Less than a week after reporting a single case of Legionnaires’ disease, The Queen’s Medical Center said it has treated three more patients for the potentially deadly pneumonia at its Punchbowl campus.

The string of cases caused by bacterial infections was alarming enough for Queen’s and the state Department of Health to issue a news alert ensuring the public that health officials are “working closely with the Centers for Disease Control and Prevention to investigate these cases and all potential sources of Legionella exposure within and outside of the hospital.”

Queen’s said it is taking additional precautions to keep high-risk patients who are at greatest risk of contracting the disease away from tap water in any form at the hospital. That includes people with chronic diseases or AIDS, those on chemotherapy and transplant patients. Legionnaires’ disease is primarily spread through inhaling aerosolized water droplets.

An internal staff memo released Tuesday warned staff to keep patients with weakened immune systems away from water fountains, ice machines and water used for drinking, baths, tooth brushing, wound care, sinus rinses and contact lens cleaning or insertion, as well as toilet flushing.

“Instead patients should call for a nurse or nurse’s aide to assist and be outside of the bathroom with the door closed when flushing occurs,” the memo read. “Bottled water will be provided to these patients as an alternative.”

Queen’s and the DOH wouldn’t say whether the cases were related since an investigation is ongoing. The hospital uses its own water via a private well beneath the facility. There have been eight cases of Legionella statewide so far this year and an average 10 cases annually over the past five years, according to the Health Department.

“We are asking all health-care providers to have heightened awareness of the possibility of Legionella in immunocompromised patients who develop unexplained fevers or pulmonary symptoms, and to test all patients presenting with moderate to severe pneumonia for Legionella,” the hospital said.

The medical center said it is also increasing the chlorination of water, testing water cultures with the DOH, replacing flow devices on faucets and scheduling the running of showers and faucets as part of routine room cleaning.

While Legionella is naturally found in freshwater lakes, streams and soil, it is a public health concern when spread in building water systems like shower heads and faucets, hot tubs and cooling systems. The disease is not readily transmissible from person to person.

Most people do not become ill when exposed to the bacteria, but those with compromised immune systems are particularly vulnerable to developing Legionnaires’ disease, which is serious because it has a higher fatality rate than other types of pneumonia.

“Obviously, you’ve got compromised patients both immunologically and also general health (in the hospital),” said Dr. Chris Flanders, executive director of the Hawaii Medical Association, the trade association for physicians. “That would be worse than if it’s out in the general public where people are generally healthy. If (Queen’s) is the source, that’s obviously going to be a high-level concern. They might have to transfer some of the patients who are having increased susceptibility to getting infections: immunocompromised patients and sick elderly patients.”

Dr. Erlaine Bello, a Queen’s infectious disease specialist, said patients are not being evacuated, and there are no definitive results on the source of infection.

“This is not unique to Queen’s Medical Center. In fact, there have been recent reports of Legionella problems (on the mainland),” she said. “The reason Queen’s is always in the news is we take care of the largest number of patients, and we also take care of the sickest. We do have the greatest number of immunocompromised patients in the state. (But) if you’re not exposed to aerosols of water that contain the bacteria, you will not get infected.”

Legionella Fact Sheet by Honolulu Star-Advertiser on Scribd

Legionnaires’ Disease Fact Sheet by Honolulu Star-Advertiser on Scribd