Q&A with Alex Peck, Atlas National Director of Industrial Hygiene & Building ScienceÌý

What isÌýLegionella,Ìýand why is it dangerous?

In 1976,Ìýone of the topÌýnewsÌýstories was theÌýmysterious pneumoniaÌýoutbreak at the landmark Bellevue-Stratford Hotel in Philadelphia, Pennsylvania.ÌýÌý

Approximately 4,000 representatives from the stateÌýAmerican Legion metÌýfor a bicentennial conventionÌýat the hotelÌýthatÌýJuly.ÌýThe meeting went off without any issues, but several daysÌýfollowing the event,Ìýhundreds ofÌýattendeesÌýbegan coming down with pneumonia-like symptoms.ÌýBy August,ÌýapproximatelyÌý30 people hadÌýdiedÌýfrom complications. Following the outbreak, a research microbiologist fromÌýthe Center forÌýDiseaseÌýControl and Prevention (CDC) determined the cause to be aÌýnewÌýbacterium, known today asÌýLegionellaÌýpneumophilia, which is commonlyÌýfound in water pipes and air conditioning units.ÌýÌý

This first outbreakÌýidentifiedÌýaÌýpublic healthÌýthreatÌýforÌýlarge facilities like hotelsÌýand hospitals, where waterÌýmoves slowly through a complex web of pipes, valves and other plumbing fixtures, and the threat is still veryÌýreal today.ÌýYearly outbreaks ofÌýLegionnaire’s diseaseÌýand Pontiac feverÌý(a milder case ofÌýlegionellosis)Ìýoccur,Ìýincluding recent casesÌýinÌýCalifornia,ÌýNew YorkÌýand Florida.ÌýÌý

While the threat is realÌýand likely increasingÌýdue to a combination of increased surveillance, aging populations, increased urban densityÌýandÌýwarmer temperaturesÌýthat create a prime environment for increased bacteria growthÌý(especially inÌýAmerica’sÌýagingÌýbuildings and their waterÌýsystems), it is imperative for businesses to focus on prevention, rather than mitigation.ÌýÌýNot only is prevention less costly,Ìýbut itÌýcanÌýmost importantly helpÌýsave livesÌýandÌýprotect yourÌýcompany’s reputation.ÌýNot to mention, outbreaks can lead to extended closures and loss of business, which can be costly too.ÌýÌý

Is Legionnaire’sÌýdisease preventable?ÌýÌý

Yes, Legionnaire’s disease is preventable if businesses take proper precautions toÌýmaintainÌýtheir water systems.ÌýThe CDC reported 6,000 cases in 2015Ìýand predicts annual cases range from 10,000 to 15,000.ÌýÌý

How can your business protect itself fromÌýlegionella outbreaks in your facilities?ÌýÌý​

LegionellaÌýoutbreaks are likely to occur in buildings withÌýlarge,Ìýcomplex water systems, such as hospitals, nursing homes,Ìýhotels, office buildings,ÌýmanufacturingÌýfacilitiesÌýand inÌýengineered water systems like cooling towers, waterÌýfountainsÌýand hot tubs.ÌýÌý

The mostÌýcommonÌýplacesÌýto breed bacterial growth include:Ìý

• Cooling towers.Ìý

• Water features (falls, foundations, ponds, misters).Ìý

• Swimming pools and hot tubs.Ìý

• Drinking water fountains.Ìý

• Aging water systems.Ìý

• Unused plumbing.Ìý

• Ice machines.Ìý

• Water heating and hot water distribution.Ìý

• Shower heads and faucets.Ìý

However, by conducting formal evaluations toÌýidentifyÌýplacesÌýwhereÌýLegionellaÌýgrowthÌýis likely to occur in your facility, you can proactively mitigate your risk by taking a basic approachÌýthat involves:Ìý

• CreatingÌýa team.Ìý

• DiagramingÌýwater systems.Ìý

• EvaluatingÌýsystems for risks.Ìý

• ImplementingÌýcontrols.Ìý

• MonitoringÌýcorrective actions.Ìý

• AssessingÌýprogram effectiveness.Ìý

• Documentation.Ìý

How is Legionella regulated?ÌýÌý​

Unfortunately,ÌýnotÌýmanyÌýregulations specific toÌýLegionellaÌý(although the number is increasing)Ìýexist, and currently no federal regulationsÌýare in place.ÌýTheÌýCenters for Medicare and MedicaidÌýServices (CMS)Ìýhas issued aÌýmemoÌýthat requiresÌýall Medicaid facilitiesÌýnationallyÌýto develop andÌýmaintainÌýaÌýLegionellaÌýmanagement program,Ìýin accordance withÌýtheÌýCDC recommendations.ÌýÌý

Some state agencies have adopted their ownÌýLegionellaÌýregulations.ÌýFor instance, in 2015 and 2016, New York published rules for cooling towers and medical facilities, whichÌýinclude registration of cooling towers, monitoring, notification,ÌýmaintenanceÌýand reporting.ÌýÌý

More recently,ÌýNew JerseyÌýpassedÌýaÌýcomprehensiveÌýrule,ÌýrequiringÌýcommunity water systems toÌýalwaysÌýmaintainÌýa minimum detectable disinfectantÌýlevel inÌýall active parts ofÌýitsÌýpublic water system.ÌýThisÌýlawÌýalsoÌýrequires owners or operators of covered buildings or facilities (including hospitals, certain health care facilities,ÌýprisonsÌýand certain senior housing facilities) to develop a water management program to minimize the growth of L±ð²µ¾±´Ç²Ô±ð±ô±ô²¹â€¯bacteria in the facility’s water system and to include periodic sampling and testing for the presence of bacteria. It also includes fines for non-compliance.ÌýWhile some state regulations exist, more can be done to protect public health.Ìý

What is Atlas’ Experience in Addressing Legionella?Ìý

Atlas’ team of highly qualifiedÌýindustrial hygiene and building science experts have worked with businessesÌýand organizationsÌýfor many years to mitigate the potential risk ofÌýLegionella.ÌýOur teamÌýhelps byÌýcreatingÌýwater management plans,Ìýas well asÌýconductingÌýsamplingÌýto identifyÌýLegionellaÌýand makeÌýrecommendations to helpÌýmitigateÌýanyÌýissues.Ìý

Atlas recently helped aÌý25-storyÌýoffice building by performing initial water sampling.ÌýWeÌýidentifiedÌýLegionellaÌýin one of the kitchen sinks. Our team helpedÌýthe client remediate the issue until theÌýLegionellaÌýbacteria wereÌýgone.ÌýÌý

We have many case studies like this; however,Ìýto understand the real risks,ÌýweÌýconsiderÌýseveral factors.ÌýThis might includeÌýthe number and age ofÌýwater and plumbingÌýfixtures, as well as how the systems have been maintained.ÌýFor example, a hotel has moreÌýriskÌýthan an office, and an old hotelÌýis more likely to haveÌýconditions favoringÌýLegionellaÌýgrowthÌýthan a newly constructed hotel. Also, occupants of a retirement community are more likely to be susceptible toÌýLegionellosis disease than the occupants of a high school.ÌýÌý

If you are curious as to whether your business might be at risk for aÌýLegionellaÌýoutbreak, justÌýremember,ÌýifÌýa building hasÌýaÌýwater system, there is a risk forÌýLegionellaÌýgrowth. While there areÌýnumerousÌýfactors at play, the key to preventingÌýLegionellaÌýgrowth isÌýmaintainingÌýproper water quality,ÌýdisinfectionÌýresiduals, temperatures and flow-through—all pieces of an effective water management program.ÌýÌý