The ongoing remediation of the contaminated water system at the Quincy, IL veterans’ residence made headlines again last week when Illinois’s senator called upon the Illinois Department of Veterans Affairs to implement CDC recommendations.
“I know we’re facing budgetary problems, but this literally a matter of life or death, this should be a high priority from the state of Illinois to make this investment,” urged Senator Dick Durbin (D).1
Initially, the state of Illinois earmarked $4.8 million to upgrade the 129-year-old facility’s water system, including the installation of a new water main and other water lines. The facility was also approved for over $24.6 million in additional operating funds, but this money was withheld until late December due to a budget impasse in the Illinois state legislature.2
What the CDC Recommends
In late December, the Centers for Disease Control (CDC) issued its official report of its findings at Quincy. It pinpointed three primary contributors to the deadly outbreak: a) a pressure valve failure inside the main water tower that allowed the Legionella pneumonia bacteria to proliferate; b) a “largely absent” execution of operation and maintenance record keeping for a subpar cooling tower; and c) the absence of electronic medical records for long-term residents.
Prior to its final conclusions in December, the CDC made the following recommendations to the Illinois Department of Public Health (IDPH) and the Adams County Health Department (ACPH)3:
1) Cooling Tower: the facility’s cooling tower should contain adequate and continuous biocide levels, with continuous water flow through both cooling tower cells and basins. Fan speed should be kept to a minimum to avoid aerosol dispersal, corrosion and scale inhibitors should be applied, and the system should be cleaned regularly to minimize buildup of sediments and biofilm, with documentation of all cooling tower maintenance operations;
2) Potable Water: Point-of-use filters should be installed on faucets and showerheads, adequate disinfection levels should be maintained aligned with EPA recommendations, hot-water temperature should be maintained at levels to prevent Legionella growth, and there should be adequate potable water flow to eliminate stagnant water; the water tower’s main pressure valve should be eliminated or fixed and backflow prevention devices installed. Post-remediation testing should be continued every 2 weeks for 3 months, and then once a month for an additional 3 months. A Legionella prevention plan (also required by VA Directive 10614) should be developed and implemented.
3) Clinical / Surveillance Recommendations: The facility should “consider” enhancements to its clinical / infection control for pneumonia and respiratory disease surveillance protocols, including weekly rather than monthly data collection and analysis, integration of surveillance into an electronic medical record (EMR) system, formalization of response and communications protocols to care providers and environmental health specialists, and establishment of surveillance baselines. Any case of confirmed Legionnaires’ disease should trigger an epidemiologic investigation (this last point is a departure from previous CDC guidelines that formal “outbreak” investigations should be initiated only after 2 cases were reported).
Legionnaires’ Disease in Long-Term / Residential Healthcare Facilities
As an ongoing trend of increased cases has demonstrated in recent years, Legionnaires’ disease is a serious risk in long-term health facilities, particularly when they – like the Quincy Veterans Home – are operating with antiquated infrastructures and water systems. Residents in these facilities generally present many of the risk factors which contribute to death rates of up to 50% in those who contract Legionnaires’ disease in these environments: advancing age (50+), smoking, suppressed immune systems, and / or underlying health conditions including COPD, other lung disease, or cancer.
Sources:
1) “Sen. Durbin Calls For Changes at Quincy Veterans Home.” Fox Illinois. Web. 11 Jan. 2016 [date cited: 20 Jan. 2016].
2) The Associated Press. “Quincy veterans home replacing water system after Legionnaire’s outbreak.” The State Journal-Register. Web. 21 Dec. 2015 [date cited: 20 Jan. 2016].
3) CDC Vets Report to IDPH and ACPH Officials. Web. 4 December 2015. [date cited: 20 Jan. 2016].
4) Department of Veterans Affairs. “Prevention of Healthcare-associated Legionella Disease and Scald Injury form Potable Water Distribution Systems.” VA Directive 1061. Web. 13 Aug. 2014 [date cited: 20 Jan. 2016].