Six Things You Should Know About Legionella
According to the Centers for Disease Control (CDC), the number of Legionella cases reported in the US has been on the rise since 2000. This has prompted government organizations to mandate new legislation for water treatment plants operating in the health care industry. While most have heard of Legionella, there are a few things you should be sure to know about its origins, how it spreads and how to reduce the risk of Legionella in your facility.
History of Legionella
Legionella is a genus of pathogenic Gram-negative bacteria that includes the species L. pneumophila. Legionella may be visualized with a silver stain or cultured in cysteine-containing media such as buffered charcoal yeast extract agar. It is common in many environments, including soil and aquatic systems, with at least 50 species and 70 serogroups identified. These bacteria, however, are not transmissible from person to person.
In 1968, workers and visitors of the Pontiac, Michigan health department suffered from an unidentified illness with flu-like symptoms. This became known as Pontiac Fever. Eight years later, in 1976, Legionella was discovered after an outbreak among people who attended a Philadelphia convention of the American Legion. The symptoms were similar to those of pneumonia and more severe than that of Pontiac Fever. It wasn’t until then that public health officials were able to prove that Legionella was the cause of both diseases.
Legionella bacteria are found naturally in freshwater environments, like lakes and streams. In healthcare facilities, the largest and most common source of Legionella is cooling towers, primarily because of the risk for widespread circulation. Cooling towers, along with other risk environments in your facility, today are the focus of water management programs and chemical treatment programs designed to reduce the risk of Legionella infection.
Legionella bacteria can become a serious health concern when they grow in human made building water systems like plumbing structures, hot-water tanks, decorative fountains, cooling towers, evaporative condensers of large air-conditioning systems, even hot tubs or ice machines. Most people contract Legionnaires’ disease by inhaling the bacteria from water droplets.
Many people exposed to the bacteria don’t develop symptoms. Those who do may experience cough, fever, chills, shortness of breath, muscle aches, headaches and diarrhea. Adults over the age of 50 and people with weak immune systems, chronic lung disease, or heavy tobacco use are most at risk.
How Does it Spread?
While Legionnaires’ disease is not spread from human to human, it is spread through human-made water systems. The bacterium thrives in the mist aerosolized from different water sources. Thus, it can infest an entire building. After Legionella grows and multiplies in a building water system, water containing Legionella can spread in droplets small enough for people to breathe in.
An analysis of more than 2,800 cases of Legionnaires’ that occurred in 2015 found that 553 cases definitely or possibly occurred in a health care facility according to the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report. Sixty-six patients died from the disease. Factors that are now known to enhance the growth of Legionella bacteria in human-made water environments include the following:
- Water temperatures of 77 F-107.6 F
- Stagnation of the water
- Scale and sediment in the water
- Certain free-living amoebae organisms in water capable of supporting intracellular growth of Legionellae
How is it Treated?
Legionnaires’ disease is treated with antibiotics. The sooner therapy is started, the less likely the chance of developing serious complications. In many cases, treatment requires hospitalization. Pontiac fever goes away on its own without treatment and causes no lingering problems.
The old saying that an ounce of prevention is worth a pound of cure couldn’t be more appropriate when it comes to preventing the spread of Legionnaires’ disease. The best preventative measure comes in the form of regular maintenance of all water systems. Storage tanks and cooling towers should be inspected for defects and deficiencies and cleaned regularly. Flush the distribution system and exercise/check all stagnant plumbing. Regularly test for Legionella to ensure the preventative measures are effective. Document all findings so that all team members are aware of the situation and can react to it quickly.
Prevention of Legionella is everybody’s business, so make sure that all employees are aware of the steps needed to keep water systems safe from bacteria. Hold regular meetings with all staff to ensure that they understand their role and the best practices required for a safer water system. Also consider a certified consultant to assist in this process.
What Can You Do?
For healthcare facilities, it’s especially important to help reduce the risk of infection among vulnerable patient populations, staff and visitors. You won’t be able to do this though unless you are knowledgeable about your water systems and the areas in which growth could occur. A building-wide risk assessment survey can help identify these areas. That’s why a Water Management Plan (WMP) is critical to your success. A Water Management Plan identifies hazardous conditions and steps to take to minimize the growth and spread of Legionella and other waterborne pathogens in building water systems. It provides critical information about current water uses and defines a plan for water efficiency improvements, conservation activities and goals.
The Joint Commission has released a new standard EC.02.05.02 that will go into effect on January 1, 2022. EC.02.05.02 mandates that hospitals and other healthcare facilities must have a water management program in place to handle Legionella and other waterborne pathogens in accordance with any laws or regulations the facility may be subject to.
As this is going to be a major requirement by government regulators going forward, it’s best to start now, if you haven’t already, to ensure compliance.
Developing and maintaining a water management program is a multi-step process that requires continuous review. The main goals of a water management program are:
- To ensure patient and staff safety
- To reduce risk of Legionnaires disease
- To reduce your legal risk
- To protect your company’s image and revenue
- To comply with CMS, CDC and ASHRAE Standard 188
Another important part of the management plan is to document activities and corrective actions regularly. To learn more be sure to read our blog about how to create an effective Water Management Plan. And, talk to our Legionella experts at ChemREADY to learn about performing a risk assessments for your facility and the available disinfection products suited for your water systems to reduce the risk of Legionella.
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