Background
Basildon Hospital in Essex is facing prosecution for allegedly failing to protect the public from Legionella pneumophila, the pathogenic agent responsible for causing Legionnaire’s Disease. The Health and Safety Executive has charged the hospital under the Health and Safety at Work Act. The charge stems from cases of legionella at the hospital in Nethermayne between 2004 and 2010. Since 2002, there have been 13 people infected with the bacteria. In August 2011, a patient died from Legionnaire’s disease.
Health and Safety at Work Act 1974
Under Section 3(1) of the act, an employer has an obligation to protect non-employees from risks to their health and safety. If the HSE case is successful, the hospital could be subject to a fine of no more than £20,000 in magistrates courts or unlimited fines at crown court.
Legionnaires disease
Legionnaire’s disease is the most serious form of the disease caused by the bacteria. Also known as Legion Fever, it causes pneumonia in association with a high fever. Pontiac Fever, also caused by Legionella, is milder than Legionnaire’s disease and more closely resembles a bad case of flu.
The disease got its name as the result of an outbreak at the Bellvue-Stratford Hotel in Philadelphia, Pennsylvania, in July 1976. An outbreak of pneumonia occurred among several people attending a conference of the American Legion at the hotel. When the species of bacteria that caused the outbreak was identified, it was given the name ‘Legionella’ because of that outbreak.
How is the disease transmitted?
In nature, L. pneumophila is a gram negative bacteria that lives in soil and in freshwater lakes, rivers and streams. In the hospital environment, it may find its way into cooling towers, air conditioners, showers, faucets, swimming pools, nebulizers and physical therapy equipment.
A person may develop Legionnaire’s disease or Pontiac Fever by inhaling mist or water droplets or from choking on water containing the bacteria. Contaminated tap water has been implicated in the disease found in newborn babies after water births.
Who is most at risk from the disease?
The people who are most likely to develop Legionnaire’s disease upon exposure to the bacteria are:
- Smokers
- People aged 65 or older
- Persons with chronic respiratory problems such as emphysema and asthma
- People with lung cancer or other type of cancer
- People with weak immune systems. This includes people with HIV/AIDS, people undergoing chemotherapy, people taking corticosteroids such as prednisone or people taking immunosupressants
- People who work in the cooling towers of buildings with air conditioning
What are the symptoms of Legionnaire’s disease?
Symptoms may develop anywhere from two days to two weeks after exposure to Legionella bacteria. Initially, the patient presents with a fever in excess of 104F/40C, muscle pains or headaches, and chills.
A cough will usually develop, which may produce blood-stained sputum within two or three days. This may be accompanied by shortness of breath and/or chest pains. Patients may also develop anorexia and fatigue along with vomiting and diarrhoea. Some people become confused and have difficulty concentrating.
Legionella bacteria may also infect wounds that have come in contact with contaminated water.
How is the disease treated?
Legionella responds to antibiotics such as Azithromycin (best drug for children), Levofloxacin, Ciprofloxacin, Doxycycline, sulfamethoxazole and Trimethoprim. Treatment should be started as soon as possible to prevent complications from developing. These may include:
- Memory loss
- Kidney failure
- Septic shock
- Respiratory failure
- Death
How is Basildon Hospital responding to the charge?
Clare Panniker, recently appointed Chief Executive of Basildon and Thurrock University Hospitals NHS Trust, said that in the past decade, the hospital had committed £3 million and introduced several changes in an effort to bring the problem under control.
She pointed out that the hospital has not had a case of the disease since 2011 and assured the public that the Trust was working closely with the HSE to fight Legionella. A joint report produced by the hospital in collaboration with other health organisations concluded that the present risk of contracting Legionella at the hospital is one in a million.
The date for the first hearing of the case, taking place at Chelmsford Magistrate’s Court, has not been set.