Expert warns Sir Charles Gairdner Hospital used flawed methods in legionnaires tracing

There are serious concerns over the handling of possible legionnaires cases at Sir Charles Gairdner Hospital with an infectious diseases expert claiming authorities are dismissing possible healthcare acquired illness without thorough investigation. In August, The West Australian’s Hospital of Horrors investigation revealed Legionella bacteria, which causes the serious pneumonia-like respiratory infection, had been found at unacceptable levels almost 60 times in the past two years. The Cook Government immediately downplayed the results and denied there was a risk to patients. Health Minister Meredith Hammat asserting in State Parliament: “The information that I have is that I have been advised that there are no confirmed cases of legionnaire’s disease having been acquired at hospitals since 2021.” While her comments were accurate, official documents from Sir Charles Gairdner Hospital’s infection prevention and control committee show that a fortnight earlier the experts were assessing a recent legionnaires infection in a patient. Internal minutes recorded at the August 7 meeting, and obtained by The West, show the committee considered the case as “likely” acquired in the community despite the patient attending SCGH for appointments before falling ill, including in an area with confirmed Legionella test results. “Hematology patient with a background of acute myelogenous leukemia presented,” the minutes state. “Seems to be a community acquired. Patient presented to DD block. Presented to pulmonary physiology at Fiona Stanley Hospital. “The presentations are within the 10-day incubation period (for legionnaires infection).“ At a follow-up meeting on the 20th August, the committee’s notes show there were two positive Legionella detection’s in water samples taken from the hospital block where the infected patient had been. The bacteria was the same common strain as the one that had made the patient unwell. Despite the results, the committee officially wrote-off the infection as not acquired in the hospital. “Two-outlets in rad-oncology outpatients DD block tested positive for Legionella pneumophilia via July,” the minutes state. “Opposite side of the building (to infected patient). Low risk of exposure based on clinic appointment and duration of presentation. “Consensus that infection not attributed to healthcare, and likely community acquired.” Meeting minutes from June 7 show another patient admitted to ICU had become infected with legionnaires. That case was “deemed community acquired” by the committee with no explanation as to whether any water sampling was conducted, or how the determination was made. Then in its January meeting, the committee was dealing with another infection in a patient at the hospital — with the minutes showing legionella bacteria had been detected in the air con cooling tower where the person had been, in the months prior to their attendance but it was remediated. The committee stated the cooling tower “ may require re-testing” following the patients infection but concluded: “not for re-testing at this time.” At its next meeting the following week, the experts relied on “verbal reports” from staff that there had been no recent Legionella in the air con cooling tower before dismissing the hospital as the source of infection. “Public Health have been notified and have acknowledged that the risk of Legionella infection associated with this patient’s outpatient presentations to Sir Charles Gairdner Hospital is low” the meeting minutes state. “Nil further actions (or) investigations requested. Event closed.” The West Australian provided a copy of the meeting minutes to an experienced clinical microbiologist and infectious diseases expert, who has provided consultancy work for WA hospitals, and asked for their professional opinion. Speaking strictly on the condition of anonymity, the doctor said the committee’s rational for determining legionnaires cases as community acquired was “critically flawed” and would not be able to confidently rule out hospital acquired illness. “The Infection Prevention and Control Committee demonstrates a consistent and scientifically untenable pattern of prematurely concluding that infections are ‘community-acquired’,” the doctor said. “They often reach conclusions without a rigorous, evidence-based investigation that adequately considers the known environmental contamination within the hospital. “Plausible windows of in-hospital exposure during the recognised 2-14 day incubation period are frequently overlooked, and potential epidemiological links to contaminated water outlets are dismissed without sufficient justification.” This lack of due diligence created a “dangerous blind spot” which, according to the expert, wasn’t accurately documenting any potential legionnaires outbreak at SCGH. The doctor said the committee’s meeting minutes should outline the full basis for how decisions are made on the source of legionnaires infections. “It’s a deficient clinical investigation framework which places patients at an unacceptable and preventable risk,” they said. “Identification of a patient with legionnaires’ disease within a healthcare facility should trigger a rigorous and systematic investigation to determine the source of the infection. “The committee’s methodology appears to suffer from fundamental flaws, leading to a confirmation bias that favours a community-acquired source.” North Metropolitan Health Service categorically rejected the criticism of its infection prevention experts and said the hospital’s processes were systematic and evidence based. “The specialist referred to by ‘The West Australian’ has not been part of any clinical assessments (at the hospital), they do not have a comprehensive knowledge of the cases or our processes,” the spokesperson said. “SCGH prides itself on providing safe, high-quality care. Rigorous assessments are undertaken by specialist clinical teams on patients who present with legionella symptoms. “Each legionella case is reviewed by a team of clinical experts to map out the origin of the infection and ensure appropriate infection control management.” The spokesperson denied that the committee relied on “verbal” assurances, as detailed in it’s own meeting minutes. “The word ‘likely’ is used in the early stages of an investigation until the process is complete and the evidence confirms where the patient acquired the infection,” they claimed. “No patient has acquired legionella while in SCGH since 2021.”