Mr. Chairman and Committee Members, thank you for inviting me to testify at this hearing today.  My name is Aaron Marshall and I am Operations Manager for Enrich Products.  Enrich supplies copper-silver ionization systems for the control of Legionella in potable water systems.  I am also a veteran of the US Army having served honorably for just over four years.  My father, also a veteran, received exceptional medical care from the Pittsburgh VA Health System for many years.  Currently he receives the same exceptional care in the West Virginia VA Health System.

The intent of my testimony is to provide information that will contribute to a better understanding of what transpired at the VA University Drive Campus in Pittsburgh and to provide supporting evidence that copper silver ionization, when applied properly, is an effective method for controlling Legionella in potable hot water systems.

There are two ways copper-silver ionization systems can be implemented.  The first is a proactive course and the second is a reactive course. 

In a proactive course, a copper-silver ionization system is installed as a preventative measure.  In these facilities there is no confirmed case(s) of Legionnaires’ disease or Legionellosis.  The facility may not even test for Legionella.

In a reactive course, a facility either has confirmed the presence of Legionella in the water through testing, or the facility’s potable water system is suspected or implicated as the source of Legionnaires’ disease or Legionellosis cases; in response, a copper silver ionization system is installed (temporarily or permanently).  Once the desired results are achieved through the reactive course, the equipment is either removed or continues to operate and the course is transitioned to the proactive regimen. 

The differences between the two rest in the course of actions recommended and they are significant:

In the proactive course, lab monitoring for copper and silver ions is recommended monthly, flushing of non-used fixtures is recommended monthly and Legionella testing may or may not happen.

In the reactive course, lab monitoring for copper and silver ions is performed weekly, the facility institutes a controlled flushing program such that all fixtures are flushed weekly, and Legionella testing at day 15 and day 30 is conducted to determine the course’s effectiveness.

This reactive course has been successfully implemented at numerous facilities including The Cleveland VA Medical Center, as well as facilities in Pennsylvania, Florida, New York State, North Carolina, and Illinois.    

I am here today because in June of 2012, at the request of the Pittsburgh VA, I was called in to perform a review of the copper-silver ionization system (and its operation) at their facility located on University Drive in the Pittsburgh neighborhood of Oakland (sometimes referred to as the VA Oakland facility).  I was asked to make recommendations that would help to improve the functioning of their existing LiquiTech equipment.   LiquiTech is another supplier of copper-silver ionization equipment. 

Before submitting my general recommendation report on July 6, 2012, I visited the VA University Drive Campus facility three times.  The dates were June 4th, June 21st and July 2nd.   There was no charge to the VA for these visits or my report.

During my visits I personally viewed the four different locations where the LiquiTech copper-silver systems were installed.  I was provided access to the site records from January 2012 until the end of June 2012, and the lab copper-silver data from June 2011 through July 2012.  I requested but was denied access to view the Legionella test results. 

During two of the three visits, I had separate meetings with Infection Control and Engineering / Maintenance personnel. 

The two meetings covered similar topics.  The major topics were:  system maintenance, frequency for monitoring copper-silver ion levels, and criteria to determine site test locations.  In each of the two meetings I covered Enrich recommendations for the routine course and reactive course as described earlier.

Had Enrich Products been aware of the presence of Legionella or Legionellosis cases at the VA University Drive Campus, we would have recommended implementing the reactive course immediately.

Sometime in November of 2012, Enrich learned through the media that in fact, there were reported cases of Legionnaires Disease at the VA University Drive Campus and that there were deaths as a result.  In addition to the reporting of the outbreak, the media, through quotes from the CDC and others, offered doubt on the efficacy of copper silver ionization.  

Copper silver ionization is an effective method of controlling Legionella bacteria. However, in order to maintain its efficacy, the installed system needs to be properly maintained and regularly monitored.

Another important note is that in order to definitively know where the source is, testing must be conducted.  Often it is assumed (automatically) that the source must be the hot water system in a facility; we have found a number of times that sources were ice machines or decorative water features in the facility.

Conclusion:

During the short time that Enrich worked with the VA University Drive Campus, through today, the VA has not shared its Legionella testing data or results.

If the investigation concludes that the potable hot water system was the source of the outbreak , there is no question that regular testing could have detected the presence of the bacteria and that the reactive course of actions would have been implemented immediately minimizing the risk of outbreak.

We hope to have the opportunity to work with the Department of Veterans Affairs in the future in an effort to reduce this risk at all of their facilities.

We also hope to establish a dialogue with the CDC where we can share data and information demonstrating the “real world experiences” of copper silver ionization’s effectiveness in treating Legionella in facilities throughout the country.

Thank you for your attention.