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Legionnaires' Disease, is your facility at risk? [patient safety]
We will examine the factors that are playing a role in the increase in reports or Legionnaires' Disease and what can be done to increase patient safety.
In the News
Recently in the news, we’ve been hearing more about Legionnaires’ disease showing up in our U.S. hospitals and, in July of this year, the Centers for Disease Control (CDC) publically warned of more instances occurring throughout the U.S. population (McWhirter, 2016). Although the report did not issue the warning directly to hospitals, they have become a major source of the increase in recent infections and related deaths. This article will examine the causative factors that are playing a role in the increase in reports and what can be done to decrease the risk of healthcare-associated infections (HAIs) and increase patient safety.
So, exactly what is Legionnaires’ disease? According to the Mayo Clinic, “Legionnaires' disease is a severe form of pneumonia — lung inflammation usually caused by infection. Legionnaires' disease is caused by a bacterium known as legionella” (Mayo Clinic Staff, 2016). Symptoms usually occur between 2-10 days after exposure and are very similar to flu-like illnesses. It is an airborne illness caused by the inhalation of water droplets containing the bacteria through contaminated water sources, air conditioning cooling towers, and decorative fountains. Early-onset treatment with antibiotics is imperative for a cure, although some individuals may continue to have problems after their treatment (Mayo Clinic Staff, 2016).
Rise in cases
USA Today reported in June that Legionnaires’ cases have more than quadrupled from 1,127 reported in 2000, to 5,166 in 2014 (Szabo, 2016). CDC Director Tom Frieden attributes the increase in risk to several factors including a rise in the average age of the U.S. population and water systems needing replaced in older buildings. CDC investigators who were reviewing outbreaks that took place in “hotels and resorts, long-term care facilities, senior living facilities, and hospitals (McWhirter, 2016)” between 2000 and 2014 found that “workers had not used enough disinfectant, didn't change filters often enough, or didn't monitor their water pipes and storage areas properly, leading to the outbreaks” (McWhirter, 2016).
Water systems management is causing the biggest issues with hospitals and instances of Legionnaires’ today. Recently, two patients died at the University of Washington Medical Center after being diagnosed with Legionnaires’ during their hospital stay. Investigations traced the contamination back to an ice machine and two sinks in their cardiac care unit, where both patients were treated for unrelated illnesses prior to the onset of the symptoms of Legionnaires’ (Aleccia, 2016). Patients, family, and staff were warned not to use drinking fountains and sinks in the affected area of the hospital until facility management could install new filters on sinks, fountains, and showers and perform additional water testing to ensure that additional cases would not occur (Aleccia, 2016).
Using the above instance as an example, what should you look for at your hospital when assessing patient risk for exposure to Legionella?
Historically “ice machines have been linked to past episodes of Legionella infections — and deaths — in hospitals. The machines often contain water reservoirs located next to compressors, which can warm the water enough to allow any bacteria present to grow” (Aleccia, 2016). When was the last time your ice machines were looked at or maintained? I could guess that most individuals would not know. However, from my vast experience working with different hospitals, I see where ice machines could constitute a very big risk – the ones I’ve observed have had calcium-encrusted spouts, dirty and slimy trays, obstructions in the drainage area – it wouldn’t surprise me in the least that most ice machines weren’t growing a plethora of bacteria. If the machine itself is that poorly maintained, who knows when the last time the filters were changed or what the positioning of the heater coil is in relationship to the water hose.
Repurposed Patient Rooms:
Every hospital has done this – ran out of room for offices, storage, etc. and has converted an unused patient room to meet a unit’s needs. On the surface, nothing is wrong with that, other than I hope the engineering department was involved to address any changes in NFPA fire-safety requirements. But did anyone stop to think about the bathroom? It’s not enough to leave open plumbing (particularly in baths/showers) in unused rooms as regular-use water flow will be lessened and any water left in the pipes may stagnate and start the process of bacterial growth. These piping issues need to be addressed and corrected by the facilities’ engineering department during the time of conversion.
The Joint Commission requires that “the hospital minimizes pathogenic biological agents in cooling towers, domestic hot- and cold-water systems, and other aerosolizing water systems” in EP.02.05.01, EP 14 (The Joint Commission, 2016). What is your organization doing to meet this element of performance? If there is not a current plan in place that produces measurable, actionable results, the State of New York Department of Heath put together a great package of material that you should take a look at as you develop a plan to limit the risk of Legionella occurring in your hospital.
Legionnaires’ disease is just one example of harm that can come to our patients when the hospital environment is not vigilantly evaluated and maintained. We all need to do our part in keeping our patients safe.
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Aleccia, J. (2016, September 14). Ice machine, sinks linked to Legionnaires' cases at UW Medical Center. Retrieved from Seattle Times: http://www.seattletimes.com/seattle-news/health/uw-medical-center-reports-2nd-death-from-legionnaires-bacteria-is-in-water-supply/
Centers for Disease Control. (2016, May 31). Legionella (Legionnaires' Disease and Pontiac Fever). Retrieved from Centers for Disease Control and Prevention: http://www.cdc.gov/legionella/fastfacts.html
Mayo Clinic Staff. (2016, September 24). Legionnaires' disease. Retrieved from Mayo Clinic: http://www.mayoclinic.org/home/ovc-20242041
McWhirter, C. (2016, June 7). CDC Warns of More Instances of Legionnaires’ Disease. Retrieved from The Wall Street Journal: http://www.wsj.com/articles/cdc-warns-of-more-instances-of-legionnaires-disease-1465318948
Szabo, L. (2016, June 7). Legionnaires' disease diagnoses quadrupled since 2000. Retrieved from USA Today: http://www.usatoday.com/story/news/2016/06/07/cdc-most-legionnaires-disease-outbreaks-preventable/85518646/
The Joint Commission. (2016). The Joint Commission E-dition. Retrieved from Accreditation Requirements, Environment of Care (EC): https://e-dition.jcrinc.com/MainContent.aspx