State task force considers new anti-infection rules

Legionnaires' outbreak worries health officials

July 23, 1999|By Dan Thanh Dang | Dan Thanh Dang,SUN STAFF

After a recent outbreak of Legionnaires' disease that killed four people in Harford County, a task force is being set up to evaluate whether additional guidelines are needed to reduce the risk of infections in Maryland's health facilities and work sites, the state Department of Health and Mental Hygiene announced yesterday.

The task force of health care professionals will also determine what type of institutions will be regulated by the new guidelines and whether mandatory testing of water systems should be standard practice.

The group will be led by J. Glenn Morris, a University of Maryland professor of medicine, epidemiology and preventive medicine who also served as a leader of the medical team that evaluated the possible public health effects of Pfiesteria in 1997.

Of the four people who died of Legionnaires', three contracted the disease at Harford Memorial Hospital in Havre de Grace. The fourth patient is believed to have been infected at a Havre de Grace nursing home where the water system has tested positive for the bacteria.

The state has no specific guidelines for dealing with Legionella bacteria. Instead, it follows those provided by the federal Centers for Disease Control and Prevention.

"We're looking at risk reduction," said Secretary Georges C. Benjamin of the state health department. "Legionella is everywhere. One of the things we have to decide early on is what do we test? Where do we test? Is there any new science that would change the way we test? Is there anything state-of-the-art that would improve our decision making?"

Legionellosis is a bacterial infection that can cause a very mild respiratory illness or severe pneumonia that can lead to death. Symptoms include a dry cough, high fever, chills, muscle aches, diarrhea, fatigue, headache and abdominal pain. The disease is spread by water droplets in the air, and the bacteria can develop in air conditioners, whirlpools, spas and showers.

CDC guidelines offer two methods of dealing with hospital-acquired infections, said Dr. Diane Dwyer, the state's chief epidemiologist. One approach is to conduct periodic routine culturing of water samples; the other is to initiate an investigation as soon as one definite case or two possible cases of Legionella are associated with a facility.

In the case of Harford Memorial, an investigation was launched after a patient died of Legionella on June 26. Both the hospital and Citizens Care Center nursing home heat-treated and hyperchlorinated their water system after patients were diagnosed with the disease.

Testing the water system is just one way of preventing Legionella outbreaks in hospitals, Legionnaires' experts say. Testing could also be conducted on air conditioning cooling towers, respiratory therapy equipment and shower heads.

Some experts have called for hospitals to test their water every year, as is being done in the Pittsburgh and New York City areas. The CDC, however, says more research needs to be done before adopting that guideline at health care facilities nationwide.

In Maryland, no regulation requires periodic testing of health facilities' drinking water or other water sources for the Legionella bacteria.

Dwyer says the state does require that in situations where clusters of pneumonia cases are reported, immediate testing should be done to rule out such diseases as Legionnaires', tuberculosis, influenza and pneumoccocal pneumonia.

The task force is expected to take three to four months to complete the study, Benjamin said.

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