Compliance • Audits/Analysis • Reimbursement/Regulatory • Education/Efficiency
Issue: LD (Legionnaires’ Disease), a severe and sometimes fatal pneumonia may occur is patients who inhale aerosolized water contaminated with the Legionella bacterium. Of the recent outbreaks, 19% occurred in Long-Term Care facilities while 15% occurred in hospitals. The reported cases have increased 286% from 2000 to 2014, with 9% being fatal infections.
Transmission: Outbreaks usually occur with large or complex water systems and require aerosolizing of the bacterium or aspiration of drinking water or ice. The bacterium may be aerosolized by:
- Water Storage Tanks
- Water Heaters
- Pipes, Valves and Fittings
- Showerheads and Hoses
- Eye Wash Stations
- Ice Machines
- Decorative Fountains
- Medical Devices
- Water Filters
Regulation: 42 CFR §483.80 for skilled nursing facilities and nursing facilities:
“The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.”
Compliance: Policies and Procedures must be developed and include documentation of water management implementation. The facility must:
- Complete a facility risk assessment to identify potential sources of Legionella and other pathogens that could grow and spread in the facility’s water system.
- Develop and implement a water management program using the ASHRAE (American Society of Heating, Refrigeration and Air Conditioning Engineers) standards and the CDC Toolkit including physical controls, temperature management, disinfectant control levels, visual inspections and environmental testing for pathogens.
- Specify testing protocols and acceptable ranges for control measures.
- Document results of testing.
- Document corrective action taken when test results are out of range of the control limits.
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