Tests show Legionnaires' disease bacteria still in S.A. hospital's pipes

[Guest guest]

Tests show Legionnaires' disease bacteria still in S.A. hospital's

pipes, but reduced

by MyUSA.com

http://www.imakenews.com/pureaircontrols/e_article000612775.cfm?

x=b7Fk9yr,bvtv58G

MySA.com Web Posted: 06/26/2006 12:00 AM CDT

On May 1, DeChant checked into North Central Baptist Hospital

for gastrointestinal bleeding. As the days stretched into weeks, he

grew sicker, unable to breathe on his own.

And when the 78-year-old retired postal worker and community leader

finally died earlier this month, it wasn't from bleeding or even a 6-

year-old mechanical heart valve that had worried his doctors.

Instead, DeChant — a member of the San Crime Commission and

several other civic groups and committees — became the fourth person

in two months here to die from Legionnaires' disease. In all, 11

people were diagnosed with the illness — 10 of them linked to the

same hospital.

A team of state and federal epidemiologists later confirmed the

presence of legionella bacteria in the hospital's water system. And

despite aggressive steps over the past two months to get rid of it —

including repeated superheating of the water system, installation of

a chlorine injection system — test results last week indicate the

bacteria is still lurking in the pipes, although at much lower

levels.

" We're dealing with a lot of grieving stuff right now, but when my

dad passed we were angry, " said Dechant's son, J. DeChant of

Austin. " It baffles me that a hospital can build a whole new wing

and be proud of that, but they can't have a decent filter system for

their water. "

Next month will mark the 30th anniversary of the discovery of

Legionnaires' disease. In July 1976, several hundred American Legion

members gathered at the Bellevue-Stratford Hotel in Philadelphia to

commemorate the nation's bicentennial. Within days, more than 200

fell ill with a mysterious pneumonia. Thirty-four of them died.

Three decades later, the disease remains a mystery in many ways. How

is it that legionella can invade 10 hospitals and only sicken

patients at one? Why are some cities more prone to outbreaks than

others?

Although the bacteria can be found in many places, hospital-acquired

infections are fairly common. And far more people are infected each

year than the official statistics indicate, said Dr. Muder,

hospital epidemiologist with VA Pittsburgh Healthcare System, who

has studied legionella for 25 years.

Areas to watch

" Many apartment buildings are contaminated with legionella, but you

don't see a lot of cases, " Muder said. " That's because the vast

majority of people are healthy. Hospitals tend to be areas of high

risk because they have a concentration of patients who are highly

susceptible to Legionnaires' disease. "

Officials at North Central Baptist say they did everything they were

required to do — and more — to prevent such an outbreak, and health

officials don't disagree. Hospital staff regularly inspected and

cleaned cooling towers and hot water heaters where legionella

bacteria like to grow. Patient room showerheads and faucets were

submerged in bleach twice a year.

A national consulting company, EBSol, has since been brought in to

recommend additional measures.

" One of the important things we want the public to understand is

that this is an environmental issue, and the hospital is safe, " said

Dr. Herman , chief medical officer of Baptist Health System.

Testing questions

In 1996, San recorded 16 Legionnaires' cases, a sharp rise

from past years. Another team of state and federal disease trackers

came and tested 12 large hospitals here for legionella, as well as

four more in Austin.

Their findings, published three years later, were surprising.

Of the 12 San hospitals inspected, 11 had legionella growing

in their water systems. No. 12 had recently eliminated the bacteria

after some hospital-acquired cases were confirmed there. No

legionella was found at any of the Austin hospitals.

The difference between San and Austin? The San Water

System uses chlorine to disinfect its drinking water. Austin uses

monochloramine, a mix of chlorine and ammonia that's better suited

to treating water from lakes and reservoirs.

" Living in Bexar County means you have a greater likelihood of being

exposed to legionella bacteria than if you lived in County, "

concluded Bergmire-Sweat, one of the researchers, who now

serves as vice president of the American Social Health Association

in Research Triangle Park, N.C.

San wasn't going to switch disinfectants just to prevent an

average of five or so confirmed cases of Legionnaires' disease each

year. Monochloramine has its drawbacks, too. But the findings, since

confirmed by other studies, helped researchers understand why some

cities are at greater risk.

Still, a state task force that convened the same year the study was

published decided not to recommend that hospitals routinely test for

legionella bacteria, as some states require. That might divert money

and resources from more pressing problems, they decided.

" I disagree with that position, " Muder said. Doctors don't routinely

test pneumonia patients for Legionnaires' disease unless they

suspect it. And they might not suspect it if the hospital's plumbing

isn't tested. Instead, Muder said, doctors treat the mystery

pneumonia with antibiotics, the patient gets better and the bacteria

lingers in pipes, awaiting another victim.

Testing a building for legionella can cost as little as $1,200 a

year at a small hospital that performs its own tests, Muder said.

And although the simple presence of legionella doesn't guarantee

patients will become ill, some studies have suggested that if a

hospital's water system is tested at multiple sites and if 30

percent or more of those tests are positive, patients probably are

at risk.

Risk factors

Other factors that raise the risk of legionella include hot water

heated at no more than 122 degrees, buildings taller than 10 stories

and a disruption of a building's water system.

The latter might be an issue at North Central Baptist, which is

undergoing a major building expansion that will double the

hospital's size. In early April, a water line to the hospital was

cut, interrupting service and causing problems with toilets and

discolored water.

No new cases have been identified in two weeks at North Central

Baptist. The hospital is staffing a telephone hot line, at (210) 297-

4444, for patients or family members with legionella questions.

Cancer and transplant patients and others with weakened immune

systems are being given bottled water and ice from outside sources.

The hospital has superheated its water system repeatedly to kill

legionella in the water, and it's flushed additional chlorine

through its pipes. It may take additional steps, depending on what

EBSol recommends.

A device that injects copper-silver ions into the water system can

be effective in killing hard-to-reach legionella bacteria colonies.

Such a device can cost tens of thousands of dollars.

Like the other 10 Legionnaires' cases, DeChant — who was transferred

from North Central to North East Baptist before his death — was

older and suffering from underlying health problems. That's no

reason, his family says, to minimize what happened to him.

" My dad was a big advocate for citizens in the city, " his son

said. " We want to put a face to it, and not just make it someone who

was elderly. "