675. Current Physician Knowledge, Attitudes, and Clinical Practice Regarding Legionnaires’ Disease in the Aftermath of the Flint Water Crisis in Genesee County, Michigan

Abstract

Background. Legionnaires' disease (LD) is a respiratory illness caused by the inhalation of aerosolized water contaminated with Legionella bacteria. For reasons not yet understood, the incidence of LD has steadily increased across the United States during the past 10 years. In 2014 and 2015, the City of Flint in Genesee County (GC), Michigan underwent a change in the city's water source, which resulted in the third largest recorded LD outbreak in American history and over 100,000 residents being exposed to contaminated water. In order to reduce the incidence of LD in at-risk populations it is imperative that we evaluate and improve LD knowledge and clinical practice among healthcare personnel. Methods. This investigation surveyed clinicians practicing in Genesee County who are also members of the Genesee County Medical Society (GCMS). A survey was designed to assess current clinical knowledge, attitudes, and practices related to LD, in addition to measuring the uptake and utility of the LD clinical guidelines. The survey and the LD clinical guidelines were distributed to all GCMS members over a 6-month period. Prompts to complete the survey using Qualtrics programming were emailed to GCMS members and posted in the GCMS monthly bulletin. In addition, surveys were distributed to members at GCMS meetings. Completed responses were entered into Qualtrics software and exported into MS Excel and SPSS statistical software for analysis. Results. In total, 95 healthcare personnel responded. Of those surveyed, 79.5% have been in practice for more than 10 years and 55% identified as practicing in family, internal or emergency medicine. Despite, the well-publicized LD outbreak in GC, 45% of respondents did not believe or were unsure if LD was a current public health issue, and 65% have either not received, have received but are not interested, or have received but not read the LD clinical guidelines. Despite this, 47% and 61% of respondents were able to correctly identify the symptoms and risk factors for LD, respectively. In addition, 34% of participants believe that drinking tap water is a risk factor for contracting LD. Conclusion. This survey underscores the continuing need for comprehensive physician education to improve the clinical recognition and evaluation of patients with LD.