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Nursing Facility Infection Control Requirement – Legionnaires Disease

The Centers for Medicare & Medicaid Services (CMS) issued a S&C letter for all Medicare certified healthcare facilities regarding its expectation that facilities have water management policies and procedures in place to reduce the risk of growth/spread of Legionella and other opportunistic pathogens in building water systems. CMS notes that Legionella outbreaks have been linked to poorly maintained water systems in buildings with large/complex systems, including nursing homes and hospitals.

In reviewing Legionnaires’ Disease outbreaks over the period of 2000-2014, CMS found that 19% of outbreaks were associated with long-term care facilities. Transmission can occur via aerosols from devices such as cooling towers, showerheads, or decorative fountains. Legionella can cause Legionnaire’s Disease, a severe type of pneumonia, in at-risk populations. The at-risk population includes:

  • People who are at least 50 years old
  • Smokers
  • People with underlying medical conditions, including chronic lung disease or immunosuppression

Since nursing facilities often service the at-risk population, as part of their Infection Prevention and Control Program, they must develop and adhere to P&Ps that inhibit microbial growth in their building water systems to reduce the risk of growth and spread of Legionella. To be compliant, providers must conduct a facility risk assessment to identify potential locations where waterborne pathogens could grow and spread in the water system. Facilities must also implement a water management program that considers the ASHRAE industry standard and CDC toolkit. The program must contain control measures. Testing protocols and acceptable ranges for the control measures must be specific, results documented, and corrective actions taken when necessary.

The effective date is June 2, 2017. Read CMS S&C memo “Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires’ Disease (LD)” (Ref: S&C 17-30-ALL).

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