Water Management in Healthcare Facilities

A note about assisted living and senior living facilities

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

CDC encourages healthcare facilities included in the scope of ASHRAE Standard 188 (Section 5.2) to develop and implement comprehensive water management programs to reduce the risk for Legionella growth and transmission. Health departments play an important role in encouraging healthcare facilities to implement Legionnaires’ disease prevention strategies.

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, such as 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, though, 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.