The Healthcare Difference

Dec. 27, 2018

Preventing Legionella outbreaks in healthcare facilities

About the author:

Chris Boyd is general manager of building water health for NSF Intl. Boyd can be reached at [email protected] or 734.769.8010.

By now, we have all heard about the risk of Legionnaires’ disease outbreaks in commercial buildings and the documented connection to building water systems. In 2017, newspapers across the country reported on a U.S. Centers for Disease Control and Prevention (CDC) study that found evidence of Legionella bacteria in 84% of 196 cooling towers tested across the country. The research highlighted the potential for cooling-tower-related outbreaks to occur anywhere in the U.S.

A Likely Host

Many of us also understand the increased risk of Legionella outbreaks in hospitals and other
healthcare environments. According to the CDC, hospitals and long-term care facilities account for 34% of all building-associated Legionella outbreaks. In addition, people who contract Legionnaires’ disease in a healthcare setting are at an increased risk of death compared to people who get the disease in other settings. Why are Legionella bacteria and other waterborne pathogens so common in healthcare facilities and long-term care centers? 

As it turns out, answering this question is the first step in reducing opportunistic waterborne pathogens like Legionella pneumophila, Pseudomonas aeruginosa and non-tuberulous mycobacteria in healthcare facilities. Normally, we say developing a water management plan is the first step in mitigating waterborne hazards, but in healthcare facilities the first step is understanding all the ways that a specific healthcare facility is unlike any other. A hospital is not just a hotel for sick people; the water management plan used in a hotel will not be effective in a hospital. In fact, no off-the-shelf water management plan will be effective in a healthcare environment. In order to develop an effective water management plan for a hospital or long-term care facility as required by the Centers for Medical and Medicaid Services, we first must understand exactly how and why healthcare facilities are different than other types of buildings. Here are four ways healthcare facilities are different from other types of buildings: 

  • Healthcare devices. A hotel’s water management plan might need to account for potential microbial contamination sources, such as cooling towers and chillers, showers, decorative fountains, pools and spas, and ice machines. In a healthcare environment, the water management plan will need to cover those standard elements, as well as dozens of other potential hazards that are unique to healthcare. From hydrotherapy units and heater-cooler devices to respiratory care devices and dental or surgical water lines, hospitals and long-term care facilities contain many water applications that must be incorporated into the water management plan. 
  • Systems within systems. Rather than thinking of the building water system as a whole, it is essential to consider all the individual water systems within the larger building water system. Transplant units, surgical suites, dialysis centers and burn units all have unique water management requirements. The water management plan needs to focus in on each of these areas.
  • High-risk population. The people in a healthcare or long-term care facility generally include the sick, elderly, immunosuppressed, post-surgical, infants and children—all individuals who have a higher risk of infection. Because of this population, water treatment efforts need to be more rigorous in a healthcare setting than in any other environment.
  • Training challenges. In a typical building, access to building water systems is limited to facility managers, maintenance technicians and janitors. It is fairly easy to train these individuals in water safety and prevention practices. In a healthcare facility, hundreds of people play a role in controlling waterborne pathogens. Administrators, plant managers, infection control personnel, clinical engineers, environmental services staff, dietary aides, nurses, physicians and respiratory care technicians all have a potential impact on building water safety. This makes training a challenge.

Understanding these fundamental differences between commercial buildings and healthcare facilities is an essential part of a site-specific risk assessment and water management plan. It is a first step that ultimately should lead to a culture of prevention and a positive water safety culture. 

About the Author

Chris Boyd