Something’s In The Water: Getting Proactive About Legionella Prevention

The full article appears in the December issue of Patient Safety Monitor Journal.

This past summer, a spotlight was shone on the risks posed by Legionella. The bacterium is frequently found in healthcare settings, and the diseases it causes (Legionnaire’s disease and Pontiac fever) are common and often life-threatening.

Legionella breeds naturally in warm water and can usually be found in the parts of hospital systems that are continually wet. Badly maintained water systems have been linked to the 286% increase in legionellosis between 2000 and 2014. And in 2015, over 75% of all Legionnaire’s disease cases were healthcare related.

According to the Centers for Disease Control and Prevention (CDC), Legionnaire’s disease kills 10% of those who contract it. More distressing for physicians and nurses, the disease kills 25% of people who contact it while in a healthcare facility. And for immunocompromised patients,that mortality rate jumps to between 40% and 80%.

Who’s taking notice?

Last June, CMS issued a new memo on the importance of reducing cases of Legionella infections in hospitals, critical care hospitals, and nursing homes. The memo reminds facilities to:

  • Conduct a facility risk assessment to identify where Legionella and other waterborne pathogens could grow and spread in the facility’s water system.
  • Implement a water management program that considers the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) industry standard and the CDC toolkit. The program should include control measures such as physical controls, temperature management, disinfectant level control, visual inspections, and environmental testing for pathogens.
  • Specify testing protocols and acceptable ranges for control measures. Document the results of testing and corrective actions taken when control limits are not maintained.

Then in August, the CDC issued a request for more information on best practices for water management programs (WMP) and called for better oversight of ambulatory healthcare centers or other sites outside of traditional hospital campuses. The agency also held a town hall addressing how to prevent Legionella contamination.

The CDC noted that ASHRAE’s standard recommend WMPs for the following buildup and devices:

  • Healthcare facilities where patients stay overnight
  • Buildings that house or treat people who have chronic and acute medical problems of weakened immune systems
  • Buildings that primarily house people over the age of 65 (like retirement homes or assisted living facilities)
  • Buildings that have a centralized hot water system (like a hotel or high-rise apartment complex)
  • Buildings 10 stories or more (including basement levels)
  • Devices that have been linked to transmission of Legionella:
  • Cooling towers
  • Hot tubs (or spas) that are not drained between each use
  • Decorative fountains
  • Centrally installed misters, atomizers, air washers, or humidifiers

This topics was also brought up during the September 2017 at The Joint Commission’s Executive Briefings by Lisa Waldowski, The Joint Commission’s infection control specialist, and The Joint Commission’s acting director of engineering John Maurer.

The pair warned that Legionella and water exposure risk can occur anywhere on hospital grounds, meaning a risk assessment is needed for all areas of your hospital. That includes assessing your facility’s risk for Legionella infection across your campus, including non-patient care areas and off-campus sites.

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