What is Legionnaires Disease
In recent years a worldwide, waterborne bacteria named Legionella pneumophila has been proliferating in the warm water found in building water systems, especially in healthcare facilities and hospitals. The bacterium causes Legionnaire’s disease and it is being spread through aerosolized water droplets which, when inhaled as mist, causes a serious lung infection that leads to pneumonia and has a 1 in 10 chance of death. The disease can also spread through aspiration of contaminated water or ice. Some of the symptoms include coughing, shortness of breath, high fever, muscle pains and headaches. In 2017, 7,500 cases of the disease were reported in the US according to the CDC.
One of the latest run ins with Legionella bacteria occurred at Advocate Christ Medical Center. According to CBS Chicago, since 2018 there have been four cases of Legionnaires disease reported at the medical center. Three patients and one member of the hospital staff contracted the disease leading state health officials to send investigators to test the hospital’s water. The state also asked that the hospital run surveillance to check for other potential cases of the disease. The hospital is working with IDPH to strengthen its water management plan and implement control measures. Attorney Louis Cairo explained that hospitals are particularly susceptible to the disease due to their large water systems, which can remain stagnant for extended periods, and the abundance of patients with weakened immune systems.
Legionella bacteria growth is promoted through fluctuations in water temperature, pH, humidity as well as changes in water pressure and water stagnation. The bacteria can then be spread through many different sources including:
- Cooling towers
- Nearby construction dislodging biofilm which could free Legionella bacteria into the water distribution system
- Water main breaks
Resolution to the Outbreak
This disease may sound scary but it’s preventable. The CDC stated that 9 out of 10 outbreaks could have been avoided. They recommend monitoring ventilation systems in positive airflow areas with continuous monitoring for air change rates and pressure fluctuations. There are already regulations and standards being put in place to help prevent the spread of this disease. As of 2017, The US Centers for Medicare and Medicaid Services enforces a federal requirement to monitor Water management systems. Legionella Water Management programs have become an industry standard for large buildings in the US. In addition to that, it’s recommended that facilities use the ASHRAE risk management guidelines for Water Management Programs. When the Joint Commission conducts surveys they check that buildings are complying with ASHRAE standard 188, Risk Assessments, a Water Management Program, and anything else that the CDC recommended to reduce Legionella growth. A lack of compliance with these recommendations and standards can lead to areas getting shut down and hospitals getting defunded.
The most highly recommended solution is a continuous monitoring system which would monitor all available system data from upstream and downstream contributors and would understand the state of the working systems rather than just the isolated equipment. Continuous Monitoring-Based Commissioning systems with built in Commissioning metrics and analytics have been becoming the standard over the last several years. These systems are able to identify the highest priority issue and reap the benefits of corrections while also keeping the equipment in control, lowering maintenance and energy costs, increasing equipment life, and ensuring HVAC equipment works together properly.
Fault detection analytics is another option to detect issues, prioritize them and recommend solutions to best address them.
According to the IFMA magazine, here are some steps facility managers can take to prevent Legionnaires’ disease:
- Identify any water systems in your building where Legionella control measures are necessary
- Asses how much risk the hazardous conditions in those water systems pose
- Apply control measures to decrease hazardous conditions
- Document that the program is functioning as planned, meaning it’s running properly and monitoring risk factors
- Write protocols for responding to heightened risks
- Validation sampling that verifies the program is properly managing Legionella exposure risks
Preventing Cooling Tower Outbreaks
With about 60% of outbreak related deaths attributed to cooling towers, they are one of the biggest potential liabilities for spreading the disease (2018 study “Outbreaks of Legionnaires’ Disease and Pontiac Fever 2006-2017” published in Current Environmental Health Reports). A WHO Legionella Fact sheet stated that illnesses from Legionella have been reported from up to a mile away from the contamination source due to water towers spreading the bacteria into the air as an inhalable aerosol. To ensure consistency when managing cooling towers, faculty managers should use detailed protocols to establish the risk management expectations from the water treatment companies running their cooling tower systems. A publicly accessible registry of cooling towers could aid health investigators in pinpointing a source of outbreak. A public registry could also be used to help develop strategies to monitor management practices at the building level. Incorporating routine maintenance and management information into the registration system would allow risks to be addressed before the outbreak.