Hospital outbreaks fairly common

Legionnaire's afflicts hundreds of facilities, is called controllable

July 13, 1999|By Diana Sugg and Lisa Respers | Diana Sugg and Lisa Respers,SUN STAFF

Even as officials at Harford Memorial Hospital sought to identify new cases of Legionnaire's disease, experts say outbreaks of the infection are far more common nationwide than many people believe and could be controlled.

"It's hundreds of other hospitals that this is happening to right now," said Dr. Victor Yu, the country's leading expert on Legionnaire's and a professor of medicine at the University of Pittsburgh. "There are ways to prevent Legionnaire's disease that any hospital in the U.S. should be doing."

Five cases of Legionnaire's disease have been diagnosed at Harford Memorial since June 26, and three people, 79-year-old Elizabeth M. Cox and two unidentified patients, have died. Preliminary tests show that the source of the infection is a hospital water tank.

Officials said yesterday that a staff of 10 nurses have contacted about 350 of the more than 400 people hospitalized at Harford Memorial since May 1, including a half-dozen who were identified as particularly vulnerable by a Johns Hopkins Hospital epidemiologist.

"We have been constantly on the lookout for new cases," said Bob Netherland, a spokesman for Upper Chesapeake Health Systems Inc., which runs the hospital. "We have not identified any new cases since Friday."

The Havre de Grace facility heat-treated and flushed its water system to kill any bacteria on July 2. The incubation period for the disease is two to 10 days.

The bacteria that causes Legionnaire's grows well in lukewarm water and is found everywhere from creeks to people's homes. A person can breathe the bacteria through aerosolized droplets from showers and air conditioners or inhale droplets while drinking water.

The elderly, heavy smokers and people with weakened immune systems are most susceptible to the disease, a form of pneumonia.

According to the U.S. Centers for Disease Control and Prevention in Atlanta, 20 percent to 60 percent of hospitals have Legionella bacteria in their drinking water. As a result, Yu and others have called for hospitals to test the water every year, as is being done in the Pittsburgh and New York City areas.

But the CDC says more research must be done before adopting that guideline for health care facilities nationwide.

"We just don't have the data to know," said Barry Fields, chief of the CDC's respiratory disease diagnostic lab.

No mandated testing

In Maryland, no regulation requires periodic testing of health facilities' drinking water or other water sources for the Legionella bacteria. Dr. Diane Dwyer, state epidemiologist, said yesterday that there are no plans to change that.

Fields and other experts noted that getting Legionnella out of the water is difficult. Even after heating and flushing, the bacteria can recolonize in the pipes in a few weeks to a few months. Others say eliminating bacteria from large institutions' water systems is "logistically impossible."

But Yu cited a new copper technology that can reduce the amount of Legionella bacteria by 100-fold. He said just knowing that the bacteria is present can prompt physicians to test vulnerable patients and use the appropriate antibiotics more quickly.

Local health authorities are required to report Legionnaire's cases to the Maryland health department. But no federal law requires states to report cases. Only one-tenth of the Legionnaire's cases are reported to the CDC, Fields said.

Too often, physicians don't know a patient has Legionnaire's, which can resemble other types of pneumonia. Symptoms include dry cough, high fever, chills, muscle aches, diarrhea, fatigue, headache and abdominal pain.

During a news conference yesterday, Dr. Trish Perl, an assistant professor of Infectious Diseases at the Johns Hopkins School of Medicine, said she looked for those symptoms as she reviewed 200 cases at Harford Memorial.

The hospital has established a hot line and mailed letters to patients to help identify potential Legionnaire's patients.

Norma Burkins, 63, received that letter Saturday and went to the hospital yesterday to be tested. Burkins, who lives outside Aberdeen, said she had been experiencing several of the symptoms after a stay at the hospital for knee-replacement surgery on June 10.

"It was pretty hot when I came home from the hospital so I thought it might be the heat," said Burkins, who retired from the hospital last year after 25 years as an EKG technician. "After I received the letter, I called the hospital and they told me to get in touch with my physician."

Harford Memorial efforts

Netherland, the hospital spokesman, said officials test the cooling tower -- a part of the air-conditioning system -- every summer and are awaiting a consultant's report on other steps they can take to prevent outbreaks.

The hospital has experienced a few cancellations in outpatient services and no decrease in admissions, he said. Hospital officials plan to evaluate how they handled the outbreak, Netherland said.

"Since this has been the first time any of us have dealt with anything like this, I think we've learned some things as well," said Netherland. "As soon as we have time after this is resolved, we will take a look at how we did everything."

Pub Date: 7/13/99

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