Infection Control & Hospital Epidemiology

Original Articles

An Outbreak of Legionnaires Disease Associated with a Decorative Water Wall Fountain in a Hospital

Thomas E. Haupta1 c1, Richard T. Heffernana1, James J. Kazmierczaka1, Henry Nehls-Lowea1, Bruce Rheinecka1, Christine Powella2, Kathryn K. Leonhardta3, Amit S. Chitnisa1 and Jeffrey P. Davisa1

a1 Wisconsin Division of Public Health, Madison, Wisconsin

a2 Wisconsin State Laboratory of Hygiene, Madison, Wisconsin

a3 Aurora Health Care, Milwaukee, Wisconsin


Objective. To detect an outbreak-related source of Legionella, control the outbreak, and prevent additional Legionella infections from occurring.

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

Patients. 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.

Conclusion. 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.

Infect Control Hosp Epidemiol 2012;33(2):185-191

(Received July 27 2011)

(Accepted October 12 2011)


c1 Wisconsin Division of Public Health, 1 West Wilson Street, Madison, WI 53701 (