Becker's Clinical Quality & Infection Control

14 INFECTION CONTROL Legionnaires' Disease is Still a 'Widespread' Problem for Hospitals, CDC Study Finds By Heather Punke H ealthcare-associated Legionnaires' disease cases are still a common occurrence, and hospitals need to monitor their water systems and prevent growth of bacteria that cause the deadly disease, accord- ing to a CDC study released June 7. "Legionnaires' disease in hospitals is widespread, deadly and preventable," said Anne Schuchat, MD, acting director of the CDC. "Controlling these bacteria in water systems can be challenging, but it is essential to protect patients." Researchers examined 2,809 confirmed Legionnaires' disease cases reported from 20 states and New York City in 2015. Of those, 3 percent were definitely asso- ciated with healthcare facilities — patients had a stay of 10 days or more before symptoms started — and an additional 17 percent of cases were likely associated with a healthcare facility — patients were in a facility for less than 10 days before symptoms started. Of the cases definitely associated with healthcare facilities, researchers found the following: • 80 percent were in long-term care facilities, 18 per- cent were in hospitals and 2 percent were in both • Cases were reported by 72 facilities • Most of affected patients (88 percent) were 60 years old or older Healthcare-associated Legionnaires' disease cases are more deadly than other cases of the severe pneumo- nia — about 9 percent of all Legionnaires' disease cases are fatal, but 46 percent of healthcare-associated cases end in death. Legionnaires' disease is caused by Legionella bacteria, which thrive in building water systems that are not adequately managed, according to the CDC's Vital Signs report. e CDC has a toolkit available on how to develop a water management program to reduce Legionella growth. "ese data are especially important for healthcare facility leaders, doctors and facility managers because it reminds them to think about the risks of Legionella in their facility and take action," said Dr. Schuchat. n CMS Memo: Hospitals Must Develop Water Management Policies to Prevent Legionnaires' Disease By Heather Punke A survey and certification memo released by CMS June 2 says hospitals and other healthcare facilities "must develop" policies to inhibit Legionella growth in water systems to prevent Le- gionnaires' disease cases. Per the memo from the director of CMS' survey and certification group, "CMS expects Medicare certified healthcare facilities to have water management policies and procedures to reduce the risk of growth and spread of Legionella and other opportunistic pathogens in building wa- ter systems." Hospitals need to conduct a risk assessment, implement a water management program and specify testing protocols. Moving forward, CMS surveyors will review facilities' water manage- ment implementation policies, procedures and reports. Healthcare facilities that do not meet the expectations could be at risk of a non-compliance citation. The memo was effective immediately. n Study Links Bacterial Outbreak in Hospital NICU to Contaminated Tap Water By Heather Punke A study published in May in Infection Control & Hos- pital Epidemiology links a 2013-2014 Pseudomonas aeruginosa outbreak in a hospital neonatal intensive care unit to contaminated hospital tap water. Thirty-one babies were infected in the outbreak from June 1, 2013, to Sept. 30, 2014. An inves- tigation into the outbreak found the cases were "associated with absence of point-of-use filters on faucets in patient rooms," accord- ing to the study. Cultures from the water also grew P. aeruginosa, and the investigation ultimately attribut- ed the outbreak to contaminated water. The hospital installed point-of- use filters as a short-term solution, but did have to eradi- cate P. aeruginosa from the water system and faucets as a long- term fix. "This outbreak highlights the importance of understanding the risk of stagnant water in healthcare facilities," the study concludes. P. aeruginosa in healthcare set- tings typically spreads through contaminated equipment like breathing machines or catheters, as well as by healthcare workers' hands, according to the CDC. Such infections are treatable with antibiotics, but can be deadly, especially when caused by mul- tidrug-resistant strains. The CDC classified multidrug-resistant Pseu- domonas as a serious threat in a 2013 report. n

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