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Hospitals and Health Care Facilities
Hospitals and health care facilities pose a special situation for managing Legionella risk due to the increased number of people who may be susceptible to infection, such as the elderly and those with weak immune systems, as well as the complexity of their plumbing, heating, and cooling systems. For this reason, it is important that facility managers of hospitals and health care facilities follow the guidance of the Centers for Disease Control (CDC) Toolkit.
According to CDC, a water management plan is recommended when the building has:
- Patients stay overnight or where people are treated who have chronic or acute medical problems or weakened immune systems.
- People are older than 65 years
- A centralized hot water system
- More than 10 stories
- A cooling tower
- A hot tub, Jacuzzi®, or a spa) that is not drained between each use
- A decorative fountain
- A centrally-installed mister, atomizer, air washer, or humidifier
Even if a health care facility does not contain any of the above elements, a water management plan should be developed. In June, 2017, the Centers for Medicare & Medicaid Services (CMS) of the US Department of Health & Human Services directed all Medicare certified health care facilities to have water management policies and procedures to reduce the risk of growth and spread of Legionella and other opportunistic microbes in building water systems. CMS pointed to the ASHRAE and CDC guidelines and noted that “facilities unable to demonstrate measures to minimize the risk of Legionnaires disease are at risk of citation for non-compliance.”
The facility manager in a hospital or health care facility should create a water management team and include:
- One who understands the accreditation standards and licensing requirements for health care facilities
- One with expertise in infection prevention
- A clinician with expertise in infectious diseases
- Quality management staff
It may be necessary to hire outside professionals with Legionella experience in order to have people with all these backgrounds. It will be necessary to gather schematics of the building’s water-flow diagrams to identify all areas where Legionella can grow and be transmitted, so that control measures and corrective actions can be taken, and monitoring can be done. Once control measures are established and running, it is important that all activities of the water management plan are documented to ensure all effective actions are being taken to safeguard the water system.
Resources:
- ASHRAE Standard 188-2018, Legionellosis: Risk Management for Building Water Systems
- About Legionella from The Center for Disease Control
- Legionella Toolkit from The Center for Disease Control
- Fact Sheet for Clinicians
- Sample Procedures and Sites
- Sample Data Sheets
- Environmental Assessment Forms
- Requirement to Reduce LegionellaRisk in Healthcare Facility Water Systems from Centers for Medicare & Medicaid Services
Source: Customer Messaging on Opportunistic Pathogens in Plumbing Systems by the Water Research Foundation