In September of 2019, thousands of people visited the North Carolina Mountain State Fair for days of fun and entertainment at one of America’s favorite pastimes. However, for over 100 people, their trips to the fair would turn sickening. According to North Carolina health officials, in the days and weeks following the fair, 124 people became sick and one person died with Legionnaire’s disease, a disease that causes pneumonia symptoms, including coughing, fever, shortness of breath, and can lead to breathing issues and death in vulnerable populations.
What makes this outbreak so interesting is the nature of how the victims were exposed to Legionella, the bacteria that causes Legionnaire’s disease. Officials traced the outbreak back to a hot tub display set up at the fair. Legionnaire’s disease is not spread through direct contact; rather it is spread through the aerosolization of water that is infected with the Legionella bacteria. The combination of hot water, jets that create bubbles, and the open air display created the perfect environment for Legionella to thrive and infect the air around the display, which many people walked through during the fair.
As a healthcare facility professional, what does this sound like? Water that circulates though hospitals and other healthcare facilities can create the same scenario found at the NC Mountain State Fair. Because hospitals serve populations that are at the highest risk for developing Legionnaire’s disease when in contact with Legionella, the CDC consider’s it essential that hospitals and nursing homes have water management plans in place to limit Legionella and other waterborne pathogens from growing and spreading in those facilities.
These pathogens occur naturally in the environment, so the first line of treatment occurs at municipalities’ water treatment plants. But facility managers must also work to create policies and procedures that prevent these pathogens from entering the water distribution system. Contamination can happen during construction and renovation projects, where vibrations and water pressure changes can damage the bio film within plumbing systems, releasing existing waterborne pathogens. They can also happen in piping breaks, whether in the facility or to water main breaks that service the facility.
Facility managers need to discuss these opportunities for contamination within their departments and create a unified water management plan on how to deal with those potential issues. Management procedures can include water sampling, ensuring adequate disinfection, maintain correct water temperature to prevent growths, and ensuring lines are flushed before, during, and after construction. By creating front line defenses against waterborne pathogens, facilities can stay ahead of contamination and reduce the risk to the patients under their care.
COREY JP CUNNINGHAM 