Public healthHospital fountains a dangerous source of bacterial outbreaks

Fountains such as this pose a hazard for Legionnaire's disease // Source: blogspot.com

A recent study conducted by researchers at the Wisconsin Division of Public Health found that fountains in health care facilities can actually be a dangerous source of air-borne bacterial diseases.

In their investigation into how eight healthy individuals contracted Legionnaires’ disease, officials found that tiny bacteria-laced water droplets from Aurora Hospital’s lobby fountain were the cause of the outbreak.

“Fountains and health-care facilities don’t mix,” said Thomas Haupt, a respiratory diseases epidemiologist and the study’s lead author.

All eight infected individuals were not in-patients and were just passing through for appointments, delivering packages, or on their way to the pharmacy.

Each had spent time in the lobby where they were exposed to the Legionella bacteria. As a result, all of the infected had to be hospitalized, but eventually recovered.

According to Haupt, this is not the first reported instance of individuals being infected with Legionnaires’ disease, but it is the first case where people who were not even patients at the hospital were infected.

It is commonly known that Legionella bacteria is pervasive in low levels in water. Given the right conditions, the bacteria can flourish and reach dangerous levels. In the past, outbreaks of Legionnaires’ disease have been linked to air conditioning units, shower heads, and other systems that aerosolize water.

In the case of Aurora Hospital, pieces of foam in the facility’s water wall display were the source of the bacteria. A careful investigation found that the display consisted of a tiled wall where water gently flowed into a trough filled with decorative rocks at its base.

The rocks rested on a bed of foam-like material, and flood lights from above and below the display heated the water to temperatures suited for the bacteria to thrive.

Investigators tested the foam and found that it had been heavily contaminated with Legionella bacteria, even though the fountain was routinely cleaned.

“They’d clean it off and rinse it off once a week, but you really can’t disinfect foam,” Haupt explained. “They did great routine maintenance at the facility, but again the foam could not be decontaminated. Because it’s a semi-porous type of foam, that little bit of moisture stays in there and with the heat the Legionella just continued to grow to very large amounts.”

Following the study, Haupt said his department now advises health care facilities to avoid fountains or any other decorative water display.

Another solution is to seal the display.

Dr. Allison McGeer, the head of infection control at Toronto’s Mount Sinai Hospital, said her hospital has an enclosed water feature in its emergency department.

“It’s sealed — for precisely that reason, because anything that generates aerosols around patients poses a risk for Legionella,” McGeer says. “It’s not open to the air anywhere in the emergency department.”

“There are, I think, good reasons why people like water features,” McGeer added. “But there are also good reasons why we don’t have them in hospitals.”