Pittsburgh's Mercy Hospital switched water treatment system after 2 Legionnaires' cases
Two patients contracted Legionnaires' disease at UPMC Mercy before the Uptown hospital switched from the type of water-treatment system that investigators are eyeing as a cause of the deadly outbreak at the VA Pittsburgh Healthcare System.
The Mercy patients recovered from Legionnaires', identified between October 2009 and September 2010, UPMC officials said last week. At the Oakland VA, which uses the same copper-silver ionization method to prevent the Legionella bacteria, at least five people became sick recently and one died.
Copper-silver systems release charged particles —ions — that kill Legionella bacteria in the water supply. Ionization systems are not inherently flawed, experts said. They just demand regular maintenance and a basic understanding of their effectiveness, which can be compromised when facilities undergo construction or renovations, they said. Mercy and the Oakland VA had construction around the times of their Legionnaires' cases.
“When that (water flow) is disrupted, there has to be awareness,” said Neil Silverberg, president of Enrich Products Inc., a Wilkinsburg company that specializes in copper-silver. “When you implement the hot water again and turn it back on, the best policy would be to run it and flush outlets.”
UPMC found construction at Mercy interrupted water flow and temporarily inhibited the copper-silver system, spokeswoman Wendy Zellner said. She said a switch to automatic sinks made the Mercy system less effective. The automatic sinks use less water, so fewer Legionella-fighting ions were present to kill the bacteria.
“Our monitoring caught the issue, and a decision was made to change the treatment system rather than a large number of sinks,” Zellner wrote via email. Mercy now uses a combination of chlorine and ammonia, called monochloramine, for Legionella prevention.
The VA is investigating all possible causes for the Legionella in Oakland and at the Heinz campus near Aspinwall, including whether renovation or construction might have contributed to the problem, according to VA spokesman David Cowgill.
A spokesman for the Centers for Disease Control and Prevention, which is investigating the VA outbreak, said a report to the VA will outline a potential source or sources for the outbreak.
Nationwide, the Department of Labor counts about 10,000 to 50,000 Legionnaires' cases a year. People with weakened immune defenses are especially susceptible. Most healthy people exposed to Legionella will not develop the disease.
UPMC uses a combination of copper-silver and other treatment systems across its network. The West Penn Allegheny Health System also uses copper-silver systems, checks them regularly and has not seen any Legionnaires'-related problems, spokeswoman Stephanie Waite said.
Microbiologist Janet E. Stout said several disinfectant techniques can kill Legionella, but that “you don't always recommend the same one.”
“When you evaluate a facility for Legionella disinfection, you have to take into consideration the facility as a whole,” said Stout, a former VA researcher who helped investigate the Mercy Legionnaires' cases. “It's not a one-size-fits-all when it comes to Legionella disinfection.”
The director of the Special Pathogens Laboratory in Oakland, she and fellow researcher Dr. Victor Yu left the Pittsburgh VA about five years ago after a disagreement involving the VA's pathogens lab. They advocated the installation of the copper-silver system at the Oakland VA hospital in 1994. Yu and Stout in the early 1980s pinpointed hospital water systems as one source of Legionnaires' outbreaks.
They said lackluster maintenance of the copper-silver system might have led to the Legionnaires' outbreak at the Pittsburgh VA. The VA has not answered the criticism.
Copper-silver systems are “clearly not perfect if they're not maintained,” said Russ Nassof, executive vice president of the Scottsdale, Ariz., consulting firm Risknomics. He alerted clients after the VA's November announcement of an outbreak that copper-silver remains effective “as long as they follow manufacturer instructions.”
Chlorine has “at least equal negative problems,” Nassof said, citing corrosion of plumbing and carcinogens linked to the element.
Some research, however, has suggested chlorine dioxide may be more effective than copper-silver ionization in preventing Legionella. Every facility that engineer Tim Keane has seen switch from copper-silver to chlorine dioxide reduced its Legionella counts, he said.
“I think this (VA) outbreak will make people take a second look,” said Keane, a water-systems consultant in Bucks County who once worked for a chlorine-dioxide company. “My guess is, this is going to wake up a lot of people to the issues associated with copper-silver.”
Adam Smeltz is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or firstname.lastname@example.org.