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Prevent Legionnaires: Water Safety Tips for Healthy Environments

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In healthcare, nothing tops the priority list quite like the health and safety of patients and staff. As facility managers, you've got a plate full of responsibilities, but keeping sneaky waterborne pathogens like Legionella is one of the most important responsibilities for hospital compliance on your list to keep your patients and staff safe from harm. Why? Because Legionnaires' disease — a type of lung infection caused by bacteria — can wreak havoc in a medical setting.

What Healthcare  Professionals Need to Know About Legionnaires’ Disease

Legionnaires' disease is caused by Legionella bacteria, which thrive in warm water environments. It’s related to other types of bacterial pneumonia, but it is unique in the fact that it is not transmitted from person to person through direct content but by the inhalation of steam or mist contaminated with the bacteria. Because of this, Legionnaires' disease can quickly become a major issue in the water systems of large healthcare facilities. For facility managers in a medical setting, taking proactive steps to protect against this and other kinds of disruptive bacteria can make the difference between a healthy hospital and a major outbreak of disease. 

The Dangers of Legionella Bacteria in Healthcare

The population of your healthcare facility is likely much more vulnerable due to weakened immune systems or pre-existing health conditions. The last thing that they need is exposure to potentially deadly bacteria from the water they’re coming into contact with. The Legionella bacteria flourish in stagnant water and warm environments, making hospital water filtration systems potential breeding grounds for these pathogens. 

Because water is everywhere in a medical center, the risk to patients and staff is particularly dangerous. In fact, between 8,000 to 18,000 cases of Legionnaires' disease are hospitalized annually in the United States alone, disproportionately impacting individuals over the age of 50, smokers, those with chronic lung disease, and those with weakened immune systems.

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Where Does Legionella Contamination Happen Most Often? 

The most common way that individuals contract Legionnaires' disease is through inhaling contaminated water in the air from aerosols, steam, or mist rather than person-to-person contact. 

In a healthcare setting, common high-risk sources of Legionella include: 

  • Air conditioning cooling towers
  • Hot water tanks
  • Humidifiers
  • Whirlpool spas
  • Showers
  • Stagnant water sources 

Why Are Healthcare Facilities at Increased Risk for Legionella Outbreaks?

Modern healthcare facilities are uniquely at risk for diseases like Legionnaires’ because of how several factors including immunocompromised patients, proximity, and complicated water systems indoors.

Vulnerable Populations

The primary clientele of healthcare facilities includes the elderly and those with chronic conditions or compromised immune systems, who are particularly susceptible to Legionnaires' disease.

Complex Water Systems

The intricate hospital water systems of healthcare facilities can easily become breeding grounds for Legionella if not rigorously managed.

Presence of Opportunistic Pathogens

Conditions that allow Legionella to flourish in healthcare water systems also support the growth of other dangerous and opportunistic pathogens.

Pathogen Introduction and Growth Conditions

Legionella can enter healthcare facilities' water systems in a variety of ways, including construction or due to water main breaks. Once inside, the bacteria find favorable conditions for growth, like biofilm and stagnant water. This is a huge reason why hospital water filtration is so important. 

How to Build a Water Safety Strategy to Protect Against Legionella

For hospitals and healthcare facilities, establishing a water safety strategy is crucial to safeguard everyone within from Legionella's dangers. This strategy revolves around strict water safety protocols and detailed water management plans aimed at limiting the risks of Legionella's growth. 

Here's a simplified approach to crafting an effective water safety strategy:

Develop Comprehensive Water Management Plans: The heart of your strategy should be a detailed plan tailored to your facility's water system. It should cover how to monitor, maintain, and respond effectively to reduce Legionella risks, including forming a specialized team, assessing water systems for risk areas, and applying targeted control measures.

Regular Monitoring and Testing: Proactively check your water systems for Legionella through scheduled sampling and monitoring of water quality parameters like temperature, pH, and disinfectant levels. This early detection practice helps manage any potential health risks swiftly.

Maintain Proper Water Temperatures and Disinfection Protocols: Since Legionella bacteria flourish between 77–113°F, keeping water temperatures outside these ranges — by heating water or keeping it cool — and applying disinfectants like chlorine or UV light can prevent unruly bacterial growth.

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Minimize Stagnant Water and Biofilm Formation: Stagnant water and biofilms provide ideal conditions for Legionella. To combat this, strategies such as regularly flushing out rarely used outlets, performing routine system maintenance, and altering water system designs to avoid stagnation points are essential.

Increased Air Filtration: Because of its transmission through water in the air, even your air filtration system must be prepared to remove Legionella bacteria from the air. 

3 Ways to Treat Legionnaires as a Facility Manager

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Do you suspect that your facility could be at risk for Legionnaires’? These three treatments can kill bacteria and protect your most vulnerable populations. 

1. Simple Chlorine Treatments

Chlorination is a straightforward yet effective method to control Legionella by killing bacteria and preventing its reproduction.

2. Chlorine Dioxide

Injecting chlorine dioxide into water systems can eliminate bacteria and the biofilms that support Legionella growth.

3. Ultraviolet Disinfection

UV light treatment disrupts the DNA of Legionella bacteria, rendering them sterile and unable to reproduce, offering a chemical-free approach to water disinfection.

Regulatory Compliance and Standards

For infection control in general, facility managers must take compliance and safety standards seriously. Legionnaires’ in general pose a major risk to healthcare facilities around the globe, and continually keeping up with requirements and guidelines is your best defense against these threats. In particular, ASHRAE 188 and the CDC offer valuable resources to keep up with Legionnaires’ prevention in healthcare. 

ASHRAE 188The American Society of Heating, Refrigerating and Air-Conditioning Engineers, or ASHRAE, provides an entire library of helpful resources related to all things heating and air — including specific guidelines for preventing Legionnaires’ disease and similar bacteria that can wreak havoc in a healthcare facility. 

CDC: The Center for Disease Control offers healthcare facility managers with a comprehensive guide to infection control for nearly any kind of infection or disease that might threaten their hospital or medical facility. 

To ensure that your prevention plan is up-to-date and most effective, be sure to consult these two resources regularly to keep up with changing regulations and best practices in your facility’s fight against bacteria like Legionnaires’ disease. 

Prioritize Healthcare Safety with HEPACART®

Whether Legionnaires’ disease is your biggest concern, or strengthening your infection control strategy, it all starts with the air inside your facility being as safe and healthy as possible. From mist and steam to dust and debris, infection can come from the most unsuspecting places. 

To get ahead of your infection control strategy today, download our free guide to indoor air quality to make sure that the air in your hospital is creating the atmosphere of healing and health that you’re after. Trust air filtration in hospitals to the experts at HEPACART and confidently take on infection control with ease. 


Infection Control Risk Assessment - ICRA Matrix