Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems
Read guidance. Legionnaires’ Disease outbreaks are commonly associated with long-term care facilities and hospitals. The Centers for Medicare & Medicaid Services (CMS) requires facilities to 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 in water. This policy memorandum applies to Hospitals, Critical Access Hospitals (CAHs), and Long-Term Care (LTC). However, this policy memorandum is also intended to provide general awareness for all healthcare organizations.
Risk Management for Building Water Systems
Read guidance. ASHRAE 188 addresses the minimum components of a water management program, including water management program team guidance, and how often these programs should be reassessed and updated. The guidance outlines requirements for risk mitigation programs, building surveys, and the identification of locations that require control measures and control limits.
New Standards for Hospitals and Critical Access Hospitals
Read guidance. The Joint Commission (TJC) requires hospitals to manage risks associated with their utility systems for patient care. This is inclusive of the design and installation of utilities to meet patient care and operational needs. This updated requirement reflects a multi-pathogen approach to the prevention of healthcare-associated infections (HAI,) which are infections acquired while patients are receiving treatment for other conditions in a healthcare setting and can be caused by many infectious agents including fungi, bacteria, viruses, and other types of pathogens.
Water Management Program FAQs
Read guidance. The CDC offers recommendations for establishing Water Management Programs (WMPs) to identify hazardous conditions and mitigate the risk of waterborne pathogens in water systems. These recommendations include guidance on WMP maintenance, identification of high-risk areas, prevention of the growth and spread of Legionella and other opportunistic waterborne pathogens, routine checks, and corrective actions.
Guidelines for Environmental Infection Control in Healthcare Facilities
Read guidance. These guidelines cover the infection-control impact of water system performance. Key recommendations include the establishment of teams to conduct infection-control risk assessments. Guidance is offered regarding appropriate indications for routine culturing of water as part of a control program for Legionella, for recovering from water system disruptions, including leaks and natural disasters, and for infection control strategies involving healthcare facilities.
It is suggested to perform assays at least monthly using quantitative methods for endotoxins in water used to reprocess hemodialyzers, as well as for bacteria in water used to prepare dialysate for hemodialyzer reprocessing. Facilities should maintain a high index of suspicion for HAIs, and perform laboratory diagnostic tests for Legionellosis on suspected cases.
Adequate records of all infection-control measures and environmental test results for potable water systems should be maintained.
Six-Year Review of Drinking Water Standards
Read guidance. The Environmental Protection Agency (EPA) announced a third revision of the Six-Year Review. Eight National Public Drinking Water Regulations (NPDWRs) are candidates for regulatory revision, including Chlorite, heterotrophic bacteria, Giardia lamblia, viruses, and Legionella.
This announcement is not a regulatory decision, but the initiation of a process for further detailed analyses of health effects and outcomes regarding regulation and rulemaking. Other existing NPDWRs including lead, E. Coli, and volatile organic compounds are not in need of a detailed review and are not being revised.
Lead Contamination in School Drinking Water
Read guidance. School administrators must publish a guidance document and a testing protocol to assist public water systems and schools in determining the source and degree of lead contamination in school drinking water supplies and in remedying such contamination. The guidance document shall include guidelines for sample preservation and guidance in ascertaining the levels of lead contamination in drinking water coolers and in taking appropriate action to reduce or eliminate such contamination.
Bipartisan Infrastructure Law Clean Water and Drinking Water State Revolving Funds (SRFs)
Read guidance. The Bipartisan Infrastructure Law’s investment in the water sector is transformational, as it includes $50 billion to the EPA to strengthen the nation’s drinking water and wastewater systems. This interactive tool facilitates the exploration of funding state-by-state.