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Hospital Linked to Two Deaths

Health: Legionnaires' kills patients at Good Samaritan. Seven more become ill at the facility, which says outbreak has been contained.

July 01, 2002|CHARLES ORNSTEIN | TIMES STAFF WRITER

Nine people have become ill since January, including two who later died, with Legionnaires' disease acquired at Good Samaritan Hospital in downtown Los Angeles, county health officials confirmed Sunday night.

One patient, a 55-year-old man, died June 15, said Dr. David Dassey, deputy chief of acute communicable disease control for the Los Angeles County Department of Health Services. The man, who was admitted May 25, underwent several heart procedures, including bypass surgery, while in the hospital.

Details on the other patient who died were not available. It is not clear whether the patients' previous medical conditions contributed to their deaths.

County health officials believe the patients became sick with the respiratory infection because of the hospital's water system, which contained the bacterium Legionella pneumophila. All of the sick had undergone cardiac procedures at the hospital that ranged from insertion of a temporary pacemaker to coronary artery bypass surgery.

Eight of the nine also spent time on the same floor in the hospital's main building, said Dr. Laurene Mascola, chief of acute communicable disease control for the county. Dassey said all nine had spent time there.

"These are not persons who had specific defects in their immunological systems, such as AIDS or chemotherapy, which would have ablated their ability to fight infection," Dassey said. "It's very interesting and doesn't make sense."

Hospital and county officials believe the outbreak has been contained, in part because of recommendations that all patients be served bottled water, instead of tap water. The hospital also has changed all shower heads and has performed a super-heated water flush of its plumbing system.

For a time, patients also were advised not to take showers because they could breathe in the Legionella bacterium through the shower mist, county officials said. In addition to the nine patients who became ill at the hospital, Good Samaritan said county testing has shown that some patients were exposed to the Legionella bacterium in the community. In response, the 408-bed hospital said it is screening all patients for pneumonia.

"Through our work with the public health department and outside certified testing facilities, at this time we have no evidence of ongoing transmission of Legionella at Good Samaritan Hospital," President and Chief Executive Andrew Leeka said in a written statement. "We have been assured by the public health department that the hospital has taken all appropriate recognized measures to halt further appearances of the bacteria."

The general public is not at risk, Mascola said, because the disease is not passed from person to person. She praised the hospital's response, saying that employees and patients are probably at no greater risk of being exposed to the bacterium at the hospital than at home.

The county did not intend to publicize the illnesses or deaths but did confirm them after contacted by a reporter.

Good Samaritan became aware of the first potential Legionnaires' case acquired at the hospital in January, Mascola said.

Laboratory tests confirmed the illness several weeks later, and it was then reported to the health department in late February or early March. Around that time, a second case was identified, Mascola said.

Legionnaires' disease affects 8,000 to 18,000 people per year. Most cases are acquired in the home or community, not in health-care facilities. The disease is fatal in 5% to 30% of cases, according to the federal Centers for Disease Control and Prevention.

Authorities in southeastern Pennsylvania are investigating an outbreak of Legionnaires' at a nursing home there that struck 12 people, including two who have died.

The last large cluster of Legionnaires' in Los Angeles County occurred in late 1997 when eight cases were identified near a movie studio in Culver City. Health officials determined that the cases did not originate in a hospital or other health facility, but they were unable to pinpoint the exact cause, Dassey said. All of the sick patients lived or worked within blocks of one another.

In 1988, Legionnaires' outbreaks in the county were linked to at least seven deaths. One outbreak at the Westwood Horizons retirement home in West Los Angeles resulted in four deaths. A second at UCLA Medical Center resulted in eight cases, including three deaths of patients who were already gravely ill.

Legionnaires' took its name in 1976 when an outbreak of pneumonia afflicted people attending an American Legion convention in Philadelphia.

All told, 29 people died and 221 more became sick. Symptoms of the disease include fever, chills and a cough. Some patients also have muscle aches, headache, fatigue, loss of appetite and sometimes diarrhea.

Generally, it takes two to 10 days between a person's exposure to the Legionella bacteria and the onset of symptoms. Special tests are required to confirm the diagnosis and distinguish the illness from other forms of pneumonia.

Legionnaires' often affects middle-age and older people, especially those who smoke cigarettes or have chronic lung disease. People with suppressed immune systems also are at risk.

The bacterium is present naturally in the environment and can be found in hot tubs, water tanks, humidifiers, cooling towers and air-conditioning systems.

Hospitals and research centers that are contaminated with the bacterium often use a chlorine solution to kill it. Raising the temperature of water heaters also affects the germ's ability to multiply.

If caught early, Legionnaires' is treatable with the antibiotic Erythromycin. Sometimes, a second drug, Rifampin, is used.

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