BIRMINGHAM, AL (WBRC) - UAB and the state department of health issued a joint statement on Thursday in an effort to clear up the confusion about when the hospital first reported the legionella outbreak.
The statement says the Alabama Department of Public Health requires an outbreak to be reported to the ADPH within 24 hours of it being identified.
UAB did not report the legionella outbreak within 24 hours of it being identified, ADPH State Health Officer Dr. Donald Williamson said in a phone interview.
However, UAB took all of the proper measures that they would have taken if they had reported it to the ADPH within 24 hours, Williamson clarified. The only difference, he said, is that the CDC would have been involved sooner.
"We are continuing to work with them. The actions based on conversations this afternoon with the CDC, the actions that UAB took, appear to have been effective, in preventing future transmission. And that's all any of us can hope for once there is an outbreak," Dr. Williamson. explained.
He said the legionalla outbreak is an opportunity to improve surveillance, reporting and communication.
"One of the things we will be doing is to look to see if there's some way we can get better reporting from clinicians. To see if theirs is something better that we can do to marry the results, that we get from labs with a clinical situation, so that if there is a way to have intervened earlier, we would have intervened earlier," Williamson added.
The ADPH learned about the legionella outbreak at UAB on May 19. But they had been receiving individual lab results from UAB between April 11 and May 19.
"Each identified positive Legionella result was investigated locally. Since Legionella is very prevalent in the environment, the identification of an outbreak from isolated laboratory reports is very difficult as in this instance," the joint statement from UAB and ADPH says.
Two out of nine people who tested positive for the bacteria died in early-to-mid May, UAB confirmed on Tuesday, May 27. However, the hospital says the causes of deaths for those patients have not been determined and their exact times of death won't be released due to medical privacy laws.
Eight of those who tested positive for legionella, a bacteria that can cause a form of pneumonia called legionellosis or Legionnaire's disease, were patients in UAB's hematology/oncology unit. The ninth person was a visitor to the hospital, Jefferson County health officials confirmed on Wednesday.
People with weaker immune systems are more susceptible to legionella bacteria, according to UAB's Chief Patient Safety Officer Dr. Loring Rue.
Dr. Rue said the hospital they took the proper measures to address legionella in their water system—installing filters on shower heads and faucets, flushing out the system, shocking the water with extreme temperatures and warning patients to wear masks when flushing the toilet.
The hematology/oncology unit shares a plumbing system with three floors in the Woman and Infants Center, so the water treatments were done on floors 5, 6 and 7 as a precaution.
Since the hospital made those remedial treatments to the water system on May 7 through May 9, they have not seen any new infections of legionella.
Read the full release from UAB's Dr. Loring Rue and Dr. Donald Williamson, below:
There has been significant confusion about the timeliness of reporting by UAB of the Legionella outbreak. In Alabama, reporting of communicable disease often follows multiple tracks, including both clinical and laboratory reports.
Lab test results were forwarded in a timely manner from UAB to ADPH between April 11 and May 19. Each identified positive Legionella result was investigated locally. Since Legionella is very prevalent in the environment, the identification of an outbreak from isolated laboratory reports is very difficult as in this instance.
The identification of a cluster of cases associated with an outbreak is more easily done through clinical reporting. It is for this reason that ADPH requires suspected outbreak reporting within 24 hours of identification. However, we recognize that an outbreak cannot be reported by the facility until it is identified. In a hospitalized population with multiple severe underlying health problems, the diagnosis of Legionella is often difficult to make.
UAB focused on protecting patients and reducing the risk of future cases. Based upon the information available at this time, it appears that there have been no further cases after the UAB interventions of May 7-9. We continue to work with UAB, CDC, and the Jefferson County Health Department.
Every outbreak presents an opportunity to improve the surveillance system. We will continue to work with laboratories, hospitals, physicians, and other reporting entities to enhance reporting and our ability to identify outbreaks.