Washington, D.C. — In an effort to protect veterans from hospital-acquired infections and eliminate the threat of Legionella bacteria in water supplies, Congressman Tim Murphy (PA-18) sent a letter to Dr. Thomas Frieden, Director of the Centers for Disease Control and Prevention (CDC), seeking further information related to the Legionnaires’ disease outbreak at the VA Pittsburgh Health System (VAPHS). In his letter, Congressman Murphy requested information about the cause and scope of the Legionnaires’ disease outbreak; recommendations for eliminating the threat posed by elevated levels of Legionella bacteria in water supplies; and information about Legionella infections in veterans with service-connected respiratory illnesses.

“My efforts are on behalf of the Southwestern Pennsylvania veterans, families and hospital workers to ensure public health is protected and to prevent this situation—which tragically resulted in loss of life—from repeating. It is a positive step forward that the hospital has implemented the CDC’s recommendations to eliminate the Legionnaires’ disease outbreak, but further review is needed for long-term strategies to be effectively deployed.”

The full letter can be viewed below.

Thomas R. Frieden, MD, MPH
Director
Centers for Disease Control and Prevention
Atlanta, GA

Dear Dr. Frieden,

Thank you for taking the time to brief me on December 4, 2012 on efforts underway by the Centers for Disease Control and Prevention (CDC) at the VA Pittsburgh Healthcare System (VAPHS) following the recent outbreak of Legionnaires’ disease. I am grateful for your quick response to provide me information and ensure public health is protected for the veterans, workers, and visitors who access the VAPHS’ University Drive hospital, Highland Drive facility, and H.J. Heinz campus in Aspinwall daily. With the Legionella bacteria remediation work now complete, I respectfully request further information pertaining to the following items as the investigation into the root cause of the outbreak proceeds.

•         Veterans who have been diagnosed with Gulf War Syndrome or have been exposed to asbestos, burn pits, and Agent Orange suffer from chronic respiratory illnesses. Please advise if these veterans have an increased risk of contracting Legionnaires’ disease and/or a higher mortality rate when exposed to Legionella bacteria?

•         According to VAPHS officials, in the last twelve months, 29 cases of pneumonia at the University Drive hospital had an associated diagnosis of Legionella. Of those 29 cases, only five were affirmatively connected to the hospital’s water supply. Other patients have come forward claiming to have contracted Legionnaires’ disease after visits to the VAPHS’ Aspinwall facility. Please review the remaining 24 cases to determine the likelihood those patients contracted Legionnaires’ disease at one of the VAPHS facilities.

•         It is my understanding the copper-silver ionization water system at the University Drive hospital is tested for elevated levels of Legionella bacteria once every two months. Nationally-recognized infectious disease experts have suggested the VAPHS should test the system monthly, and that a well-maintained copper-silver ionization system can in fact eliminate the threat of a Legionella bacteria outbreak. What is the recommended testing frequency for the University Drive system, and was the system properly maintained?

•         Documentation reflects that in 2006 the Department of Veterans Affairs closed the Legionella research laboratory at the VAPHS. Later, VA officials ordered the destruction of thousands of Legionella samples collected over 30 years. If these samples were available for testing, could the CDC have used those specimens to determine whether the newly discovered Legionella bacteria at VAPHS were resistant to disinfection methods and treatments?

•         There have been press reports of recent Legionella cases at other Pittsburgh-area hospitals in the past 24 months. Please advise as to whether there is a broader public health concern, or if the Legionella outbreak is isolated only to facilities within the VAPHS.

•         It is my understanding the VAPHS adopted all CDC recommendations to eliminate the presence of Legionella bacteria, but those efforts would only suffice in the near term and that the VAPHS would need to adopt a long-term solution. Moving forward, what strategies are recommended for the VAPHS to utilize to prevent a future Legionella bacteria outbreak?

•         In 2002, VAPHS implemented a MRSA Reduction Initiative that reduced the incidence of hospital-acquired Methicillin-resistant Staphylococcus aureus by 80 percent over five years. Today, VA hospitals across the country have adopted this infection prevention model first perfected in Pittsburgh. In addition, based on legislation I authored, medical facilities are now required to publicly disclose rates of hospital-acquired infections, helping to shed light on a deadly and costly problem. As we build on these efforts, what additional strategies could hospitals like the VAPHS adopt to eliminate the threat of hospital-acquired infections?

I thank you in advance for your timely response and stand ready to assist you in any way that I can as we work to ensure Western Pennsylvania veterans  receive the highest quality care at the VAPHS. Please stay in regular communication with my office as the review process moves forward.

Sincerely,

Tim Murphy
Member of Congress

Cc:       The Honorable Eric K. Shinseki, Secretary of the Department of Veterans Affairs

Background:
 
In early November, the VA Pittsburgh Health System (VAPHS) called in the CDC after testing of its Oakland hospital water supply showed abnormally high levels of Legionella. The CDC then directed the VAPHS to take specific steps that eliminated the bacteria. On Friday, the VAPHS reported remediation efforts for Legionella bacteria in the water system were successfully completed at the H.J. Heinz campus in Aspinwall as well.  

Almost all water supplies have Legionella bacteria. At high levels, Legionella bacteria can cause a severe form of pneumonia known as Legionnaires’ disease when breathed in through mist or water vapors. The bacteria cannot be spread from person to person. According to the CDC, between 8,000 and 18,000 people are hospitalized with the disease in the United States each year. Most people who are infected can be treated with antibiotics, but Legionnaires’ can be deadly for persons in frail health.  

The cause of the outbreak is currently under investigation by the CDC, the Allegheny County Health Department, and the Pennsylvania Department of Health. An investigative report could be available in the next month.