Legionella Information, UPDATED June 12, 2014

Latest updates regarding legionella.

Update, June 12, 2014:

After extensive testing, review and close consultation with the Jefferson County Department of Health, the Alabama Department of Public Health and the CDC, UAB Hospital has lifted the precautionary recommendation that everyone on floors 5, 6 and 7 of the Women and Infants Center wear a mask when flushing the toilet. This precautionary measure was implemented after patients on a single unit on one floor tested positive for legionella, a bacteria that can lead to a type of pneumonia called legionellosis.

UAB Hospital has received preliminary results from the extensive tests taken on June 4 of the water system that serves the hematology/oncology unit. Those tests showed no presence of legionella bacteria. Those tests were conducted to confirm the effectiveness of the chemical shock that was successfully completed on May 31.

An additional patient on the hematology/oncology unit has tested positive for legionella bacteria; this patient was admitted to the unit several days before special filters that remove legionella from water were installed throughout the building on May 25. The patient is receiving appropriate treatment. Based on the incubation period of legionellosis and the preliminary test results that show no presence of legionella in the water system, the county and state health departments and the CDC agree that the onset of the patient’s symptoms suggest that exposure occurred prior to the installation of the water filters on the unit.

Water filters remain in place, and planned testing and remediation will continue with the guidance of public health authorities.

Patient and guest information: 205-934-CARE (2273)

 


 

Update, June 2, 2014:

UAB Hospital successfully conducted a planned chemical shock to the water systems of the Women and Infants Center this weekend, which followed previous steps of flushing and heat shocking that took place May 7-9. We will continue to work with public health authorities to test the water supply frequently and take appropriate steps to safeguard the health of our patients.

We discussed preliminary results of tests taken last week with the CDC, ADPH and JCDH. We understand from these discussions that it is common for certain levels of legionella to remain in a water system even after remediation. Some level of legionella was detected, and CDC, ADPH and JCDH did not recommend any additional water restrictions or precautions. The goal is to have no legionella detected, and remediation efforts are on schedule and will continue until that goal is reached. We continue to take proper steps in conjunction with our public health partners to allow for safe use of water on the affected floors, including the use of filters that remove legionella from water as a precautionary measure.

A patient who was recently admitted to UAB has tested positive for legionella bacteria; after review by CDC, ADPH and JCDH, it was determined that the patient acquired the bacteria from an unknown source prior to admission to UAB, and that this case is not related to those identified in early May. We continue to have no knowledge of new hospital-acquired infections contracted following our remediation efforts May 7-9.

 


 

Update, May 30, 2014:

We are continuing with our planned remediation efforts for Women and Infants Center floors 5-7 by moving to the next stage, a chemical shock to the water system using chlorine dioxide to kill any legionella bacteria that may be present. This will take place from 10 p.m. Friday to approximately 6 p.m. Saturday. During this time, the water in the system will be similar to that of a chlorinated swimming pool; water use on these floors will be limited. Out of an abundance of caution, we will deliver similar remediation systematically to the rest of the building as part of our ongoing response developed with our county and state public health partners and the CDC. We have no knowledge of new infections contracted after our remediation efforts that took place May 7-9.

 


 

Original post, May 28, 2014:

UAB Hospital has lifted most of the water restrictions it implemented in a limited area of the hospital late Saturday. Those precautionary measures were implemented out of an abundance of caution pending final results of tests after eight patients on one unit – hematology/oncology – tested positive for legionella, a bacteria that can cause a form of pneumonia called legionellosis.

We took proper actions to address the presence of legionella and installed special filters on shower and faucet heads, flushed the water system, and shocked it with extreme temperatures, to ensure safe use. We have consulted with public health authorities including local and state departments of health and the Centers for Disease Control and Prevention (CDC) and implemented these measures pursuant to proposed guidelines of the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) commonly followed in the U.S. and referred to by the CDC. We have no knowledge of new infections contracted after our remediation efforts.

Until we receive the test results that confirm these steps addressed the presence of legionella, we have asked that patients wear masks when flushing the toilet. Although the initial water restriction limited sink and shower use, that has been addressed by the filters.

Two patients who were on the unit prior to the remediation of the water system and tested positive for legionella, have died. The causes of their deaths have not been determined. We only know that in addition to their original illness the patients tested positive for legionella.

Legionella bacteria are found naturally in the environment, usually in water. The bacteria grow best in warm water, like the kind found in hot tubs, hot water tanks and large plumbing systems common in office buildings, schools, hotels and hospitals. Most people are exposed to legionella regularly and do not contract legionellosis. People with weak immune systems are more susceptible to legionellosis. According to the CDC, most cases of legionellosis can be treated successfully with antibiotics.

We will continue to make the safety of patients, staff and visitors our primary concern and communicate throughout this process.

Alabama Department of Health, UAB Hospital Joint Statement on Reporting


What happened?
Precautionary measures were implemented pending final results of tests after eight patients on one unit – hematology/oncology – tested positive for legionella, a bacteria that can cause a form of pneumonia called legionellosis. Two patients who were on the unit prior to the remediation of the water system and tested positive for legionella, have died. The causes of their deaths have not been determined. We only know that in addition to their original illness the patients tested positive for legionella.


What is legionellosis and how do you get it?
According to the CDC, legionellosis is a form of pneumonia caused by a type of bacteria called legionella. The legionella bacteria are found naturally in the environment, usually in water. Most people are exposed to legionella regularly and do not contract legionellosis. The bacteria grow best in warm water, like the kind found in hot tubs, hot water tanks and large plumbing systems common in office buildings, schools, hotels and hospitals. According to the CDC, people get legionellosis “when they breathe in a mist or vapor (small droplets of water in the air) containing the bacteria. The bacteria are not spread from one person to another person.”


What are the symptoms?
The symptoms are very much like those of pneumonia — cough, shortness of breath, high fever, muscle aches and headaches.


Is it often fatal?
Not in healthy people. People with compromised immune systems are more susceptible to legionellosis, and the mortality rate for such patients is higher.


What is the treatment?
Per the CDC, most cases of legionellosis “can be treated successfully with antibiotics. Healthy people usually get better after being sick with Legionnaires’ disease, but hospitalization is often required.”


What were the measures UAB took to address legionella?
We took proper actions to address the presence of legionella and installed special filters on shower and faucet heads, flushed the water system, and shocked it with first with extreme temperatures followed by a second shock of chlorine dioxide, to ensure safe use.We have consulted with public health authorities including local and state departments of health and the CDC and implemented these measures pursuant to proposed guidelines of the American Society of Heating, Refrigerating and Air Conditioning Engineers (ASHRAE) commonly followed in the U.S. and referred to by the CDC.


What did the water restriction entail?
Until we receive additional test results that provide further confirmation that these steps addressed the presence of legionella, we have asked everyone on the three floors under water restriction to wear a mask when flushing the toilet. Although the initial water restriction limited sink and shower use, that has been addressed by the filters.


Should I be concerned about receiving treatment at UAB Hospital?
No. We have taken steps to address the possible sources of the bacteria.  We have consulted with local and state health departments and the CDC. Out of an abundance of caution, wearing a mask when flushing the toilet on floors 5-7 of the Women and Infants Center is the extent of precautionary measures advised for patients, guests and staff.


The water restriction is for Women and Infant Center floors 5-7. Are other units/building/floors at risk?
No. The cases were limited to the hematology/oncology unit; there is no evidence that any other areas of the hospital were affected. The process of addressing the legionella has occurred; the temporary water restriction is a precautionary measure while we await additional test results. The water system that provides water to the hematology/oncology unit serves only floors 5-7 in the Women and Infant building and no other areas of the hospital. Out of an abundance of caution, we will deliver similar remediation systematically to the rest of the building as part of our ongoing response developed with our county and state public health partners and the CDC.


Are patients still getting sick?
We have no knowledge of new infections contracted after our remediation efforts.


How can you be sure other patients who have been discharged are not going to get sick?
We had a team of physicians investigate and proactively identify at-risk patients. If these patients had been discharged, a physician contacted and informed them of the possible risk and made them aware of symptoms. Many were prescribed antibiotics as a proactive measure. Given the incubation period for legionella and that we have seen no new infections after our remediation efforts, additional cases are not anticipated. While it is unlikely patients will present symptoms of legionellosis, as a precautionary measure, we are working with public health authorities including local and state departments of health and the CDC to review, including contacting patients where appropriate.


How do we know the unit is safe?
It is safe to receive care in areas affected by the water restrictions. Guidelines to ensure safety regarding water use have been communicated to patients and visitors and are available.


Why do you not know the source definitively? If you don’t know the source, is there still a danger?
We addressed the possible sources of the bacteria. We have no knowledge of new infections contracted after our remediation efforts.


Why was the water restriction not implemented sooner?
In working closely with the county and state health departments and CDC, it was recommended just recently that we restrict water use temporarily out of an abundance of caution while we await further test results expected to confirm that our efforts effectively addressed the presence of legionella. We implemented a water restriction that same day. Since then, further efforts have allowed us to reduce the water restriction.


Does UAB test for legionella proactively?
Yes. UAB conducts annual testing of our water systems. 





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