{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T14:31:33Z","timestamp":1763389893721,"version":"build-2065373602"},"reference-count":10,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T00:00:00Z","timestamp":1721260800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>A better understanding of risk factors and the predictive capability of water management program (WMP) data in detecting Legionella are needed to inform the efforts aimed at reducing Legionella growth and preventing outbreaks of Legionnaires\u2019 disease. Using WMPs and Legionella testing data from a national lodging organization in the United States, we aimed to (1) identify factors associated with Legionella detection and (2) assess the ability of WMP disinfectant and temperature metrics to predict Legionella detection. We conducted a logistic regression analysis to identify WMP metrics associated with Legionella serogroup 1 (SG1) detection. We also estimated the predictive values for each of the WMP metrics and SG1 detection. Of 5435 testing observations from 2018 to 2020, 411 (7.6%) had SG1 detection, and 1606 (29.5%) had either SG1 or non-SG1 detection. We found failures in commonly collected WMP metrics, particularly at the primary test point for total disinfectant levels in hot water, to be associated with SG1 detection. These findings highlight that establishing and regularly monitoring water quality parameters for WMPs may be important for preventing Legionella growth and subsequent disease. However, while unsuitable water quality parameter results are associated with Legionella detection, this study found that they had poor predictive value, due in part to the low prevalence of SG1 detection in this dataset. These findings suggest that Legionella testing provides critical information to validate if a WMP is working, which cannot be obtained through water quality parameter measurements alone.<\/jats:p>","DOI":"10.3390\/ijerph21070939","type":"journal-article","created":{"date-parts":[[2024,7,18]],"date-time":"2024-07-18T16:51:12Z","timestamp":1721321472000},"page":"939","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Factors Associated with Legionella Detection in the Water Systems of National Lodging Organization Facilities with Water Management Programs in the United States"],"prefix":"10.3390","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9511-6142","authenticated-orcid":false,"given":"Rebecca","family":"Kahn","sequence":"first","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"},{"name":"Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gordana","family":"Derado","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5476-0345","authenticated-orcid":false,"given":"Elizabeth J.","family":"Hannapel","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9462-7733","authenticated-orcid":false,"given":"Patrick","family":"Vander Kelen","sequence":"additional","affiliation":[{"name":"Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6215-7682","authenticated-orcid":false,"given":"Jasen M.","family":"Kunz","sequence":"additional","affiliation":[{"name":"Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7563-6201","authenticated-orcid":false,"given":"Chris","family":"Edens","sequence":"additional","affiliation":[{"name":"Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30329, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,7,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.15585\/mmwr.mm6442a2","article-title":"Active bacterial core surveillance for legionellosis\u2014United States, 2011\u20132013","volume":"64","author":"Dooling","year":"2015","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_2","unstructured":"CDC (2017). Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings: A Practical Guide to Implementing Industry Standards."},{"key":"ref_3","unstructured":"(2018). ASHRAE. Legionellosis: Risk Management for Building Water Systems (Standard No. ANSI\/ASHRAE Standard 188-2018)."},{"key":"ref_4","unstructured":"CDC (2023, September 01). Routine Testing for Legionella, Available online: https:\/\/www.cdc.gov\/control-legionella\/media\/pdfs\/Control-Toolkit-Routine-Testing.pdf."},{"key":"ref_5","unstructured":"ASHRAE (2020). Managing the Risk of Legionellosis Associated with Building Water Systems, ASHRAE."},{"key":"ref_6","unstructured":"CDC (2021). Legionella (Legionnaires\u2019 Disease and Pontiac Fever): The Toolkit for Controlling Legionella in Common Sources of Exposure. Version 1.1."},{"key":"ref_7","unstructured":"CSTE (2022). Legionnaires\u2019 Disease Risk Communication Toolkit, CSTE."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Kunz, J.M., Hannapel, E., Vander Kelen, P., Hils, J., Hoover, E.R., and Edens, C. (2023). Effects of the COVID-19 Pandemic on Legionella Water Management Program Performance across a United States Lodging Organization. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20196885"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1128\/CMR.15.3.506-526.2002","article-title":"Legionella and Legionnaires\u2019 disease: 25 years of investigation","volume":"15","author":"Fields","year":"2002","journal-title":"Clin. Microbiol. Rev."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"11363","DOI":"10.1021\/acs.est.2c02194","article-title":"Factors That Affect Legionella Positivity in Healthcare Building Water Systems from a Large, National Environmental Surveillance Initiative","volume":"56","author":"Gamage","year":"2022","journal-title":"Environ. Sci. Technol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/7\/939\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:19:15Z","timestamp":1760109555000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/21\/7\/939"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,7,18]]},"references-count":10,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2024,7]]}},"alternative-id":["ijerph21070939"],"URL":"https:\/\/doi.org\/10.3390\/ijerph21070939","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2024,7,18]]}}}