Over the past few weeks, Legionnaires’ disease has been diagnosed in three individuals who had been in the east part of Adelaide, South Australia during the incubation period. Public health authorities have asked business owners to clean & disinfect cooling towers even though a common source had not been identified yet.

Insufficient heating of the hot-water system in Miami Valley Hospital’s new 12-story addition was the primary reason for the largest outbreak of Legionnaires’ disease in Ohio since 2004, according to the hospital.

 

The outbreak of Legionnaires’ disease at the hospital in February and March highlights an unintended result of plumbing codes that could put vulnerable populations like hospital patients at risk.

 

In certain cases, an outbreak of Legionnaires’ disease can be an “unfortunate consequence of something that’s intended to protect public health,” said Dr. Lauri Hicks, a medical epidemiologist with the Centers for Disease Control and Prevention.

 

In an exclusive interview this week with the Dayton Daily News, hospital officials announced the cause of the outbreak, which sickened 11 patients and may have contributed to the death of one of those patients.

 

Prior to occupancy of the $135 million patient tower on Dec. 28, a construction team made sure the water that supplied showers and faucets was heated to no more than 120 degrees Fahrenheit, as required by the Ohio Plumbing Code, hospital officials said.

 

Hospital officials said they had planned to heat the water to 130 to 140 degrees, but were told to lower the water temperature to comply with code requirements, which are intended to prevent scalding.

 

“When the codes recommended a certain water temperature, those codes didn’t contemplate a vulnerable population” and its susceptibility to waterborne bacteria such as Legionella, said Jennifer Theibert, the hospital’s risk-management director. The acutely ill are more susceptible to contracting Legionnaires’ disease than the general population.

 

State codes like Ohio’s that require hospitals to keep water temperatures at 120 degrees are “irresponsible,” said Tim Keane, who was hired by Miami Valley Hospital after it detected its first cases of Legionnaires’ disease in late February.

 

“One of the primary drivers of Legionella in health care are codes,” Keane said.

 

Such codes aim to minimize the risk of scalding by requiring caps on water temperatures. But Keane claims the risk of hot water systems becoming colonized with Legionella bacteria is far greater than those associated with scalding.

 

Legionella bacteria begin to die at 108 degrees Fahrenheit, according to the CDC. But not all of those bacteria die at that temperature, and water typically begins to cool as it moves away from the heating source, the CDC’s Hicks said. In large buildings, the temperature can drop as much as 10 to 20 degrees in some parts of the hot water plumbing system. Consequently, “bacteria may be thriving in the pipes near the shower head, but not in the hot water heater itself,” Hicks said.

 

Miami Valley Hospital is now heating water in the entire hospital to 140 degrees, and has the ability to mix hot and cold water at faucets and other points where people come in contact with the water to reduce scalding risks.

 

The hospital also has installed a hyperchlorination system to “make sure this never happens to us again,” said Barbara Johnson, the hospital’s chief operating officer.

 

Reduced water flow in parts of the new addition’s plumbing system also contributed to the outbreak.

 

Legionella is found in most water sources, but is usually contracted by breathing in mist from water that contains high concentrations of the bacteria. Legionnaires’ disease is not contagious.

 

The hospital spent about $61,000 to eradicate Legionella from the hot water system. It declined to release both its report on the outbreak and a white paper summarizing what it’s learned.

 

The hospital has received inquiries about the outbreak from attorneys representing patients who had Legionnaires’ disease, but no legal action has been taken against the hospital, Theibert said.

 

Contact this reporter at (937) 225-7457 or bsutherly@DaytonDailyNews.com.

 

World Health Organization Publication – Water Safety in Buildings

Pittsburgh, PA (PRWEB) March 9, 2011

Water in hospitals, hotels, commercial office buildings, and long-term care facilities contain waterborne pathogens, like Legionella, Pseudomonas, and antibiotic resistant bacteria. If you are elderly or a hospital patient, you are vulnerable to illnesses, like Legionnaires’ disease, which are caused by these bacteria.

Now, guidance documents developed by the World Health Organization; the Veterans Affairs Healthcare System; the New York Department of Health; and the American Society of Heating, Refrigeration and Air-conditioning Engineers (ASHRAE) offer new methods for disinfection and prevention.

Faucets, shower heads, drains, humidifiers, and hot tubs provide rich environments for bacteria to colonize. Illness is caused when water is ingested, aerosolized, aspirated, or directly instilled through tubes like feeding tubes.

“You’d be surprised at what’s in your water,” says Dr. Janet Stout, director of Special Pathogens Laboratory. (http://www.specialpathogenslab.com) “We want to believe that the water coming from the tap in a hospital or hotel is safe, that assumption is incorrect especially for the elderly, smokers, and anyone whose health is compromised.”

According to Stout, wherever there is water there should be concern about its quality with respect to waterborne pathogens. One study showed 41 facilities in 18 states reporting a death rate of 34% when hospitalized patients got Legionnaires’ disease from the hospital water. Of those, 88% were acute care hospitals, 12% long-term care and rehabilitation facilities.

“Unmonitored levels of bacteria pose a definite threat to public health. Yet for too long there has been a policy of avoidance especially in the case of Legionnaires’ disease where nothing is done until a case is diagnosed or there has been a death,” says Stout, a research assistant professor at the University of Pittsburgh, and leading expert in Legionella detection and disinfection. “These new guidelines offer a preventative approach as well as effective detection and disinfection methods.”

Stout will lead an educational session for the National Facilities Management and Technology Conference in Baltimore on Wednesday, March 16, 2011. In “Waterborne Pathogens: Keeping People Healthy in the Building,” (http://www.nfmt.com/EducationEvents/sessiondescription.asp?id=1147) she will identify waterborne pathogens in building water systems that pose a risk of infection; review the Do’s and Don’ts for assessing and managing risks from utility water systems; give the status of guidance documents, and the impact on utility system operation and maintenance.

Special Pathogens Laboratory®
Special Pathogens Laboratory, The Legionella Experts,® is the leading analytical microbiology laboratory offering the healthcare industry, water treatment industry, and commercial and industrial sectors reliable, high-quality microbiology services. An accredited laboratory and ELITE certified by the CDC for expertise in Legionella testing, SPL® specializes in the detection, control, and disinfection of Legionella, and other waterborne microorganisms, responsible for serious infections, including thousands of hospital-acquired infections annually.

    Febuary 2010

Sharron Morris sued Ohio

State Medical Center after her

husband, David, died after

contracting Legionnaires’

disease in Doan Hall.

Sharron Morris didn’t want another family to watch a loved one die

after contracting Legionnaires’ disease from drinking water.

So she felt some satisfaction this week when Ohio State University

Medical Center agreed to settle a lawsuit she’d filed over the death of

her husband.

David Morris died in 2007, five months after he drank water from an

OSU Medical Center faucet and came down with the disease.

“The important thing is getting it out into the community to let them

know,” Mrs. Morris said yesterday. “It was the only way I could get

anyone to do anything.”

Ohio State agreed on Thursday to pay Mrs. Morris $1.2 million.

Mr. Morris, 66, of Lima, came down with Legionnaires’ six days after

he drank tap water on the ninth floor of the medical center’s Doan

Hall. His leukemia was in remission, and he was having an outpatient

procedure when he drank the water to wash down medication.

Mrs. Morris’ complaint says that nurses and other staff members on

the ninth floor knew that the water could contain the bacteria that

causes Legionnaires’ but had been instructed not to tell patients to not

drink the water.

Instead, staff members regularly gave patients bottled water and ice

made from bottled water.

David Shroyer, Mrs. Morris’ attorney, said signs warning that the

water should not be consumed were added to the faucets after Mr.

Morris got sick.

He said he doesn’t know whether anyone else contracted

Legionnaires’ from the water and doesn’t know whether the threat

remains at Doan Hall.

OSU Medical Center spokesman David Crawford issued a statement saying that Ohio State believes the

  OSU pays $1.2 million in man’s Legionnaires’ death | The Columbus Dispatch http://www.dis10 8:18 AM

©2010, The Cs fair and adequately compensates the family for the loss of their loved one,” and that “the

risk of contracting the disease is extremely low due to the safeguards we have in place.”

Dr. Andrew Thomas, associate medical director at OSU, said the university installed special filters on

some sinks and ice machines in the hospital in March 2007 to protect from Legionella bacteria, which is a

common risk in older buildings with big plumbing systems.

“It’s hard to eradicate,” Thomas said. He said the medical center also is planning to add a system that

would inject chlorine gas into the water to reduce the risk of the bacteria.

He said it is difficult to determine where anyone picks up the bacteria. Two other OSU patients have had

Legionnaires’ since Mr. Morris and possibly contracted it in the hospital. Both of them died of other

medical problems, he said.

Medical Center employees who were deposed in the Morris case said that they knew it was not OK to

drink the water on the ninth floor because Legionella was in the water. But although the staff gave patients

bottled water, it did not warn them about drinking the tap water, employees testified.

Thomas said nurses now instruct patients not to drink the tap water.

kgray@ s $1.2 million in man’s Legionnaires’ death | The Columbus Dispatch http://w14/2010 8:18 AM