title: A Review of Guidelines for the Primary Prevention of Legionellosis in Long-Term Care Facilities.
abstract: Legionellosis is an important public health problem in the United States and other countries, and residents of long-term care facilities (LTCFs) are at higher risk for Legionnaires' disease than the general population. In this study, we reviewed published US and international guidelines for the primary prevention of legionellosis in LTCFs, including nursing homes, skilled nursing facilities, assisted living facilities, and aged care facilities. The results of this review indicate that most guidelines emphasize adequate design and maintenance of water systems and water temperatures; however, guidance regarding routine preventative environmental testing for Legionella bacteria is not uniform among various jurisdictions, and facilities are generally left without clear guidance on this issue. In the United States, the Centers for Disease Control and Prevention does not recommend such testing in LTCFs, in contrast to the Veterans Health Administration and Environmental Protection Agency. Internationally, the World Health Organization recommends routine environmental testing, as do Ireland; France; The Netherlands; South Africa; Vienna, Austria; and Queensland, Australia. Among domestic and international guidelines in favor of environmental testing, recommendations on the frequency of testing for Legionella in water systems vary. Further research to inform recommendations on the usefulness of routine environmental testing and other measures for the primary prevention of legionellosis in this setting is needed.
authors.affiliation: Center for Public Health Preparedness and Research, Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: kimberly.barker@emory.edu.
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Barker
authors.affiliation: Center for Public Health Preparedness and Research, Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: ewhitn2@emory.edu.
authors.forename: Ellen A
authors.initials: EA
authors.lastname: Whitney
authors.affiliation: Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Blake
authors.affiliation: Center for Public Health Preparedness and Research, Rollins School of Public Health, Emory University, Atlanta, GA. Electronic address: rberkel@emory.edu.
authors.forename: Ruth L
authors.initials: RL
authors.lastname: Berkelman
mesh_terms: D004203:Disinfection; D004784:Environmental Monitoring; D006801:Humans; D007876:Legionellosis / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011322:Primary Prevention; D012112:Residential Facilities; D013696:Temperature; D014881:Water Supply
keywords: Legionella; Legionnaires' disease; environmental testing; long-term care