{"id":1119,"date":"2013-06-24T13:16:25","date_gmt":"2013-06-24T03:16:25","guid":{"rendered":"http:\/\/blog.dbohs.com\/?p=1119"},"modified":"2024-10-11T15:48:17","modified_gmt":"2024-10-11T05:48:17","slug":"legionella-at-wesley-hospital","status":"publish","type":"post","link":"https:\/\/blog.dbohs.com\/?p=1119","title":{"rendered":"Legionella at Wesley Hospital"},"content":{"rendered":"

A preliminary analysis<\/b><\/p>\n

There was an outbreak of Legionnaire\u2019s disease from the hot water system at the Wesley Hospital in Brisbane. One patient has died and another is seriously ill. There is a legal requirement for the outbreak to be reported immediately to the Health Department, but this was not done by either the Hospital or the Pathology laboratory, citing an IT failure. This excuse is not acceptable.<\/p>\n

From an\u00a0occupational hygiene perspective,<\/strong>\u00a0what is interesting is the\u00a0way<\/strong>\u00a0in which the Hospital is responding, particularly in its use of\u00a0respiratory protection<\/strong>.<\/p>\n

\"surgicalIt is essential that\u00a0P2<\/strong>\u00a0(N95) particulate face masks are provided and properly fitted. A new bulletin on\u00a0SBS One News<\/strong>\u00a0(7 June 2013) showed an\u00a0unshaven p<\/strong>lumber<\/strong>\u00a0wearing a face mask that appeared to be a surgical mask with\u00a0one set of the straps dangling<\/strong>. A similar picture in the\u00a0Courier Mail\u00a0<\/strong>shows “Wesley Hospital staff flush pipes and check water temperatures<\/em>\u00a0\u201c.\u00a0 In this picture the person is again appears to be wearing a surgical masks and only one strap is done up. Facial growth is clearly evident.\u00a0Wrong mask, bad fit and almost no protection for the wearer.<\/b><\/p>\n

The use of surgical masks for respiratory protection is very common in healthcare and indicates major cultural and technical issues in managing OH&S.<\/p>\n

Much of the problem must lie in the design of the hot water system. Obviously there is a patient safety issue when the temperature is required to be blow that which kills the bacterium. This requires better design, better maintenance and verification by monitoring that the controls are working. It appears that the hospital has failed in all three counts.<\/p>\n

In disinfecting the system, the obvious first stage is to raise the water temperature to a level that will ensure disinfection of the furthest point in the system and to run the hotter water through the system to ensure this temperature is reached for a sufficient time to be effective.<\/p>\n

In running hot water through the system, it is necessary to\u00a0prevent the generation of aerosols<\/strong>\u00a0at taps and showers. Ideally shower heads should be removed and a tube attached to lead the water to the drain in such a way as to minimise aerosols. The shower head would then be disinfected with hot water and chemicals.\u00a0 It is known that show heads provide a good reservoir for the bacterium and it is well known that the risk in using an infected shower is greater for the first person than the second.<\/p>\n

One of the other important aspects of the project is to properly\u00a0identify dead end and legs<\/strong>\u00a0in the system and remove them, as they can act as reservoirs. It is not known whether simple hot water treatment of the system will suffice to minimise the problem.<\/p>\n

If the Wesley hospital is getting it so wrong with reporting the outbreak and protecting its staff dealing with the outbreak,\u00a0one should have great concerns about whether they are able to properly control the outbreak.<\/b><\/p>\n

The August 2013<\/strong> edition of Applied Occupational and Environmental Hygiene<\/strong> has a commentary “The Use of Respirators to Reduce Inhalation of Airborne Biological Agents<\/a><\/strong>” by Janssen et al.<\/p>\n

Their conclusions support my views:<\/p>\n