Illness probe targets water

Tests results awaited to determine if hospital is Legionnaires' source

`Possible common factors'

State also checks nursing home where one patient became ill

July 09, 1999|By Lisa Respers | Lisa Respers,SUN STAFF

State health officials focused yesterday on the water system at Harford Memorial Hospital as the likely source of the Legionnaires' disease infection that has struck four people there since June 8, leaving two dead.

Officials were still awaiting results of water samples taken last week to determine if the hospital is the source of the Legionella bacteria, but have ruled out other connections among the four people who were infected.

"We had to determine what other possible common factors they shared," said Tori Leonard, a spokeswoman for the state Department of Health and Mental Hygiene. "Right now, all we know that they had in common was the hospital."

Meanwhile, state officials yesterday tested the water at a Havre de Grace nursing home where one of the four, a woman in her 80s, had become ill before being sent to the hospital last week.

"Our patient was admitted there on June 28 after she started to vomit and it affected her breathing and sent her into respiratory distress," said Janet McDonald, a spokeswoman for the Citizens Care Center, a 200-bed facility in Havre de Grace. "She's still at Harford Memorial."

McDonald said there was no indication that the nursing home was infected. But the nursing home planned to heat-treat its water last night, send out letters to its staff and contact a water testing agency, McDonald said.

Legionnaires' disease, which most often affects middle-aged or older people and those with other health problems, can resemble pneumonia, with symptoms including a dry cough, chills, high fever, muscle aches, diarrhea, fatigue, headaches and abdominal pain.

Health officials said the disease is spread by water droplets in the air and does not appear to be spread by personal contact.

The state had 35 reported cases last year, two of which resulted in deaths, including a woman who died in October after an outbreak at Poly-Seal Corp. in Dundalk.

Legionnaires' disease is fairly uncommon in hospitals, said Dr. Trish Perl, epidemiologist at Johns Hopkins Hospital.

"It's rare, though it's more common in certain parts of the country than in others," Perl said.

More common in hospitals, she said, are blood infections and pneumonia.

Officials have refused to give details about those diagnosed with the disease at Harford Memorial Hospital, including their names. They said the first case was discovered June 8 in an intensive care unit patient, and a second case with similar symptoms was discovered June 25.

One of those patients died June 26. Two more cases were diagnosed July 2 and one of those patients died Tuesday. Of the two survivors, one has been released, and one is still in the hospital.

On Saturday, after state officials had taken samples from the hospital's water system, workers heated the water supply to 150 degrees and flushed and chlorinated all of the water outlets, said Debbie Egerland, a spokeswoman for Upper Chesapeake Health Systems Inc., which runs the hospital.

No area of the hospital was shut down.

Nurses also went to each room that day and explained to patients why the procedure was being done, she said.

"We've treated this all along as if we were the source," Egerland said. "Legionnaires' disease is not something that is easily identifiable at first, but as soon as we had confirmation of these cases we began investigating."

Leonard, the state health department spokeswoman, said hospital officials followed standard procedure in notifying the county health department within 48 hours of confirmation of each case. The county then notified the state within 24 hours.

Hospitalized patients, particularly those in intensive care units, are more vulnerable to Legionnaires' because of underlying illnesses that reduce their ability to fight infection, Perl said.

Infections that are discovered in an ICU may have been acquired there, but not necessarily, she said.

Perl said patients might have been caught the disease in other parts of the hospital, then were transferred to intensive care when their conditions worsened.

The bacteria grow in standing water.

In hospitals, likely sources are air conditioners, humidifiers, renovation sites and ventilators that use humidified air. Other sources include the water that can pool around drains or accumulate in pipes that hit dead-ends.

"If you look at a lot of outbreaks, most of them occur at home," Perl said. Outbreaks have also occurred in hotels, on cruise ships and at conference centers.

Kay Kearns, communicable disease coordinator for the Harford County Health Department, said five cases were reported in the county last year.

"Those cases were sporadic and occurred at various locations throughout the county," Kearns said. "We are fielding calls from concerned people and answering their questions as best we can."

Harford Memorial has set up a hot line at 800-515-0044 from 8 a.m. to 7 p.m. to answer questions.

The hospital also mailed letters Wednesday to anyone who had been treated at the hospital during the period the infected patients were treated.

Sun staff writer Jonathan Bor contributed to this article.

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