Legionella E-news -- 11 October 2000

Legionella E-news, 11 October 2000
HC Information Resources Inc.
Matthew R. Freije, Editor

**IN THIS ISSUE**
1. Outbreaks: Denmark, Virginia, Washington DC
2. JCAHO EC 1.9
3. Consider dialysis when disinfecting hospital domestic water

1. OUTBREAKS: DENMARK, VIRGINIA, WASHINGTON DC  return to contents list

-- 2 cases in same neighborhood, Denmark, Spring 2000
Two individuals who lived in the same block of flats and shared the same hot water system contracted Legionnaires' disease; the two cases were reported to Copenhagen health officials in the spring of 2000. Legionellae were found in each of the two flats and also in the water circulating line for the entire building. Three serogroups of Legionella pneumophila were found in the water. The serogroup found in one of the patients matched one of the serogroups found in the circulating water. The serogroup found in the other patient matched the serogroup found in both of the flats and in the circulating water. Subtyping indicated identical matches. Water temperatures were increased to 60 C (140 F). One month later, legionellae were still found in water samples, but at lower levels. The water system was then disinfected with chlorine. More samples will be collected in the fall. Source: Eurosurveillance Weekly, 5 October 2000 and Epi-News 2000

-- Two community cases, Virginia (USA), Sept. 2000
Two cases of Legionnaires' disease were reported in Covington, Virginia over a two-week period. The two individuals live six blocks apart. As of 15 September, both patients were still on lung ventilators. Health Department officials are trying to determine the source of infection. Source: Richmond Times Dispatch, 15 September 2000

-- Washington DC schools, two cases, Aug-Oct 2000 
On 6 October 2000, DC health officials reported that a case of Legionnaires' disease contracted by a teacher at Benning Elementary was the second case of the disease involving city school workers recently. The first case occurred in August 2000 in a custodian who worked at Eastern Senior High School. The case at Benning involved a woman of only 24 years of age. She was still recovering in the hospital as of 6 October. Health authorities are investigating the buildings. Source: The Washington Post, 7 October 2000

2. JCAHO EC 1.9  return to contents list
JCAHO's updated standard EC 1.9, effective January 2001, will require a utility systems management program to "reduce the potential for organizational-acquired illness." Health facilities will be responsible for "managing pathogenic biological agents in cooling towers, domestic hot water, and other aerosolizing water systems." The standard is posted at http://www.jcaho.org/standard/stds2001_mpfrm.html. Neither the standard nor any other JCAHO document provides details as to what JCAHO will look for specifically. However, a JCAHO engineer, in discussing the standard with Matt Freije, revealed that JCAHO will look for engineering measures-at least planned, if not yet implemented-to minimize the growth of legionellae and other waterborne pathogens. Water sampling will not be an absolute requirement. If your hospital needs help in drafting a management plan for EC 1.9, contact Matt Freije at 760-494-3063 or mf@hcinfo.com.

3. CONSIDER DIALYSIS WHEN DISINFECTING HOSPITAL DOMESTIC WATER  return to contents list
One man died and 18 were hospitalized after receiving treatment at a dialysis center in Youngstown, Ohio (USA) on 30 August 2000. As of 26 September, one patient was still in critical condition; the others had been released from the hospital. Investigators suspect that the problem could have been chloramines or bacteria in the water used for dialysis. Chloramines, chlorine, or chlorine dioxide used by water utilities, as well as bacteria and other impurities, must be removed from water to be used for dialysis. The same applies for disinfectants introduced into a building water system for legionellae control. Before selecting and implementing a system for legionellae disinfection, the effect on dialysis patients must be considered. If you have questions about a particular application, contact Matt Freije at 760-494-3063 or mf@hcinfo.com .

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THANK YOU!

Matt Freije
HC Information Resources Inc.
http://hcinfo.com
 

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