Legionella cases seem to be increasing based on all the recent news stories. Facility managers and infection preventionists at healthcare facilities want specifics on where they should focus their time for the greatest safety impact to prevent legionella in the water delivery system.
A Water Management Plan requires steps that are designed to reduce the likelihood of deadly bacteria from building in the water delivery system. The four cases presented below could have been prevented by following three main mandates within a water management plan:
• Establishing a water management committee
• Diagraming the water system
• Designating a system maintenance and surveillance protocol
The table below outlines four recent legionella exposure cases in hospitals.
|
Case |
Case Summary |
Determined Cause |
Lesson for Facility Managers |
|
1 |
Hospital experiences 14 Legionella cases and 3 deaths related to the bacteria |
Hospital decided to reduce the flow of water into the facility when patient census levels were lower to reduce cost. This action changed the pressure in the system and allowed the bacteria to further colonize. |
Do not adjust the flow of water into the facility. When water service is interrupted or shut off for construction needs , an extensive flushing plan should be implemented. |
|
2 |
Two patients were exposed to Legionella in a Chicago hospital |
Nine shower heads tested positive for Legionella bacteria. Even after cleaning shower heads, tests still failed leading to more investigation. |
Shower head and faucets are to be flushed on a scheduled basis and a more aggressive plan when rooms have been unoccupied for a period of time. |
|
3 |
Ice machine in patient wing is the suspected cause of four patients with Legionella exposure |
Testing determined that Legionella levels were elevated in the ice maker used by the patients. |
Ice makers are to be on a scheduled routine for inspection and cleaning. Many new filters for ice makers are in cartridges that cannot be visually inspected. It is recommended to change these cartridges every 3 months and completely drain and sanitize the ice maker every 6 months. |
|
4 |
Hospital hot water system change sickens 14 patients with legionella, 3 died |
Unspecified change made to the hot water system at a major Midwestern hospital. |
Changes to any aspect of the water delivery system requires planning with internal specialists as well as extensive flushing and testing. |
Establishing a water management committee
One of the most important tools in a water management plan is to establish a committee of professionals from the hospital. This committee evaluates decisions affecting the water system and overlays the conditions of the patient population. Having additional professionals evaluating decisions can prevent an exposure to Legionella from occurring.
In Case 1 from the table: a committee that includes the infection preventionist, nursing manager and the engineering manager should have voiced concerns when the facility decided to reduce the water flow into the building during low census periods.
Diagraming the water system
When changes are made to any part of the water delivery system the simple diagram can inform the committee what downstream water points can be impacted. In Case 4, a flushing program focused on impacted delivery points should be part of the prevention plan. The diagram allows everyone to oversee what parts of the water distribution and storage systems should be focused on to prevent bacteria lingering in the system.
Designating a system maintenance and surveillance protocol
All water management plans should include an established protocol for flushing, testing and checking the water distribution system at various points. The action items become preventative maintenance tasks for assigned individuals from the facility.
In Case 2, a designated routine flushing program may have prevented patient exposure to the Legionella bacteria that caused their illness.
The Why
Instead of thinking that a water management plan is another “to-do” added to facility managers or infection preventionists’ already swelling task list, this program is necessary since patients can be harmed when this duty is neglected. The science-based water management plan demonstrates that reasonable care was taken if a court case came up. Following a plan designed with reasonable steps to avert patient harm is the most prudent course for all healthcare facilities.
Thom Wellington is the founder and CEO of Wellington Environmental, a specialized environmental service company based in St. Louis, Mo. www.environmentalcare.com.
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