Infection Control

Waterborne illnesses can fly under the radar

Briefings on Infection Control, August 1, 2010

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Ornamental water structures gain popularity but run the risk of legionella 

After reading this article, you will be able to: 

  • Explain how legionella can become a risk in your facility
  • Identify what a Joint Commission surveyor will look for with waterborne diseases
  • List recommendations for controlling legionella

Waterborne pathogens may not be first on your list of IC priorities—perhaps because you haven’t seen an outbreak—but that doesn’t mean it’s not a risk in your facility, particularly if you have ornamental water structures. 

Hospitals are by far the most at risk for legionella outbreaks of any building, says Tim Keane, consultant for Environmental Infection Control Consultants in Chalfont, PA, and author of the Guidelines for Control of Legionella in Ornamental Water Features. 

“There is no structure built in America—none—that has the risk factors of a hospital building for growing and culturing legionella,” Keane says. 

Just like any infectious outbreak, managing and controlling legionella requires a risk assessment of your water systems. Hospitals with a high risk for legionella colonization in their potable water systems need to implement a number of controls. 

Joint Commission requirements and legal backlash

Under EC.02.05.01, The Joint Commission requires healthcare facilities to manage risks associated with their utility systems, including “engineering controls of waterborne pathogens in potable water, cooling tower systems, and other aerosolized water systems.”

Not only can this affect compliance with Joint Commission accreditation, failure to adhere to these standards can also work against you in the court of law, particularly if an outbreak affects numerous people. 

“The environment of care is not a guideline, it’s a standard—a standard that carries tremendously much more legal weight than a guideline,” Keane says. 

Essentially, the Joint Commission standard requires that you do an engineering risk assessment, you have a plan for preventing waterborne illnesses, and you implement controls when necessary. 

“Controls start with the assessment, a comprehensive engineering review of all aerosolizing water systems, and then implementation of recommendations from that assessment, which may include a treatment system for the potable water,” Keane says.

In February 2009 and March 2010, a waterfall-type fountain in the lobby of a Wisconsin hospital caused an outbreak of Legionnaires’ disease in eight people.

The state health department released recommendations on decorative waterfalls, but the outbreak remains fresh in the minds of Joint Commission surveyors, says Peggy Prinz-Luebbert, MS, MT(ASCP), CIC, CHSP, owner of Healthcare Interventions, Inc., in Omaha, NE.

“Especially since we’ve had outbreaks now, if [a surveyor] sees a waterfall, they are going to want to see what kind of maintenance you do on it, what kind of testing you do on it, and if you’ve had problems, how you’ve responded to them,” Luebbert says.

This is an excerpt from a member only article. To read the article in its entirety, please login.

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