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.

1. Janet E. Stout, PhD
Microbiologist, Director
Special Pathogens Laboratory
Research Associate Professor
University of Pittsburgh
Legionella Testing:
Key to Legionnaires’
Disease Prevention

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Why Test?
§ RESPOND don’t react
§ PROTECT yourself and
your patients/client
§ VERIFY effectiveness of
treatment program

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

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217% Increase in Cases (2011)

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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

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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.

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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.

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Denial
Most wait to address
the problem until
after
a case of
Legionnaires’
disease
is diagnosed

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Outbreak Response at
Pittsburgh VA Hospital
$ 10 Million

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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.

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§ NOT a common
source for
sporadic and
hospital-
acquired cases
§ More commonly
associated
with large
community
outbreaks
Cooling Towers

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Legionella Breeding Grounds
§ Faucets
§ Drains
§ Humidifiers
§ Fountains, spas
§ Hospitals
§ Hotels
§ Commercial buildings
§ Homes

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1 Drop of
Water
Contains
Thousands of
Legionella

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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

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Planktonic Biofilm
Legionella
Environmental Monitoring

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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

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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.

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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

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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)

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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

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Proactive Approach Reduced
Legionnaires’ Disease
Am. J. Infection Control 2005; 33(6):360-367

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§ Consulting services
§ Risk assessments
§ Outbreak response
§ Education and research
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Thank you
info@specialpathogenslab.com