Requirements and regulations for water safety

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.

New York

Read guidance. This resource provides information to comply with permanent regulatory requirements of the New York State Sanitary Code Title: Part 4-Protection Against Legionella. The information is primarily for cooling tower owners, operators, water treatment consultants and inspectors, and operators of all general hospitals and residential health care facilities. Legionella culture sampling and analysis, potable water systems, and the importance of assessments and recordkeeping are covered in this resource.

New Jersey

Read guidance. This bill would require the Department of Environmental Protection (DEP), the Department of Health (DOH), owners or operators of public water systems, and the owners or operators of certain types of buildings to take specified actions to help inform citizens of the State about, and prevent and control cases of, Legionnaires’ disease. The bill would require the DOH to conduct an investigation into every reported diagnosis of Legionnaires’ disease and require the DOH to advise an individual diagnosed with Legionnaires’ disease about the availability of testing by the DOH of the fixtures and water-using equipment in the individual’s residence, locations frequently visited, and places of employment in the 45 days immediately prior to the individual’s diagnosis.

Florida

Read guidance. The Florida Department of Environmental Protection and the Florida Department of Health ensure that drinking water from public water systems meets water quality standards for lead (Pb) and copper (Cu). The Inorganics Monitoring Rule, in 62-550.513, Florida Administrative Code, requires community water systems and non-transient, non-community water systems to monitor for lead at each point of entry to its distribution system (in other words, after the water leaves the treatment plant, but before it reaches the water system’s first customer.

Illinois

Read guidance. This resource details requirements of on-site Legionella control systems to comply with specified requirements. “On-site Legionella control system” means a system constructed and operated on the premises of a premise plumbing system, either temporarily or permanently, to prevent, reduce, or eliminate the potential for propagation of Legionella in finished water within the premise plumbing system. This includes, but is not limited to, the following control technologies: chlorination, chlorine dioxide, copper-silver ionization, and ultraviolet light disinfection.

Read guidance. The Illinois General Assembly recently enacted new legislation requiring water utilities to notify healthcare and senior living facilities of water supply disruptions that could lead to water quality and microbial risks, such as Legionella and other pathogens. This legislation builds on Illinois’ efforts to proactively manage water supply quality by ensuring closer coordination between water utilities and facilities with the most vulnerable residents and visitors. House Bill 4988 has been signed into law as Public Act 102-0960 May 27, 2022.

North Carolina

Read guidance. This bill requires owners and operators of certain buildings and facilities to establish and operate water management plans that include validating and testing of water to minimize the growth of Legionella. Building owners must assess the risk of Legionella, implement necessary mitigations, and conduct routine sampling.

Virginia

Read guidance. Public schools must maintain a water management program for the prevention of Legionnaires’ disease. Each school board is responsible for maintaining said program. The Department of Education is required to make recommendations for the establishment, maintenance, and validation of water management programs and notify local school boards. Once being put into effect; the water management programs are required to be maintained via the school boards.

Massachusets

Read guidance. Facilities served by public water systems must meet criteria. Local Boards of Health, healthcare providers, laboratories, and other public health personnel must report occurrences. Testing protocols are at the discretion of the provider, and the CMS does not require testing.

Arkansas

Read guidance. Under national Primary Drinking Water Regulations, each public water system must routinely sample for bacteriological and microbiological organisms. Samples must be routinely analyzed in certified laboratories based on the type of water system, the type of water source, and the size of the served populations.

California

Read guidance. Under SB 1144, the water systems at public schools and state agencies must undergo testing to determine if lead is present. It will also require schools and agencies to test their water appliances and fixtures for water use efficiency. If any plumbing fixture is found to contain levels of contaminants beyond the legal limits, remediation methods such as filters, testing, or full replacement is expected at the earliest practice time, subject to funding.