Understanding and Managing Your Risk to Legionella

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

What is Legionella, and why is it dangerous?

In 1976, one of the top news stories was the mysterious pneumonia outbreak at the landmark Bellevue-Stratford Hotel in Philadelphia, Pennsylvania.  

Approximately 4,000 representatives from the state American Legion met for a bicentennial convention at the hotel that July. The meeting went off without any issues, but several days following the event, hundreds of attendees began coming down with pneumonia-like symptoms. By August, approximately 30 people had died from complications. Following the outbreak, a research microbiologist from the Center for Disease Control and Prevention (CDC) determined the cause to be a new bacterium, known today as Legionella pneumophilia, which is commonly found in water pipes and air conditioning units.  

This first outbreak identified a public health threat for large facilities like hotels and hospitals, where water moves slowly through a complex web of pipes, valves and other plumbing fixtures, and the threat is still very real today. Yearly outbreaks of Legionnaire’s disease and Pontiac fever (a milder case of legionellosis) occur, including recent cases in California, New York and Florida.  

While the threat is real and likely increasing due to a combination of increased surveillance, aging populations, increased urban density and warmer temperatures that create a prime environment for increased bacteria growth (especially in America’s aging buildings and their water systems), it is imperative for businesses to focus on prevention, rather than mitigation.  Not only is prevention less costly, but it can most importantly help save lives and protect your company’s reputation. Not to mention, outbreaks can lead to extended closures and loss of business, which can be costly too.  

Is Legionnaire’s disease preventable?  

Yes, Legionnaire’s disease is preventable if businesses take proper precautions to maintain their water systems. The CDC reported 6,000 cases in 2015 and predicts annual cases range from 10,000 to 15,000.  

How can your business protect itself from legionella outbreaks in your facilities?  ​

Legionella outbreaks are likely to occur in buildings with large, complex water systems, such as hospitals, nursing homes, hotels, office buildings, manufacturing facilities and in engineered water systems like cooling towers, water fountains and hot tubs.  

The most common places to breed bacterial growth include: 

• Cooling towers. 

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

• Swimming pools and hot tubs. 

• Drinking water fountains. 

• Aging water systems. 

• Unused plumbing. 

• Ice machines. 

• Water heating and hot water distribution. 

• Shower heads and faucets. 

However, by conducting formal evaluations to identify places where Legionella growth is likely to occur in your facility, you can proactively mitigate your risk by taking a basic approach that involves: 

• Creating a team. 

• Diagraming water systems. 

• Evaluating systems for risks. 

• Implementing controls. 

• Monitoring corrective actions. 

• Assessing program effectiveness. 

• Documentation. 

How is Legionella regulated?  ​

Unfortunately, not many regulations specific to Legionella (although the number is increasing) exist, and currently no federal regulations are in place. The Centers for Medicare and Medicaid Services (CMS) has issued a memo that requires all Medicaid facilities nationally to develop and maintain a Legionella management program, in accordance with the CDC recommendations.  

Some state agencies have adopted their own Legionella regulations. For instance, in 2015 and 2016, New York published rules for cooling towers and medical facilities, which include registration of cooling towers, monitoring, notification, maintenance and reporting.  

More recently, New Jersey passed a comprehensive rule, requiring community water systems to always maintain a minimum detectable disinfectant level in all active parts of its public water system. This law also requires owners or operators of covered buildings or facilities (including hospitals, certain health care facilities, prisons and certain senior housing facilities) to develop a water management program to minimize the growth of Legionella 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. While some state regulations exist, more can be done to protect public health. 

What is Atlas’ Experience in Addressing Legionella? 

Atlas’ team of highly qualified industrial hygiene and building science experts have worked with businesses and organizations for many years to mitigate the potential risk of Legionella. Our team helps by creating water management plans, as well as conducting sampling to identify Legionella and make recommendations to help mitigate any issues. 

Atlas recently helped a 25-story office building by performing initial water sampling. We identified Legionella in one of the kitchen sinks. Our team helped the client remediate the issue until the Legionella bacteria were gone.  

We have many case studies like this; however, to understand the real risks, we consider several factors. This might include the number and age of water and plumbing fixtures, as well as how the systems have been maintained. For example, a hotel has more risk than an office, and an old hotel is more likely to have conditions favoring Legionella growth than a newly constructed hotel. Also, occupants of a retirement community are more likely to be susceptible to Legionellosis disease than the occupants of a high school.  

If you are curious as to whether your business might be at risk for a Legionella outbreak, just remember, if a building has a water system, there is a risk for Legionella growth. While there are numerous factors at play, the key to preventing Legionella growth is maintaining proper water quality, disinfection residuals, temperatures and flow-through—all pieces of an effective water management program.