In light of numerous Legionnaires’ disease outbreaks in the last few years, the CDC has asked clinicians in the field what should be emphasized in revised guidance to reduce the growth and transmission of Legionella spp. in healthcare water systems.
The Association for Professionals in Infection Control and Epidemiology (APIC) recently submitted comments, asking for more clarity on ambulatory settings and testing water supplies.
“It is not clear from current guidelines how institutions and healthcare professionals should be assessing risk for ambulatory care practices such as physician offices or specialty care centers,” APIC stated. “In addition, it would be helpful to have guidance on proper sampling methodology and when sampling is warranted. Specific guidance on sampling after a Legionella remediation event would also be helpful.”
Ambulatory services may be contracted out by hospitals and healthcare networks, making it difficult to access water treatment plans and exercise oversight.
“Having concrete directives on what project managers and owners are required to provide in order to assist in the prevention of Legionella and other waterborne pathogens would be helpful in driving accountability with building owners,” APIC stated. “A clear understanding of high-risk populations is something that is not [possessed] by project managers and site owners.”
While supporting guidelines for water systems to prevent Legionella infections, APIC told the CDC that water management requirements and recommendations from multiple sources are confusing.
“The challenge lies in placing the burden on healthcare personnel to perform a crosswalk of guidelines from multiple sources such as ASHRAE [American Society of Heating, Refrigerating and Air-Conditioning Engineers], CDC, and individual state or local requirements,” APIC stated in the comments. “Water management plans are designed to assess risk and put practices in place to prevent transmission, but it is difficult for healthcare facilities to be fully compliant with sometimes contradictory guideline requirements.”
When and if to test potable water supplies in hospitals has been a subject of ongoing debate, and APIC raised the issue in appealing for CDC guidance.
“It will be helpful for guidance on testing parameters and sampling methodology to better understand when testing is warranted and how to properly collect samples and interpret findings,” the association said. “APIC also encourages the development and approval of novel rapid test methods for quantifying live Legionella in water samples for use by accredited laboratories. In addition, more precise guidance including specific steps to take after renovation or prior to opening new construction would be most helpful to our members.”