Army officials at Redstone Arsenal in Huntsville, Alabama have confirmed that an employee who recently died was diagnosed with Legionnaires’ disease 4 days before his death. The building where the man worked – Building 5681 – was tested for the presence of legionella, which was not found; a second round of testing is currently underway. So far, although other employees have reported pneumonia-like symptoms, no other cases of Legionnaires’ disease have been confirmed. Building 5681 remains open and operational.
Aug 182011
According to the hospital as reported in a newspaper article, the outbreak of Legionnaires’ disease at Miami Valley Hospital, which sickened 11 people between February and March 2011, was primarily caused by inadequate hot water temperatures. Officials at MVH claim that the hospital originally planned to heat the water in the new patient tower to 140 degrees Fahrenheit, a temperature at which legionella bacteria may reasonably be expected to die. Construction management officials, however, (again, according to the hospital) allegedly instructed the hospital to lower its hot water temperatures to 120 degrees Fahrenheit in order to comply with the Ohio Plumbing Code, which supposedly caps hot water temperatures at 120 degrees due to a potential risk of scalding. Since the outbreak, Miami Valley Hospital has raised its hot water temperature to 140 degrees and has adopted temperature control measures that lower the water temperature at faucets and fixtures by mixing hot and cold water. The hospital has decided not to release either its report on the outbreak or a white paper discussing lessons it has learned.
The hospital seems to be eschewing blame by citing state regulations on water temperatures. Although thermal disinfection is one method for legionella control, it is not sufficient as the sole component of a legionella management plan, which the hospital should have had in place prior to the construction of the new patient tower. Legionella is commonly associated with building construction and renovation, when water flow is shut off, water sits stagnant, and biofilm, a shelter for bacteria from chemical treatment, develops. It is unclear what happened during construction to foster conditions ideal for the growth of legionella; regardless, Miami Valley Hospital should have been aware of the possibility for a surge in legionella levels and prepared to handle them. While it is true that the hospital implemented a hyperchlorination program in response to the outbreak, it is also true that they waited three weeks after the first confirmed case of Legionnaires’ disease to do so. Had the hospital acted more quickly, it could possibly have contained the outbreak and minimized the number of cases.
Six confirmed cases of Legionnaires’ disease from December, 2009 to April, 2011 have been linked to the Aria Resort and Casino in Las Vegas, Nevada. After receiving reports of Legionnaires’ disease connected with recent travel to the Aria, the Southern Nevada Health District conducted tests of the hotel’s hot water system between June 21 and July 4, 2011 and found heightened levels of legionella bacteria. In response, the Aria has issued letters to guests who stayed there in that time frame, and has implemented “additional precautionary measures,” though it is not clear at this time what those measures are.
Three patients of the Elizabeth Severance Prentiss Center for Skilled Nursing in Cleveland, Ohio were recently transferred to MetroHealth Medical Center to receive treatment for Legionnaires’ disease. According to a hospital spokesperson, all three patients were chronically ill before they were exposed to legionella. As of Friday, June 24, 2011, two patients have been treated and released, and the third remains hospitalized.
In response to the outbreak, MetroHealth has restricted shower use by patients and is providing bottled water in place of tap water. It is not yet clear what methods the hospital is employing to sterilize the water system. To read more about this outbreak of Legionnaires’ disease, please refer to this article.
A nursing home in Cumberland, Maryland has teamed up with a private firm that specializes in legionella control after a case of Legionnaires’ disease was confirmed there in December 2010. Moran Manor, in conjunction with local and state health officials, continues to monitor the levels of legionella in the water supply. Water restrictions, including the use of bottled water instead of tap water, have been put in place while water treatment methods, namely super-heating and hyper-chlorination, have been adopted in order to kill the bacteria. Although no new cases have been confirmed, several employees have fallen ill with respiratory problems and there are concerns about how long it took before employees of Moran Manor were made aware of the bacteria’s presence in the water and of the single case of Legionnaires’ disease confirmed last December. For more information, see this article.
Jun 202011
Jules Zacher, Esq. is currently representing a patient of Miami Valley Hospital who contracted Legionnaires’ disease during his stay in the hospital’s new patient tower. As of March 11, 2011, 10 patients of Miami Valley have become ill with Legionnaires’ disease and one has become ill with Pontiac Fever, a milder strain of legionellosis. So far, the following information can be confirmed.
1. On December 28, 2010, Miami Valley Hospital began moving patients into the new patient tower, which houses the Heart and Vascular Center. At an undetermined time before the tower was opened to patients, the hospital flushed the plumbing of the addition, which is proper procedure following construction.
2. On February 3, 2011, the first case of Legionnaires’ disease was confirmed.
3. On February 17, 2011, the second case of Legionnaires’ disease was confirmed.
4. On February 19, 2011, the third case of Legionnaires’ disease was confirmed.
5. On February 20, 2011, the fourth case of Legionnaires’ disease was confirmed.
6. On February 22, 2011, the hospital implemented water restrictions and a program of disinfection involving hyper-chlorination of super-heating of the water system in the new patient tower.
7. On February 25, 2011, Miami Valley Hospital’s water was declared safe.
It is not uncommon for cases of Legionnaires’ disease to follow episodes of major construction. Legionellae bacteria occur naturally in the environment, so when construction breaks up soil containing legionellae, the disturbed bacteria can settle in the new building’s water system. Legionellae thrive in areas of warm, stagnant water, and are fed by the dust and dirt of a construction site. It is essential, therefore, to flush the plumbing of a new building in order to thoroughly remove dirt and bacteria that may have settled there.
Miami Valley apparently completed this important step, yet legionellae still found their way into the new patient tower’s water system, resulting in an outbreak of Legionnaires’ disease among several patients. Not every case was diagnosed at the same time, however, as the timeline above demonstrates. The first case of Legionnaires’ disease was confirmed on February 3, 2011; at this point, the hospital should have acted immediately to curb patients’ potential exposure to bacteria in the water system and thereby prevent additional cases. But the hospital waited until three more cases were confirmed – three weeks later – before it restricted water use and disinfected the system. If Miami Valley had responded more quickly and attentively to the first diagnosis, 10 of its patients would not have been infected with the bacteria that causes Legionnaires’ disease.
Jun 162011
There has been heightened concern in the United Kingdom recently following the May, 2011 outbreak of Legionnaires’ disease in Glasgow when nine people became ill, of whom three died. While no new cases have been confirmed since May 18, the presence of legionellae in a sports complex in Wishaw, in the IBM plant in Warwick, and in one-third of toilet systems on UK trains, is not being taken lightly.
The bacteria that cause Legionnaires’ disease were detected in the plumbing system of Wishaw Sports Centre in Wishaw, Scotland. Routine testing led to the discovery of the legionellae on shower heads and faucets in the changing areas on May 25, and the facility was immediately closed for disinfection, then re-opened on May 27. Last week, a staff member of the Centre was diagnosed with Legionnaires’ disease, but it is not certain that this person was infected with the same strain of legionella as found in the complex. The Wishaw Sports Centre remains open to the public while investigations are conducted.
Most employees of an IBM plant in Warwick, England were sent home on the morning of June 2 after legionellae were discovered in the water system the night before. On June 3, health officials from the Warwick District Council agreed to disinfect the water system while an investigation into the source of the bacteria was underway.
Finally, tests revealed that one-third of the UK’s train toilet systems contained legionellae, and ScotRail in particular confirmed that it had found legionellae in 2 of 15 tanks tested. The Health Protection Agency has stated that the risk to the public was very low, but a disinfection plan has been implemented nevertheless.
The water system at Richmond Health Center is being tested for Legionella bacteria following the recent death of one of its employees, according to media reports. The man, a medical records technician, died after contracting Legionnaires’ disease, and the location of the bacteria within the health center remains unclear, though hopefully the test results expected this week will shed some light on the question. For now, the health center remains open and no other cases of Legionnaires’ disease have been found. For more information, see this article.
According to media reports, the water system at Sacred Heart Medical Center in Spokane, Washington has been cleaned and no longer contains Legionella bacteria. The hospital has now lifted the water restrictions put in place following the discovery of Legionella bacteria in its water system, and is beginning to outline and execute a long-term plan to prevent another growth of Legionella bacteria in its water. For more information, see this article.
An employee of the Richmond Public Health Center in Richmond, California, died during the weekend of May 7-8, 2011 after contracting Legionnaires’ disease. This is the second incident since 2008 in which an employee of the Health Center has fallen ill with the disease. Another employee, who was first infected in 2008, spent several days in Intensive Care and remains on long-term medical leave. After her confirmed diagnosis, the Health Center investigated and found the legionella bacteria in the air conditioning tank on the roof of the building. Despite this fact, the director of Contra Costa County Health Services asserted in a press release on Wednesday, May 11, 2011 that the source of the 2008 case “was never confirmed” and that “the [Legionella] bacteria is frequently found in water whenever it is tested for.” He added that the precautions undertaken as a result of the 2008 case continue today, and that the Health Center now intends to repeat the investigative efforts employed three years ago, which include testing the air and water supplies of the building. For more information, please see this article.
