What exactly is Legionnaires' disease and how does someone contract it?

Legionnaires' disease is a severe form of pneumonia caused by Legionella bacteria. These bacteria thrive in warm, stagnant water systems, such as those found in the plumbing of hospitals and other large buildings. Individuals contract the disease when they inhale mist or vapor contaminated with Legionella.

What are ASHRAE Standard 188 and the CDC toolkit, and how are they used in Legionella prevention?

ASHRAE Standard 188 provides guidelines for developing water management plans to control Legionella growth in building water systems. The CDC also offers resources, including toolkits, to assist facilities in minimizing the risk of Legionella transmission. Compliance with these guidelines, and a water management plan, is required by The Centers for Medicare and Medicaid Services for Medicare-certified healthcare facilities.

What is a water management plan in a hospital setting and what does it typically involve?

A water management plan is a comprehensive strategy implemented by healthcare facilities to minimize the growth and spread of Legionella bacteria within their water systems. Key components often include routine monitoring of disinfectant levels, temperature, and pH, as well as regular testing for the presence of Legionella. These plans involve expertise from infection control and facilities/engineering staff.

According to the survey, what are some of the key findings regarding Legionella prevention practices in hospitals?

The survey revealed that while many hospitals have implemented or are developing water management plans, the specifics of these plans can differ. A significant number of hospitals routinely monitor disinfectant levels, temperature, and pH, and test for Legionella. However, a substantial percentage of facilities don't conduct risk assessments to identify areas prone to Legionella growth, which is a critical step in effective prevention.

How do hospitals typically diagnose Legionnaires' disease, and are there any limitations to the common diagnostic methods?

Hospitals primarily rely on urine antigen testing for diagnosing Legionnaires' disease. However, this method may miss cases caused by less common Legionella strains. A broader range of diagnostic approaches and expertise would be beneficial. The American Industrial Hygiene Association (AIHA) Legionella guidelines should also be considered. Regular testing and monitoring for Legionella is key, and hospitals should also consider expanding risk assessments to improve patient safety.

Hospital water pipes with green plants symbolizing safe water and health.

Is Your Hospital Ready? A Quick Check on Legionnaires' Disease Prevention

Rhea Morgan in Health & Wellness December 2025 • 4 min read.

"New research reveals gaps in how US hospitals are tackling Legionella, the bacteria behind Legionnaires' Disease. Find out what you need to know to protect yourself and your loved ones."

Legionnaires' disease (LD), a serious type of pneumonia, is caused by Legionella bacteria that loves warm, stagnant water – the kind often found in hospital plumbing systems. This is a concern because those most vulnerable, such as the elderly, individuals with weakened immune systems, and those with chronic lung issues, are frequently present in hospitals. Preventing Legionnaires' within healthcare facilities, therefore, is critical.

The good news is that by understanding where Legionella thrives and implementing effective water management plans, hospitals can significantly reduce the risk. Guidelines and standards have been developed, including ASHRAE Standard 188 and resources from the CDC, to help facilities minimize Legionella growth and transmission. Furthermore, The Centers for Medicare and Medicaid Services requires Medicare-certified healthcare facilities to have a water management plan.

To understand how hospitals are putting these recommendations into practice, a survey was conducted among hospitals in the Society for Healthcare Epidemiology of America Research Network (SRN). The results provide a snapshot of current clinical practices for diagnosing LD and the characteristics of water management plans in place.

What the Survey Revealed: Key Findings on Legionella Prevention

Hospital water pipes with green plants symbolizing safe water and health.

The survey, conducted in 2017, involved 29 hospitals within the SRN. Here's a breakdown of the key insights:

Water Management Plans: The vast majority (94%) of responding hospitals had either implemented or were developing a water management plan. However, the specifics of these plans varied significantly.

Diagnostic Testing: Most hospitals primarily relied on urine antigen testing for diagnosing Legionnaires' disease.
Water Quality Monitoring: A significant number of hospitals routinely monitored disinfectant levels (64%), temperature (61%), and pH levels (54%) in their potable water systems.
Legionella Testing: 61% of hospitals reported routinely testing for the presence of Legionella as part of their water management plan.
Expertise: Water management plan development typically involved infection control (93%) and facilities/engineering staff (90%).

Guideline Awareness: Awareness of key guidelines like ASHRAE Standard 188 (97%) and the CDC toolkit (89%) was high. However, fewer facilities were aware of the American Industrial Hygiene Association (AIHA) Legionella guidelines. Risk Assessments: Almost a quarter (24%) of facilities admitted to not conducting risk assessments to pinpoint areas susceptible to Legionella growth.

Protecting Patients: What This Means for You

These findings highlight that while many hospitals are taking steps to prevent Legionnaires' disease, there's still room for improvement. The reliance on urine antigen testing alone, for example, can miss cases caused by less common Legionella strains. Furthermore, while infection control and engineering are typically involved in water management plan development, a broader range of expertise could be beneficial.

So, what can you do? While you might not be directly involved in hospital management, being informed is crucial. Ask your healthcare providers about the hospital's water management plan and what steps they take to prevent Legionnaires' disease. This simple question can encourage greater transparency and accountability.

Ultimately, preventing Legionnaires' disease in hospitals requires a multi-faceted approach, including comprehensive water management plans, thorough diagnostic testing, and ongoing risk assessments. By staying informed and engaged, we can all contribute to safer healthcare environments.