How to prevent the outbreak waiting in your water

How to prevent the outbreak waiting in your water

JULY 31,2019

Dangerous germs can lurk in the water systems of healthcare facilities, putting the most vulnerable at risk. Examples of these include Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas, nontuberculous mycobacteria, various species of fungi and Naegleria fowleri. In recent years, the Centers for Medicare & Medicaid Services (CMS) has turned its focus on reducing the risk of Legionella. CMS’ Survey and Certification Group released a memoin 2017 that requires healthcare facilities to develop policies and procedures to deter the growth of germs in building water systems to reduce the risk of growth and spread of Legionella and other pathogens. A 2018 revision clarified expectations for providers, accrediting organizations and surveyors.

The bacterium Legionella can cause a serious and sometimes fatal type of pneumonia called Legionnaires’ disease. Those at risk include people at least 50 years old, current or former smokers and people with weakened immune systems or medical conditions such as chronic lung disease. Legionella occurs naturally in low amounts in freshwater environments such as lakes and streams and generally does not lead to Legionnaires’ disease. However, when Legionella gets into a building’s water system, it can grow, spread and pose a serious health risk. The bacterium can sicken people when they inhale contaminated water droplets. Transmission can occur from showerheads, cooling towers, humidifiers, hot tubs and decorative fountains.

According to the Centers for Disease Control and Prevention (CDC), reported cases of Legionnaires’ disease have grown by nearly four and a half times since 2000. Large, complex water systems like those found in hospitals and long-term care facilities can become susceptible, if they are not properly maintained. According to the CDC, occurrences such as construction, water main breaks, changes in municipal water quality, fluctuations in water temperature and pH and inadequate levels of disinfectant can create opportunities for Legionella growth. A CDC reportreleased in 2017 reviewed 27 outbreaks of Legionnaires’ disease during 2000-2014 and found health care-associated Legionnaires’ to be common and deadly. It accounted for 33 percent of the outbreaks and 85 percent of outbreak-associated deaths. Therefore, it is vital that healthcare facilities work to deter the growth and spread of Legionella and other pathogens in their buildings. The CDC has a toolkit to aid in the development of a water management program for industry standards. It covers seven elements:
  1. Establish a water management program team.
  2. Describe the building water systems using text and flow diagrams.
  3. Identify areas where Legionella could grow and spread.
  4. Decide where control measures should be applied and how to monitor them.
  5. Establish ways to intervene when control limits are not met.
  6. Make sure the program is running as designed and is effective.
  7. Document and communicate all the activities.
The Compliance Store has the CDC’s toolkit and other resources on Legionella, including a section on water management in our Infection Control Binder Basics. For more information, go to

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