Preventing Hospital-Acquired Legionnaires' Disease: Assessment of water management plans and practices in acute-care hospitals in the U.S. Open Access

Ehret, Karen (Spring 2018)

Permanent URL: https://etd.library.emory.edu/concern/etds/t435gd000?locale=en
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Abstract

Increased prioritization of Legionnaires’ Disease (LD) has led to the development of a recently published mandate, guidelines, regulations, and in some jurisdictions, laws, around water management. However, little is known about the extent to which LD prevention initiatives and activities have been adopted within U.S. acute care hospitals. In Fall 2017, we developed and distributed an anonymous cross-sectional survey to members of the Society for Healthcare Epidemiology of America (SHEA) Research Network. The survey addressed clinical protocols for diagnosing LD, maintenance practices of potable and non-potable water systems, Legionella-specific prevention strategies, and knowledge of recent guidelines and regulations. Respondents from thirty of 101 (30%) hospitals completed the survey, with majority representing large facilities (more than 250 inpatient beds). Sixty-six percent reported having a water management plan for both potable and potable water, while 28% had one in development. While 72% reported the capacity to perform culture testing for LD diagnosis, only 14% reported doing so routinely. The most well-represented areas of expertise within facilities’ water management teams were infection control (97%) and facilities/engineering (90%). Within this small sample of hospitals, we found variety in LD diagnostic testing and prevention practices. With many facilities relying exclusively on non-culture-based diagnostic testing, many cases of LD will be missed. While many respondents reported having a water management plan in place, it is uncertain whether these plans are adequate or comprehensive. Finally, with other areas of expertise less well-represented on water management teams, there may be a need to include a broader range of professional knowledge among those responsible for developing water management plans.

Table of Contents

Introduction 1.1. The Problem of Hospital-Acquired Legionnaires’ Disease………………...1 1.2. Clinical Practices in Diagnosing Legionnaires’ Disease…………………...2 1.3. New Recommendations for Water Management Plans…………………….4 1.4. Regional Policies on Legionella……………………………………………5 2. Methods…………………………………………………………………………6 3. Results 3.1. Facility Demographics……………………………………………………...7 3.2. Clinical Diagnostic Practices……………………………………………….8 3.3. Water Management Plans…………………………………………………..8 3.4. Knowledge of Guidelines and Regulations………………………………...9 4. Discussion……………………………………………………………………….9 4.1. Conceptualizing a Comprehensive LD Strategy…………………………...11 4.2. Requirements for a Comprehensive LD Strategy…………………………..12 5. Conclusion………………………………………………………………………13 6. References……………………………………………………………………….14

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