Legionella E-news -- 23 August 2001

**IN THIS ISSUE**

1. Hospital Hot Water System Blamed for 18 Cases, 3 Deaths

2. Three Cases Among Guests of Las Vegas Resort

3. Legionella Prevention Training Course

4. Decorative Fountains in Hospitals

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1. HOSPITAL HOT WATER SYSTEM BLAMED FOR 18 CASES, 3 DEATHS

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The hot water system at a hospital in Pamplona, Spain is believed to be the source of 18 cases of Legionnaires' disease that occurred between 29 July and 18 August 2001. Three of the cases were fatal. The cases were confirmed by urinary antigen tests. The victims ranged in age from 39 to 96 years. 16 of the 18 cases occurred in patients who developed pneumonia in the hospital; the other two were in persons who accompanied patients to the hospital. Legionellae were found in the domestic hot water system. Clinical isolates and positive environmental samples have been sent to the national reference laboratory, presumably for subtyping to determine if the Legionella strains found in the hot water system match those detected in patients. Hyperchlorination was carried out during the night of 17 August 2001. Source: Eurosurveillance Weekly, 23 August 2001. Reported by Aurelio Barricarte and Mikel Urtiaga, Regional Health Council of Navarra, Spain, and Salvador de Mateo, National Centre of Epidemiology, Madrid, Spain.

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2. THREE CASES AMONG GUESTS OF LAS VEGAS RESORT

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The Clark County (Nevada, USA) Health Department reported that three people staying at a Las Vegas timeshare resort contracted Legionnaires' disease in recent months. The first was in February; the most recent was in June. All three were hospitalized and have since recovered. Isolates from only one of the patients were saved and tested. Health officials reported that legionellae were found in a water heater and a rooftop spa, and that the Legionella strain in the environmental samples matched the strain found in the patient. The property owner voluntarily shut down the floors served by the water heater in which the bacteria were found and relocated about 300 guests. According to health officials, evidence is insufficient to conclude for certain that the three people were exposed to Legionella while staying at the resort. Source: Associated Press

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3. LEGIONELLA PREVENTION TRAINING COURSE

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 * Baltimore, Tues.-Wed., 18-19 September 2001

 * San Diego, Thurs.-Fri., 25-26 October 2001

 * Atlanta, Tues.-Wed., 13-14 November 2001

For more information, visit http://hcinfo.com/legionellaseminar.htm.

You can host a seminar in your city - visit http://www.hcinfo.com/hostseminar.htm for information.

You can also get customized onsite training for your organization (http://www.hcinfo.com/onsitetraining.htm).

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4. DECORATIVE FOUNTAINS IN HOSPITALS

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Cases of Legionnaires' disease have been linked to decoration fountains (Hlady, GW, RC Mullen, CS Mintz, BG Shelton, RS Hopkins, and GL Daikos. "Outbreak of Legionnaires' Disease Linked to a Decorative Fountain by Molecular Epidemiology." American Journal of Epidemiology, Oct. 15, 1993; 555-561). Here are recommendations for hospitals for reducing risk (excerpted from Management Plan for Legionella and Other Waterborne Pathogens - http://hcinfo.com/managementplan.htm):

    * Carefully consider the installation of a decorative fountain in any area of the hospital -- it is best to avoid them altogether.

    * Do not locate decorative fountains in or near high-risk patient-care areas.

    * Treat the water in decorative fountains for control of microorganisms. Maintaining chlorine at 2-3 ppm may be appropriate. Consult the water treatment service for advice.

    * Check disinfectant levels in decorative fountains at least once a week to ensure that the appropriate biocide level is maintained.

    * Drain and clean decorative fountains at least twice a year -- more often if slime or dirt is visible.  Scrub all surfaces with a chlorine solution (1 part chlorine to 20 parts water may be appropriate).

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(c) Copyright 2001, HC Information Resources Inc.

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THANK YOU!

Matt Freije

HC Information Resources Inc.

http://hcinfo.com