[Journals]: Wisconsin Legionnaire’s Disease Outbreak Linked to Decorative Fountain

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For Immediate Release ###DRAFT###

The University of Chicago Press / Infection Control and Hospital Epidemiology
Contact: Kevin Stacey / kstacey@press.uchicago.edu / 401-284-3878
Society for Healthcare Epidemiology of America
Contact: Tamara Moore / tmoore@gymr.com / 202-745-5114
Source Contact: Thomas E. Haupt, Wisconsin Division of Public Health /       Thomas.Haupt@wi.gov  
Wisconsin Legionnaire’s Disease Outbreak Linked to Decorative Fountain
A 2010 outbreak of Legionnaire’s disease in Wisconsin has been linked to a decorative wall fountain in a hospital lobby, according to a report published in the January issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.
The investigation, conducted jointly by state and local public health officials in close collaboration with hospital staff, detected eight cases of Legionnaires disease during a four-week period. The only factor in common with all the patients was that they visited the same hospital.  Subsequent environmental testing detected notable amounts of Legionella, the bacterium that causes the disease, in samples collected from the water wall-type decorative fountain located in the hospital’s main lobby.
The investigation revealed that all eight patients had spent time in the main lobby where the fountain was located. This fact, along with the close timing of these patients’ illness onset, the degree of Legionella contamination in the fountain, and the lack of any other commonalities among the patients, all strongly support the conclusion that the decorative fountain was the source of the outbreak. Hospital officials quickly shut down the fountain when it was first suspected as a source, and notified staff and approximately 4,000 potentially exposed patients and visitors. 
Legionnaire’s disease is a severe and potentially life-threatening form of pneumonia caused by directly inhaling Legionella bacteria, which thrive in aquatic environments. All eight patients in the Wisconsin outbreak recovered from the disease, and no cases occurred following the shutdown of the fountain.
The outbreak is notable because none of the patients were in-patients at the hospital when they were exposed. And some patients reported only incidental exposure to the fountain, such as delivering a package or visiting the hospital pharmacy.
At the time of this outbreak there was no published information on the effectiveness of fountain disinfection and maintenance procedures to reduce the risks of Legionella contamination.  
“Accordingly, the Wisconsin Division of Public Health developed interim guidelines advising healthcare facilities with similar water-wall type fountains or any other decorative fountains to establish strict maintenance procedures and conduct periodic bacteriologic monitoring for Legionella,” said Thomas E. Haupt, an epidemiologist with the Wisconsin Division of Public Health and the study’s lead author. “The guidelines stress that until additional data are available that demonstrates effective maintenance procedures for eliminating the risk of Legionella transmission from indoor decorative water fountains in healthcare settings, water fountains of any type should be considered at risk of becoming contaminated with Legionella bacteria,”
Since this investigation, many healthcare facilities in Wisconsin shut down and in some cases removed decorative fountains in their facilities, while others enhanced their regular testing protocols to reduce the risk of Legionnaires disease, the researchers report.  State healthcare facility construction guidelines published during 2010 after this outbreak stipulate that, “fountains and other open decorative water features may represent a reservoir for opportunistic human pathogens; thus they are not recommended for installation within any enclosed spaces in healthcare facilities.”
Thomas E. Haupt, Richard T. Heffernan, James J. Kazmierczak, Henry Nehls-Lowe, Bruce Rheineck, Christine Powell,Kathryn K. Leonhardt, Amit S. Chitnis, and Jeffrey P. Davis, “An outbreak of Legionnaires disease associated with a decorative water wall fountain in a hospital.” Infection Control and Hospital Epidemiology 33:2 (February 2012).
Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 15 out of 140 journals in its discipline in the latest Journal Citation Reports from Thomson Reuters.

SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals around the world with expertise in healthcare epidemiology and infection prevention and control. SHEA’s mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society leads this field by promoting science and research and providing high-quality education and training in epidemiologic methods and prevention strategies. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings. Visit SHEA online at www.shea-online.org.


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