Germs No Match For Montgomery's Nurse Detectives

Montgomery County's nurse detectives in the Disease Control team include, from left, Holly Conners, Cindy Edwards, Catherine Rasa and Celia Adams, who have more than 140 combined years of service. They investigate infectious-disease cases across the country to track down their causes and prevent larger outbreaks. (Photo: Kevin Clark/Post)
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· When a youth group visiting Washington saw one child after another fall sick in a Montgomery hotel, investigators sniffed around until a janitor tipped them to the key event: a child had vomited near the group's collected luggage on the day of their arrival.

"You could track it from that point," said Holly Conners, an investigator. She and her colleagues then went into containment mode, advising group leaders on keeping the sick children isolated and directing the hotel on how to clean what was probably a norovirus. "Nobody else got sick. We stopped it there."

Most of the time, an investigation begins when a medical lab alerts the team that the blood or stool sample of an area patient has tested positive for one of 68 listed agents and diseases, including cryptosporidium, salmonella, giardia and hepatitis. The nurses frequently compare the reports they've seen, looking for patterns and any sign of an outbreak.

"Two or three times a day, you see them gathered in the hallway, brainstorming," Jordan said.

Last month, when four lab slips from one part of the county came in showing shigella -- a waterborne agent that causes severe diarrhea and cramps -- the nurses began cross-checking reports and calls they had received individually. That led them to a company picnic that, they would learn, had sickened more than 30 kids. The source of the bacteria was found to be an inflatable water slide, possibly contaminated by a child's dirty diaper.

"Often, we never know where it comes from originally," Edwards said. "Our goal is to identify it and put some measures in place to prevent its spread."

Most of the detective work is done by phone, and a lot of that is leading patients through the tricky process of remembering where they've been and, more difficult, what they have eaten for the past week.

"The food histories can be tough," investigator Sue Wilby said. "The first one I ever did was with a person who was on Weight Watchers and kept a log of every bite she ate. I've never had one that easy since."

Patients also tend to the start the process with some firmly fixed ideas of what made them sick. They are quick to blame restaurants rather than their own kitchens. And they assign themselves powerful diagnostic powers.

"They say, 'I knew that food didn't taste right,' " investigator Celia Adams said. "But taste has nothing to do with it. Tainted food usually tastes perfectly normal."

Every now and then, some serious fieldwork is called for. One of those incidents occurred earlier this summer when six members of a Gaithersburg family ended up in intensive care after eating homemade stew. Edwards and her team found themselves confronted by "the Case of the Backyard Belladonna."