Legionella Testing: Key to Legionnaires' Disease Prevention


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Legionella testing is the key to preventing Legionnaires' disease. Studies show that taking a proactive approach through routine environmental monitoring is effective. Presentation by Dr. Janet E. Stout, director of Special Pathogens Laboratory.

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Legionella Testing: Key to Legionnaires' Disease Prevention

  1. 1. Janet E. Stout, PhD Microbiologist, Director Special Pathogens Laboratory Research Associate Professor University of Pittsburgh Legionella Testing: Key to Legionnaires’ Disease Prevention
  2. 2. © Special Pathogens Laboratory Why Test? §  RESPOND don’t react §  PROTECT yourself and your patients/client §  VERIFY effectiveness of treatment program
  3. 3. © Special Pathogens Laboratory “Legionella … is the single most common etiologic agent associated with outbreaks involving drinking water.” 2006. National Academy of Sciences Report Report by the U.S. Environmental Protection Agency (EPA) and the Committee on Public Water Supply Distribution Systems
  4. 4. © Special Pathogens Laboratory 217% Increase in Cases (2011)
  5. 5. © Special Pathogens Laboratory Estimated Number of Cases §  In the U.S. approximately 600,000 adults are diagnosed with community-acquired pneumonia requiring hospitalization §  Approximately 2-5% are caused by Legionella
  6. 6. © Special Pathogens Laboratory Legionnaires’ Disease in Hospitals §  35% of reported cases met the case definition for hospital-acquired infection (range 45%-25%) §  Case fatality rate was 28% (range 46%-14%) From Benin A.L., Benson R.F., Besser R.E. Clin Infect Dis 2002; 35:1039-46. Data reported to the CDC from 1980-1998.
  7. 7. © Special Pathogens Laboratory Cost Associated with LD: CDC Estimates §  Cost per patient $34,000 §  Average hospital stay 10 days §  Total hospitalization costs per year between Collier, SA. 07. Presented at: 2010 International Conference on Emerging Infectious Diseases; July 11-14, 2010; Atlanta.
  8. 8. © Special Pathogens Laboratory Denial Most wait to address the problem until after a case of Legionnaires’ disease is diagnosed
  9. 9. © Special Pathogens Laboratory Outbreak Response at Pittsburgh VA Hospital $ 10 Million
  10. 10. © Special Pathogens Laboratory Most Common Source for Legionnaires’ Disease Potable Water especially in hospitals (and other buildings) with complex hot water systems, is the most important source of Legionella transmission.
  11. 11. © Special Pathogens Laboratory §  NOT a common source for sporadic and hospital- acquired cases §  More commonly associated with large community outbreaks Cooling Towers
  12. 12. © Special Pathogens Laboratory Legionella Breeding Grounds §  Faucets §  Drains §  Humidifiers §  Fountains, spas §  Hospitals §  Hotels §  Commercial buildings §  Homes
  13. 13. © Special Pathogens Laboratory 1 Drop of Water Contains Thousands of Legionella
  14. 14. © Special Pathogens Laboratory Legionella Testing If you don’t look for it, you won’t find it. If you don’t find it, you don’t think you have a problem. If you don’t think you have a problem,you don’t do anything about it. −Bruce Dixon, M.D. Director, Pittsburgh ACHD
  15. 15. © Special Pathogens Laboratory Planktonic Biofilm Legionella Environmental Monitoring
  16. 16. © Special Pathogens Laboratory Legionella Sampling Instructions §  Types: •  Suspected case investigation •  Routine monitoring •  Post-disinfection monitoring §  Sources: •  Potable •  Hot water storage tank •  Cooling towers Click for Legionella Sampling Instructions
  17. 17. © Special Pathogens Laboratory Select Sites for Environmental Sampling §  Select a minimum of 10 distal sites (faucets or showers) that roughly represent the water distribution system, plus hot water tanks or recirc. line. §  Include sites on multiple floors and wings, high risk areas like oncology, transplant units, medical surgical units.
  18. 18. © Special Pathogens Laboratory Select Sites for Environmental Sampling § Select sites that are representative water distribution system and high risk areas •  Different floors, wings, risers • Hematology-oncology, transplant units (BMT), med-surg units, ICU’s
  19. 19. © Special Pathogens Laboratory Sample Collection Kit §  Sterile bottles with neutralizer (sodium thiosulfate) and/or sterile swabs §  Insulated shipping pouch or box to protect samples §  Chain of custody (click to download)
  20. 20. © Special Pathogens Laboratory Recommended: Ship Next Day Delivery § No significant increase or decrease in Legionella viability when cultured within the time recommended from collection to processing, i.e. 48 hr. of collection. Shaffer A. Mietzner, et al 2013 APIC Click to download PDF poster
  21. 21. © Special Pathogens Laboratory Proactive Approach Reduced Legionnaires’ Disease Am. J. Infection Control 2005; 33(6):360-367
  22. 22. © Special Pathogens Laboratory § Laboratory services § Consulting services § Risk assessments § Outbreak response § Education and research www.s pecialpathogens lab.com Thank you info@specialpathogenslab.com