Source: http://www.seattletimes.com, September 27, 2016
By: JoNel Aleccia

A 32-year-old woman from Washington state had a heart transplant Aug. 8 at the University of Washington Medical Center, and later learned she was part of a deadly outbreak of Legionnaires’ disease. She plans to sue.

A 32-year-old Vancouver, Wash., woman who struggled with heart failure for more than a decade received a lifesaving transplant this summer — only to contract Legionnaires’ disease during a deadly outbreak at the University of Washington Medical Center (UWMC).
Victoria Martin planned to file a claim Tuesday notifying UW Medicine that she intends to sue the hospital for failing to prevent the infection that also has sickened four other people, including two who died.
“You shouldn’t go to the hospital and be doing well and be knocked down by something that shouldn’t have happened,” said Martin, whose chest scar is still fresh from her Aug. 8 heart transplant. “This whole thing is just insane.”
UW Medicine officials said they had no information about a pending lawsuit.
The claim being filed by Martin’s attorneys gives UW Medicine 60 days to respond.
Martin said she contracted Legionnaires’ disease, a serious type of pneumonia, while recovering in hospital’s Cascade Tower. She was in an intensive-care unit for 25 days and released Sept. 7.
Martin only learned of the larger outbreak by reading early news reports, which at the times said three people had been sickened. They included a man who died Sept. 8 and a woman whose infection was detected during autopsy Aug. 27.
“I was the only survivor out of the three of us,” she said. “That could have been me.”
On Sept. 16, hospital officials said another man had been sickened. On Monday, King County health officials said another woman had been diagnosed with the disease, days after the outbreak was thought to be contained.
In an apparently unrelated case, a man in his 60s has been diagnosed at Overlake Hospital Medical Center in Bellevue.

Investigation continues

In the UWMC investigation, Legionella bacteria have been found on several sites, including an ice machine and sinks in the hospital’s Cascade Tower and on heater-cooler units that regulate patients’ temperature during surgery.
Martin was one of two patients in the outbreak exposed to the heater-cooler units. It’s not clear whether the device she used was contaminated. Similar devices have been linked to bacterial infections, but not previously to those caused by Legionella, infection-control experts said.
The problem has been that bacteria can grow in water tanks inside the devices and spread through the air, or aerosol, through vents or by exhaust fans, according to a warning by the Food and Drug Administration.
Three of the 12 heater-cooler units at UW Medicine were found to be contaminated with Legionella bacteria, hospital officials said. All of the units have since been disassembled and cleaned by the manufacturer, CardioQuip of Bryan, Texas.
Doug Platt, a partner with CardioQuip, said his firm’s devices haven’t been associated with infections and aren’t capable of spreading bacteria in the same way as other machines because the fans used aren’t as powerful.
But Dr. Daniel Diekema, a spokesman for the Society for Healthcare Epidemiology of America (SHEA), said the problem likely isn’t limited to one brand.
“These heater-cooler devices have been used for many years, decades perhaps, and they may be bioaerosol generators really hiding in plain sight,” said Diekema, director of infectious diseases at the University of Iowa Carver College of Medicine.
Dr. Jeff Duchin, King County health officer, said his team is continuing to investigate, but the heater-cooler devices are likely not the culprit. Among the reasons? Two of the patients weren’t exposed to the machines and the other two were on ventilators that protected their lungs from bacteria, he said. In addition, the infections occurred near the end or outside the typical incubation periods.
“It’s not high on our list,” Duchin said.
It’s more likely that the water system in Cascade Tower is the general source of the outbreak. The particular sources — which faucet, which ice machine — may not be known, he added.
“It’s unlikely we will pinpoint the specific sources for individual patients,” said Duchin, who has had extensive experience investigating Legionella outbreaks. “There are likely multiple sources for each patient.”
On Saturday, hospital officials noted it had been 11 days since the hospital implemented precautions to prevent Legionella infection and said it appeared the outbreak may have been contained.
However, a fifth case was diagnosed Sunday. The woman was admitted to the hospital in late August, then went home. She returned in mid-September after water restrictions had been put in place and the system had been flushed with chlorine. But she fell ill within days after the water restrictions were lifted on Sept. 20, raising the possibility the bacteria were still present.
“Sometimes it takes a few tries to really eradicate the Legionella,” Duchin said.

Notoriously tough

Legionella contamination is a difficult problem for hospitals. The bacteria live in all freshwater sources and they’re notoriously tough to get rid of. Guidelines from the Centers for Disease Control and Prevention (CDC) are general and haven’t been updated for years.
Said Duchin, “We’re hopeful that the recommendations will be revised and updated to give hospitals more clear and directed advice.”
Still, Martin said, “This was preventable.”
Martin suffered near-total heart failure from a congenital condition when she was 21. She spent the next decade in and out of hospitals, finally requiring a left ventricular-assist device two years ago to help her weak heart pump blood. She was placed on the heart-transplant list in July and got word weeks later that a match had been found.
The transplant itself went smoothly, but Martin has suffered other problems. She woke up blind in her left eye, perhaps because the optic nerve didn’t get enough oxygen, lawyer Ralph Brindley said.
And then, as she was recovering, she was diagnosed with Legionnaires’ disease.
“I expected to be safe in there,” she said. “I trusted them.”