Water Management Program Validation

According to the CDC/Healthcare Infection Control Practices Advisory Committee (HICPAC) Guidelines for Environmental Infection Control in Health-Care Facilities and Guidelines for Preventing Health-care-associated Pneumonia, healthcare facilities have two options for confirming that their water management program is working as intended. These options are

  1. performing environmental sampling for Legionella
  2. performing active clinical surveillance for infections due to Legionella

Routine Environmental Sampling

Routine environmental sampling for Legionella is 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). It is also 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. Important factors to include are 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. This ensures the risk for Legionella transmission within a healthcare facility is minimized as much as possible.

Active Clinical Surveillance

HICPAC recommends active 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 188’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).