Water Management Program Validation

According to the CDC/Healthcare Infection Control Practices Advisory Committee (HICPAC) Guidelines for Environmental Infection Control in Health-Care Facilitiespdf icon and Guidelines for Preventing Health-care-associated Pneumonia pdf icon[179 pages], healthcare facilities have two options for validating the efficacy of their water management program (i.e., for confirming that the water management program is working as intended): 1) performing environmental sampling for Legionella or 2) performing active clinical surveillance for infections due to Legionella.

Routine Environmental Sampling

Routine environmental sampling for Legionella (i.e., sampling that is performed proactively as part of an effort to reduce risk of Legionella growth and transmission in building water systems, not in the context of an outbreak investigation) is one way to validate a water management program. Healthcare facility water management program teams should base decisions about routine environmental sampling for Legionella on a variety of factors, including the building environmental assessment and water quality data supporting the overall performance of the water management program. See Routine Environmental Sampling for additional information.  Note: The approach to routine sampling in the absence of disease may be different than the approach to environmental sampling in the context of an outbreak.

HICPAC recommends environmental sampling for Legionella in healthcare facilities as an option for validating the effectiveness of water management programs in transplant units. Although not a specific HICPAC recommendation, healthcare facilities can expand this practice to all areas with at-risk populations, to ensure the risk for Legionella transmission within a healthcare facility is minimized.

Active Clinical Surveillance

HICPAC recommends clinical surveillance as a second option for validating the effectiveness of a water management program in healthcare facilities.  Infections due to Legionella, if present, could signal that there is a problem with the facility’s water quality. This validation option applies to facilities addressed in ASHRAE Standard 188external icon’s Annex A. A certified infection preventionist (or other qualified individual) should conduct active clinical surveillance, if performed. The HICPAC guidelines include additional guidance for controlling Legionella in facilities with protective environments (i.e., transplant units).