Monday, January 16, 2012

Water interests in hospitals: Spraying infections?

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 health-care 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.

Here's a lovely example from Carson City:

People probably crave views of water in Nevada
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." 

Wait!  You can see it now, too!

A happy donor, no doubt.
 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 (HICPAC): 

Although not considered a standard point-of-use fixture, decorative fountains are being installed in increasing numbers in health-care 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] 

Hmm, is a cancer center a high-risk patient area?
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.


Anonymous said...

Good Lord!

Who knew??

Paul Levy said...

From Facebook:

Mary: Paul haven't these people ever considered using an automated chemical system like a pool?

Mark:Have hospitals considered a new era of form follows function where patient safety is a priority over marble fountains and luxury hotel entry ways?

Alex: As Fernando used to say: "Better to look good than to feel good, dahling."

Anonymous said...

It (long) has been time for serious innovation in medical philanthropy. How about listing donors in institution Annual Reports not under money contributed, but lives saved?

For Year 2011:

Mr. and Mrs. Gatsby

$5000 - 9,999
Ms. Scout Finch

$100 - 499
Dr. Jonathan Snow Jr.

For Year 2011:

(unknown)lives (and 2 careers) saved
Mr. and Mrs. Gatsby

500+ lives saved (by calling out safety concern)
Ms. Scout Finch

5000+ lives saved (in U.S. alone) (by developing and spreading a checklist for emergent infections)
Dr. Jonathan Snow Jr.

hmmm....Wouldn't it be nice to know the heroes among us? I would venture that Ms. Finch wouldn't want a fountain in her name. And Dr. Snow's would have a very different purpose.
*names changed to protect status quo.