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GUARDIAN HOSPITAL WATER CONSULTANTS

A CONSORTIUM OF TECHNICAL PEOPLE

Engineering – Dr. Guenter B. Moldzio

BiOzone Corporation – Tel: 303-770-2095

Consultant – John C. White

Polynox Technologies – Tel: 409-786-4116

We engineer professionally certified engineered systems to resolve pathogenic organism problems. Our specialty systems are designed to last over twenty trouble-free years.

WATER STERILIZATION

We offer a state-of-the-art water sterilization system that includes the entire water supply. Our patented* system is physicochemically designed with a microprocessor installed real-time digital database with (hard copy) available system data that can report efficacy 24/7. *patent pending. We are capable of producing conclusive evidence that will defeat claims of waterborne infections.

HOSPITALS CAN NOT WIN WATERBORNE INFECTION LAWSUITS

WE GUARD AGAINST PATHOGENIC MULTIMILLION DOLLAR AWARDS

INFECTIONS COULD BE THE NEXT ASBESTOS

The past assumption that “infections are unavoidable” shielded hospitals from liability for decades, but not in the future. That is changing. Nearly all hospital infections are currently identifiable and preventable. These findings put hospitals in a new legal situation. Soon jurors will be told that the hospital failed to implement necessary and available infection sanitation practices, and consequently, should be deemed negligent and held strictly liable in some cases for patient infections. Trial lawyers will claim that an infection “speaks for itself”, and shifts the burden onto the hospital to offer evidence that it was not negligent. 

Res ipsa loquitur has already played a prominent role in medical malpractice cases in New York and elsewhere. What is new will be its applicability to hospital infection. The New York Court of Appeals ruled that the jury should have been told that the error “speaks for itself”: once the plaintiff proves that “the event was of a kind that ordinarily  does not occur in the absence of someone’s negligence, and that it was caused by an agency or instrumentally within the control of the defendant, and that it was not due to any voluntary action or contribution on the part of the plaintiff, a prima facie case of negligence exists”. The court also explained (and this is the key to future litigation based on infection) that to rely on res ipsa loquitur, a plaintiff need not conclusively eliminate the possibility of all other causes of injury. It is enough, that it is more likely than not, that the injury was caused by the defendant’s negligence.

ARCHIVES OF INTERNAL MEDICINE

The Hospital Water Supply as a Source of Nosocomial Infections

Some of the most frequently isolated gram-negative bacteria, including Pseudomonas and Enterobacter, have been found to persist in hospital water for extended periods and have been responsible for nosocominal outbreaks. In fact, a recent review of prospective studies published between 1998 and 2005 indicated that between 9.7% and 68.1% of random intensive care unit water samples were positive for Pseudomonas aeruginosa, and between 14.2% and 50% of patient infections were due to genotypes found in intensive care unit water. (ref: Arch. Int. Med., vol. 167, No. 1, Jan. 8, 2007)

Anaissie, et. Al., in their 2002 article in Archives in Internal Medicine estimate that 1,400 deaths occur each year in hospitals in the United States as a result of waterborne nosocomial pneumonias caused by Pseudomonas aeruginosa alone. (ref: Arch. Int. Med. ,vol 162,1483-92,July 8,2002)

Hospital-acquired pneumonia (HAP) or nosocominal pneumonia refers to any pneumonia contracted within 48-72 hours of being admitted in a hospital.

Bacteria, viruses, and protozoa are primarily associated with waterborne disease.

          1) Key bacterial pathogens responsible for waterborne disease include Legionella, Salmonella, typhi, Shigella, and Vibrio cholerae (from stools of cholera victims).

          2) Key viral pathogens include hepatitis A and Norwalk virus.

          3) Key protozoa, as agents of waterborne disease, include Giardia and Cryptosporidium. (Protozoa are "Trojan Horses" of the microbial world)

The maximum contaminate level for viruses is zero.(heretofore unachievable)  In recent years, chlorine has been replaced by chloroamine in municipal water supplies.  Chloroamine does not inactivate cryptosporidium. (World Health Organization Data)

Approximately 18,000 cases of Legionnaires' disease occur annually in the U.S. and 25 per cent of these cases are acquired from hospital water systems. (Water Cond.&Pur.(Oct.2004).  About 5-15% of known cases have been fatal. (Can. J. Mic,44:1998)

Recently, another waterborne bacterium, the deadly and antibiotic resistant Acinetobacter, was linked to 101 CASES and 39 DEATHS in a major London hospital.

OSHA has made it very clear that Legionella is a known biological hazard for which protection from harm is required by the General Duty Clause of the Occupational Safety and Health Act.

Contamination of the hospital water supply with potentially pathogenic organisms is very common, but the magnitude of the problem is largely unrecognized and there are no specific guidelines for protecting patients from exposure.

Patient exposure to waterborne pathogens can occur while showering, bathing, drinking water, ingesting ice, from exposure to medical equipment rinsed with potentially contaminated tap water. 

There is solid evidence linking contamination of hospital point-of-use water supplies to waterborne nosocominal infections in patients. 

Sources for the Transmission of Waterborne Pathogens

Aronson, et. al. (1999)

(1) Examined potable water in Los Angeles as a possible source of infection in AIDS and non-AIDS patients. Water samples were evaluated from reservoirs, homes, commercial buildings, and hospitals. Mycobacterium avium isolates were recovered from potable water in 8 hospitals that had varying degrees of relatedness to 19 clinical isolates from 17 patients. 

Patterson, et. al. (1997)

(2) Tested hot and cold point of use water supplies in 81 units in the UK. More than half of the water outlets in these transplant units (61 of the 81) were found to be contaminated with Legionella species.

Several clinical references are of particular interest because they teach about hospital water contamination as a risk of nosocomial infection.

Tautman, et. al. (2001)

(3) Studied tap water colonization with Pseudomonas aeruginosa in a surgical intensive care unit. Twenty-nine percent (5 out of 17) patients were infected with a genotype identical to that found in the tap water samples. All water outlets harbored distinct genotypes of Pseudomonas aeruginosa over prolonged periods of time. The individual water faucets served as an environmental reservoir or “breeding ground” for development of distinct genotypes of the organism.

Kolmos, et. al. (1993)

(4) Identified showers and tubing connecting the shower head to the tap as a source of transmission of Pseudomonas aeruginosa. This led to vesepticemia in five patients as a result of using contaminated shower equipment to irrigate burn wounds. 

Weber, et. al. (1999)

(5) At the University of North Carolina concluded that low levels of bacteria contamination of potable water in the hospital led to contamination of faucet aerators, with subsequent bacterial amplification on the aerator, leading to a nosocomial outbreak in patients in a surgical intensive care unit of patients colonized or infected with Stenotrophomonas maltophilia. 

Bert, et. al. (1998)

(6) Studied a nosocomial outbreak associated with a multi-resistant Pseudomonas aeruginosa organism transmitted to patients via the hands of nursing staff or nutrition solutions contaminated with tap water. 

Anaissie, et. al. (2002, 1997)

(7) Demonstrated that a Fusarium species of mold colonized a hospital water system over a long period of time (five plus years) and was associated with patient isolates of the same organism. The organism was isolated from sink faucet aerators, shower heads, sink drains, and the hospital water tank.

Anaissie, et. al. (2002)

(8) In a three-year prospective study of hospital air, environmental surfaces, and the water distribution system, demonstrated that Aspergillosis, a life-threatening infection in immuno-compromised patients thought to be transmitted by Aspergillus organisms in the air was in the hospital water system with high concentrations found in bathrooms with showers and taps. During the study, a clinical isolate of Aspergillus furmigatus was recovered from a patient with Aspergillosis that was genotypically identical to an isolate recovered from the shower in the patient’s room.

BETWEEN 1995 AND 2005, OVER 32,000 CASES OF LEGIONNAIRE’S DISEASE AND MORE THAN 600 OUTBREAKS WERE REPORTED TO THE EUROPEAN WORKING GROUP FOR LEGIONELLA INFECTIONS.

THE GENERAL DUTY CLAUSE OF THE OCCUPATIONAL SAFETY AND HEALTH ACT (OSHA) CLEARLY STATES THAT LEGIONELLA IS A KNOWN BIOLOGICAL HAZARD THAT REQUIRES PROTECTION. 

NOTABLE OUTBREAKS OF LEGIONNAIRE’S DISEASE 

Philadelphia, 1976

The first recognized outbreak occurred on July 27, 1976 at the Bellevue Stratford Hotel where members of the American Legion had gathered. Within two days of the event’s start, veterans began falling ill. They had high breathing rates and chest pains. Perhaps as many as 221 people were given medical treatment, and 34 deaths occurred. In January 1977, the Legionellosis bacterium was identified and found to be breeding in the cooling tower, which then spread through the entire building. 

United Kingdom, 1985

A large outbreak of Legionnaire’s disease was associated with the Stafford District Hospital. A total of 68 confirmed cases were treated in the hospital and 22 of these patients died. The BBC reported 101 infected with 28 deaths resulting.

Netherlands, 1999

In March 1999, an outbreak occurred during a flower exhibition. Two hundred people became ill and at least 32 people died. The source was thought to be from a whirlpool and a humidifier in the exhibition area.

Spain, 2001

The world’s largest outbreak happened in July 2001 (patients began arriving at hospitals on July 7) in Murcia, Spain. More than 800 suspected cases were reported, and 6 died.

Norway, 2001

The first case occurred in 2001 when 28 people were infected in the city of Stavanger and 7 died. The source was the cooling tower at the nearby SAS Radisson Hotel.

United Kingdom, 2002

Barrow-in-Furness suffered the U.K.’s worst outbreak of Legionnaire’s Disease. Six women and one man died; another 172 people also contacted the disease. The cause was found to be a contaminated cooling tower at the town’s art center. It became the first public body charged with manslaughter. 

France, 2003

Legionella in the cooling tower water in the Exxon Mobil Plant in Harnes, France infected 86 local residents and killed 17 people.

France, 2004

A team of French scientists reviewed the details of an epidemic of Legionnaire’s Disease that took place in Pas-de-Calais, France. There were 86 confirmed cases of whom 21 perished. The source was a cooling tower in a petrochemical plant. Some infected people lived as far away as 6-7 km from the plant.

Norway, 2005

In May, there was a second-greater outbreak in Fredrikstad. Fifty-two patients confirmed infected and ten people died, with ages ranging from 68 to early 90s. Legionnaire’s Disease was determined by DNA matching from an air purifier scrubber.

New York, 2007

Legionnaire’s Disease was confirmed in New York City nursing homes, all of whom were hospitalized and recovered. Two later cases were confirmed at Rochester General Hospital in Syracuse, New York in 2008.