Emergency Upgrades to Domestic Water System to Alleviate the Outbreak of Legionella
Illinois Veterans Home, Quincy, IL

Background:

The Illinois Veterans’ Home in Quincy is a 210 acre campus comprised of almost 50 buildings, a central utility plant and a 500,000 gallon water tower.  The state-owned facility provides long term skilled nursing care to approximately 380 elderly veterans and employs over 500 direct care and support staff. Beginning in July 2015, the Home experienced a rapid outbreak of Legionnaire’s disease ultimately causing illness in 54 residents and employees and claiming the lives of 12 veterans.    Emergency measures, including water management and engineering controls were needed to provide an immediate response to the outbreak and to reduce risk of future outbreaks.  Due to the central utility plant configuration of the campus, potable water and process water systems were addressed.

Approach:

The emergency project approach was twofold with maintaining and improving existing water management strategies and engineering controls being the initial mission.  Developing long-term mitigation strategies suitable for immediate execution in an operating healthcare setting comprised the remainder.  Our work included: extensive site investigation; planning and programming of infrastructure work in an occupied healthcare setting.  Project execution involved  developing, staging and sequencing of  plans;  utilizing ground penetrating radar for underground utility location; preparation of construction plans and specifications; reviewing shop drawings;  daily construction observation and validation; and finally, leading a multi-agency, multi-discipline project team.  The project team, made up of state regulatory authorities from IEPA and IDPH, representatives of the Illinois Department of Veteran’s Affairs, the Illinois Capital Development Board along with Quincy Public Works, contractors and A/E firms executed a response package including 17 major scope items aimed at reducing risk to the veterans and employees. 

The scope items were to be developed and executed on a parallel track under emergency timeframes without posing additional risk to building occupants or interrupting operations.  Despite the emergency nature of the work, compliance with all relevant building, plumbing, fire, electrical, health care codes and the Primary Drinking Water standards was achieved.  Further, the project execution was governed by relevant standards, such as, US VHA Directive 1061, ASHRAE 188-2014 and mandates from the Illinois Department of Public Health.  Ultimately, the project delivered an EPA-compliant water treatment plant, decentralized water utility services with isolation, extensive domestic hot water system improvements and engineering controls supportive of the Home’s Water Quality Management Team implementation of a comprehensive Water Management Plan.  

Findings:

The IVHQ project provided a unique learning opportunity in not only responding to a health care campus-based Legionnaires disease outbreak, but also, the reliance the public places upon the quality of potable water.  Beginning with surface water treatment, chloramination and delivery, the suitability of publically treated water to address a significantly colonized campus was understood.   The effect of backflow, building isolation and age of water were better understood through evaluation of extensive water quality data sets.  Updating critical infrastructure and operating water systems with an eye to reducing risk were imperatives identified by this project.  Finally, implementing and executing a comprehensive Water Quality Management Plan, which includes not just building owners, but water operators, public utilities, local health departments, engineers and scientists, proved to be a life-saving strategy that has broad implications across the water industry.    

Conclusion:

As the IVHQ project was completed, levels of Legionella bacteria in the water systems were found to be orders of magnitude reduced from 2015 levels.  While risks still and will always exist, confidence in the campus and community water supplies have increased and no additional fatalities have occurred.  The ongoing treatment of the IVHQ campus with high quality potable water has resulted in declining bacteria loading and increased safety for its residents and employees. Lastly, the robust water quality management program provides vigilant oversight of water systems and ensures control of life-threatening risks from water-borne pathogens.