Questions asked after Legionnaires’ cases at St. John’s

 

The Minnesota Department of Health is standing behind the city of Albert Lea’s water system after St. John’s Lutheran Community administration raised concerns following the diagnosis of a resident last month with Legionnaires’ disease.

The care facility’s campus on Fountain Lake had five cases of Legionnaires’ last year from June through August, and at that time underwent extensive monitoring and treatment. One case was diagnosed this year on April 16 in a resident at The Woodlands, the skilled nursing building, and the facility remains under water restrictions and monitoring.

St. John’s Administrator Scot Spates said the Minnesota Department of Health and Minnesota Valley Testing Laboratories, a Centers for Disease Control-certified lab for Legionnaires’ hired by St. John’s, took water samples at the site April 18.

Of the 17 samples taken by Minnesota Valley Testing Laboratories, 10 had the presence of legionella bacteria. Of those 10, five tested positive for the legionella pneumophila strain, which can lead to Legionnaires’ disease or a flu-like illness called Pontiac fever. According to the Department of Health, this strain is primarily responsible for most cases of legionellosis — which includes Legionnaires’ and Pontiac fever — with other species accounting for about 10% of cases. Some species of legionella do not cause disease.

Spates said of the five sites that tested positive for the legionella pneumophila strain, three were samples taken from sinks, one was from a shower and the fifth was from the water main that serves the nursing home and the assisted living building.

The other water main that serves the Waters Edge apartments tested positive for legionella bacteria but not the legionella pneumophila strain.

Of the 19 samples taken by the Department of Health, 10 tested positive for legionella pneumophila, one tested undetermined for legionella pneumophila and one tested positive for legionella species that was not pneumophila. Legionella species were not found in seven samples, including on both water mains.

Positive tests for the pneumophila strain were on a hot water heater, two sinks, a shower room and tub room and two resident showers in The Woodlands, along with two salon sinks and a bathroom sink in the town center.

Spates said Minnesota Valley Testing Laboratories also took samples at two offsite locations, which tested positive for legionella bacteria — not the pneumophila strain — one of which was at the new Edgewater pavilion west of the St. John’s site and one from the faucet of a home on Crescent Drive, which is east of the facility.

Spates questioned whether it was safe to have the legionella bacteria at these two locations and why there was the positive legionella pneumophila test result on the water main on the test conducted Minnesota Valley Testing Laboratories.

Albert Lea City Manager Chad Adams said the water main where the test was found positive for pneumophila by Minnesota Valley Testing Laboratories was within the walls of St. John’s and it is the organization’s responsibility to treat the water at that point. He noted that the Department of Health’s test of the same location did not come back positive.

Both the city and St. John’s tested the backflow mechanism on the water main and found it to be in good order.

Adams said it is one of the many things the city has checked to ensure nothing is backing into the water supply.

“Even if it did, the temperature of our water and the chlorine levels would have mitigated the legionella affecting anyone else in the system,” the city manager said.

Spates said last year the city requested access to the two water mains at St. John’s on Fountain Lake to check the chlorine levels. St. John’s provided access to the water mains on a number of occasions.

He said regardless of who owns the water mains themselves, the water mains are the best locations to access the conditions of the source water coming into a building.

“City leadership dismisses the Minnesota Valley Testing Lab water main results, and then uses the MDH water main lab results as verification that the water is safe,” Spates said. “This is ridiculous.”

Doug Schultz, information officer with the Minnesota Department of Health, said legionella bacteria can be found everywhere in the environment in aquatic habitats and moist soils and it is not unusual or unexpected to occasionally find it.

“However, the city of Albert Lea chlorinates its water and maintains good chlorine residuals (which limits growth of bacteria),” he said. “They follow established best practices for monitoring and maintenance; their testing results fall within the range we consider adequate. In other words, the city’s water is safe and meets all water quality standards.”

He noted even well-treated drinking water that meets all federal and state quality guidelines can have legionella in it, but that doesn’t mean it’s capable of causing disease or illness.

“It’s really only capable of causing infection when three things happen: It becomes stagnant and warm and thus is amplified (the bacteria grow in number and concentration), and then becomes aerosolized so that it enters a person’s lungs, where the bacteria can cause disease,” Schultz said. “So premise plumbing, including fixtures such as cooling towers or showers, are where we see problems.”

He said if there were problems with legionella in the city’s water, other illness cases would be popping up around the city.

“Albert Lea’s water is as safe as any other city in Minnesota that meets our water quality standards,” Schultz said.

Adams said the city increased its chlorine levels from the standard and acceptable level by about 70 percent for a temporary period last summer when the Legionnaires’ cases were reported.

“We did so, along with frequent flushing of hydrants in the St. John’s area, to get St. John’s a higher level of chlorine content in their facility to assist in any way with clearing their facility of the legionella,” Adams said.

At that time, he said the city was still learning about legionella and responded with the only ability it had to increase the chlorine and water flow by flushing the hydrants.

“At no time was our chlorine levels too low or was our water at risk,” Adams said.

Based on what the city learned last summer, he said it is not necessary for the city to flush the hydrants frequently or increase chlorine levels because the need is for St. John’s to manage its water internally.

 

What are the city requirements for legionella testing?

Schultz said cities are not required to test for legionella, specifically. However, they are required to monitor regularly for total coliform, which is used as an indicator for the potential for a host of bacteria that can be found in water.

“If public water supplies are treating their water, maintaining good water quality and operating according to established best practices (e.g. flushing the system on a regular schedule) and meeting other monitoring requirements, they will be controlling for legionella,” he said.

He noted that a public water supply is not required to supply facilities with sterile water.

“Legionella is ubiquitous and can be found in any finished water,” Schultz said. “It is the facility’s responsibility to manage the water quality inside their facility.”

 

What is St. John’s doing for its water safety?

Spates said after the first Legionnaires’ cases were reported in 2018, the facility increased the hot water temperature on its hot water heaters to 140 degrees and has been flushing its system more regularly.

He said one of the requirements to open the nursing home after it was built was to have a water management plan submitted and approved by the Minnesota Department of Health. After the Legionnaires’ outbreak in 2018, that plan was again reviewed by the Department of Health.

After this year’s case was reported, St. John’s chemically treated the water and then took new samples for testing.

Spates said this testing came up with 12 samples positive for legionella bacteria — of species other than pneumophila. He said the Department of Health representative told him this was “very concerning.”

Water restrictions cannot be lifted until there are two rounds of testing with negative results.

He said before it heard back from the Department of Health about its most recent round of testing, St. John’s had decided to flush its water system even more for both vacant and occupied rooms — he estimated about two to three times a week — until a new secondary disinfection system gets installed at both water mains.

Spates said he continues to question the testing results received by Minnesota Valley Testing Laboratories, along with the timing of the construction taking place to extend sewer and water to the Stables area, saying heavy trucks started going over the edge of the St. John’s property near the water line around the same time as when this year’s case of Legionella was reported.

Schultz said there is no evidence to suggest that construction of sewer and water in other areas of the city has impacted the water coming into St. John’s.