Physicians' degree of awareness regarding the risks, clinical practices, and management challenges of nosocomial legionnaires' disease: A cross-sectional study from two Ethiopian hospitals

Abstract

Objectives: Legionella pneumophila is a waterborne bacterium known to cause Legionnaires' disease, a severe form of pneumonia particularly affecting older and immune compromised individuals. This study evaluates the level of risk awareness, clinical practices, and barriers to optimal management of nosocomial Legionnaires' disease in Ethiopia's two largest hospitals.

Methods: We employed a cross-sectional survey design, utilizing a self-administered questionnaire to collect data from 374 practicing physicians at two specialized hospitals in Addis Ababa.

Results: A total of 324 questionnaires were returned, yielding a response rate of 86.6%. Eighty percent (n = 270) reported some level of awareness of Legionnaires' disease as a clinical condition. However, 43% of the physicians were unaware of the association between hospital water systems and the risk of nosocomial Legionnaires' disease. Fifty-seven percent of the respondents indicated the absence of technical guidelines to inform the diagnosis and management of nosocomial Legionnaires' disease. Most physicians relied on clinical assessment (57%, n = 51) for diagnosing the disease, citing diagnostic barriers (68%, n = 140) and perceived low reliability of existing laboratory tests as key challenges. Notably, physicians with limited knowledge about Legionnaires' disease were associated with a 79% reduction in accurate diagnosis of cases. Additionally, poor hospital water quality (43%) and inadequate infection prevention and control measures were identified as significant contributors to the persistence of waterborne hospital-acquired pneumonia.

Conclusions: This study highlights physicians' limited awareness of the risks posed by hospital water systems in the transmission of Legionnaires' disease. Additionally, the diagnosis of Legionnaires' disease is impeded by the lack of clinical guidelines and specific diagnostic testing capabilities. These findings underscore the urgent need to revise hospital-acquired pneumonia protocols, strengthen infection prevention and control guidelines, and enhance hospital water management practices.

Keywords: Ethiopia; L. pneumophila; Nosocomial Legionnaires’ disease; cross-sectional study; healthcare-associated infections; hospital infection control; hospital-acquired pneumonia; legionella infection; physicians’ awareness; waterborne nosocomial infections.

Figure 1.

Percentage of awareness on risk factors for LD by physicians at Tikur Anbessa and St. Paul’s Hospitals, Addis Ababa, Ethiopia, February 2024–April 2024.

Figure 2.

A List of barriers to targeted nosocomial pneumonia treatment reported by Physicians at Tikur Anbessa and St. Paul’s Hospitals, Addis Ababa, Ethiopia, February 2024–April 2024.