search.noResults

search.searching

dataCollection.invalidEmail
note.createNoteMessage

search.noResults

search.searching

orderForm.title

orderForm.productCode
orderForm.description
orderForm.quantity
orderForm.itemPrice
orderForm.price
orderForm.totalPrice
orderForm.deliveryDetails.billingAddress
orderForm.deliveryDetails.deliveryAddress
orderForm.noItems
INFECTION CONTROL BRIAN HAGEMAN – LEED AP, ASSOCIATE PRINCIPAL, MAZZETTI, USA


Protecting against the threat of Legionnaires


Brian Hageman, from Mazzetti, offers an insight into the steps that must be taken to protect occupants from the potential threat lurking within building water systems.


Concerns about healthcare-associated infections (HCAIs) have been growing within the healthcare industry. Among these, Legionnaire’s Disease is particularly endemic to building water systems. The US Centers for Disease Control (CDC) asserts that there are, on average, 8000 to 18,000 hospitalised cases of Legionellosis within the United States, yearly, and the mortality rate among these is around 10%. Reported cases have increased by over 400% since 2000. Although the increase may be due to a combination of factors such as better diagnostic practices, more Legionella in the environment, a more vulnerable population, or changing conditions within the built environment, the fact remains: a significant health risk exists that can be mitigated with some focused modifications to how we design, build, and maintain healthcare facilities. In June of 2017, this risk became


prominently highlighted when the Centers for Medicare & Medicaid Services (CMS) issued a memo requiring hospitals that provide services reimbursed by Medicare & Medicaid to develop a plan of action to mitigate Legionella in building water systems. The memo references ASHRAE Standard 188: Legionellosis: Risk Management for Building Water Systems as a resource for facilities to use in developing their plan of action. Also, in 2017, the American Society of


Healthcare Engineers (ASHE) published a very handy monograph summarising how ASHRAE 188 applies to healthcare facilities, and CDC published a free toolkit Developing a Water Management Plan


Legionella is commonly present in our environment, but it may not be the type that poses a risk to humans.


to Reduce Legionella Growth and Spread in Buildings. As a result of this increased focus on


waterborne pathogens, facility leadership and engineering managers across the country are coalescing in Water Management Teams with the goal of protecting building occupants and visitors with preventative steps to detect the illness. This special report will discuss key considerations to understanding where Legionella is most likely to live and measures that to help prevent and detect the disease.


Legionella and Legionellosis The bacterium Legionella can cause a form of pneumonia known as Legionnaire’s disease, or a form of influenza know as Pontiac Fever. A person can drink a glass of water laden with Legionella and not get sick. This pathogen only poses a health risk when certain conditions are present: l Legionella bacteria of the specific type that causes illness in humans must be present in the building water supply.


Brian Hageman


Brian Hageman, LEED AP, leads the firm’s plumbing discipline with over 30 years of experience. His expertise extends beyond plumbing engineering into infection control issues, risk


management, conservation of energy and water, and systems sustainability. Some of Brian’s accomplishments in healthcare include: designing one of the first large-scale water reuse systems in an Acute Care Facility and co-writing a new set of construction guidelines for the country of Liberia.


IFHE DIGEST 2020


l Biofilm must be present on interior surfaces of equipment, storage tanks, or distribution piping. This is where the bacteria can multiply, and mature. In the biofilm, they are protected from eradication by normal levels of disinfectants. Bacteria can be released into the water stream by sloughing off pieces of biofilm due to pressure fluctuations, water hammer, or cutting of pipe for renovations.


l A warm environment – Legionella grows best at around 100˚F. It grows at a slower pace below this temperature, and it dies more quickly over 100˚F. The effect of the environment’s temperature on bacteria growth varies considerably depending on the specific bacterium and the biofilm in which it lives.


l A person with a weakened immune system or respiratory illness must inhale or aspirate mature Legionella- infected water droplets into their lungs. This is an important distinction. Even a sick person could drink a glass of water laden with Legionella and not get sick. It must get into their lungs to pose a risk. At the same time, a healthy person may inhale infected water droplets and not get sick.


Within healthcare facilities, these conditions are often all present and accounted for – especially at patient bathrooms and facility cooling towers. There, the right temperature conditions, Legionella-harboring biofilm, and the ability to aerosolise infected water in the presence of sick people, all come together – the perfect storm, unfortunately. To understand why Legionella is likely


to be present in healthcare environments, we will look at how water systems may support waterborne pathogens.


Legionella in municipal domestic water systems Most water naturally contains some Legionella. Although municipal domestic


53


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88  |  Page 89  |  Page 90  |  Page 91  |  Page 92  |  Page 93  |  Page 94  |  Page 95  |  Page 96  |  Page 97  |  Page 98  |  Page 99  |  Page 100  |  Page 101  |  Page 102  |  Page 103  |  Page 104  |  Page 105  |  Page 106