Legionella, the bacterium that causes a type of serious lung infection known as Legionnaires’ disease grows or amplifies in building water systems. Some building water systems have a higher risk for Legionella growth and spread than others. Since 2000, there has been over a fourfold increase in Legionella infections reported to the Centers for Disease Control and Prevention (CDC) nationwide.
Proactive water management is key to ensuring that building water systems are maintained to reduce the risk of growth and amplification of Legionella. The development of a water management plan or program (WMP) helps facilities identify pathogen concerns for water systems or devices. WMPs are essential to helping reduce the risk of legionellosis and other diseases among vulnerable patient populations, staff and visitors.
Both the Centers for Medicare and Medicaid Services (CMS) and CDC have issued guidance regarding WMPs. In June 2017, CMS released Survey and Certification Letter 17-30, Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires’ Disease. This Letter requires Medicare certified health care facilities to develop, implement, and adhere to a WMP. Also in June 2017, CDC released Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings: A Practical Guide to Implementing Industry Standards, which provides practical instructions for any building developing a water management plan with emphasis on health care facilities.
Consistent with this guidance, a WMP includes the following:
- Establishment of a water quality management team;
- A description or survey of the facility’s water systems and water quality;
- Identification of areas of potential amplification and exposure to water aerosols capable of introducing Legionella, including faucets, showers, hydrotherapy tubs, evaporative cooling equipment, humidification units, decorative fountains or sprinkler systems;
- A description of control measures and limits to control growth of Legionella;
- A plan describing intervention strategies to be taken when test results are positive or when there is an illness associated with Legionella or other water-borne pathogens.