Sherrie Dornberger, RNC, CDONA, FACDONA, executive director, NADONA

We are building a new patient care area and as a nurse leader I am working with the team on developing the area. I would like to have some fountains and trickling water features in the area. However, I am hearing from our environmental services that there may be some issues with the fountains and worry of Legionnaires’ disease. Can you offer advice?

I know from living close to Philadelphia about the hotel that first had affected a convention of American Legion attendees, which is where the name originated. I asked two physician experts in infection prevention, J. Hudson Garrett, Ph.D., and Nimalie Stone, M.D. about your question. Their response is enlightening:

“The preferred would be to not have a fountain due to the water maintenance requirements to ensure adequate mitigation of potential Legionella, especially where there is a high potential for the population to be immuno-compromised,” they wrote.

(CDC has posted its recommendations for prevention here: . This document talks about the specifics of disease outbreak, CDC vessel sanitation, and everything you need to know to prevent an outbreak.)

“The risks of Legionella associated with indoor water features are well-described and have led many healthcare facilities to remove these kinds of decorative features due to patient safety concerns. There are also guidelines for healthcare facility construction which may provide more information,” concluded Garrett and Stone. 

Based on these two experts’ opinions, I would forego the simple water systems, especially if they spray aerosol droplets. Perhaps consider a garden or aviary instead.