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CDC Legionella toolkit

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Page 26 of 31

DEVELOPING A LEGIONELLA WATER MANAGEMENT PROGRAM 23 Special Considerations for Healthcare Facilities ELEMENTS OF A WATER MANAGEMENT PROGRAM Developing and maintaining a water management program in healthcare facilities requires a few more considerations than the ones explained on page 6. All healthcare facilities should have a Legionella water management program. Continuous program review (see page 6) Establish a water management program team 1 The team should include someone who understands accreditation standards and someone with expertise in infection prevention Describe the building water systems using text and flow diagrams 2 Identify areas where Legionella could grow and spread 3 Include all areas where hazardous conditions may contribute to Legionella growth and spread: • Patient care areas (such as patient rooms and ICUs, but don't forget other places like dialysis, respiratory therapy, and hydrotherapy) • Clinical support areas (including dietary and central supply) which could contribute to spread by aspiration Include all components and devices that can contribute to Legionella growth and spread, as listed in the glossary on page 3. Think about all of the places where patients can be exposed to contaminated water. Don't forget about ice machines, heater-cooler units* and respiratory therapy equipment. Decide where control measures should be applied and how to monitor them 4 Think about: • Areas where medical procedures may expose patients to water mists, such as hydrotherapy and respiratory therapy devices • Areas where patients are more vulnerable to infection, such as bone marrow transplant units, oncology floors, or intensive care units Establish ways to intervene when control limits are not met 5 Make sure the program is running as designed and is effective 6 Document and communicate all the activities 7 *Devices that are commonly used during cardiac surgical procedures to warm and cool a patient's blood during cardiopulmonary bypass Reference: ASHRAE 188: Legionellosis: Risk Management for Building Water Systems June 26, 2015. ASHRAE: Atlanta. www.ashrae.org Note: ASHRAE 188 Normative Annex A applies to accredited healthcare facilities that have a Certification Board of Infection Control and Epidemiology (CBIC) certified infection preventionist or a master's-level epidemiologist.

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