Utilizing a System Water Management Program to Mitigate Legionella Risk

Abstract

BACKGROUND A Wisconsin Healthcare System established a compliant Water Management Program (WMP) with the goal to mitigate risk of waterborne pathogen disease. The program was developed in accordance with American National Standards Institute/American Society of Heating, Refrigerating and Air-Conditioning Engineers (ANSI/ASHRAE) Standard 188-2018, Legionellosis: Risk Management for Building Water Systems. This standard and the Centers for Disease Control (CDC) Toolkit: Developing a Water Management Program to Reduce Legionella Growth and Spread in Buildings, are referenced as guidance in Centers for Medicare & Medicaid Services Memo 17-30 Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and outbreaks of Legionnaires’ Disease (LD). The WMP was established at site and system levels to ensure standardization. This included Verification and Validation strategies and Contingency Response Protocol for environmental surveillance of water systems. METHODS With guidance from the System level, the site Water Management Teams utilized environmental water culture methods and clinical surveillance to validate the program effectiveness with controlling hazards such as Legionella. Through industry drivers, the team was inspired to develop their Contingency Response Protocol to identify safety requirements and specific measurable response actions. RESULTS The System has a robust validation program and associated Contingency Response Protocol that is effective at mitigating Legionella risk. This is demonstrated by the consistent downward trend from 11% (2014) of the environmental surveillance results from the water culture exceeding Legionella validation criteria to 3% (2018). In the event results exceeded Legionella validation criteria, the Contingency Response Protocol has proven effective at reducing retest results that exceed validation criteria from 35% (2014) to 0% (2018). CONCLUSIONS A comprehensive and compliant system WMP with a robust validation program and associated Contingency Response Protocol is an effective tool at mitigating Legionella risk as evidenced by the reduction in initial positive tests and positive retests. A Wisconsin Healthcare System established a compliant Water Management Program (WMP) with the goal to mitigate risk of waterborne pathogen disease. The program was developed in accordance with American National Standards Institute/American Society of Heating, Refrigerating and Air-Conditioning Engineers (ANSI/ASHRAE) Standard 188-2018, Legionellosis: Risk Management for Building Water Systems. This standard and the Centers for Disease Control (CDC) Toolkit: Developing a Water Management Program to Reduce Legionella Growth and Spread in Buildings, are referenced as guidance in Centers for Medicare & Medicaid Services Memo 17-30 Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and outbreaks of Legionnaires’ Disease (LD). The WMP was established at site and system levels to ensure standardization. This included Verification and Validation strategies and Contingency Response Protocol for environmental surveillance of water systems. With guidance from the System level, the site Water Management Teams utilized environmental water culture methods and clinical surveillance to validate the program effectiveness with controlling hazards such as Legionella. Through industry drivers, the team was inspired to develop their Contingency Response Protocol to identify safety requirements and specific measurable response actions. The System has a robust validation program and associated Contingency Response Protocol that is effective at mitigating Legionella risk. This is demonstrated by the consistent downward trend from 11% (2014) of the environmental surveillance results from the water culture exceeding Legionella validation criteria to 3% (2018). In the event results exceeded Legionella validation criteria, the Contingency Response Protocol has proven effective at reducing retest results that exceed validation criteria from 35% (2014) to 0% (2018). A comprehensive and compliant system WMP with a robust validation program and associated Contingency Response Protocol is an effective tool at mitigating Legionella risk as evidenced by the reduction in initial positive tests and positive retests.