Lack of Legionella protocol frustrates U-46 leader
The head of the Elgin-area school system says there is an alarming lack of public health standards and protocols for dealing with the Legionella bacteria in schools.
Eastview Middle School in Bartlett, Larkin High School in Elgin and the district's Educational Services Center housing the central office and Gifford Street High School programs in Elgin were shut down for three days after officials found abnormally high levels of the bacteria in the water cooling towers. The buildings, which were occupied by about 3,000 students and 350 staff members, were reopened a week ago.
"It was incredibly frustrating," Elgin Area School District U-46 CEO Tony Sanders said about not receiving any guidance from state and federal agencies on whether it was safe to reopen the buildings once the towers were cleaned.
Sanders highlighted the gaps in state and federal regulations in an email addressed to U-46 employees, other school districts and regional education officials.
Despite the U-46 scare, state health officials don't get involved until an actual case of Legionnaires' disease is found, nor are there guidelines for acceptable levels of the bacteria.
"There are no public health minimum standards for levels of Legionella bacteria," said Melaney Arnold, spokeswoman for the Illinois Department of Public Health. "There is no safe level of Legionella in a water system. IDPH becomes involved when there are human case of Legionnaires' disease (legionellosis),"
Between 2005 and 2014, Illinois recorded 1,639 cases of legionellosis, of which only two occurred in people younger than 18.
"While IDPH encourages proper facility maintenance and proactively protecting the health of staff and students, we do not recommend routine sampling for Legionella," Arnold said. "However, if school systems decide to test for Legionella, IDPH recommends that it first develop a water management plan."
When Legionella is identified in a water system, the Centers for Disease Control and Prevention recommends remediation measures, including superheating or hyper-chlorinating the water system.
"These methods do not usually lead to permanent removal, so a long-term plan for prevention of Legionella growth is almost always necessary," the federal agency recommends.
Standards listed on the Occupational Safety and Health Administration's website call for "immediate cleaning and/or biocide treatment" if Legionella bacteria levels reach above 1,000 colony-forming units per milliliter. They also call on employers to "take prompt steps to prevent employee exposure." Those guidelines were adopted based on a 1991 study conducted by Georgia-based Pathogen Control Associates, OSHA's website states.
Decision to close
After testing all three U-46 buildings, Eastview's results came in at 1,480 cfu/mL, the central office's at 1,350 cfu/mL and Larkin's just under the threshold at 940 cfu/mL, officials said.
"That's why we evacuated the schools and kept the students out," Sanders said. "I still do not know if (closing the buildings) was absolutely necessary, or if (the bacteria) was only in the region of the HVAC system."
Sanders said he consulted with officials in the local and state health departments and in OSHA. While health officials offered some advice on cleaning the cooling system, the decision to close buildings was left to U-46.
A state OSHA representative said public school districts do not fall under the agency's jurisdiction.
OSHA's website lists the protocol for facilities that have experienced an outbreak of human cases of Legionnaires' disease, which includes steps to clean the facilities. Yet nowhere does it list the protocol for when the bacteria is found somewhere within a building. The agency does not advise on whether such buildings should be evacuated or how safe it is to remain inside.
At the affected U-46 buildings, the water in the cooling system is separate from drinking water. To rid the cooling system of the bacteria, the district performed a "shock" of all 19 cooling towers by draining and flushing them with four times the recommended level of cleaning/disinfecting agents, plus descaling or removing any hard water deposits, officials said.
"There is really nobody that can give you guidance as to when it's safe to have people in or around the area when the bacteria level comes in that high," Sanders said. "They could not advise whether we should reopen or remain closed. I don't have a full-time infectious diseases person or an epidemiologist to tell me what we should or should not do. We needed help."
Ultimately, district officials reached out to Advocate Sherman Hospital in Elgin for expertise.
Robert Tiballi, head of infection control at the hospital, gave U-46 the green light once the cooling towers were flushed and cleaned.
"We would expect a greater than 95 percent reduction in colony count after one treatment," Tiballi said. "The treatment was repeated three additional times. The decision to reopen the buildings was based on the statistical likelihood that we would have achieved 100 percent reduction in the colony counts."
U-46 performed the Legionella bacteria test this year based on a recommendation from the American Society of Heating, Refrigerating and Air-Conditioning Engineers. Nineteen of the district's 53 schools have cooling towers that require testing; the other schools have different cooling systems.
As more school districts adopt this test, it can cause confusion and problems, Tiballi said.
"It's going to create chaos all over the country," he said. "(U-46 is) kind of like the canary in the coal mine. When ASHRAE put these protocols out, I'm sure they did not foresee the consequences of their recommendations."
The society's new standard -- released in June -- suggests testing for Legionella bacteria in water systems, but it also advises building owners or operators to create a comprehensive plan to manage the building's water system, said Michael Patton of Griswold Water Systems, who served on the committee that created the standard.
"If you do decide to test, you have to build a program that has an appropriate response to a given result," he added.
Sanders said school districts could learn from U-46's experience and become better prepared.
"They need to have a plan in place for what you do when the results come back high," Sanders said. "We will have a plan in place so that this does not happen again. One of the first things we have to do is back up our testing so that we know the results before school opens.
"The second step is what are the action steps we take as soon as we know."