Leaders of Pittsburgh VA say water system safe from Legionnaires'

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Last winter, after George Eason read about the Legionnaires' disease outbreak at the Pittsburgh Veterans Affairs buildings, he canceled all of his pending appointments with his VA doctors.

"I have asthma and that's the last place I need to be," said Mr. Eason, 61, an Air Force veteran from Homewood.

Since Legionnaires' is a form of pneumonia, he didn't feel he could risk contracting the disease.

Pittsburgh VA officials had veterans like Mr. Eason in mind Wednesday when they invited a reporter to hear all that they have done to make sure its water is safe and stop the outbreak that sickened 21 patients and killed five in 2011 and 2012.

"We really do want to get the word out," Pittsburgh VA director Terry Wolf said. "We want our veterans to continue to come to us."

She made her comments during an interview with the Pittsburgh Post-Gazette that also included regional VA director Michael Moreland and Ali Sonel, Pittsburgh VA's chief of staff, in their first public comments on the outbreak.

In addition to extra testing of the water for the Legionella bacteria and additional treatment of the water with chlorine, the Pittsburgh VA is spending $10 million to install new "mixing valves" on every shower head and faucet at its hospital in Oakland and H.J. Heinz health care facility near Aspinwall. That will allow the VA to increase the water temperature to 140 degrees to help kill Legionella.

The VA is spending $750,000 to map its water system and locate and get rid of "dead legs" that can be a source of Legionella by allowing stagnant water to fester, and building a database of its faucets and shower heads to track problems by examining their Legionella growth, temperature and pH levels.

Perhaps most important, the officials said, all the extra work and testing and treatment has continued to keep the Legionella bacteria under control. There has not been a Legionnaires' case that began at a VA facility since November, Dr. Sonel said.

In a change in protocol, if a patient is suspected to have pneumonia, he or she is given not only the urinary antigen test, but a sputum (mucus) test to determine Legionnaires'. The sputum tests -- which had not been regularly performed until the outbreak occurred -- can also be used to grow a Legionella culture that can then be compared to a sample of the bacteria in the hospital's water to see if the disease was contracted in the building.

Dr. Sonel said that more than 1,000 samples have been taken from water faucets, shower heads and other areas, 2 percent of which tested positive for Legionella.

That is a safe finding in any setting, since Legionella is present in many water systems and the goal is to keep the percentage down to minimize the risk of contact.

"Everything you do to maintain Legionella is to manage risk," Mr. Moreland said. "You can't eradicate it."

Mrs. Wolf said the Pittsburgh VA is still evaluating how to treat its water. It is exploring long-term methods such as using chlorine dioxide to replace the chlorination system now in place.

But the VA probably won't go back to the copper-silver ionization treatment system it was using when the outbreak occurred, she said. "I think we're very hesitant to go back to copper-silver because we believe it failed us," she said.

Water treatment consultants and current and former VA employees believe that the copper-silver system failed because Pittsburgh VA employees were not maintaining it properly.

Dr. Sonel does not believe that.

When the CDC came to Pittsburgh in November to analyze the problem, tests found that there were proper level of copper and silver in the water and it was not killing enough of the Legionella to be safe, Dr. Sonel said.

Despite all of that, as well as several completed and ongoing investigations into the outbreak, Mrs. Wolf said: "We have not been able to definitively say what caused the outbreak. We really can't say if it was the copper-silver, new construction, or the people [at the VA]."

For now, none of that is enough for Mr. Eason, who said he would go back only "if they could get an independent source to go in there and find that everything is fine, then I'd believe it."

mobilehome - region - health

Sean D. Hamill: shamill@post-gazette.com or 412-263-2579. First Published March 20, 2013 4:00 PM


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