Legionnaire Disease and Healthcare Facilities

Healthcare Facilities Management Society of New Jersey

May 21, 2009

LINDEN E. WITHERELL, P.E., M.P.H., J.D., D.E.E.

© 2001 Linden E. Witherell

The Most Important Information That I Can Provide – Always Know Your Consultant’s Training and Experience!!!

OK – WHAT IS MY TRAINING AND EXPERIENCE?

FIRST - I HAVEN’T HAD A SERIES OF MID-FIRST - I HAVEN’T HAD A SERIES OF MID-LIFE CRISES! IT ALL FITS TOGETHER!LIFE CRISES! IT ALL FITS TOGETHER!

Commissioned Corps United States Public Health Service

EXAMPLES OF UNFORTUNATE CHOICES OF

CONSULTANTS FIRST - BEWARE OF THE INTERNET!!!!FIRST - BEWARE OF THE INTERNET!!!!

Los Angeles HospitalLos Angeles Hospital

BEWARE OF THE INCORRECT BACKGROUNDBEWARE OF THE INCORRECT BACKGROUND GSA Building New York CityGSA Building New York City

KNOW YOUR REFERENCESKNOW YOUR REFERENCES A Compilation of the Good, Bad & UglyA Compilation of the Good, Bad & Ugly

INTRODUCTION TO LEGIONNAIRES’ DISEASE

BRIEF HISTORY OF DISEASEBRIEF HISTORY OF DISEASE THE ORGANISM– THE ORGANISM– LegionellaLegionella THE NATURAL ENVIRONMENTTHE NATURAL ENVIRONMENT ANTHROPOGENIC DISEASEANTHROPOGENIC DISEASE GROWING INCIDENCE OF GROWING INCIDENCE OF

LITIGATIONLITIGATION POPULATIONS AT RISKPOPULATIONS AT RISK

LEGIONELLOSIS PONTIAC FEVERPONTIAC FEVER LEGIONNAIRES’ DISEASELEGIONNAIRES’ DISEASE SOURCESSOURCES

COOLING TOWERSCOOLING TOWERSHOT WATER SYSTEMSHOT WATER SYSTEMS

OTHEROTHER FACILITIES AT RISKFACILITIES AT RISK

• HOSPITALSHOSPITALS• NURSING HOMESNURSING HOMES• MOTELS/HOTEL, ETC.MOTELS/HOTEL, ETC.

POTENTIAL PROBLEMS WITH TESTING SAMPLING AND ANALYSIS ISSUESSAMPLING AND ANALYSIS ISSUES RESULTS - WHAT DO YOU DO WITH A RESULTS - WHAT DO YOU DO WITH A

POSITIVE?POSITIVE? WHOM DO YOU TELL?WHOM DO YOU TELL? USE TESTING TO MONITOR CONTROL!!!USE TESTING TO MONITOR CONTROL!!!

START WITH LEGIONELLA RISK AUDIT ENVIRONMENTALENVIRONMENTAL

Cooling TowersCooling Towers Domestic Hot Water SystemsDomestic Hot Water Systems OtherOther

INFECTION CONTROL INFECTION CONTROL ADMINISTRATIVE COORDINATIONADMINISTRATIVE COORDINATION

CONTROL OF LEGIONELLA

BEWARE THE BLACK BOX SOLUTIONBEWARE THE BLACK BOX SOLUTION WATER SYSTEMSWATER SYSTEMS COOLING TOWERSCOOLING TOWERS OTHEROTHER MUTIPLE BARRIER CONCEPTMUTIPLE BARRIER CONCEPT LEGIONELLA CONTROL TEAMLEGIONELLA CONTROL TEAM

Domestic Hot Water Systems

Source WaterSource Water Sediment ControlSediment Control Plumbing Materials and Devices Plumbing Materials and Devices Thermal TreatmentThermal Treatment Overview of Chemical Treatment ChoicesOverview of Chemical Treatment Choices Supplemental ChlorinationSupplemental Chlorination

Source Water

Work with supplierWork with supplier Normal QualityNormal Quality RepairsRepairs FlushingFlushing NotificationNotification

Pipe Repairs

IsolationIsolation RepairRepair FlushFlush DisinfectionDisinfection FlushFlush TestTest

Sediment Control

““Dead Legs”Dead Legs” TanksTanks Unused FixturesUnused Fixtures AeratorsAerators

Tanks

Sediment TrapsSediment Traps Need to FlushNeed to Flush

Overview of Treatment Choices

Thermal TreatmentThermal Treatment Copper Silver IonsCopper Silver Ions Supplemental ChlorinationSupplemental Chlorination Chlorine DioxideChlorine Dioxide MonochloramineMonochloramine

Supplemental Chlorination

DesignDesign ConstructionConstruction OperationOperation ControlControl CheckingChecking

Supplemental Chlorination

Safety GogglesSafety Goggles Record BookRecord Book SinkSink Eye Wash StationEye Wash Station

Cooling Towers

Brief OverviewBrief Overview Primary Need for TreatmentPrimary Need for Treatment Methods for Legionella ControlMethods for Legionella Control

Brief Overview

Heat ExchangeHeat Exchange Water to Air Water to Air

ExchangeExchange Operating Operating

TemperaturesTemperatures AerosolsAerosols

Primary Need for Treatment

Corrosion/Scale Corrosion/Scale ControlControl Blow DownBlow Down InhibitorsInhibitors

Heat ExchangeHeat Exchange AlgaeAlgae FungiFungi TestingTesting

Primary Need for Treatment

Corrosion/Scale Corrosion/Scale ControlControl

AlgaeAlgae FungiFungi

Methods for Legionella Control

Operating Temperature (Pan Operating Temperature (Pan Temperature)Temperature)

Sediment ControlSediment Control Start-upStart-up Blow DownBlow Down Routine CleaningRoutine Cleaning

Drift ControlDrift Control

Need for Drift Control

Note Air IntakeNote Air Intake

Sediment Control

Start-upStart-up Wisconsin Wisconsin

ProtocolProtocol Blow DownBlow Down

From Low PointFrom Low Point Shut Out w/ Shut Out w/

chemical chemical additionaddition

Cleaning Cleaning

Decorative Fountains