[Greenbuilding] Legionnaire's in water wall features

[Jason Holstine]

With the off-and-on discussion on Legionnaire¹s Disease exposure, this new
news is relevant:

http://www.washingtonpost.com/national/health-science/hospital-fountain-link
ed-to-legionnaires-outbreak/2012/01/10/gIQAyLwEpP_story.html?hpid=z5

Hospital fountain linked to Legionnaires¹ outbreak
By  Lena H. Sun 
<http://www.washingtonpost.com/lena-h-sun/2011/03/03/ABUvPGP_page.html> ,
Tuesday, January 10, 7:35 PM

An outbreak of Legionnaires¹ disease in Wisconsin has been linked to a
decorative water wall in a hospital lobby, according to a study published
Tuesday that suggested the popular architectural feature can pose dangers in
a health-care setting, especially for people with weakened immune systems.

In 2010, eight people contracted the severe and potentially life-threatening
form of pneumonia caused by the bacteria. None had been admitted to the
Milwaukee-area hospital at the time of exposure. But they all had walked by
the water wall in the main hospital lobby, researchers said.

The disease is spread through inhalation contact with contaminated water
sources.

One person who got sick was a delivery man. Three others were picking up
medication at the hospital pharmacy. Three were outpatients. And one man was
waiting to pick up his wife.

³He really enjoyed sitting next to the water wall,² said Thomas Haupt, a
Wisconsin  health division epidemiologist and lead author of the study.
³These water walls are indeed very beautiful, but they¹re very risky.²

All eight either had underlying medical conditions or other factors that
increased their risks of getting Legionnaires¹ disease. Three were
hospitalized in intensive care and were on mechanical ventilators; all eight
survived.  

The study, published online in Infection Control and Hospital Epidemiology
<http://www.jstor.org/stable/10.1086/663711> , is the second documented
outbreak of Legionnaires¹ disease in a health-care setting associated with a
wall-type water fountain, a design that is increasingly popular in
hospitals, hotels, spas and other public settings, the study said. In 2007,
two cancer patients at the National Institutes of Health in Bethesda were
diagnosed with the disease after being exposed to a contaminated wall-type
water fountain.

Decorative water fountains and water walls can be soothing and calming, so
many hospitals and clinics included those amenities as a way to be more
patient-friendly, said Jan Patterson, a professor of medicine and infectious
diseases at the University of Texas Health Science Center at San Antonio.

But the problem is, even with regular cleaning and testing, ³it¹s possible
for legionella to accumulate,² said Patterson, who is also president of the
Society for Healthcare Epidemiology of America. ³I guess the takeaway here
is that if you have any underlying conditions, you should avoid walking by
them or stay as far away as possible.²

As for hospitals and other health-care facilities, ³they should avoid having
these in their facilities altogether,² she said.

When the fountain was first suspected as the source of the Wisconsin
outbreak, the hospital shut down the water wall and turned it into a
planter.  No known additional cases of Legionnaires¹ disease occurred after
that. Many other health-care facilities in Wisconsin shut down or removed
their decorative fountains, the study said.

Every year, the federal Centers for Disease Control and Prevention receive
reports  of about 3,000 people diagnosed with Legionnaires¹ disease. But
experts say that many more cases go unrecognized
<http://www.cdc.gov/legionella/faq.htm> and between 8,000 to 18,000 wind up
in the hospital, according to Lauri Hicks, a CDC medical epidemiologist and
specialist on Legionnaires¹. More than 10 percent of cases are fatal.

Some of the most common symptoms, such as shortness of breath, cough and
severe fatigue, are also associated with pneumonia, she said.

The Wisconsin study, she said, is a ³good reminder that in settings where
you have people with increased risk of getting Legionnaires¹ disease, you
should be considering carefully the management of any of your water systems
that these persons could be exposed to.²

CDC experts have been working with a professional organization, the American
Society for Heating, Refrigerating and Air Conditioning Engineers, to come
up with a standard practice for building managers and owners to prevent the
disease, she said.

Inpatient facilities with fountains, or any center that takes care of people
with weakened immune systems, such as nursing homes, should be conducting
regular assessment for Legionnaires¹ disease, she said.

The water in fountains or water walls is often an ideal breeding ground for
bacteria because it is warm or at room temperature and because the
recirculating water can stagnate. In addition, fountains develop scum, ³and
the bacteria like to live in that slime layer that forms on fountains, in
whirlpools, even in your shower,² Hicks said.

Fountains  can also create bacteria-bearing aerosols as water sprays or
cascades down walls or rocks.

The fountain at the Aurora St. Luke¹s South Shore hospital was installed in
2008. All visitors using the hospital main entrance passed by it on their
way to the information desk. Water flowed down a tile wall about 8 feet wide
by 5 feet high, and through a bed of decorative rocks that rested on a
spongelike foam material.

The water collected in a trough at the bottom of the fountain, beneath the
rocks and foam, and an electric pump recirculated it to the top of the water
wall.

Health officials found that the water was kept warm by two heat sources: an
electric fireplace on the opposite side of the same wall that housed the
fountain and low-voltage flood lights in the ceiling and in the water
trough.

 Although hospital staff performed weekly and monthly maintenance, ³it¹s
very difficult to clean those things out,² Haupt said. A sampling of a
3-inch by 4-inch piece of the foam material found it had more than 1 million
bacteria, he said.

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