Legionella E-news -- 11 January 2001

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Legionella E-news, 11 January 2001
HC Information Resources Inc.
Matthew R. Freije, Editor

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**IN THIS ISSUE**
1. Quotes from the CBS Legionnaires' story
2. Outbreaks
3. JCAHO provides guidance for complying with new standard
4. The first rapid field test for Legionella (Advertisement)

1. QUOTES FROM THE CBS LEGIONNAIRES' STORY
CBS Evening News with Dan Rather aired a story on hospital-acquired Legionnaires' disease 15 December 2000. The story focused on the need for hospitals to test patients for Legionella per US CDC guidelines, and on the debate about water sampling. Here are quotes from the story:

Dr. Richard Besser of the CDC's Respiratory Diseases Branch said thousands of Legionnaires' cases go undetected every year because 80 percent of hospitals do not follow federal guidelines to test their pneumonia patients for Legionella. "Legionnaires' disease is greatly underreported, is under-recognized by clinicians, is under-tested for," Besser said. Hospitals "need to be testing their patients. That's essential." According to the CDC, only five to 10 percent of estimated cases are reported.

One patient who wasn't initially tested was 70-year-old Ernest Gresko, whose death from Legionnaires' disease three years ago fit an alarming pattern. Gresko was admitted to a Michigan hospital with symptoms of pneumonia -- of which Legionnaires' is a particular type -- but according to his daughter Valerie Greene, he wasn't tested for Legionnaires' for five days. The results came after he died. "He was so congested he could not breathe," said Greene. "It was the most horrible, painful death that anyone could imagine."

Dr. Glenn Morris, the chief of the Maryland task force, argues the CDC approach essentially tells hospitals to wait until patients are already sick before testing the water. "If you test, if you know what's going on, you can keep the cases from happening," said Morris. "This nation would save lives if hospitals were testing [water] on a routine basis."

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2. OUTBREAKS

New hospital in Paris, 4 cases, Dec. 2000: Four individuals contracted Legionnaires' disease in December 2000 at a hospital in Paris. One of the patients has died, but his death was related to a heart condition, according to the hospital director. The ultramodern 750-bed hospital opened in July. Because the hospital was only partially occupied, officials suspect that stagnant water in unused portions of the plumbing system was the source of contamination. Source: Associated Press, 30 December 2000.

1 nosocomial case, 3 others, Melbourne, Australia, Dec. 2000: A patient who died from Legionnaires' disease at a hospital in Melbourne on 12 December 2000 had been there for more than two weeks, indicating that the illness was acquired at the hospital (nosocomial). Graham Brown, the head of the Victorian Infectious Diseases Service, located at the hospital, said the patient who died would most likely have been infected by legionellae sprayed from the cooling towers when he went out on a balcony or outside the hospital. Legionellae were found in only 2 of the hospital's 12 cooling towers, and at low levels, but one of the Legionella strains found in the cooling tower matched the strain found in the patient. Details about the testing methods were not given. Three other patients in the same hospital were confirmed as having legionellosis. Two of them were admitted with flu-like symptoms, so the hospital reported that their cases were probably not nosocomial. Source: www.theage.com.au and Promed

Rennes, France, 19 cases, 5 deaths, Fall 2000: Between the end of July and 15 Nov 2000, 19 cases of Legionnaires' disease were reported in Rennes, France, five of whom have died. The French National Reference Centre has reported that the same strain of Legionella pneumophila serogroup 1 was found in seven of the patients. The source of infection is unknown. An investigation is in process. Source: Eurosurveillance Weekly, 20 Dec 2000.

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3. JCAHO PROVIDES GUIDANCE FOR COMPLYING WITH NEW STANDARD
ASHE (American Society for Healthcare Engineering ) and JCAHO (Joint Commission on Accreditation of Healthcare Organizations) recently collaborated to draft interim guidance for the management of waterborne pathogens per JCAHO's new standard EC 1.7 (formerly EC 1.9) requiring a program to reduce organizational-acquired illness. The document, which is posted at www.ashe.org/media/water.html, instructs health care facilities to conduct a risk assessment of potential sources (e.g., domestic water system and cooling towers) of Legionella contamination, and then to develop a management plan that includes standard operating procedures for maintenance and operation of water systems. (Hospitals that would like more information, including a price on a risk assessment and management plan, may contact Matt Freije at 760-494-3063 or mf@hcinfo.com.)

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4. THE FIRST RAPID FIELD TEST FOR LEGIONELLA (ADVERTISEMENT)
Binax introduces the Equate Legionella Water Test, the first rapid test to deliver results in under an hour. Equate detects Legionella pneumophila serogroup 1, the cause of up to 90% of cases of Legionnaires' Disease. It's rapid, accurate and easy to use and works on both potable and cooling tower water. For more information, visit http://www.binax.com or call Binax at 1-800-323-3199.

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THANK YOU!

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

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