Long-term care Legionella prevention and control strategies: Experiences of nursing homes in Florida and Georgia

Background: Over the past several years, there have been more than 100 confirmed cases in US healthcare facilities of Legionnaires’ disease, a severe and potentially fatal pneumonia caused by the Legionella bacterium found in contaminated water systems. Older people and those with weakened immune systems are particularly vulnerable to Legionella, putting long-term care patients at greater risk of infection. Past efforts to address this growing environmental health crisis have been limited to local surveillance programs for testing water systems in multi-family housing units. In June 2017, the Centers for Medicare and Medicaid Services (CMS) required Medicare-certified healthcare facilities to establish water management programs to reduce the risk of Legionella. Methods: We conducted a mixed methods study (surveys, interviews) to examine the adoption and implementation of these guidelines as well as existing Legionella prevention and control strategies in nursing homes in Florida and Georgia. Results: Findings reveal that most nursing homes in these states do not test their water systems for Legionella because either they have never experienced an outbreak of Legionnaires’ disease or do not have a large water system for testing. Conclusion: Nursing home administrators know of the new CMS Legionella testing requirements and are currently developing water management plans.