Defining Healthcare Facilities and Healthcare-associated Legionnaires' Disease

What Is a Healthcare Facility?

For the purpose of Legionnaires’ disease surveillance, CDC defines a healthcare facility as a hospital, long-term care facility, or clinic. Other healthcare facilities include associated sites such as pharmacies and outpatient laboratories. This healthcare definition does not include assisted living facilities, senior living facilities, prisons, or group homes.

Assisted living facilities, by definition, provide custodial care without skilled nursing (e.g., assistance with activities of daily living, like bathing and dressing). Senior living facilities provide independent living for the elderly.

CDC tracks the type of healthcare exposure (inpatient, outpatient, visitor or volunteer, employee) and the healthcare facility setting. Healthcare facility setting categories, as listed on the CDC Legionellosis Case Report Form pdf icon[2 pages]^, and examples of types of facilities that fall within them include:

A note about assisted living and senior living facilities

Although CDC does not consider assisted living facilities, senior living facilities, prisons, and group homes to be healthcare facilities for Legionnaires’ disease surveillance purposes, they often house at-risk populations and can have large, complex building water and plumbing systems. Because residents may have limited or no exposures outside these facilities, it is important to consider these facilities as likely sources in outbreak investigations. These facilities should all have effective water management programs.

Table lists types hospitals, long-term care facilities, and clinics
Hospitals Long-term care facilities Clinics1
  • Acute care hospitals (general or specialty)
  • Long-term acute care hospitals
  • Critical access hospitals
  • Children’s hospitals
  • Psychiatric hospitals
  • Skilled nursing facilities
  • Nursing homes
  • Inpatient hospice
  • Rehabilitation hospitals
  • Psychiatric residential treatment facilities
  • Outpatient clinics2: general and specialty
  • Ambulatory (same day) surgery centers2
  • Outpatient rehabilitation clinics
  • Dialysis centers
  • Dentists

1 Examples of specialty clinics include outpatient cancer treatment centers, outpatient infusion centers, dental offices, or subspecialist offices that provide clinical care not affiliated with a hospital. Other healthcare facilities not listed here include associated sites such as pharmacies and outpatient laboratories.
2 If a clinic visit or same-day surgery occurs within a hospital, the setting for that exposure is hospital, not clinic.

Additional Considerations

Public health officials should consider a patient who spent ≥10 days of continuous stay in multiple healthcare facilities during their 14 day exposure period in multiple healthcare facilities (e.g., a patient who is discharged directly from an acute care hospital to a long-term care facility) as a presumptive healthcare-associated case for surveillance purposes. The distinction between the facilities would be important for investigation purposes.

*These standardized definitions can be found in Appendix 3 of the updated CSTE Position Statement pdf icon[17 pages]external icon.

Defining Healthcare-associated Legionnaires’ Disease

Case Classification*

Patients who meet clinical and laboratory criteria for confirmed Legionnaires’ disease are further classified based on the duration of healthcare exposure:

  • Presumptive healthcare-associated Legionnaires’ disease: A case with ≥10 days of continuous stay at a healthcare facility during the 14 days before onset of symptoms.
  • Possible healthcare-associated Legionnaires’ disease: A case that spent a portion of the 14 days before date of symptom onset in one or more healthcare facilities, but does not meet the criteria for presumptive healthcare-associated Legionnaires’ disease.

Outpatient Exposure

Public health officials should consider patients with outpatient-only exposures as possible healthcare-associated cases. These patients could have acquired the infection at a healthcare facility, but they also had other possible sources of exposure during the 14 days before date of symptom onset.

Visitor and Employee Exposure

Public health officials should consider visitors to and employees at healthcare facilities during the 14 days before date of symptom onset as possible healthcare-associated cases.

Footnotes

* These standardized definitions can be found in Appendix 3 of the updated CSTE Position Statement pdf icon[17 pages]external icon.

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