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A Multidisciplinary Approach to Water Management and Legionella Prevention

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      Background

      Legionella and other waterborne pathogens are of great concern for healthcare systems. The Center for Medicare and Medicaid Services (CMS) issued a memorandum requiring a reduction of Legionella and other opportunistic waterborne pathogens in healthcare facility water systems. A Water Management Team (WMT) was implemented in 2019 in a newly constructed 55-bed acute care facility due to lack of a formal program and to proactively prevent infection in the patient population.

      Methods

      An acute care facility collaborated with a third-party vendor to initiate a water management program (WMP). Key stakeholders collaborated and performed verification and validation strategies including environmental water sampling, water flushing, and active surveillance in high-risk areas. The first round of testing showed viable Legionella growth in multiple samples. The site implemented several actions to eliminate the viable Legionella without success. It was found that the Ultra-Violet light system that was installed on cold water prior to supplying the hot water loop was dropping chlorine levels from the city very low. A chlorine injection system was installed, and regularly scheduled water sampling was completed. The WMT collaborated to bring concerns and issues to key areas and departments as well as executive leadership to facilitate discussion and decision-making regarding the safety and operation of all potable water systems.

      Results

      Following the last intervention, the environmental water sampling showed no growth for viable Legionella. There were no reported hospital-acquired Legionella cases reported during this time frame.

      Conclusions

      A multidisciplinary WMP reduced the site's risk for healthcare associated Legionella as evidenced by results of water surveillance and supported by infection control surveillance. A WMP is a fundamental component to meet CMS mandates and address Legionella prevention.
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