THE VIRGINIAN-PILOT
Copyright (c) 1996, Landmark Communications, Inc.
DATE: Saturday, January 13, 1996 TAG: 9601130300
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY MARIE JOYCE, STAFF WRITER
LENGTH: Medium: 97 lines
The death of a patient who apparently contracted Legionnaires' disease in November at Sentara Norfolk General Hospital has prompted hospital officials to monitor a critically ill nurse who works in the same area where the patient got the disease.
Tests indicate that the nurse probably has a streptococcal infection, not Legionnaires' disease, said Dr. Edward C. Oldfield III, chairman of Norfolk General's infection control committee. But more testing is being done to confirm that.
Meanwhile, the hospital has launched an aggressive campaign to eradicate any possible traces of the bacteria from its hot water system, superheating the water and flushing the lines. Multiple tests have found no trace of the Legionella bacteria in the system.
Legionnaires' disease is an acute pneumonia caused by a bacteria that can grow in air conditioner cooling towers and stagnant water supplies, including vaporizers. It starts as flu-like illness, and includes high fever, chills, muscle aches and headaches. It is usually not fatal. It is not passed from person to person.
The hospital staff planned to flush the hot water system a second time late Friday night.
Legionella thrives in temperatures from 110 to 120 degrees Fahrenheit. It dies at 150 degrees, but the agency that accredits hospitals won't allow the water temperature to go above 120 because of the risk that patients will be scalded.
So Norfolk General employees have to work at night, superheating the water and running all the taps for five minutes in the A and B wings of the hospital. In December, they also emptied and scrubbed the water holding tank.
The flushing procedure will be repeated every month for the next six months. If there have been no more cases by then, employees likely will cut the procedure back to every other month, said Oldfield.
Although its name probably provokes fearful images of its discovery during an outbreak at the 1976 American Legion convention in Philadelphia, when 34 people died, the fact is that Legionella bacteria live in and around many people who never become sick.
``Legionella is a ubiquitous organism. It's out there. Go look for it and you'll find it,'' said Betty S. Rouse, the state Health Department's regional epidemiologist.
People usually pick it up when inhaling water droplets from a contaminated water system - when taking a shower, for instance. People may be exposed to it without getting sick, said health officials. It is most dangerous to people with compromised immune systems.
Some studies have found that as much as 20 percent of pneumonia cases may be Legionnaires' disease, said Oldfield.
The case at Norfolk General concerns officials, however, because the patient apparently picked it up at the hospital.
Illnesses acquired at the hospital, called nosocomial infections, aren't rare. Every year, there are several reported cases around the country where patients contract Legionnaires' in the hospital. Studies have discovered it lurking in hospital - and home - water systems.
``Where you have water, you can have Legionella,'' said Oldfield.
From late October through December, DePaul Medical Center in Norfolk treated three people who apparently picked up Legionnaires' outside the hospital, and Norfolk General also had a patient who acquired the disease outside the hospital.
In fact, the Health Department doesn't routinely investigate isolated cases of the disease, said John Monroe, an epidemiologist with the Norfolk Health Department. ``Legionella is not something we routinely get excited about. We start asking questions when a number of cases pop up,'' Monroe said.
Officials became concerned, however, when a second patient who stayed in the same room at Norfolk General as the first case developed the same symptoms. Tests on this patient didn't show any trace of Legionnaires'; the tests are 80 to 90 percent accurate, Oldfield said.
Even so, ``I thought, that's close enough for me. I would rather do more than less,'' said Oldfield.
About the same time, a third patient in another part of the hospital developed a different type of Legionnaires' disease. Because this case was not caused by the same micro-organism, it could not be related to the first one, he said. Oldfield said they could not determine whether that was an infection acquired at the hospital or before the patient was admitted.
Cultures taken from the hospital's water system also were negative. However, Oldfield, after consulting with the Centers for Disease Control in Atlanta, recommended the hospital purge its water system. The Norfolk Health Department was told of the cases but didn't get involved because the CDC was handling it, said Monroe.
The nurse - the fourth suspected case - developed pneumonia after the water system had been flushed once. One test - the most accurate available - showed no trace of Legionella, said Oldfield. A second test was in a ``gray zone'' said Oldfield and is being redone. But the nurse did test positive for Streptococcus, he said, and it's very unlikely that Legionnaires' disease caused her illness. ILLUSTRATION: Graphic
KEYWORDS: INFECTIOUS DISEASE by CNB