Legionnaire’s limits water use at IU Health hospitals

Patients at IU Health’s University Hospital and Simon Cancer Center have been told to drink bottled water and not bathe or shower with tap water after two patients at the Downtown hospital tested positive for Legionnaire’s disease.

The restrictions came after additional samples of water tested positive for Legionella bacteria, the germ that causes the potentially deadly illness.

IU Health officials went room to room late Thursday explaining the decision to limit water consumption for patients, many of whom have compromised immune systems and are susceptible to the disease.

“We felt that it was a precautionary move that we should make,” said Dr. Douglas Webb, medical director for infection control of Indiana University Health.

IU Health continues to investigate how water at University Hospital became infected. Legionella bacteria resides in water and is often contracted through aerosol spray, such as a shower, air conditioner or fountain.

The restrictions will stay in place until tests “verify that the water has been adequately treated and is safe to use,” Webb said.

Earlier this week, IU Health officials announced that two patients, both with compromised immune systems, had tested positive within the past month for Legionnaire’s disease and had died. Webb declined to give specific dates for the deaths.

One patient was thought to have been infected outside the hospital. Hospital officials said they think the second person contracted the bacteria in the hospital.

No additional cases of Legionnaire’s have surfaced. Hospital officials have been looking through past medical records and contacting patients who were recently treated for respiratory illnesses to see if any cases went undiagnosed.

The Marion County Health Department and the Indiana State Department of Health are assisting with the investigation. Health departments typically get involved when there is more than one case in the same location.

State health officials said the investigation could take several weeks.

“In some investigations you can find the source. In other investigations it may not be as clear-cut,” said Pam Pontones, state epidemiologist with the Indiana State Department of Health.

Experts recommend that hospital systems and other facilities test their water systems quarterly to check for Legionella bacteria.

University Hospital checked its water for Legionella bacteria every three to six months and has never had a positive sample before, Webb said. The last check was late fall and there was no evidence of bacteria.

The hospital checked again after seeing the first patient with Legionnaire’s. Again the tests were negative. But after the second patient tested positive, they ran tests again and those came back positive.

Last weekend they increased the level of the biocide in the water, and super-flushed the system, which involves heating it and then running showers to kill off any bacteria.

Late this week, samples taken before the water was treated came back positive for the bacteria, leading officials to believe the problem was greater than thought, Webb said.

None of the samples taken since the treatment has detected the bacteria, but Webb said IU Health will wait until all the recent samples come back negative before lifting the water restrictions.

The Centers for Disease Control and Prevention estimate there are from 8,000 to 18,000 cases of Legionnaire’s disease each year. Symptoms include muscle aches, fever and difficulty breathing.

But experts say the number of cases is likely as high as 80,000 because many people who have the disease go undiagnosed.

In Indiana about 100 cases are reported each year. Local health officials investigate each case, but in many cases the source of the infection — particularly if it appears to be an isolated case — is never found, Pontones said.

Only a small percentage of cases nationwide, perhaps as few as 5 to 10 percent, occur in hospitals, said Dr. Paul Edelstein, professor of pathology and laboratory medicine at the University of Pennsylvania’s Perelman School of Medicine.

“Thank God it’s not that common,” said Jules Zacher, a Philadelphia attorney who specializes in Legionnaire’s cases and has clients nationwide. “Quite frankly when it does occur, it shows that they really screwed up.”

Each year thousands of people die in hospitals from infections that they acquire during their stay, often from a contaminated piece of equipment or even a doctor’s white coat.

Legionnaire’s disease is different, Zacher said.

“Legionnaire’s disease is not necessarily medical malpractice. It’s a facility problem,” he said. “It’s not that someone forgot to sterilize a syringe. It’s because they didn’t treat the water system.”

Facilities with large, complicated water systems — such as hospitals, nursing homes, hotels and other large sites — are particularly prone to outbreaks. These sites have pipes that offers ample spots for water to stagnate, allowing the bacteria to grow.

Because hospitals treat people with compromised immune systems, they need to be particularly vigilant, experts say.

“I wouldn’t call a hospital negligent off the bat, without knowing more about the case. As an expert in litigation, you see all of the different factors that go into it,” said Matt Freije, founder of HC Info, a California-based company that provides consulting on solving Legionella problems. “Anything is possible ... but when Legionella preventive measures are effectively implemented, it does prevent disease.”

It’s much more common to contract the disease outside the hospital. Daniel Roth, Indianapolis, 55, learned that. In November, he noticed he was growing short of breath and had other flulike symptoms. Then he glimpsed his face in the mirror and saw his skin had gone gray.

The Northside man went to the doctor and who diagnosed him with Legionella pneumonia.

His doctor immediately had him admitted to IU Health North, where he spent 30 days — some of them in a medically induced coma.

During that time, his doctors tried to figure out where he might have been exposed. Tests of the water in his apartment and the air conditioning ducts revealed nothing.

“It just came up and hit me out of nowhere. We still don’t know what caused it,” he said.

Meanwhile, IU Health officials continue to ask questions about what happened and how to prevent it in the future, Webb said.

Experts say there’s no reason, though, for the average, healthy person to be concerned.

“A lot of things have to line up and factors be present for people to get the disease,” Edelstein said. “Overall it’s a pretty rare disease.”

Call Star reporter Shari Rudavsky at (317) 444-6354. Follow him on Twitter @srudavsky.