In the last two decades, the threat of Legionella contamination, especially within healthcare facilities, has grown at an alarming rate. According to the CDC, Legionella-related disease outbreaks in the United States has steadily increased since 2000, with more than three cases per 100,000 people reported in 2018.1 Further, more than 18% of all Legionella-related outbreaks can be traced back to hospitals or other healthcare facilities.2
Because the population in healthcare facilities is more vulnerable and less able to fight infection, the fatality rate from healthcare-associated infections is a staggering 25%.3 Healthcare facilities face a much more serious risk if contamination occurs, so efforts to prevent and control Legionella contamination must be proactive, specific, and coordinated.
Relevant Regulations
With the growing threat of contamination, strict guidelines have been established by governing and accrediting bodies that require control measures for Legionella and other bacteria. ASHRAE Standard 188, VHA Directive 1061, and the Joint Commission’s EC.02.05.02 are three standards that address Legionella and highlight the importance of comprehensive water management programs, with elements such as:
- Piping schematics that map the facility’s water systems, including supply sources, treatment systems, processing steps, and points of use
- Annual risk assessments and the identification of areas where potentially hazardous conditions may occur
- Establishment of monitoring protocols and clinical surveillance
- Engineering control strategies to eliminate dead legs and properly maintain the system
- Adequate documentation of water quality and corrective actions taken
While specific language may differ from standard to standard, the principles and best practices are the same across the board. Ultimately, these standards should influence every aspect of the design, construction, expansion, and maintenance of healthcare facilities to ensure protection against dangerous—and often fatal—contamination events.
Effective Legionella Control
In healthcare facilities, Legionella control is typically part of a greater, comprehensive water management program. The first step to effective Legionella control is a clear picture of the facility.
Bacteria can grow—or “colonize”—pipes when you’re not looking. Areas with stagnant water present particularly high risk. Legionella is common in:
- Hot water supplies
- Dead legs
- Infrequently used taps or service points
Once you identify areas of concern, you can take steps to protect your facility and potable water supply from the threat.
Surveys & Schematics
If you don’t know what’s going on in your system, you can’t effectively protect against bacterial contamination. An on-site survey, and the creation of detailed piping schematics, reveal vulnerable areas within your system.
- Identify and eliminate dead legs
- Find little used areas and take steps to mitigate the risk of bacterial growth
- Ensure water is stored at a safe temperature
- Eliminate any unprotected cross connections
Many times, Legionella contamination occurs because your piping system has changed, while the information you operate with has not. Periodic surveys help you stay on top of system expansions, renovations, and changes as they occur. Especially for larger facilities, the risk of Legionella increases when you don’t know what you don’t know.
Up-to-date piping schematics give you a full picture of your system to ensure you understand where your pipes go, what they carry, and how they’re being used. When making changes to the system, you can reference the schematics to help prevent the inadvertent creation of dead legs or other problems that create an environment conducive to Legionella growth.
Water Management Program
Chemical treatment that reduces the presence of Legionella and other bacteria in your piping systems is a critical step when problems have been identified, but additional water management efforts can help you proactively ensure your water is safe and free of contamination.
Comprehensive water management programs include inventorying critical control points (CCPs) and developing preventive maintenance plans to keep CCPs within safe operating and control measures. Common CCPs include:
- Cooling towers
- Evaporative condensers
- Domestic hot water systems
- Humidifiers
- Spas
- Whirlpools
- Backflow preventers
Along with other key system information—like an evaluation of water sources, building age, water treatment types, and system history—this inventory helps you maintain safe operations within the set control parameters. Keeping track of how high-risk points are working (or not working) means you can better protect the most vulnerable parts of your piping infrastructure.
Proactive Protection
Healthcare facilities are complex, and so are your piping systems. To take proactive steps in preventing Legionella outbreaks, you need a robust plan of action—one that includes knowing your system and knowing how to maintain its elements to maximize safety. Survey your system, ensure you have up-to-date piping schematics, implement control measures, and regularly monitor system status. The steps are simple and repeatable, but the impact on patient safety is significant.
Interested in learning more about HydroCorp’s piping surveys, piping schematics, and water management programs?
Sources
- Centers for Disease Control and Prevention. (2024, January 31). Legionellosis Surveillance and Trends. Centers for Disease Control and Prevention. https://www.cdc.gov/legionella/php/surveillance/index.html
- Barskey, A., Lee, S., Hannapel, E., Smith, J., & Edens, C. (2022, December). Legionnaires’ disease surveillance summary report, United States. Centers for Disease Control and Prevention. https://www.cdc.gov/legionella/health-depts/surv-reporting/2018-19-surv-report-508.pdf
- Centers for Disease Control and Prevention. (2025, January 29). Clinical features of legionnaires’ disease and Pontiac fever. Centers for Disease Control and Prevention. https://www.cdc.gov/legionella/hcp/clinical-signs/index.html
