Summer's here so look out for Legionnaires disease

Jun 28 2007

Summer's here and the living isn't always so easy especially if youre in the hospital. Patients who are vulnerable to infection run a greater risk of contracting Legionnaires disease, a severe form of pneumonia, during warm, humid weather, according to a study published in the Journal of Infectious Diseases.

The infection is caused by Legionella bacteria that can live in hospital water systems and throughout the environment.

Legionella bacteria, while usually not a problem for healthy adults, can be most serious and even fatal for patients who are immune compromised, including those in Intensive Care Units, the very young and the very old, the chronically ill, and post-surgical, cancer and transplant patients. These patients risk becoming infected through a buildup of microbes that can inhabit a hospital's water system, where they have oftentimes become resistant to traditional methods of cleaning and disinfection.

At-risk patients can become ill through any exposure to hospital water, whether through ingestion, comforting mouth sores with ice cubes, bathing, inhalation of shower mist or being treated with equipment washed in hospital water.

Many healthcare professionals aren't aware of what's lurking in their water in the summer or any season, especially the water used with critically ill and at-risk patients. As a result, countless Legionella and other harmful microorganisms that can cause serious infections go undetected, according to Janet E. Stout, Ph.D., an international expert on Legionella and other microbes in hospital water. Dr. Stout, Director of the Special Pathogens Laboratory and a microbiologist at the University of Pittsburgh, is a strong advocate for reducing the risk of waterborne infection in hospitals, nursing homes and other healthcare facilities. She is on a mission to get these institutions to test their water and then do something about it.

Speaking at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC) in San Jose, California, Dr. Stout shared stories that vividly illustrated the problem:

• A hospital's Burn Unit treated its badly burned patients with a cooling water spray to ease their painuntil it was discovered that the water was loaded with dangerous, infection-causing microbes.
• Another hospital, attempting to prevent the spread of infection, installed non-touch faucets. But a study found that every faucet tested positive for Legionella bacteria, and that 74 percent were also contaminated with Pseudomonas aeruginosa, another bacterium associated with serious, often fatal, pneumonia.

Patients, their families and caregivers need to be aware of the potential for waterborne infection any time they are hospitalized, particularly if they are seriously ill or undergoing treatment that affects their immune systems, according to Dr. Stout.

Hospital Infection Costs Lives, Reputation and Dollars Hospital-associated (nosocomial) infections of all types are a serious problem in the U.S. They affect two million people in hospitals and nursing homes each year, adding $30.5 billion annually to the nation's health tab. This year more than 100,000 people will die from these infections, the fourth leading cause of death in the U.S., according to the Committee to Reduce Infection Deaths (RID), one of the nation's leading organizations in the fight against hospital-associated infection.

Dr. Stout noted that 18,000 cases of Legionnaires disease are reported in the U.S. each year. She estimates that nearly 40,000 lives are known to have been lost to the disease over the past two dozen years as a result of infections acquired in the hospital, with thousands more cases thought to go undetected or misdiagnosed.

The financial costs associated with a single Legionella outbreak can run anywhere from $800,000 to well over $1.5 million, according to Dr. Stout, with an incalculable cost to a hospital's reputation. And that's just the tip of the iceberg, as infectious disease experts continue to identify new microbes in hospital water. Prevention is critical because many of these microbes are increasingly antibiotic-resistant, making the infections even harder, if not impossible, to treat.

Point-of-use Filtration Helps Reduce Spread of Infection

There are solutions, however, according to Dr. Stout, noting that no single systemic disinfection technology can completely eliminate these microorganisms from hospital water systems. The germs survive and even thrive in hospital plumbing despite chemical and heat-based treatments designed to eradicate them. Many of the germs live in biofilms, communities of microorganisms that adhere to the pipes and are protected from systemic disinfection treatments. Waterborne microbes may also be harbored by amoebae that shelter them and safely transport them to distant locations in the hospital's water system.

Effective protection for high-risk immunocompromised patients (cancer and transplant patients) requires delivery of water that meets a higher standard than normal tap water. One option is the addition of point-of-use filtration technology. Citing studies conducted by the VA Pittsburgh Healthcare System, the University of Pittsburgh and the University of Bologna using Pall-Aquasafe Water Filters, Dr. Stout stated that this technology minimizes patient exposure to waterborne microbes, including Legionella and Pseudomonas aeruginosa, by breaking the infection chain between water and patients. She advises that point-of-use filters may be used on faucets, showerheads and ice machines in all areas where there are high-risk patients. She also recommends the quick implementation of point-of-use filters in a targeted approach during an infectious outbreak.

Patients should become familiar with these problems and take preventive steps to protect themselves. Dr. Stout offers the following tips to patients, their families and caregivers:

Dos and Don'ts To Reduce Your Risk Of Waterborne Infection In The Hospital

1. Check your hospital's infection rates if you can, and find out how your hospital compares to others in your region. The issue is timely because a growing number of states, including New York and California, are enacting legislation to make hospital infection rates public.
2. Ask the hospital if it tests its water system for Legionella, common waterborne microorganisms that cause disease and other sources of infection.
3. Find out if the hospital has a waterborne pathogen prevention plan and whether any water treatment measures are used, such as chemical treatment or filters (point-of-use filtration) on faucets, showerheads and ice machines to reduce your risk of exposure to waterborne microbes.
4. Transplant patients and other high-risk patients can reduce the risk of Legionella and other disease-causing germs in the water by using filtered or bottled water.
5. If you are a patient at high risk for infection (especially transplant patients) and your hospital care unit does not have a prevention plan or point-of-use filters for faucets, showers and ice machines, avoid exposure to non-sterile or untreated tap water. Typical tap water exposures include sucking on ice, drinking water, bathing, showering and use of medical equipment that has been rinsed in hospital tap water.
6. Ask the hospital about any precautions you should take once youve been discharged. Boiling water for drinking has been recommended for immunocompromised patients.

The nation has a critical need for effective infection control practices for patients and for healthcare workers, particularly in the summer, noted Dr. Stout.This is a wake-up call for preparedness and prevention, not just for hospitals, but for patients as well, she said.