Paul Levy: Water Interests in Hospitals: Spraying Infections?

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The following is excerpted with permission from the blog, "Not Running a Hospital," authored by Paul Levy, former CEO of Beth Israel Deaconess Medical Center in Boston.

By now, you may have heard about the outbreak of Legionnaires’ disease in Wisconsin that was linked to a decorative water wall in a hospital lobby.  

As noted in this Washington Post story:

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.


I wonder how many more people may have been unknowingly infected. The article continues:

The study, published online in Infection Control and Hospital Epidemiology, is the second documented outbreak of Legionnaires’ disease in a healthcare 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.

I see this as yet another example of an expensive and poorly thought through health care fad:

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.

...I would go further and suggest that this particular fad was often driven by a desire to persuade rich people to make donations to support hospitals' capital expansion programs. I can see it now:  A visit by the hospital CEO to a wealthy potential donor, showing the architect's rendition of a beautiful lobby, complete with "water interest."

By the way, The Joint Commission has rules about this issue that were prepared in 2003 by Centers for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee:

Although not considered a standard point-of-use fixture, decorative fountains are being installed in increasing numbers in healthcare facilities and other public buildings. Aerosols from a decorative fountain have been associated with transmission of Legionella pneumophila serogroup 1 infection to a small cluster of older adults. This hotel lobby fountain had been irregularly maintained, and water in the fountain may have been heated by submersed lighting, all of which favored the proliferation of Legionella in the system. Because of the potential for generations of infectious aerosols, a prudent prevention measure is to avoid locating these fixtures in or near high-risk patient-care areas and to adhere to written policies for routine fountain maintenance. [page 47]

...But "routine fountain maintenance" may not always work, notes the story in the Washington Post:

The fountain at the Aurora St. Luke’s 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.

Although hospital staff performed weekly and monthly maintenance, “it’s very difficult to clean those things out,” 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.


To read the full post by Mr. Levy, click here.

More Articles by Paul Levy:

Paul Levy: End-of-life Conversations, as Seen By the Intensivist
Paul Levy: Good Diagnosis, Zeke. Why No Cure?
Paul Levy: Debate Surrounds Ability to "Teach" Bedside Manner

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