Legionella in Residential Healthcare Facilities

There are more than 15,000 nursing homes in the United States with more than 1.7 million licensed beds. In addition, there are nearly 29,000 assisted living communities with nearly 1 million licensed beds.

Residents in nursing homes and assisted living facilities (collectively, residential healthcare) are typically more susceptible than the general population to Legionella, Pseudomonas and Non-Tuberculous Mycobacteria (NTM)pathogens that live in water systems and affect significant numbers of persons outside of healthcare environments. But residents of residential healthcare facilities also are vulnerable to pathogens that rarely affect persons in non-healthcare settings. These include PseudomonasAcinetobacterBurkholderiaStenotrophomonas, nontuberculous mycobacteria (NTM), and fungi, opportunistic waterborne pathogens specifically mentioned in CMS Memo QSO-17-30 (June 02, 2017; Revised July 06.2018)

While the complex considerations, challenges and regulatory/accreditation requirements associated with the management of building water systems in residential healthcare facilities is similar to those faced by hospitals, most nursing homes and assisted living facilities do not have many of the unique resources and capabilities that hospitals use to meet these challenges and requirements. 

In many residential care facilities, true “as-built” plumbing systems are unavailable, and risers are frequently out of balance. Scalding limitations make it difficult to maintain temperatures needed for microbial control at patient-accessible taps, especially in memory-care units. 

Scalding limitations make it difficult to maintain temperatures needed for microbial control at patient-accessible taps. And the population served—the elderly and others requiring nursing care—are especially vulnerable to infection by plumbing-associated waterborne pathogens, such as Legionnaires’ disease.

Standard of Care

In 2015, ASHRAE Standard 188 helped establish a new standard of care for managing building water systems. The scope of ASHRAE Standard 188, most recently updated in 2021, specifically covers residential health care facilities.

Accreditation Requirements

The US Centers for Medicare and Medicaid Services (CMS) issued a directive in 2017, CMS Memo S&C 17-30, Requirement to Reduce Legionella Risk in Healthcare Facility Water Systems to Prevent Cases and Outbreaks of Legionnaires’ Disease (LD). The directive, which covers Medicare-certified healthcare facilities (including hospitals), requires policies and procedures that address Legionella as well as other opportunistic pathogens, — e.g., PseudomonasAcinetobacterBurkholderiaStenotrophomonas, nontuberculous mycobacteria (NTM), and fungi. The CMS Memo references ASHRAE Standard 188.

The Joint Commission (TJC) published new requirements, EC.02.05.02 (effective January 1, 2022) for managing water systems in buildings to prevent disease from multiple pathogens. TJC EC.02.05.02 references ASHRAE Standard 188.

Contact Us To Schedule a Consultation

Micromanagement offers comprehensive turnkey services for the reliable, regulation-compliant treatment of potable water systems in buildings. We help you protect your residents, staff and visitors from Legionnaires’ disease and other plumbing-associated infections. Call or write us today to learn more about our services.