than 30 percent – When samples show less than 30 percent presence of L. pheumophila and if no high-risk areas come back positive, it is suggested by industry experts* that hospitals culture again every six to eight months. If two to three cultures are performed and there is no sign of L. pheumophila for a year, hospitals can move to testing once per year. 

• More than 30 percent – According to industry experts, there is a reason to be concerned if more than 30 percent of the samples come back with L. pheumophila present or if a high-risk area tests positive according to industry experts*. When this occurs, it is recommended that hospital culture again immediately to determine if treatment is needed or if they should continue monitoring. 

*   Special Pathogens Laboratory; et.al.

Culturing provides hospitals a proactive approach to treating Legionella, as well as being one of the most effective long-term indicators for ensuring treatments are being properly implemented. It is important that we break down the confusion behind it and make it part of the solution for this problem. 

Legionellosis by the numbers

• 217 percent – the increase in annually reported U.S. Legionellosis cases from 2000-2009. Officially reported incidence rate has tripled in this decade.  Source: CDC

• $34,000 – the number of direct healthcare dollars it costs in the U.S. to treat a single case of Legionellosis.  Source: CDC

• $539 million annually – the cost to the healthcare system for hospitalizations for three common waterborne diseases with Legionnaires’ disease being the largest cost.  Source:  CDC

• $193 million – the largest dollar jury award (so far) for gross negligence and other failures in a case of Legionellosis that resulted in long-term disability and severe debilitation. The case was not fatal.  Source: Claims Management

• $255,000 - $5.2 million – range of reported settlements and jury awards. Reports of settlements are rare as most agreements include stipulations that payout amounts remain confidential. The serious personal injury or death caused by this disease makes proof of extensive compensatory damages simple.  Source: Claims Management

• 8,000-18,000 – the estimated number of people hospitalized with Legionnaires’ disease each year in the U.S.  Source: American Society for Microbiology

Phillip Maloy is the executive brand manager – healthcare industry at Fremont Industries, Inc. 

Related article:

Legionella: An 'everyone' issue