SPL article on evaluation efficacy of disinfection technology in Infection Control and Hospital Epidemiology
August 01, 2007
Safety and Efficacy of Chlorine Dioxide for Legionella Control in a Hospital Water System
In a 30-month prospective study, we evaluated the efficacy of chlorine dioxide to control Legionella bacteria in a water distribution system of a hospital with 364 patient beds and 74 skilled nursing beds. The number of hot water specimens positive for Legionella bacteria decreased from 12 (60%) of 20 to 2 (10%) of 20. An extended time (18 months) was needed to achieve a significant reduction in the rate of Legionella positivity among hot water specimens. At the time of writing, no cases of hospital-acquired Legionnaires disease have been detected at the hospital since the chlorine dioxide system was installed in January 2003. Use of chlorine dioxide was safe, based on Environmental Protection Agency limits regarding maximum concentrations of chlorine dioxide and chlorite.
SPL study results on role of environmental surveillance in Infection Control and Hospital Epidemiology
July 01, 2007
Role of Environmental Surveillance in Determining the Risk of Hospital-Acquired Legionellosis: A National Surveillance Study With Clinical Correlations
This 20 hospital study in 13 states shows environmental monitoring followed by clinical surveillance was successful in uncovering previously unrecognized cases of hospital-acquired Legionella pneumonia. Published in Infection Control and Hospital Epidemiology. Stout et al. July 2007: vol 28 no. 7.
Hospitals Urged to Exercise Greater Vigilance Over Their Water Systems In Summer Months Legionella Goes Undetected, Infection Often Misdiagnosed
June 27, 2007
Legionella Goes Undetected, Infection Often Misdiagnosed
East Hills, NY (June 27, 2007) Summer’s here and the living isn’t always so easy – especially if you’re in the hospital. Patients who are vulnerable to infection run a greater risk of contracting Legionnaires’ disease, a severe form of pneumonia, during warm, humid weather, according to a study published in the Journal of Infectious Diseases. The infection is caused by Legionella bacteria that can live in hospital water systems and throughout the environment.
Legionella bacteria, while usually not a problem for healthy adults, can be most serious and even fatal for patients who are immune compromised, including those in Intensive Care Units, the very young and the very old, the chronically ill, and post-surgical, cancer and transplant patients. These patients risk becoming infected through a buildup of microbes that can inhabit a hospital’s water system, where they have oftentimes become resistant to traditional methods of cleaning and disinfection.
At-risk patients can become ill through any exposure to hospital water, whether through ingestion, comforting mouth sores with ice cubes, bathing, inhalation of shower mist or being treated with equipment washed in hospital water.
“Many healthcare professionals aren’t aware of what’s lurking in their water in the summer or any season, especially the water used with critically ill and at-risk patients. As a result, countless Legionella and other harmful microorganisms that can cause serious infections go undetected,” according to Janet E. Stout, Ph.D., an international expert on Legionella and other microbes in hospital water.
Dr. Stout, Director of Special Pathogens Laboratory and a microbiologist at the University of Pittsburgh, is a strong advocate for reducing the risk of waterborne infection in hospitals, nursing homes and other healthcare facilities. She is on a mission to get these institutions to test their water and then do something about it.
Speaking at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC) in San Jose, California, Dr. Stout shared stories that vividly illustrated the problem:
- A hospital’s Burn Unit treated its badly burned patients with a cooling water spray to ease their pain…until it was discovered that the water was loaded with dangerous, infection-causing microbes.
- Another hospital, attempting to prevent the spread of infection, installed non-touch faucets.
But a study found that every faucet tested positive for Legionella bacteria, and that 74 percent were also contaminated with Pseudomonas aeruginosa, another bacterium associated with serious, often fatal, pneumonia.
Patients, their families and caregivers need to be aware of the potential for waterborne infection any time they are hospitalized, particularly if they are seriously ill or undergoing treatment that affects their immune systems, according to Dr. Stout.
Hospital Infection Costs Lives, Reputation and Dollars
Hospital-associated (“nosocomial”) infections of all types are a serious problem in the U.S. They affect two million people in hospitals and nursing homes each year, adding $30.5 billion annually to the nation’s health tab. This year more than 100,000 people will die from these infections, the fourth leading cause of death in the U.S., according to the Committee to Reduce Infection Deaths (RID), one of the nation’s leading organizations in the fight against hospital-associated infection.
Dr. Stout noted that 18,000 cases of Legionnaires’ disease are reported in the U.S. each year. She estimates that nearly 40,000 lives are known to have been lost to the disease over the past two dozen years as a result of infections acquired in the hospital, with thousands more cases thought to go undetected or misdiagnosed.
The financial costs associated with a single Legionella outbreak can run anywhere from $800,000 to well over $1.5 million, according to Dr. Stout, with an incalculable cost to a hospital’s reputation. And that’s just the tip of the iceberg, as infectious disease experts continue to identify new microbes in hospital water. Prevention is critical because many of these microbes are increasingly antibiotic-resistant, making the infections even harder, if not impossible, to treat.
Point-of-use Filtration Helps Reduce Spread of Infection
There are solutions, however, according to Dr. Stout, noting that no single systemic disinfection technology can completely eliminate these microorganisms from hospital water systems.
The germs survive and even thrive in hospital plumbing despite chemical and heat-based treatments designed to eradicate them. Many of the germs live in biofilms, communities of microorganisms that adhere to the pipes and are protected from systemic disinfection treatments. Waterborne microbes may also be harbored by amoebae that shelter them and safely transport them to distant locations in the hospital’s water system.
“Effective protection for high-risk immunocompromised patients (cancer and transplant patients) requires delivery of water that meets a higher standard than normal tap water. One option is the addition of point-of-use filtration technology.” Citing studies conducted by the VA Pittsburgh Healthcare System, the University of Pittsburgh and the University of Bologna using Pall-Aquasafe™ Water Filters, Dr. Stout stated that this technology minimizes patient exposure to waterborne microbes, including Legionella and Pseudomonas aeruginosa, by breaking the infection chain between water and patients.
She advises that point-of-use filters may be used on faucets, showerheads and ice machines in all areas where there are high-risk patients. She also recommends the quick implementation of point-of-use filters in a targeted approach during an infectious outbreak.
Patients should become familiar with these problems and take preventive steps to protect themselves. Dr. Stout offers the following tips to patients, their families and caregivers:
Dos and Don’ts To Reduce Your Risk Of Waterborne Infection In The Hospital
- Check your hospital’s infection rates if you can, and find out how your hospital compares to others in your region. The issue is timely because a growing number of states, including New York and California, are enacting legislation to make hospital infection rates public.
- Ask the hospital if it tests its water system for Legionella, common waterborne microorganisms that cause disease and other sources of infection.
- Find out if the hospital has a waterborne pathogen prevention plan and whether any water treatment measures are used, such as chemical treatment or filters (point-of-use filtration) on faucets, showerheads and ice machines to reduce your risk of exposure to waterborne microbes.
- Transplant patients and other high-risk patients can reduce the risk of Legionella and other disease-causing germs in the water by using filtered or bottled water.
- If you are a patient at high risk for infection (especially transplant patients) and your hospital care unit does not have a prevention plan or point-of-use filters for faucets, showers and ice machines, avoid exposure to non-sterile or untreated tap water. Typical tap water exposures include sucking on ice, drinking water, bathing, showering and use of medical equipment that has been rinsed in hospital tap water.
- Ask the hospital about any precautions you should take once you’ve been discharged. Boiling water for drinking has been recommended for immunocompromised patients.
The nation has a critical need for effective infection control practices for patients and for healthcare workers, particularly in the summer, noted Dr. Stout. “This is a wake-up call for preparedness and prevention, not just for hospitals, but for patients as well,” she said.
About Pall Corporation
Pall Corporation (NYSE: PLL) is the global leader in the rapidly growing field of filtration, separation and purification. Pall is organized into two businesses: Life Sciences and Industrial. These businesses provide leading-edge products to meet the demanding needs of customers in biotechnology, pharmaceutical, transfusion medicine, energy, electronics, municipal and industrial water purification, aerospace, transportation and broad industrial markets. Total revenues for fiscal year 2006 were $2.0 billion. The Company headquarters is in East Hills, New York with extensive operations throughout the world. For more information visit Pall at www.pall.com.
May 10, 2007
Experts: Don’t drink hospital water
May 10, 2007 by Karl B. Hille, The Examiner
BALTIMORE (Map, News) - What you don’t know about your hospital’s water supply could kill you. Maryland health officials put guidelines in place for Legionella testing in hospital water supplies six years ago, but there is no enforcement component, and the state does not know who is complying, health officials told The Examiner on Wednesday.
Maryland General Hospital in Baltimore identified a colony of the bacteria in its water supply in March and notified patients.
“Maryland General is one of the first hospitals that was following the Maryland state guidelines and conducting proactive testing,” said microbiologist Janet Stout of the University of Pittsburgh, an expert in water-borne pathogens who has communicated with Maryland General about its water supply.
“They are doing the monitoring for Legionella. They are being proactive, and they are being unfairly criticized for it.”
Officials from Maryland General did not return calls for comment.
Maryland guidelines call for routine monitoring in all hospitals throughout the state. Allegheny County, Pa., and New York state also have proactive guidelines, but only New York provides citations and penalties for hospitals that don’t comply.
Federal guidelines call for monitoring only after infections are identified.
“I think the [state] guidelines have been reasonably effective,” said Dr. Glenn Morris, professor of epidemiology and preventive medicine at the University of Maryland School of Medicine. “We have seen a reduction in the number of cases of hospital-acquired Legionella.”
He said Maryland has not published information on which hospitals are complying but plans to do so in the next few years.
Legionella bacteria causes Legionnaires’ disease, which has a nearly 50 percent death rate when picked up in a hospital setting, Stout said.
A type of pneumonia that hospitalizes between 8,000 and 18,000 people in the United States each year, Legionella is usually more active in the summer and early fall, according to the Centers for Disease Control and Prevention. Symptoms include a high fever, chills and a cough, but muscle aches and headaches can also be present.
Sources of infection in hospitals include some of the very tools promoted for keeping patients healthy, Stout said, such as sinks, showers, sensor faucets and spray devices for patients in burn units.
Aerosolized bacteria can be inhaled, speeding infections. Ice machines, decorative fountains and medical equipment, such as ventilators and humidifiers, also can spread the disease, she said.
Reprinted by permission from The Examiner
March 15, 2007
By DOUG SWORD
SARASOTA COUNTY -- Two local cases of Legionnaires' disease were confirmed Wednesday by the Sarasota County Health Department, which has a team of investigators trying to determine the source of the often fatal illness.
"Normally, for any outbreak of this type we're not only going to have a good number of investigators, but take a multiple disciplinary approach" to determine if these are isolated cases or if the bacteria has a single source, said Dr. Zenobia Brown, the department's acting executive medical director.
While Brown said she was precluded by law from revealing where the cases occurred, neighbors in The Landings subdivision in Sarasota County confirmed that health officials had interviewed them and that the whirlpool bath in the gated-community's club had been drained as a precaution.
The first case of Legionnaires,' a type of pneumonia, was discovered about 10 days ago and both victims are still hospitalized.
The Centers for Disease Control say there are between 8,000 and 18,000 cases a year and Brown says there are, on average, five cases a year in Sarasota County.
Legionnaires' has a mortality rate of around 20 percent, but if identified, there is a "very effective antibiotic therapy," said Janet Stout, a University of Pittsburgh microbiologist, who specializes in the disease.
The problem is the disease's similarity to a far more common types of pneumonia. A physician must suspect Legionnaires' and order a specific test. Only about 5 percent of people exposed to the bacteria develop symptoms, although the elderly and people with an underlying health problem are more susceptible, Stout said.
The vast majority of Legionnaires' cases are isolated, and multiple cases can indicate the existence of a single source. "When two or more cases occur, that's when it triggers an investigation to identify the source," said Stout, noting that Legionnaires' disease is not contagious.
That source is water, as in the case of a Louisiana grocery store where a misting machine was spewing out the bacteria, Stout said.
Since the source hasn't been determined yet, residents are "kind of nervous," said Shirley Brodsky, who lives on Landings Boulevard.
Adding to her own personal concerns about the disease, Brodsky noted that she lived in Philadelphia in 1976 when the disease got its name after an outbreak of 122 cases at an American Legion conference.
"We're kind of upset about it that it should happen here and that there are people that are in the hospital," Brodsky said.
"From those two patients' perspective, it's a serious disease," the health department's Brown said. "From the health department perspective, our job is to find out if there's a serious public health threat."
The most common sources are hot tubs or air-conditioning cooling towers, but it's possible these two cases are isolated and there isn't a single source, Brown said.
If there is a source, Sherman Wolfson, another Landings resident, hopes they find it soon.
Residents say health department officials seem to be taking a methodical and urgent approach as they interview people.
After finding out that Wolfson was recently ill, officials interviewed him and looked at his hospital records to confirm that he hadn't had Legionnaires' disease.
"They checked me out to see if I'd had it," Wolfson said.
Reprinted by permission from the Herald Tribune.
March 08, 2007
Infection Control Saves Lives and Costs
New York, NY (March 8, 2007) - - “Hospital infections affect two million Americans every year, costing 100,000 lives and adding $30.5 billion to the nation’s healthcare tab,” said Betsy McCaughey, Ph.D., founder and chairman of the Committee to Reduce Infection Deaths (RID). “This issue is especially critical for New York right now,” she said, because infection rates of New York hospitals will be made public beginning in 2008.
Dr. McCaughey, Legionella expert Janet E. Stout, Ph.D., University of Pittsburgh, and Bruce Farber, M.D., Chief of Infectious Diseases at North Shore University Hospital, N.Y., met with New York-area hospital executives and infection control professionals today to discuss the latest medical and economic data on infections acquired in the healthcare setting and provide solutions. The seminar, held at the Hilton in Melville, New York, was sponsored by RID and the North Shore-Long Island Jewish (LIJ) Health System with an educational grant from Pall Corporation.
Maureen and Marie Daly of Brooklyn, who lost their mother, Johanna, to a hospital infection in 2004, lent a personal perspective to the clinical discussion. Johanna Daly was a healthy, active 63-year-old when she entered the hospital for repair of a fractured shoulder. Within a few days of her discharge she had a raging fever and died three months later from a severe infection caused by a combination of deadly bacteria.
Dedicating herself to the cause of reducing hospital infection, Maureen Daly gave up her business and joined RID full-time. “It means everything to me to be able to help prevent this from happening to others,” she said.
Dr. Stout, a Microbiologist at the University of Pittsburgh Department of Civil and Environmental Engineering, educated seminar attendees about a less well-known, but no less deadly, source of infection in healthcare settings. Conveying “Lessons Learned from Legionella,” she took participants on a guided tour of hospital water systems – faucets and showers, ice machines, cooling towers, humidifiers and even decorative fountains, where biofilm, Legionella and other deadly microorganisms thrive.
“If you have it in your water, you’re going to have it in your patients,” she warned. “It’s not even necessary for vulnerable patients to come into direct contact with water,” she said. “They can become infected just by breathing the aerosols, which take the form of steam or mist from hospital showers and sinks.”
While Legionnaires’ disease has been the subject of considerable media attention due to several recent outbreaks across the country, Dr. Stout highlighted other waterborne pathogens – bacteria and fungi – that can be as dangerous to patients, including Pseudomonas aeruginosa, Mycobacterium avium and Aspergillus fumigatus.
Infectious disease specialist and seminar moderator Joseph S. Cervia, M.D., Clinical Professor of Medicine & Pediatrics, Albert Einstein College of Medicine, and Medical Director, Pall Corporation, explained why disinfection is so difficult. “The problem of eradicating waterborne microbes from hospital water systems so that patients are not exposed to them is compounded by the growing threat posed by amoebae that ‘harbor’ the microbes and protect them from physical and chemical disinfection technologies,” he said. “The microbes survive and multiply inside the amoebae and are released into hospital water systems, where they can become a source of serious infection.”
Infection Control Can Make the Difference
Dr. McCaughey, a leading national figure in infection prevention and former Lt. Governor of New York, illustrated the cost-effectiveness of infection control. Research shows that eliminating infections can result in a 20-to-1 payback for the hospital within the first year alone, with no or minimal capital outlay. “Good infection control can make the difference between profitability and loss for an individual hospital,” she said.
“Hospitals can ill afford outbreaks,” said Dr. Stout, underscoring the financial impact. “A single outbreak of Legionnaires’ disease can cost anywhere from $880,000 to $1,630,000, not to mention the cost to a hospital’s reputation.”
Dr. Stout reviewed state-of-the-art solutions for reducing Legionella and other waterborne microorganisms, noting that no single systemic disinfection technology can completely and permanently eliminate these pathogens from hospital water systems. “Protection for at-risk patients also requires point-of-use filtration technology,” she said.
Experts Share Solutions, Success Stories
Dr. McCaughey focused on cost-effective measures to curb the alarming rise in methicillin-resistant Staphylococcus aureus (MRSA), one of the deadliest germs responsible for hospital infection and one of the hardest to treat. She presented success stories from hospitals in Virginia, Pennsylvania and Iowa that realized significant reductions in infection rates through simple screening programs and rigorous enforcement of staff and equipment hygiene procedures.
There is no more timely an issue than the importance of implementing effective infection controls, according to Dr. McCaughey, because of the larger impact that it can have on emerging threats such as bioterror and bird flu. “In the event of a major outbreak, proper procedures, rigorously followed, can help reduce infection in first responders, healthcare workers and patients,” she said.
“Minimizing the risk of hospital-associated infections (HAIs) is the highest priority of the North Shore-LIJ Health System,” said Dr. Farber. “The epidemiology and virulence of HAIs change over time, so it is imperative that healthcare providers have control strategies in place to stay ahead of the problem.”
Dr. Farber, who advises on infectious disease issues throughout the North Shore-LIJ system, added that many infections are the product of novel therapies that are being used to treat diseases that in the past were not amenable to therapy. The North Shore-LIJ Health System has implemented a number of programs to minimize risks, in addition to a myriad of standard policies and procedures that are already in place to accomplish this goal. These include participation in the nationwide infection awareness and education campaign being led by the Institute for Healthcare Improvement (IHI); a control program for addressing so-called staph or MRSA infections, including the use of high tech screening of high-risk patients; disinfection, notification and isolation techniques to control Clostridium difficile, a bacterium that can cause serious bowel problems; employee education on hand hygiene and disinfection; surgeon-specific infection rate monitoring; and computer tracking of HAIs.
The Committee to Reduce Infection Deaths (www.hospitalinfection.org) is a nonprofit educational organization dedicated to providing hospital administrators, caregivers, insurers, and patients with the information they need to stop hospital infections.
About North Shore-Long Island Jewish (LIJ) Health System The nation's third largest, non-profit, secular healthcare system, the North Shore-Long Island Jewish Health System (www.northshorelij.com) cares for people of all ages throughout Long Island, Queens and Staten Island – a service area encompassing more than five million people. The health system includes 15 hospitals, four long-term care facilities, a medical research institute, four trauma centers, five home health agencies and dozens of out-patient centers. North Shore-LIJ facilities house more than 6,000 beds, and are staffed by over 8,000 physicians, 10,500 nurses and a total workforce of about 37,500 – the largest employer on Long Island and the ninth largest in New York City. In recognition of its efforts to reduce hospital-acquired infections, the North Shore-LIJ Health System was awarded the 2006 Pinnacle Award by the Healthcare Association of New York State (HANYS).
About Pall Corporation
Pall Corporation (NYSE: PLL) is the global leader in the rapidly growing field of filtration, separation and purification. Pall is organized into two businesses: Life Sciences and Industrial. These businesses provide leading-edge products to meet the demanding needs of customers in biotechnology, pharmaceutical, transfusion medicine, energy, electronics, municipal and industrial water purification, aerospace, transportation and broad industrial markets. Total revenues for fiscal year 2006 were $2.0 billion. The Company headquarters is in East Hills, New York with extensive operations throughout the world. For more information visit Pall at www.pall.com