Is Legionella Water Testing Important?

Outbreaks of Legionnaires' disease receive significant media attention especially when a large number of people become ill or die. In contrast to highly publicized outbreaks, single infections with Legionella bacteria often go unnoticed. According to the Centers for Disease Control and Prevention (CDC), between 8,000 and 18,000 people are hospitalized with Legionnaires' disease in the United States each year. Legionnaires' disease is a legitimate public health concern as its fatality rate during an outbreak ranges from 5% to 30% in those who contract the disease. The immediate consequences for the building owner or manager faced with liability claims and negative publicity can be devastating and extremely costly. Many experts agree that proactively managing the risk of Legionella bacteria in cooling towers and water systems is more cost effective than responding to an outbreak retroactively.

While a few states and municipalities have instituted guidelines for monitoring Legionella, there are no federal or state regulations that require routine monitoring of buildings with susceptible individuals. We recommend building owners and hospitals establish a Legionella control and management program, including routine monitoring and testing, in areas where the risk of Legionella infection is high. This accomplishes two tasks:

• 1) It indicates the effectiveness of control measures already in place, and,
• 2) It provides an early warning of potential problems.

Potable water and cooling tower testing has enabled healthcare and other organizations to identify and eliminate the pathogen, Legionella pneumophila, responsible for potentially fatal pneumonia also known as Legionnaire’s Disease.

Under the direction of Dr. Richard Miller, a world renown expert in the field of Legionnaires Disease, our laboratory staff provides the highest quality service. Using proven techniques for identifying and quantifying Legionella contamination.

Additionally EST has performed thousands of risk assessments for Legionnaires disease.

What makes us different?

Our sample results include: Risk Summary and PhD Microbiologist Recommendations. Not just results!

All for an Industry leading low price. Claims our competition can't make.

Since 1993, Environmental Safety Technologies, Inc. has provided worldwide expertise to the water treatment industry by utilizing the latest scientific technology, a strong commitment to education, and a dedicated staff.  In 2005, AIHA awarded Environmental Safety Technologies, Inc. an accreditation for the processing of environmental microbiological samples.

LEGIONELLA MONITORING GUIDELINES

• The US Centers for Disease Control (CDC) recommends routine monitoring for Legionella in all bone marrow and organ transplant hospitals nationwide.
• Routine monitoring in healthcare facilities is recommended or required in several states such as NY, TX, MD, Los Angeles County and Allegheny County PA.
• Canada has guidelines for monitoring healthcare facilities.
• The American Society of Heating, Refrigeration and Air Conditioning Engineers (ASHRAE) recommends routine monitoring of building water supply systems.

Legionella Frequently Asked Questions (FAQ)

DID YOU KNOW?

Of the 2.4 million cases of pneumonia that occur each year in the United States, an estimated 10,000 to 25,000 are actually cases of Legionnaires disease. 5% - 15% ofthese being fatal.

Nearly 30 percent of sporadic cases of nosocomial pneumonia are caused by Legionella.

Since October 2005 over $800 million have been awarded by jury's in Legionellosis cases, with several hundred million dollars more pending.

The diagnosis of Legionellosis requires special tests not routinely performed on persons with fever or pneumonia. Standard first line antibiotic prescriptions are not generally as effective against Legionellosis.

Outbreaks of Legionellosis have occurred after persons have inhaled aerosols that come from a water source (i.e. air conditioning, cooling towers, whirlpool spas, showers, sinks and bathtubs) contaminated with thebacteria.

Consistent, routine testing of water systems is the bestdefense against Legionellosis outbreaks.

GENERAL INFORMATION

Legionella are small rod-shaped bacteria, with over 40 known individual species. The majority of human infections are caused by the species Legionella pneumophila. Legionella pneumophila was first discovered following a pneumonia outbreak at the 1976 Philadelphia Convention of the American Legion. The species Legionella pneumophila is divided into sixteen subgroups or “serogroups”.

ENVIRONMENTAL ECOLOGY:

Legionella are most commonly found in water, including groundwater, potable water, fresh and marine surface water.

Legionella are protected against standard water disinfection techniques, by their symbiotic relations with other microorganisms.

These bacteria have been found in water distribution systems of hospitals, hotels, ships, public buildings, homes, and commercial facilities. Other water sources in which Legionella have been found include cooling towers, evaporative condensers and whirlpools.

These bacteria may be transported from potable water to air by faucets, showerheads, cooling towers, and nebulizers.

OUTBREAKS:

Cases of Legionellosis (any disease caused by Legionella) have been reported in North and South America, Asia, Australia, New Zealand, Europe and Africa.

National surveillance programs are conducted in the United States, and 24 European countries.

Outbreaks in hospitals have been linked to hospital potable water supplies, air conditioning systems, and cooling towers. Travelers can be exposed to Legionella in contaminated hotel potable water, contaminated whirlpool spas, or nearby cooling towers.

Community outbreaks are caused by exposure to a wide variety of sources, the most common being potable water and cooling towers.

RISK FACTORS

The general population (healthy individuals) are fairly resistant to Legionellosis infections.

However, certain groups are at a higher risk for contracting Legionnaires’ Disease, including:

• Hospital patients requiring intubation, receiving ventilation assistance or respiratory therapy, individuals taking immunosuppressive drugs.
• People with certain chronic health conditions (chronic obstructive pulmonary disease, diabetes, head or neck cancer, or end-stage kidney disease)
• Heavy smokers or drinkers Legionnaires disease exposure to these individuals are at a higher risk of severe illness and increased mortality.

TRANSMISSION:

Legionella are transmitted directly from environment to humans.

There is no evidence of human-to-human or animal-to-human transmission of these bacteria.

Potable water and cooling towers are the most important sources of Legionella.

Humans may inhale contaminated aerosols or aspirate small amounts of contaminated drinking water.

No vaccine is available to prevent infection.

• On site testing (including emergency response)
• Development of test kits and training (for self-testing if desired)
• Complete laboratory analysis    (Laboratory Services)
• Personalized risk assessments
• Ph.D Microbiologist Recommendations

Legionnaires Disease, like all infectious diseases, requires a minimum infectious dose in order to cause disease. While the exact number required for humans varies depending on the susceptibility (I.e. immune status) of the individual, it is likely that the number for most individuals is relatively large. It should be apparent from the ubiquitous nature of this bacterium in the environment, that in order to cause disease, the number of Legionella in the water would need to be much higher than that found in most normal aquatic habitats.

It seems that Legionella suffers from an identity crisis.  How can a bacterium cause such fear and panic as a result of devastating illness and death from Legionnaires Disease, while at the same time be found all around us as a common inhabitant of most freshwater environmental ecosystems? Perhaps within the answer to this question lies the solution to reducing our risks for this disease.

Four important points need to be considered in the exploration of this question:

The number of Legionella in the water at a particular site, a mechanism for aerosolization of the Legionella associated with human work, recreation, healthcare, or home-living spaces, the susceptibility of the exposed population, the presence of free-living amoebae and other protozoa.

Thus, it can not be overemphasized, that in most situations, the mere presence or absence of Legionella at a particular site is not sufficient for making an accurate risk assessment. Rather it is the numbers (i.e. concentration) of Legionella in the water that is most important.