Cases of Legionnaires’ disease reached a record high in 2018, with more than 9,900 cases reported by the Center for Disease Control (CDC) – an 800 percent increase since 2000.¹

Healthcare facilities face great exposure and liability, as legionella cases often result in costly, complex claims of bodily injury and property damage, generating high remediation and restoration costs. When a skilled nursing facility or hospital has to shut down a block of rooms, floors or an entire facility because of legionella outbreak, it’s a major liability and public relations nightmare. Federal and state agencies can also levy fines and penalties. Together, these can lead to significant legal costs, as cases are handled by specialized attorneys with specific expertise.

Exposure to legionella, the waterborne bacteria that spreads through inhalation of water or mist from showers, sinks, humidifiers and more at healthcare facilities, is the precursor to Legionnaires’ disease. According to the CDC, the disease proves deadly for as many as one-quarter of those who contract it in a healthcare setting.²

Legionella is 40 times more resistant to chlorine than other bacteria, which means it requires a higher concentration and takes significantly longer to kill than typical plumbing-system bacteria. For this reason, a facility cannot depend on its municipalities’ disinfection methods to control its spread. Particularly susceptible are legacy plumbing and ventilation systems as well as facilities without an active facility water management plan, which includes regular bacteria testing.

The spread of legionella is 100 percent preventable.

With the right maintenance and plumbing systems in place, exposure to legionella bacteria can be avoided. Consider the following best practices to healthcare facility maintenance and water management.

1. Vet contractors. Efficient design and renovation of a facility’s plumbing systems is a first step in prevention. Make sure to hire both reputable mechanical, electrical and plumbing (MEP) engineers and contactors and those that have real healthcare experience to build showers, saunas, pools and mechanical rooms and cooling towers. This is especially important as healthcare MEP systems must meet healthcare-specific local and national codes and standards. Processes for maintenance and testing, including heating up water and shutting off the return pipe should be established during systems design and renovation.
2. Have a management plan.In 2017, the Centers for Medicare and Medicaid Services issued a rule requiring healthcare facilities to establish water management plans. Here’s what needs to be included:
   • Conduct a risk assessment for waterborne pathogens and potential exposures
   • Identify location of wet areas including humidifiers, ventilators, CPAP machines, hot tubs, wet mop areas and high-risk patient population units and locations
   • Evaluate the necessity of point-of-use water filtration in these locations
   • Establish proactive action plans to eliminate risk
   • Perform surveillance of waterborne bacteria among patients
   • If a case is identified, notify state department of public health
   • Conduct an investigation
   • Prepare a contingency plan in the event of water restriction
3. Test, test and test again. Healthcare facilities with high exposure to legionella and other bacterial like Methicillin-resistant Staphylococcus aureus (MRSA) will want to test for bacteria monthly. Knowing the operational temperature of the water system daily, where the water is coming from and where it exists the building are all critical to accurate testing.
4. Practice good maintenance. Keep the plumbing infrastructure and mechanical equipment clean via in-house maintenance or third-party maintenance contracts. Many professional healthcare-specific cleaning companies are versed in legionella bacteria and what is required to steer clear of an outbreak.
5. Get insured. Property policies won’t cover an outbreak in your facility. A specific environmental insurance policy for your healthcare facility must be negotiated by your broker to name: MRSA, mold, microbial matter, fungi, viruses and legionella as covered pollutants. A good environmental insurance policy will provide coverage for:
   • Third-party injury and property damages
   • Remediation expenses
   • Civil fines and penalties
   • Business interruption
   • Public relations costs in the event of an outbreak
   • Legal defense expenses
   Hospitals, skilled nursing facilities (SNFs) and other healthcare facilities will want to buy a site-specific policy to cover the building(s) and footprint of the real estate from environmental exposures. This is often referred to an Environmental Impact Liability (EIL) or a Pollution Legal Liability (PLL) policy.

Contact your HUB environmental expert to find out how you can safeguard your healthcare facility from the threat of legionella and other dangerous bacteria.

¹https://www.tmc.edu/news/2019/12/recent-legionnaires-disease-outbreaks-raise-concerns/

²https://www.cdc.gov/legionella/about/diagnosis.html