The Vermont Department of Health is investigating an outbreak of Legionnaire’s disease at a long-term care facility in Windsor, which has resulted in at least six confirmed cases and one fatality. The department is working with the facility’s administration to monitor the situation and has notified healthcare providers in Vermont and New Hampshire to be vigilant for patients exhibiting symptoms of the disease.
According to the Vermont Department of Health, six individuals, including both residents and staff, have tested positive for the disease. An additional individual who tested positive has died.
Legionnaire’s disease is contracted when a person inhales small droplets or mist of water contaminated with Legionella bacteria, which can lead to pneumonia. The disease is not contagious and does not typically spread from person to person. Most healthy individuals do not become ill after exposure to Legionella; however, those with higher risk factors, such as age or underlying health conditions, are more susceptible.
In an advisory posted on January 29, officials reported that the facility had implemented several measures to reduce exposure to Legionella bacteria from the facility’s water system. The potential exposure may have occurred as recently as January 20, 2025, and additional cases may still be identified. The facility is investigating the source of the bacteria and has taken steps to reduce exposure, such as installing filters and limiting the aerosolization of water.
The Vermont Department of Health has urged healthcare providers to consider Legionella infection in patients presenting with respiratory symptoms. It recommended that patients suspected of having Legionella infections be tested for the bacteria using both urine antigen tests and sputum/respiratory cultures. The department emphasized that Legionella culture tests are crucial for identifying specific strains that urine antigen tests may miss, aiding in outbreak tracking and public health efforts. While it is ideal to obtain cultures before starting treatment, care should not be delayed.
Compliance Perspective
Issue
Transmission of Legionella can be aerosol generated or can occur when an individual consumes contaminated drinking water. The Centers for Medicare & Medicaid Services (CMS) requires that each facility establish and maintain an infection prevention and control program. CMS also expects that each nursing facility will have a policy and procedure to reduce the risk of growth and spread of Legionella and other opportunistic pathogens in the building’s water system. Facilities must have water management plans and documentation that, at a minimum, ensure each facility:
- Conducts a facility risk assessment to identify where Legionella and other opportunistic waterborne pathogens (e.g. Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas, nontuberculous mycobacteria, and fungi) could grow and spread in the facility water system.
- Develops and implements a water management program that considers the American Society of heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) industry standard and the Centers for Disease Control and Prevention (CDC) toolkit.
- Specifies testing protocols and acceptable ranges for control measures, and document the results of testing and corrective actions taken when control limits are not maintained.
- Maintains compliance with other applicable federal, state, and local requirements.
Discussion Points
- Review the facility’s Infection Control Plan and the policies and procedures for water management to reduce the risk of growth and spread of Legionella and other opportunistic pathogens in the building water system. Revise as necessary.
- Train all staff on the facility’s Infection Control Plan and water management policy and procedures. Training should focus on the risks and prevention of Legionella and other waterborne pathogens, ensuring staff understand the facility’s water management protocols. Additionally, training should include emergency response protocols and be conducted regularly, with refresher courses to keep staff updated on any changes to procedures.
- Periodically audit to ensure that water samples are taken to test for presence of Legionella and other opportunistic pathogens in the facility’s water supply. Confirm that appropriate staff know how to collect and submit samples for testing, and that staff know what to do if the water samples test positive for Legionella or any other opportunistic pathogens. Ensure that a designated registered nurse is competently serving as the facility’s Infection Preventionist.
*This news alert has been prepared by Med-Net Concepts, Inc. for informational purposes only and is not intended to provide legal advice.*
