Mount Carmel Grove City says Legionnaires’ outbreak result of improperly disinfected hot water system

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The legionella outbreak at Mount Carmel Grove City has been linked to the hospital’s hot water system that was not adequately disinfected prior to the opening of the hospital, hospital officials said Thursday.

Tests received this week from water samples showed significant legionella bacteria in the hospital’s hot water system, according to Sean McKibben, president, Mount Carmel Health System.

“As an organization working toward high-reliability, we expect more from ourselves, and we hold ourselves accountable,” McKibben said Thursday. “There is nothing more important to us than the safety of our patients and colleagues. Every day we are trusted with people’s lives and we take that responsibility seriously. We are implementing a long-term solution to ensure legionella is effectively controlled and that this doesn’t happen again.”

On May 31, hospital and health officials notified the public of a Legionnaires’ disease outbreak at the hospital, McKibben said.

The total number of Mount Carmel Grove City patients infected with Legionnaires’ Disease remains at 16, according to Franklin County Public Health.

Mount Carmel officials say they sought help from, Tim Keane, an internationally known legionella expert, and immediately began steps to protect patients, staff and visitors after the outbreak began.

“Today, measures are in place to ensure that water is safe, and we want to share what we know at this point about the source of bacteria, background on timing and what we are doing,” McKibben said.

Lawyer Gordon Evans with The Donahey Law firm, who represents the family of Deanna Rezes, who is the only person who died from Legionnaires’ disease.  

“Our investigation basically confirmed what they admitted to today. That the lines were chlorinated and disinfected in February, but not re-disinfected prior to their official opening in April,” Gordon said.

Gordon said he applauds Mount Carmel’s effort to inform the public about the outbreak.

“The fact that they let this occur in the first place and how they let this slip through the cracks as a patient-centered hospital system as they claim to be is pretty unfathomable,” Gordon said.

McKibben said they have made or have plans to make the following changes:

Efforts to disinfect Mount Carmel Grove City’s water system:

  • Installed a permanent supplemental disinfection system—with 24/7 monitoring and controls—which continuously adds chloramine to the water supply on June 11.
  • Once continuous extensive testing is complete, the temporary filters will be removed.
  • Updated protocol that every patient room (occupied and unoccupied) will be flushed daily.

Actions in process include:

  • Enhancing safety measures.
  • Disinfected and cleaned cooling tower, along with upgrading disinfection controller.

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