Aug. 29 update on UW Medical Center Legionella cases

UW Medical Center implements additional water safety measures to protect patients, visitors and staff

Updated 2:30 PM, 08.29.2017

Posted in: Issues

  • Streak plate method for microbiological testing of Legionella bacteria. The plate showed in this image is illuminated with ultraviolet light. Centers for Disease Control

University of Washington Medical Center August 29 update on Legionella pneumonia cases

Subsequent testing has proven negative for the male in his 60s, mentioned below, who was hospitalized at UW Medical Center and was thought to possibly have community-acquired Legionella infection. This patient is no longer considered to have Legionnaires’ disease.

The other two people with health-care associated Legionella pneumonia were patients in the hospital's Cascade Tower. Environmental testing of this tower’s water systems is underway to identify the potential source of exposure. As an added precaution to protect patients, families and staff, special filters are being installed on showers and sinks in all patient rooms in the Cascade Tower this week. 

University of Washington Medical Center August 25 update on Legionella pneumonia cases

Geoff Austin, UW Medical Center executive director; Cindy Sayre, UW Medical Center chief nursing officer, and Dr. Tom Staiger, UW Medical Center medical director, provided this update on the three cases of Legionella pneumonia that were identified this week at UW Medical Center in Seattle:

Two patients hospitalized at UW Medical Center were diagnosed with probable healthcare associated Legionella pneumonia, commonly known as Legionnaires’ disease. One of these patients will be discharged shortly. We are sad to report that the second patient has died. This patient was very ill and had multiple underlying conditions. A third patient appears to have acquired the infection in the community and remains hospitalized at UW Medical Center.

As described earlier today in a press conference with Public Health – Seattle & King County, UWMC has implemented a robust plan to monitor our water systems, and we are following the latest and most advanced recommendations for preventing Legionella disease from the Centers for Disease Control and Prevention.

While we investigate the source of the hospital-acquired infections, we are temporarily limiting water use on all inpatient units of the Cascade Tower of the medical center until special bacterial filters are installed for showers and sinks. This restriction applies to patients, families and employees. Bottled water will be provided on all patient care units in the Cascade Tower.

We also want to assure you that Legionella disease is rarely, if ever, transmitted from person to person. Legionella is typically transmitted via inhalation of aerosolized water droplets containing Legionella bacteria or less commonly via aspiration of drinking water.

You can also watch the press conference with Dr. Jeffrey Duchin, Health Officer of Public Heath -- Seattle & King County, and Dr. Tom Staiger, medical director of UW Medical Center, on the King 5 Facebook page:

Please see our FAQ  (below) for more information about Legionella disease and about steps we are taking to protect our patients, families, visitors and staff.

What is the situation?

This month, August 2017, two patients hospitalized at UW Medical Center were diagnosed with probable healthcare associated Legionella pneumonia, commonly known as Legionnaires’ disease. An additional patient has been admitted to UWMC with Legionella acquired in the community.

UW Medical Center  are working closely with Public Health -- Seattle & King County to investigate these cases.

How long have you known about this?

All three patients were identified this week and the cases were reported to Public Health -- Seattle & King County. 

The Public Health -- Seattle & King County blog posted information regarding these patients: 

 “The first patient, a male in his 40’s, was reported to Public Health on August 23, and is in the process of being discharged from the hospital. The second, a female  in her 20’s, was reported to Public Health on August 24 and died on August 25. She was very ill and had multiple underlying conditions.  A third patient, a male in his 60’s who was also reported to Public Health on August 24 by UW Medical Center, was diagnosed with Legionella pneumonia, but appears to have acquired the infection in the community and not at UW Medical Center. He remains hospitalized.”

What is Legionella?

Legionella is a type of bacteria found naturally in freshwater environments, such as lakes and streams. It grows best in warm water.
Legionella can become a health concern when it grows and spreads in human-made water systems like hot tubs, hot water tanks, showers, decorative fountains and cooling towers. 

How do people get Legionnaires’ disease?

People can get Legionnaires’ disease when they breathe in a mist or vapor that has been contaminated with the bacteria. This can include contact with whirlpool spas, cooling towers, showering, and water used for drinking and bathing, and operating room equipment.

Legionella is rarely, if ever, transmitted from person to person.

The risk of healthcare workers acquiring Legionella infection in this type of hospital setting is considered to be low.

What is the source of these infections?

We do not yet know the source of the bacteria and are investigating various potential sources.

How long will it take before the source of these infections is identified?

It may take between10 to 14 days from the time that cultures were taken. We expect to know more information about the source at the end of August and in early September. 

How common is Legionnaires’ disease?

About 5,000 cases of Legionnaires’ disease are reported each year in the United States.

Legionnaires' disease accounts for approximately 1 percent to 9 percent of cases of community-acquired pneumonia.

How did you discover that these three patients had Legionella pneumonia?

At UW Medical Center, hospitalized patients with pneumonia are frequently evaluated for the possibility that they might have pneumonia due to Legionella bacteria.  

All three patients were identified through samples of their respiratory secretions or urine submitted for Legionella testing.

How many cases of Legionnaires’ disease have there been at UW Medical Center during 2017?

There have been no other cases of healthcare-associated Legionnaire’s disease identified at UW Medical Center during 2017.

What are the symptoms of Legionnaires’ disease?

The symptoms usually begin two to 10 days after exposure to the bacteria. The symptoms are typically similar to other types of pneumonia including fever, chills, and cough. Some people also have muscles aches and headaches.  

Who is at risk for getting Legionnaires’ disease?

Most people who get exposed to the bacteria will not become sick. The Centers for Disease Control and Prevention , also known as the CDC,  lists theses risk factors for Legionella pneumonia:

Age older than 50 years

Smoking (current or historical)

Chronic lung disease, such as emphysema or chronic obstructive pulmonary disease (COPD)

Immune system disorders due to disease or medication

Systemic malignancy, such as advanced cancer

Underlying illness such as diabetes, renal failure, or hepatic failure

How serious is this infection and what is the treatment?

Legionnaires’ disease is serious, but it can be treated with antibiotics. Most people who get sick need care in a hospital but make a full recovery. However, about 1 out of 10 people who get Legionnaires’ disease will die from the infection.

Is it safe for staff to drink the tap water at UW Medical Center?

In general, we believe that it is safe for healthy individuals to drink the tap water at at the medical center, including the patient care section known as the Cascade Tower. 

Because  Legionella bacteria are widely distributed in the environment, it is not uncommon for individuals to be exposed to Legionella in community settings such as commercial buildings and retail establishments. Since intensive sampling began in 2016, we have only identified Legionella bacteria in the Cascade Tower. Staff working in this tower who have concerns should feel free to request bottled water.  Drinking tap water in the Montlake and Pacific Towers is considered safe.

What is UW Medical Center doing to identify the source of this infection?

We are extensively inspecting and culturing equipment and water sources in the medical center.  We are also thoroughly cleaning equipment and machines that contain water.

What is UW Medical Center doing to prevent further cases of this infection?

UWMC is working closely with the Public Health -- Seattle & King County to identify a potential source of the infections and to address any ongoing risk. We will also be working with the CDC and other experts. We will keep you informed as we learn more.

How will UW Medical Center make sure that they are identifying any new cases? 

Our care providers have been made aware of this situation. They will consider the possibility of this diagnosis in any patient developing pneumonia while in the medical center and will obtain the appropriate testing for Legionella. 

In addition, each time we take a sample of an inpatient’s respiratory secretions, we are automatically testing for Legionella in addition to other microorganisms.

Should I be concerned?

We are being very vigilant in identifying a possible source.  Now that we know of these cases, we are alerting all our medical staff to be on high-alert for possible pneumonias that could be due to Legionella so that treatment can begin at the earliest possible time. If a provider suspects Legionnaires’ disease, the patient will be treated as if he or she had this infection until it has been determined that the cause is not Legionella.

Should I take antibiotics to prevent Legionella infection?

Most patients should not take antibiotics to prevent Legionella. Because only certain patients are at increased risk for this infection and because antibiotics may have side effects or interact with other medications, they should only be given to patients with active infection, or to prevent infection in highly vulnerable populations who may have been exposed to the bacteria in the Cascade Tower before enhanced precautions were started. These patients include those being treated for certain cancers or those who have recently undergone transplants. If you are in these special categories, we are already working with your healthcare teams regarding this situation.

Where can I get more information?

Call the UW Medicine Legionella Pneumonia Information Line: 1.855.520.2252.
Patients and their family members who have additional questions or concerns should talk with their care providers.

Tagged with: legionella, pneumonia, public health, UW Medical Center, environmental health, water borne illness, Legionnaires disease
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