Water Management in Healthcare Facilities

CDC encourages healthcare facilities included in the scope of ASHRAE Standard 188 (Section 5.2) to develop and implement comprehensive water management programs. Water management programs can help reduce the risk for Legionella growth and transmission.

A comprehensive water management program can have additional benefits in the control of other water-related healthcare-associated infections. Water management programs should therefore be monitored for their efficacy in reducing risk for a variety of pathogens. These pathogens include gram-negative bacteria (e.g., Pseudomonas, Burkholderia, Stenotrophomonas) and nontuberculous mycobacteria.1

Under rare circumstances, certain Legionella-specific interventions may provide an environment in which these other pathogens can increase in number. For example, researchers have documented increased colonization by nontuberculous mycobacteria in building water systems following the introduction of monochloramine, an agent effective for reducing Legionella colonization of biofilm.2  In general, you can use the same principles of water management to reduce the risk of disease from these other pathogens in building water systems. A consultant with Legionella-specific healthcare environmental expertise may sometimes be able to provide information about specific interventions, taking other pathogens into consideration.

CDC does not consider assisted living facilities, senior living facilities, or prisons, to be healthcare facilities for Legionnaires’ disease surveillance purposes. However, these facilities often house at-risk populations and can have large, complex building water and plumbing systems. So it’s important to consider these facilities as likely sources in outbreak investigations as residents may have limited or no exposure outside these facilities. These facilities should all have effective water management programs.