Atlanta, Georgia, USA, July 17, 2017: To reduce cases of Legionnaires’ disease in health care facilities, the Centers for Medicare & Medicaid Services (CMS), USA, announced that Medicare-certified healthcare facilities in the United States must develop and maintain water-management policies and procedures to reduce the risk of growth and spread of Legionella and other opportunistic pathogens in building water systems. The directive has an immediate effective date, CMS said through a Press communiqué.

Legionnaires’ disease is a serious type of pneumonia caused by bacteria, called Legionella, that live in water. Legionella can make people sick, when they inhale contaminated water from building water systems that are not adequately maintained.

The announcement was made in a recent memorandum to the State Survey Agency Directors and includes hospitals, critical-access hospitals and long-term care facilities in the United States.

Most notably, CMS called for the utilisation and compliance of ASHRAE Standard 188: Legionellosis: Risk Management for Building Water Systems, which was developed to assist designers and building operators in developing a water-management plan that includes practices specific to the systems that exist in a particular building, campus or health care facility.

The timing of CMS’ decision is significant, as the Centers for Disease Control and Prevention (CDC), in the United States, released a report last month stating that more than 76% of Legionnaires’ disease cases acquired from Legionella exposure in health care facilities can be particularly harsh, including possible fatal risks to patients.

“Incorporating good design, operations and maintenance procedures that prevent the growth and spread of Legionella is vitally important in all buildings, especially health care facilities,” said Michael Patton, member of ASHRAE Committee SSPC 188. “These are regarded as the best methods for preventing this potentially fatal disease. ASHRAE has been at the forefront of establishing best practices through ASHRAE Standard 188. We are pleased that CMS is taking a strong stance on this issue.”

The CMS memo calls on State Survey Agency Directors to conduct a facility risk assessment, implement a water-management programme that considers ASHRAE Standard 188 and the toolkit developed by the CDC entitled, “Developing a Water Management Program to Reduce Legionella Growth and Spread in Buildings: A Practical Guide to Implementing Industry Standards.” The directive also requires facilities to specify testing protocols

The CDC toolkit – initially released in 2016 and updated in June 2017 – is based upon ASHRAE Standard 188 and provides a checklist to help building owners and managers identify if a water-management programme is needed, examples to help identify where Legionella could grow and spread in a building and ways to reduce risk of contamination