Does your facility have an effective water management system and policies to reduce healthcare associated legionnares’ disease? In its Morbidity and Mortality Weekly Report (MMWR) published on June 9, 2017, the CDC highlighted the issue of healthcare-associated Legionnaires’ disease (LD). An analysis of data from 21 jurisdictions in the US that reported ≥90% of Legionella infections for 2015, found that 76% reported having at least 1 definitive case of healthcare-associated LD with 80% of the remainder reporting possible cases of healthcare-associated LD.
The CDC has concluded that despite healthcare-associated LD being less common than other healthcare-acquired infections, it has a high impact on both patients and health care facilitates due to the high CFR, financial cost, legal action etc. As such the CDC recommends that healthcare facilities establish and maintain an effective water management program to prevent the growth of Legionella in water systems and hence reduce the likelihood of Legionella infection and in turn LD.
The CMS has also identified Legionella infection as an issue for health care facilities. The CMS noted that cases of legionellosis have increased by 286% in the US between 2000 and 2014. During this same time frame, 19% of outbreaks were found to be associated with long-term care facilities and 15% of hospitals. Further, the CMS notes that the outbreaks are usually linked to environmental reservoirs in large and complex water systems, including those in health care facilities.
As such, the CMS has issued a policy memorandum to state survey agency directors, applicable to hospitals, critical access hospitals, and long-term care facilities, requiring that cases and outbreaks of LD be prevented through a reduction in Legionella risk in the healthcare facility’s water systems. This policy is effective immediately and requires that “facilities must develop and adhere to policies and procedures that inhibit microbial growth in building water systems that reduce the risk of growth and spread of Legionella and other opportunistic pathogens.” Here are 7 things you can do to reduce the growth and spread of Legionella to prevent outbreaks of LD:
- Identify a team to be responsible for the facility’s water management practices
- Develop and implement a water management program if you do not already have one in place. Use the CDC toolkit as a guide (recommended by CMS)
- Conduct a risk assessment of your facility
- Use the results of the risk assessment to address vulnerable areas
- Develop or amend policies and procedures to ensure reduction in the risk of Legionella growth is addressed
- Educate/train staff on how to reduce the risk of spreading Legionella – be sure to address areas such as water temperature and disinfection level controls
- Ensure environmental testing for pathogens is performed and results and remedial actions are documented