Responding to a Centers for Disease Control and Prevention (CDC) report indicating Legionnaires’ Disease (LD) kills 25% of those who are infected while getting treatment or residing in a healthcare facility, the Department of Health & Human Services, Centers for Medicare & Medicaid Services (CMS), on June 2, 2017, released a memorandum entitled, “Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires’ Disease.”
While the presence of Legionella in any water system presents a danger to occupants, the threat of infection is especially dangerous in healthcare facilities where the residents are more vulnerable to exposure to pathogenic organisms. The fact that these facilities also often contain complex water systems, where Legionella and other pathogens are likely to reside, makes them particularly high-risk locations.
The CMS memorandum indicates, of all “LD outbreaks in the United States occurring in 2000–2014, 19% of outbreaks were associated with long-term care facilities and 15% with hospitals….(CMS) is aware of multiple recent LD outbreaks in hospitals and long-term care facilities as reported by the CDC, state and local health departments, or investigated by State Survey Agencies.”
Areas of a facility commonly vulnerable to Legionella contamination and transmission include: hot and cold-water storage tanks, water heaters, shower heads and hoses, centrally-installed misters, atomizers, air washers, humidifiers, cooling towers, and medical devices, such as CPAP machines, hydrotherapy equipment, bronchoscopes, and heater-cooler units (heater-cooler units have also been identified as a frequent source of nontuberculosis mycobacterium infections).
The document cites multiple sections of Federal Regulation 42 CFR – Public Health, including parts 482, 483, and 485, providing requirements for hospitals, long term care facilities and specialized providers (comprehensive outpatient rehabilitation facilities, critical access hospitals and clinics), respectively. To qualify for participation in Medicare programs, healthcare facilities must have an active program for preventing and controlling communicable diseases, including a Water Management Plan (WMP). The memorandum recommends the first step of the WMP should be conducting, “a facility risk assessment to identify where Legionella and other opportunistic waterborne pathogens (e.g. Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas, nontuberculous mycobacteria, and fungi)” could grow and spread in the facility water systems. Finding a qualified laboratory capable of performing the risk assessment, as well as detecting and identifying waterborne organisms is an important step in developing a program. A laboratory Certified as Proficient in the isolation of Legionella from water samples by the CDC Environmental Legionella Isolation Techniques Evaluation (ELITE) program, is also recommended.
- Posted by Mark Goins
- On July 27, 2017
- contamination, water
- Posted by Mark Goins
- On March 8, 2017
Q Laboratories is now an HC Information Resources Inc. (hcinfo.com) approved Legionella Sampling and Testing Service Provider. Q Laboratories, Inc. can design a legionella sampling plan for businesses implementing a building water management plan for legionella control, or evaluate existing plans with building managers. Q Laboratories, Inc. analysts are trained in collection and sampling of water for Legionella analysis, designing sampling programs, interpreting Legionella test results and advising on an appropriate response to test results. Q Laboratories is Certified as Proficient in the isolation of Legionella from potable and non-potable water samples by the Centers for Disease Control and Prevention’s (CDC) Environmental Legionella Isolation Techniques Evaluation (ELITE) program.An industry best practice for hospitals, nursing homes, hotels and other industrial and institutional facilities is establishing a water management plan to protect the employees and occupants from contracting Legionnaires disease or Pontiac fever. Choosing a qualified sampling and testing partner is the first step in designing an effective Legionella control plan.