Hot water system is cause of Mount Carmel Legionnaires outbreak

The Legionnaires’ disease outbreak at Mount Carmel Grove City hospital in suburban Columbus, Ohio, has been traced to the hospital’s hot water system and likely was the result of poor disinfection, said the hospital’s parent firm.

At least 16 patients at Mount Carmel Grove City have been diagnosed with Legionnaires’ disease, a potentially deadly form of pneumonia caused by inhaling Legionella bacteria in the form of mist or vapor. In addition, one patient – Deanna Rezes, 75, of Grove City – died on June 2, and another filed a lawsuit this week.

The outbreak was announced May 31, only one month after the opening of the seven-floor, $361 million hospital. Patients who contracted Legionnaires’ disease were exposed between April 27 and May 31, said Dr. Tammy Lundstrom, chief medical officer for Trinity Health, the hospital’s Michigan-based parent company.

Hot water system:
About the disease

Anyone can become sick with Legionnaires’ disease, but people at the greatest risk of infection include:

• anyone 50 or older
• smokers, current or former
• anyone with a chronic lung disease, like COPD (chronic obstructive pulmonary disorder, most commonly emphysema or bronchitis)
• anyone with a compromised immune system
• alcoholics.

After Legionnaires’ disease has been diagnosed, if the patient is not already hospitalized, then hospitalization is almost always required. In the most severe cases, complications can occur, such as:

• endocarditis, which is an infection of the inner lining of the heart that affects the ability of the heart to maintain adequate blood flow throughout the body.
• kidney failure, which can occur when Legionella toxins damage the kidneys’ ability to eliminate waste from the blood.
• pericarditis, which is a swelling of the pericardium, the primary membrane around the heart. This can also affect the ability of the heart to circulate blood throughout the body.
• respiratory failure, which is caused by changes to the lung tissue, or oxygen loss in arteries supplying the lungs.
• septic shock, which occurs when Legionella toxins enter the blood stream and cause a drop in blood pressure, leading to loss of adequate blood supply to the organs.

Hot water system:
Legionnaires symptoms

Legionnaires’ disease generally develops two to 10 days after exposure to Legionella, and it frequently begins with the following:

• severe headaches
• muscle pains
• fever
• chills.

By Day 2 or 3, other symptoms develop, such as:

• coughing, which can produce mucus or blood
• shortness of breath (dyspnea)
• chest pains (pleurisy, or pleuritic chest pain)
• gastrointestinal problems (diarrhea, nausea, vomiting, etc.)
• confusion and other mental changes.

Although the disease primarily affects the lungs, it can cause infections elsewhere in the body, including the heart.

The Legionnaires’ disease outbreak at Mount Carmel Grove City hospital in suburban Columbus, Ohio, has been traced to the building’s hot water system. The outbreak has grown to 16 cases, and one patient has died.

Hot water system:
Water system flushed

Restrictions for water usage have been in place, preventing patients from showering and forcing them to drink bottled water. The restrictions were lifted last week after more than 2,000 temporary water filters were installed at the 210-bed hospital. Additionally, the water system was flushed and over-chlorinated.

The hospital’s long-term plan to prevent further problems with Legionella is in place. It includes extensive testing and a secondary water-treatment system, one that constantly adds a small dose of disinfectant into the water.

Portions of the water system were disinfected in February, and other areas were disinfected in April. The areas that were disinfected in February weren’t disinfected again before the opening of the hospital, said Tim Keane, a Legionella expert who is acting as consultant for the hospital.

Hot water system:
Outbreak began May 15

The outbreak’s first case was reported to Mount Carmel Grove City officials on May 15, Lundstrom said. Within a week, there were three possible cases associated with the hospital. (Because those who became ill weren’t hospitalized during the entire two-week period in which the disease develops, Lundstrom said they were considered “possible cases.”)

The hospital alerted Franklin County Public Health (FCPH), and “then as these things evolved, we determined we had an outbreak occurring with the facility,” Lundstrom said.

As for whether Mount Carmel Grove City officials should have made a declaration of an outbreak before May 31, at which point there were seven confirmed cases, Lundstrom said the health system followed guidelines and relied on the health department to make that decision, she said. “It’s not uncommon to see sporadic cases that have nothing to do with being in a health-care facility,” Lundstrom said.

Legionella is naturally found in water but can become problematic when it moves into a building’s water system and spreads to showers, faucets, drinking fountains, and ice machines.

Franklin County had the highest number of Legionella cases in Ohio in 2018.

Hot water system:
Situation preventable

A 2015 study by the Centers for Disease Control and Prevention (CDC) stated that “75 percent of (Legionnaires’ disease) acquired in health-care settings could be prevented with better water management.”