WHAT IS IT?
Legionella is a highly antibiotic-resistant form of bacteria that seeds and replicates in water. Legionella can make people sick when contaminated water is aspirated from complex building water systems and can lead to two forms of pneumonia: Pontiac Fever and a deadlier form called Legionnaires’ disease. Reported cases of Legionnaires’ disease have increased nearly four and half times in the United States since 2000.
WHERE DOES IT GROW?
Legionella can grow in any aquatic environment, but becomes a problem when it enters a building’s water system. Even facilities on city water lines, which oftentimes are already chlorinated to kill bacteria, can become a breeding ground if there is not consistent maintenance, adherance to a water management plan, and testing to validate the plan’s effectiveness.
To pose a health risk, Legionella first has to grow – anywhere which has stagnant water or deadlegs in the plumbing. Over time, the bacteria grows and breaks off from the source, traveling inside the plumbing to any number of points of use by people (see left). Once the bacteria is aerosolized, it can be inhaled and start to make people sick.
WHO IS AT RISK?
Anyone who uses the contaminated water source can be subject to becoming ill. However, the following populations are at increased risk to falling victim to the potentially lethal Legionnaires’ disease:
• Elderly or young age
• History of smoking
• Chronic lung issues
• Chronic heart issues
• Poor immune function
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HIGHEST RISK INDUSTRIES
Health care facilities consistently work with the highest risk populations susceptible to infection and disease. Many times, patients are already immunocompromised and small amounts of exposure to bacteria like legionella can result into large-scale Legionnaires’ disease outbreaks.
Simply due to the amount of exposure points the hospitality industry presents – shower heads, faucets, ice machines, pools and hot tubs – the greater guests are at risk to contract a waterborne pathogen like legionella. Unless prevention protocols are in place and regularly maintained, hospitality water systems remain at higher risk.
Complex water systems in apartment living facilities at a greater risk of legionella infection due to the frequency of use, number of exposure points, and plumbing practices commonly used for potential expansions. Units on the market for long periods of time give bacteria time to set and replicate while plumbed dead legs for future expansion provide a perfect setting for legionella growth.
WHAT ARE THE SYMPTOMS OF LEGIONNAIRES’?
Legionnaires’ disease usually develops two to 10 days after exposure to legionella bacteria. It frequently begins with the following signs and symptoms:
• Muscle pain
• Fever of 104º F or higher
By the second or third day, you’ll develop other signs and symptoms that may include:
• Cough, mucus or bloody discharge
• Shortness of breath
• Chest pain
• Nausea, vomiting and/or diarrhea
• Confusion or other mental changes
WHAT CAN BE DONE?
There are no vaccines currently available for Legionnaires’ disease. Prevention of Legionnaires’ disease depends on applying control measures to minimize the growth of legionella bacteria and consistent, vigilant testing to confirm a prevention plan is working.
WATER MANAGEMENT PLANNING
According to the Centers for Medicare and Medicaid Services (CMS), facilities at increased risk for Legionella can safeguard against an outbreak with a thorough, comprehensive water management plan devised specifically for your facility. A site survey with a certified plumber will map a facility’s water system and identify high risk areas in which the bacteria can hide and replicate. In conjunction with the facility’s operations staff, certified lab professionals can then put together an all-inclusive plan to identify proper maintenance schedules, approved hygiene processes, and best practices to prevent environments where the bacteria can spread.
While a comprehensive water management plan will greatly aid a facility in the day-to-day healthy upkeep of complex water systems, consistent testing is an ever important piece in confirming that a prevention plan is working. Legionella-negative sampling tests will confirm that a plan is successful, while a positive test can highlight problem areas in the water system, help stop the dissemination of harmful bacteria before it infects anyone, and guide future water system maintenance practices to prevent a future outbreak.