GUILDERLAND — For the second time this year, Promenade Senior Living at University Place on Western Avenue across from the University at Albany has a suspected case of Legionnaires’ disease.

In February, there were two cases and one resident died. 

The same building, when it was a hotel, had an outbreak seven years ago.

Albany County Spokeswoman Mary Rozak told The Enterprise that the state’s health department is the lead on the current investigation.

Erin Silk, spokeswoman for the state’s Department of Health, wrote in a statement, “The Department is investigating a case of Legionnaires disease associated with a resident at Promenade and we are analyzing for both clinical and environmental samples.” 

Paul Fahey of Overit, a spokesman for Promenade, told The Enterprise on Friday that the facility is awaiting the results of testing, which it expects early next week. The resident is suspected to have Legionnaires’ but, like other residents, the person leaves the facility and goes out shopping and on vacation, he said.

“We are not sure of the source,” Fahey said. He emphasized that Promenade has been following department-of-health guidelines on water quality and filtration systems.

“The Promenade has voluntarily completed testing of its potable water systems and has implemented water restrictions,” Silk wrote in an email to The Enterprise. Both the county and state health departments have collected environmental samples from the facility and are awaiting those results, she said.

Promenade has installed point-of-use filters and is in communication with residents, Silk said. “Albany County oversees the building from the perspective of compliance with local codes and ordinances,” she concluded.

Earlier outbreaks

The building was formerly a Best Western Hotel, and in 2012 a number of cases of Legionnaires’ were linked to the hotel. New owners Promenade Senior Living converted the building to an assisted-living facility that opened in December 2018. Two months after the facility opened, the state’s Department of Health announced that two residents had become sick with Legionnaires’ disease, and one of them died. 

Legionnaires’ disease is spread by inhaling small droplets of water in the form of steam or vapor that contain the Legionella bacteria, said the Albany County Department of Health in a release earlier this year. Exposure to Legionella can cause “severe disease including pneumonia, particularly in individuals who are elderly, have a weakened immune system or previous history of respiratory problems,” the release said. 

According to the Environmental Protection Agency, drinking water is the most important source of Legionella, and humans can either inhale contaminated aerosols or aspirate small amounts of contaminated drinking water. 

The disease is rare. The first outbreak occurred in 1976 at an American Legion convention in Philadelphia when 182 attendees contracted the disease; 29 died.

In March 2019, the state and county health departments announced that samples of bacteria from the outbreaks in February 2019 and in 2012 were “a molecular match.” In March the state’s Wadsworth Laboratories also found that clinical samples from one or more affected residents were a match for Legionella bacteria cultured from water samples taken at the time from the building’s internal plumbing system.

In 2012, the bacteria was found in the Best Western’s water system, and, in response, the hotel completed a process of “super-chlorinating” its water, putting in many times more chlorine than usually needed and then flushing it out; the hotel also installed a new hot-water tank. 

Promenade’s conversion of the hotel into senior residences involved an “extensive renovation that replaced every single fixture in the building, faucets as well as the hot-water heater,” said Paul Belitsis, chief financial officer and chief operating officer of Promenade Senior Living; Promenade has five facilities across New York State.

Belitsis, who spoke in March, said that all the piping was replaced in the Guilderland facility. 

After the outbreak earlier this year, Promenade took steps to minimize risk to other residents that included, Belitsis said at the time, installing new shower filters and providing all residents with bottled water for drinking and for oral hygiene.

Experts’ views 

Leonard A. Mermel, a doctor of osteopathy and professor of medicine at the Warren Alpert Medical School of Brown University — an expert on Legionnaires’ with whom The Enterprise spoke earlier this year — said he is not an engineer, but he thought it would be difficult to replace all the piping in a building without tearing the building down.

Even if all the pipes were replaced, he said, it is still possible that contaminated pipes leading to the facility or contaminated municipal water could have brought Legionella-laden water into the facility.

Mermel, who is also medical director of the Department of Epidemiology and Infection Control at Rhode Island Hospital, also made suggestions to The Enterprise earlier this year about what should be done at Promenade, going forward. He suggested: 

— FInding the source of Legionella (including testing water entering the facility); 

— Testing water in the new facility; 

— Making Legionella testing mandatory for an undetermined period of time for any patient who develops pneumonia; and 

— Developing a remediation plan for each of these issues. 

Mermel also said that a period of water-main shutoff during construction, followed by re-repressurization when the water starts back up, can dislodge biofilm that has formed on the inside walls of pipes and that is contaminated with Legionella bacteria. 

According to the Centers for Disease Control and Prevention, ways to prevent the growth of Legionella include: 

— Keeping hot-water temperatures high enough; 

— Making sure disinfectant amounts are correct; 

— Keeping water flowing and preventing stagnation; 

— Operating and maintaining equipment to prevent slim, organic debris, and corrosion; 

— Monitoring factors outside buildings including construction, water-main breaks, and changes in municipal water quality. 

The CDC recommends creating a Legionella water management program at health-care facilities as a means of preventing the first case of the disease. This team would describe the building water systems in words and diagrams, identify areas where the bacteria could grow and spread, decide where to apply control measures and how to monitor them; establish ways to intervene when control limits are not; make sure the program is running as designed and is effective; and document all of its activities.