PLATTSBURGH – Don't drink the water. Don't eat the ice. Don't shower. Don't tub bathe.
That is the present out-of-extreme-caution modus operandi at the the University of Vermont Health Network – Champlain Valley Physicians Hospital, which is restricting the use of unfiltered water in its main facility after continued attempts to reduce the level of Legionella in its water system has proven to be unsuccessful, according to a press release.
Legionella is a water-borne pathogen that can cause Legionnaires’ Disease and Pontiac Fever.
There have been no recent or current incidents of hospital-acquired Legionnaires’ Disease at CVPH, and the levels of Legionella, while sustained, present a truly low risk to patients and staff, according to Infection Disease Specialist Keith Collins, MD.
Legionnaire's disease was coined after a 1970's outbreak at a Legionnaire's convention in Philadelphia, Pa.
“I'm old enough to remember that whole thing, and it can cause pretty bad pneumonia,” Collins said.
“There are excellent treatments for it when people do get pneumonia from it and it can be associated with water sources.
“However, I just want to point out we have not had an outbreak of Legionella. We just have our water testing positive for that.”
CVPH's predicament is a different situation than what happened in Vermont a few years ago during an actual outbreak, though there was a community outbreak here.
“We've had water samples that have tested positive for this organism in our water, but they are at really low levels,” Collins said.
“We have had no cases of Legionella in our hospital identified that have been associated with anyone being exposed at our hospital for this organism.”
Since January of 2020, there have been three patients treated for Legionella at CVPH, all of whom had the disease upon admission.
“We have yet to have, knock on wood, a single case of Legionella in our hospital from our water samples that we've tested,” Collins said.
“I just want to point out that yes, our water samples have tested for this organism, but it's being barely detected. It's not like we have huge amounts of this organism being detected in our water samples.
“It's at really low levels, and I think New York State just wants to be very cautious and in an abundance of caution they are asking us to change and use bottled water and to limit bathing and showering.
“Not because there's been documented infections at this level of exposure to Legionella, but because they want to be very cautious.”
The limitation has been implemented based on the recommendation of the New York State Department of Health.
It affects only the main CVPH facility and does not impact its medical office buildings at 206, 210 or 214 Cornelia Street or the off-campus facilities.
State regulations require that health care facilities routinely sample their water systems and institute control measures should the level of Legionella exceed the DOH standard.
“That's part of what we do as part of our surveillance of things,” Collins said.
“Hospitals intermittently find this in their water systems, a lot of hospitals, not just ours. We've had this in our water before, and we've never had anyone get sick from our water over the years."
CVPH currently uses a silver and copper ionization process to address the level of bacteria in its water system, a method adopted after hyperchlorination failed to address the detectable levels.
That system will be adjusted while staying with the specified treatment range.
Director of Quality and Safety Brenda Murphy, RN explained that Legionella is spread by the aerosolization of water that contains the bacteria.
For that reason, patients, visitors and staff are being asked not to consume tap water or ice from the machines located on each unit.
Tub baths and showers are also temporarily restricted with alternative bathing/cleansing/hygiene methods being put in place.
“We are taking all of these measures out of extreme caution because we want to ensure we are providing the safest environment for our patients,” Murphy said.
“The way that this organism (enters) is not through consumption. It is through inhalation. It's aerosolization. So if your standing under a shower or standing over in a hot tub where the water is aerating and you're inhaling it that is one method.
“The other would be if you consume large amounts of water with the Legionella in it and then aspirate. It has to get into your lungs. That's where it's going to populate. So again, the chances and the risk for that are very low.”
Tap water can continue to be used for hand hygiene and to provide bedside baths where the risk of aerosolization is low and staff and visitors are masked.
“At present time, we are working on some mitigation strategies to bring in filters so that we can safely provide that water through those means but right now bottled water has been brought in, outside ice from vendors has been brought in,” Murphy said.
CVPH officials are working very closely with the State Department of Health.
“And we know that it is okay to use basins of water to do our bedside bathing,” Murphy said.
“We do have outside product that is brought in that is kind of like a bed-in-a-bath type of product if we were to need that as well. We will still maintain hygiene for our patients and consumable water, ice, all those needs that we have for our patients and our staff.”
POINT OF USE FILTERS
CVPH is making changes to the essential components of its water system, especially the hot water system, to eliminate the risk of Legionella colonization, according to Associate Vice President of Patient Care Operations Christopher Booth.
“We are assessing as we go here,” he said.
“We've already O.K.'d the purchase and are awaiting delivery on a a variety of different point-of-use filters which basically would be installed at faucet heads and shower heads throughout the facility as a way to mitigate or deal with this and reduce the potential exposure down to zero. So that's what we're engaged in right now.”
Point of use filters are being installed throughout the facility so that showers and baths can resume as soon as possible.
“I don't want to go into specific numbers on the cost, but it is significant,” Booth said.
“We realize that this is something we must do for the protection of our patients so we're going to do it. We expect the first delivery of filtration kits to be in our hands tomorrow.”
The restrictions and limitations will remain until three cycles, at prescribed intervals, meet the regulatory mandated levels.
“We are hoping to have this system basically in place throughout the facility in a relatively short period of time,” Booth said.
“Again I don't want to predict that because there are a couple of variables that need to be considered in terms of availability, delivery times, and so on.
"But we are going to do this as quickly as possible. We're hoping to be in a much different situation next week at this time in terms of reverting to normal use patterns and so on for our domestic water.”
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