A recent report from the Centers for Disease Control and Prevention has revealed a disturbing trend of waterborne disease outbreaks caused by pathogens in drinking water over a six-year period. Data from 2015 through 2020 shows a growing threat to the water of America’s healthcare facilities and the people who use it to shower, wash, and make ice.
Legionella and other bacterial pathogens that can colonize and grow in the drinking water systems of buildings have been causing outbreaks of deadly pneumonia in hospitals and other healthcare facilities. This is impacting Florida more significantly than any other state.
Florida reported the highest number of Legionnaires’ disease outbreaks in healthcare facilities that were linked to drinking water systems, and the numbers are rising. Despite being only 6.8% of the U.S. population, Florida accounted for almost 30% of disease outbreaks across the six years. In 2020 alone, Florida accounted for almost 60% of the reported outbreaks of Legionnaires’ disease nationally and 38% of outbreaks in healthcare facilities nationwide.
The CDC reports that outbreaks from Legionella in drinking water have surpassed all other waterborne pathogens combined as the cause of outbreaks. Since 2002, the number of reported cases has risen more than 650% with no signs of stopping.
Regulatory agencies and health care accreditation groups have been slow to act, despite the growing threat. A review of direct healthcare costs attributable to waterborne pathogens was published in 2021. Approximately 7.15 million waterborne illnesses occur each year, resulting in 601,000 emergency department visits, 118,000 hospitalizations 6,630 deaths, and $3.33 billion in direct health care costs.
Earlier reports from public health authorities have found the fatality rate for people who contract Legionnaires’ disease in healthcare facilities is 1 in 4, or 25%. The 2024 CDC report concludes that more surveillance is needed to detect and report disease outbreaks. Current approaches used to keep our loved ones in these facilities safe are not working and need to be changed.
Ignoring the threats posed by Legionella and other waterborne pathogens that cause respiratory infections in people has allowed them to contaminate building water systems, hot tubs, cooling towers, and even some municipal water systems. Testing a building water system for these deadly pathogens is not currently required and does not normally occur until multiple people are diagnosed with the disease and an outbreak is declared. Proactive sampling for pathogens in healthcare facility water systems only makes sense. However, that will require changes in regulations and accreditation rules for healthcare facilities that specifically “do not require” sampling water for Legionella or other pathogens.
Of course, when a Legionnaires’ disease outbreak is suspected, the public must be notified when it is being investigated, not years after the fact. Guidance and protocols published by the Florida Department of Health must be improved and updated to help protect Floridians and visitors. The Legislature needs to implement and fund an effective surveillance system to detect cases of Legionnaires’ disease and other waterborne pathogens and require healthcare facilities to implement routine testing and meaningful control measures to prevent unnecessary deaths.
Current regulations have been ineffective at controlling these pathogens because they do not require any testing for them. Regulations at the state and federal levels need to be improved and updated to address this increasing threat to Florida’s healthcare facilities and everyone who relies on them.
David Krause is the former state toxicologist for the Florida Department of Health and is a Certified Industrial Hygienist. Over his 30-year career in occupational and public health, he has authored and edited numerous state and nationally-recognized guidelines on Legionella and other microbiological agents that impact human health. He currently consults for public and private employers on subjects ranging from indoor air quality to waterborne pathogen outbreaks.