An outbreak of Legionnaires disease associated with a decorative water wall fountain in a hospital.
OBJECTIVE
To detect an outbreak-related source of Legionella, control the outbreak, and prevent additional Legionella infections from occurring.


METHODS
Epidemiologic investigation of an acute outbreak of hospital-associated Legionnaires disease among outpatients and visitors to a Wisconsin hospital.


METHODS
Patients with laboratory-confirmed Legionnaires disease who resided in southeastern Wisconsin and had illness onsets during February and March 2010.


METHODS
Patients with Legionnaires disease were interviewed using a hypothesis-generating questionnaire. On-site investigation included sampling of water and other potential environmental sources for Legionella testing. Case-finding measures included extensive notification of individuals potentially exposed at the hospital and alerts to area healthcare and laboratory personnel.


RESULTS
Laboratory-confirmed Legionnaires disease was diagnosed in 8 patients, all of whom were present at the same hospital during the 10 days prior to their illness onsets. Six patients had known exposure to a water wall-type decorative fountain near the main hospital entrance. Although the decorative fountain underwent routine cleaning and maintenance, high counts of Legionella pneumophila serogroup 1 were isolated from cultures of a foam material found above the fountain trough.


CONCLUSIONS
This outbreak of Legionnaires disease was associated with exposure to a decorative fountain located in a hospital public area. Routine cleaning and maintenance of fountains does not eliminate the risk of bacterial contamination. Our findings highlight the need to evaluate the safety of water fountains installed in any area of a healthcare facility.
Wisconsin Division of Public Health, Madison, Wisconsin 53701, USA. thomas.haupt@wi.gov
Thomas E
TE
Haupt
Richard T
RT
Heffernan
James J
JJ
Kazmierczak
Henry
H
Nehls-Lowe
Bruce
B
Rheineck
Christine
C
Powell
Kathryn K
KK
Leonhardt
Amit S
AS
Chitnis
Jeffrey P
JP
Davis
D000368:Aged; D000369:Aged, 80 and over; D003428:Cross Infection / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D004196:Disease Outbreaks; D005260:Female; D050456:Fomites; D006801:Humans; D017053:Infection Control; D016952:Legionella pneumophila / Q000302:isolation & purification*; D007877:Legionnaires' Disease / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D008297:Male; D008875:Middle Aged; D014871:Water Microbiology; D014881:Water Supply; D014922:Wisconsin