CDC Puts Providers on Alert for Deadly, Costly Disease

Skilled nursing facilities are a prime breeding ground for Legionnaires’ disease, and an outbreak could prove costly for the operator — both in terms of care outcomes and additional expenses — according to a recent presentation by the Centers for Disease Control and Prevention (CDC).

The CDC analyzed 2015 data related to outbreaks of the potentially deadly disease, looking at a total of more than 2,800 cases from 20 states and the District of Columbia. Of those, 85 were “definitely” related to exposure at health care facilities, with an additional 468 instances that were “possibly” related to stays in SNFs, hospitals, or other institutions.

Those numbers might seem relatively small, but the CDC points out that health care facilities are particularly susceptible to outbreaks — and, because they house older residents with other chronic illnesses — institutions account for a disproportionate amount of Legionnaires’ deaths.


The disease, a type of pneumonia, typically spreads through the inhalation of waterborne bacteria. Residents at SNFs and other health care facilities generally access water for drinking and bathing through the same shared system, allowing the bacteria to infect quickly: According to a separate CDC study of Legionnaires’ outbreaks from 2000 to 2014, health care facilities accounted for 57% of all cases and 85% of deaths. In addition to common culprits such as shower heads, water heaters, and faucets, the bacteria can grow in eye wash stations, decorative fountains, hot tubs, and hydrotherapy equipment.

The illness gets its name from the first well-known outbreak back in 1976, when the bacteria swept through a Philadelphia hotel that was hosting an American Legion conference, resulting in more than 30 deaths. As in the health facility cases, the Legionnaires attending the convention contracted the bacteria from the hotel’s shared water system.

Legionnaires’ outbreaks foremost represent a threat to patient health and safety, with the CDC estimating that 25% of those who contract the illness in a health-facility setting will eventually die from the disease. But for SNF operators, particularly those that take part in Medicare payment models that put a premium on preventing hospitalizations, the financial costs could be steep as well. The CDC cited a 2012 study that showed waterborne illnesses, including Legionnaires’ and other similar bacteria-based diseases, led to more than 40,000 hospitalizations each year for a total cost of $970 million, with $430 million in Medicare and Medicaid expenses.


Put in more microeconomic terms, the cost for a Legionnaires’ infection at a health facility could average $38,000 per patient, according to acting CDC director Anne Schuchat.

But the Atlanta-based government agency emphasized that Legionnaires’ illnesses and outbreaks are entirely preventable, with about 85% of cases stemming from water-system problems that could have been easily remedied. For instance, the CDC recommends that facility operators roll out dedicated water-management programs with monitoring teams to ensure that temperatures are high enough — and disinfectants strong enough — to kill bacteria before it becomes an issue.

The Centers for Medicare & Medicaid Services last week issued a memo telling all Medicare-certified facilities to develop water management policies specifically aimed at preventing Legionnaires’ outbreaks, and to test their water systems for bacteria.

“The high case fatality rate of health care-associated Legionnaires’ disease underscores the need for effective prevention and response programs,” the report concludes. “Implementation and maintenance of water management programs, combined with rapid case identification and investigation, could reduce the number of health care-associated Legionnaires’ disease cases.”

Written by Alex Spanko

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