Covenant Living Legionnaires Outbreak

Posted in Legionella,Legionnaire's disease,Our Blog,Outbreaks & Recalls on September 8, 2019

The Kane County of Health Department has confirmed four cases of Legionnaires disease at a retirement facility in Batavia. In a statement released by county health officials, the department is investigating the Legionnaires disease outbreak at Covenant Living at the Holmstad Retirement Community. Here’s what we know about the Covenant Living Legionnaires Outbreak:

All of them were hospitalized as soon as they came down the symptoms. “We do not know if they are still hospitalized, or if they were treated and released,” said Susan Stack, Kane County Health Department Public Information Officer. All residents have been informed about the situation.

Covenant Living owns retirement communities across the country, including one in Geneva and several others in the far northern suburbs.

Illinois Department of Public Health and Kane County Health Department met Batavia facility staff to discuss the issue. They have started an investigation and testing for Legionella bacteria in all the potential sources. They are also checking other residents to determine if any of them have also been exposed to the bacteria.

Covenant Living produced a statement that said their top priority is the well-being of residents and they are following all the precautionary steps recommended by the Kane County Health Department and the Illinois Department of Public Health. A strict water treatment plan is in place as well, according to the statement.

In 2018, there were 512 reported cases of Legionnaires’ disease statewide in Illinois. In 2019, 251 confirmed cases have been reported till now. Other cases of Legionnaires’ recently reported in the state include one confirmed case of Manteno Veterans’ Home in Kankakee County and two confirmed cases at a hotel in Schaumburg on August 16th.

Legionnaires’ disease is a severe form of pneumonia or lung infection that infects people when they breathe in small aerosolized droplets contaminated with the bacteria. Not everyone who breathes in the droplet will contract the disease, but some do. People at increased risk of getting Legionnaires’ after being exposed includes:

• Elderly, aged 50 years and above
• Those who have a history of smoking or are heavy smokers
• Anyone who has an underlying condition like chronic lung disease, diabetes or weakened immune system

These people not only have more chances of contracting the Legionnaires’ but it’s also more likely that they develop serious complications from the disease and their treatment takes time.

This is why Legionnaires’ in a retirement home or nursing facility is a matter of concern because those residing in them are all high-risk individuals.

1 in 10 people who contract Legionnaires’ dies.

But how does Legionnaires’ gets into those water droplets?

Legionella bacteria is naturally found in freshwater environments like lakes and streams. Low amounts of bacteria does not pose problems. The bacteria becomes a health risk when it gets into building water systems. Once it enters into the system, it grows when the conditions are favorable:

• Water temperatures are warm enough
• Stagnation of water
• Scale and sediment formation
• pH and temperature fluctuations
• Disinfectant level is low
• Water pressure changes frequently

Once Legionella grows in the systems, it gets into small water droplets. Anyone who inhales this droplet is now at risk of contracting Legionnaires.

Some of those exposed to the bacteria will get a mild form of influenza like illness called Pontiac fever. It is less serious than Legionnaires and often has the same symptoms.

Most common sources of Legionnaires’ disease:

• Air conditioning systems
• Cooling towers
• Whirlpools and spas
• Grocery mist machines
• Decorative fountains
• Showerheads and faucets
• Swimming pools
• Hot water heaters and tanks

Incubation Period and Symptoms:

Symptoms start within 72 hours of exposure. Initial symptoms of the infection include:

• Cough
• Fever
• Headache
• Muscle aches
• Shortness of breath

Gastrointestinal symptoms such as diarrhea, nausea and abdominal cramps also might occur after 2-3 days. Some patients also experience mental changes like confusion.

Diagnosis:

After preliminary examination, including questions about the symptoms and signs, your healthcare provider will recommend different tests depending on your symptoms and how severe they are.

Blood tests and urine tests can be used to determine if the patient has Legionnaires’ disease or Pontiac fever. Blood tests will establish the severity of the disease and if any other organs are affected.

A chest X-ray, even though doesn’t directly determine the disease, can help with showing the extent of infection in the lungs.

Sputum samples can be tested if a person has severe coughing

If patient is experiencing mental changes, the doctor might request a CT scan or a lumbar puncture (to rule out meningitis)

Treatment:

Legionnaires requires treatment with antibiotics. The sooner the treatment starts, the lesser the chances of complications and better the ultimate outcome. In most cases, patients will be hospitalized for treatment. Antibiotics that are commonly used for treatment are macrolides (especially azithromycin) and quinolones (levofloxacin). Your doctor will decide on the antibiotic after looking at the local data and test results.

Pontiac fever doesn’t require treatment with antibiotics and usually goes away on its own. Supportive care might be needed like talking Tylenol for fever and drinking plenty of fluids.

How to address Legionella growth:

Here is a 7-point plan to follow as part of Legionella water management program:

• Form a water management program team
• Layout the building water system plan with text flows and diagrams
• Identify places where Legionella can easily thrive
• Plan out the measures to prevent bacterial growth in these areas and overall
• Decide on ways to intervene when the measures aren’t followed
• Make sure the water management plan is running efficiently
• Document and communicate the necessary details to the required individuals

Measures that ensure effective water management:

• Making sure that the amount of disinfectants are right. Legionella thrives in water systems when disinfectant level decreases. Always make sure that water flow has the proper amount of disinfectant to limit legionella growth.
• Making sure water temperatures are right. Legionella grows best within temperature range of 77 °F – 108 °F. It’s important to keep hot water hot and cold water cold.
• Prevent stagnation. Stagnation promotes biofilm and sedimentation that can encourage legionella growth. Identify the areas of risk in your building and make sure that it’s clean always.
• Operate and maintain equipment. This will help prevent sedimentation, debris collection and corrosion: all of which are perfect nutrient set for legionella growth.
• Manage external factors: changes in municipal water quality, water main breaks and construction are important points to consider while limiting legionella growth in a water system.

By: Pooja Sharma, Contributing Writer (Non-Lawyer)