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Role of Environmental Surveillance in Determining the Risk of Hospital-Acquired Legionellosis: A National Surveillance Study With Clinical Correlations

Published online by Cambridge University Press:  02 January 2015

Janet E. Stout
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania University of Pittsburgh, Pittsburgh, Pennsylvania
Robert R. Muder
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania University of Pittsburgh, Pittsburgh, Pennsylvania
Sue Mietzner
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania University of Pittsburgh, Pittsburgh, Pennsylvania
Marilyn M. Wagener
Affiliation:
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania University of Pittsburgh, Pittsburgh, Pennsylvania
Mary Beth Perri
Affiliation:
William Beaumont Hospital, Royal Oak, Michigan
Kathleen DeRoos
Affiliation:
Veterans Affairs Medical Center, Omaha, Nebraska
Dona Goodrich
Affiliation:
Veterans Affairs Medical Center, Omaha, Nebraska
William Arnold
Affiliation:
Veterans Affairs Medical Center, Omaha, Nebraska
Theresa Williamson
Affiliation:
Southern Arizona Healthcare System, Tucson
Ola Ruark
Affiliation:
Veterans Affairs Medical Center, Wilmington, Delaware
Christine Treadway
Affiliation:
Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Elizabeth C. Eckstein
Affiliation:
Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Debra Marshall
Affiliation:
Veterans Affairs Medical Center, Dayton, Ohio
Mary Ellen Rafferty
Affiliation:
Stratton Veterans Affairs Medical Center, Albany, New York
Kathleen Sarro
Affiliation:
Veterans Affairs Medical Center, Butler, Pennsylvania
Joann Page
Affiliation:
Veterans Affairs Medical Center, Iowa City, Iowa
Robert Jenkins
Affiliation:
Veterans Affairs Medical Center, Gainesville, Florida
Gina Oda
Affiliation:
Veterans Affairs Palo Alto Health Care System, Palo Alto, California
Kathleen J. Shimoda
Affiliation:
Veterans Affairs Medical Center, Long Beach, California
Marcus J. Zervos
Affiliation:
William Beaumont Hospital, Royal Oak, Michigan
Marvin Bittner
Affiliation:
Veterans Affairs Medical Center, Omaha, Nebraska
Sharon L. Camhi
Affiliation:
Southern Arizona Healthcare System, Tucson
Anand P. Panwalker
Affiliation:
Veterans Affairs Medical Center, Wilmington, Delaware
Curtis J. Donskey
Affiliation:
Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio
Minh-Hong Nguyen
Affiliation:
Veterans Affairs Medical Center, Gainesville, Florida
Mark Holodniy
Affiliation:
Veterans Affairs Palo Alto Health Care System, Palo Alto, California
Victor L. Yu*
Affiliation:
University of Pittsburgh, Pittsburgh, Pennsylvania
*
Special Pathogens Laboratory, 1401 Forbes Ave., Ste. 209, Pittsburgh, PA 15219 (vly@pitt.edu)

Abstract

Objective.

Hospital-acquired Legionella pneumonia has a fatality rate of 28%, and the source is the water distribution system. Two prevention strategies have been advocated. One approach to prevention is clinical surveillance for disease without routine environmental monitoring. Another approach recommends environmental monitoring even in the absence of known cases of Legionella pneumonia. We determined the Legionella colonization status of water systems in hospitals to establish whether the results of environmental surveillance correlated with discovery of disease. None of these hospitals had previously experienced endemic hospital-acquired Legionella pneumonia.

Design.

Cohort study.

Setting.

Twenty US hospitals in 13 states.

Interventions.

Hospitals performed clinical and environmental surveillance for Legionella from 2000 through 2002. All specimens were shipped to the Special Pathogens Laboratory at the Veterans Affairs Pittsburgh Medical Center.

Results.

Legionella pneumophila and Legionella anisa were isolated from 14 (70%) of 20 hospital water systems. Of 676 environmental samples, 198 (29%) were positive for Legionella species. High-level colonization of the water system (30% or more of the distal outlets were positive for L. pneumophila) was demonstrated for 6 (43%) of the 14 hospitals with positive findings. L. pneumophila serogroup 1 was detected in 5 of these 6 hospitals, whereas 1 hospital was colonized with L. pneumophila serogroup 5. A total of 633 patients were evaluated for Legionella pneumonia from 12 (60%) of the 20 hospitals: 377 by urinary antigen testing and 577 by sputum culture. Hospital-acquired Legionella pneumonia was identified in 4 hospitals, all of which were hospitals with L. pneumophila serogroup 1 found in 30% or more of the distal outlets. No cases of disease due to other serogroups or species (L. anisa) were identified.

Conclusion.

Environmental monitoring followed by clinical surveillance was successful in uncovering previously unrecognized cases of hospital-acquired Legionella pneumonia.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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