Saturday, July 26, 2008

The test results

I am glad to say that test results received yesterday show no Legionella bacteria in the cooling tower of an office building on the campus on the Community General Hospital.

As reported in the news media (see "No more Legionella in cooling tower" on WSYR-TV), that tower has been the investigated by the hospital, along with the county and state health departments, in connection with Legionnaires’ disease. The hospital has also relied on independent experts, such Janet Stout, PhD, a national authority on Legionella and water systems.

To identify Legionella, a laboratory grows cultures of the organism from samples of water. To encourage the growth, the lab adds nutrients to a Petri dish containing the sample. The dish typically contains antimicrobial agents, as well, to inhibit the growth of other bacteria, thereby improving the chances of finding Legionella.

In the photo, above, the Petri dish on the left shows no growth of Legionella after seven days from a water sample obtained from the office building cooling tower. For comparison purposes, the lab provided me with a photo that shows what Legionella looks like (in the Petri dish, on the right) after four days of growth. The comparison sample was from a source not associated with Central New York. For a better look at the Petri dishes, click on the photo.

Wednesday, July 23, 2008

Behind the headlines

In the past two weeks, a number of people have asked me about Legionnaires’ disease as a result of news coverage about patients in Onondaga County, including some who visited the Community General Hospital campus.

The news media work hard to provide the facts, and the hospital has spent a fair amount of time running down answers to questions and assuring that reporters had accurate information. But Legionella is not an easy subject to pin down in a few short sentences – or in short headlines that can look somewhat alarming.

My most important message has been simple and direct: Community General Hospital has done – and will continue to do – everything possible to ensure the health and safety of our patients, visitors, employees, physicians, volunteers, and neighbors. This is our number one priority.

Our engineering staff, our clinical professionals, and our communications people have spent many, many hours in recent days assuring that we have done the right things and that we fully respond to all requests, whether from patients or staff, from the County and State Departments of Health – or from the news media.

There have been several frequently asked questions, which I answer below.

For those with individual concerns, Community General Hospital has a health info line at (315) 492-5253. Feel free to call us.

To learn more about Legionella, please visit the website of Janet Stout, PhD, and her colleagues, who are experts on the subject. Dr. Stout has worked with Community General during our investigation.

How do I know I won’t get Legionnaires’ disease on the Community General Hospital campus?

You are safe on the Community General Hospital campus. We have taken proactive measures with our physical plant and patient protocols to ensure the health and safety of everyone on our campus – and we will continue to take every step necessary to do so.

Right now the office building on our campus has one of the most studied, most tested, and most treated water cooling towers in upstate New York, if not in the entire northeast. The New York State Department of Health continues to monitor the situation and has said there is no information to suggest any ongoing exposure on the Community General campus. Our hospital continues to work collaboratively with both the Department of Health and the Onondaga County Health Department.

A member of my family – and I personally – have sought care at Community within the past several weeks.

News reports said that an office building cooling tower on the hospital campus tested positive for Legionella, even after a first disinfection. What are you doing about it?

For years Community General Hospital has proactively treated cooling towers using outside water treatment experts – and will continue to do so. From the very first signs of concern, the office building cooling tower was disinfected using a chemical shock treatment to eradicate the presence of Legionella. A second disinfection process, about ten days after the first, was undertaken before we received any test results from the first one. The second disinfection used a 48-hour treatment program recommended by independent Legionella experts and the Centers for Disease Control. We felt this was an important precautionary measure. Preliminary test results indicate that this treatment was effective, and we await final results.

Is the office building cooling tower the source of the outbreak?

Although the cooling tower has not been confirmed as a source of the Legionnaires’ outbreak, we have acted as if it were, taking all the steps necessary to increase treatment and to measure results. Health officials have told me they continue to investigate other possible sources within the county.

Have any patients or hospital employees contracted Legionnaires’ disease?

Our surveillance program for diagnosing Legionnaires’ is very aggressive. No patients or hospital employees have been known to have contracted the disease. We have gone back and identified with employees who were ill and asked them to take a test for Legionella. All results have been negative.

Of the 13 cases identified as having Legionella in Onondaga County, Community General Hospital has firsthand knowledge of six who were treated at the hospital or by members of the medical staff. None of them are believed to have contracted the illness while in the hospital.

Am I able to drink the water at Community General Hospital?
Yes. The water is safe to drink. Patients are reminded to follow physician and nurse instructions.

Where does Legionnaires’ disease come from?
Legionnaires’ disease is caused by the Legionella bacteria, which is found naturally in the environment, usually in water. Legionella is very common, and small traces of the bacteria can be found in most water systems.

How do people contract Legionnaires’ disease?
People contract Legionnaires' disease when they breathe in a mist or vapor (small droplets of water in the air) containing the bacteria. The disease is not spread from person to person, and is most commonly found in people who smoke, who are 50 years of age or older, and who have a chronic lung disease or immune deficiencies.

What are the signs and symptoms of Legionnaires’ disease?
Although most people exposed to the bacteria do not become ill, Legionnaires' disease can have symptoms similar to other forms of pneumonia. Signs of the disease can include a high fever, chills and a cough. Some people may also suffer from muscle aches and headaches. Should you experience any of these symptoms, please contact your health care provider.

Tuesday, July 8, 2008

Today's Legionella announcement

This afternoon Dr. Cynthia Morrow, the Onondaga County Health Commissioner, announced that seven cases of Legionnaires’ disease were reported in the county over the past ten days. This includes four unconfirmed cases that Community General Hospital reported last week.

Obviously, there's a fair amount of news coverage this evening, including The Post-Standard, and Central New York television stations WSYR, WTVH, WSTM, and News10Now.

The Department of Health’s preliminary investigation identified that all of the unconfirmed cases were on or near Onondaga Hill, including at Community General Hospital. The source of this cluster of cases has not yet been determined.

Last week Community supplied the Health Department with water samples from both the hospital and the physicians’ office building cooling towers. In addition, over the course of the past several days, Community has undertaken additional measures involving experts in water treatment to assure disinfection of the cooling towers. Keeping Legionella below detectable levels in cooling towers at all times is practically impossible due to the ubiquitous nature of the bacterium, according to the Association of Water Technologists.

Community has routinely tested the hospital’s cooling tower and water supply. Also, Community has for years been one of the relatively few hospitals that actively tests for Legionella all patients who have pneumonia.

The office building cooling tower did recently test positive for the bacterium. In cooperation with the Health Department, we completely disinfected and sanitized that tower to eliminate the bacterium (even before test results were received).

Dr. Mitchell Brodey, Community’s Infectious Disease Specialist, and Sue Chamberlain, RN,CIC, our Director of the Infection Control Program, have been fully engaged with surveillance and with communications with the Department of Health, as has Community's engineering staff. We are glad to work with the state and county health department professionals, and we will continue to do so.