Hostname: page-component-77c89778f8-gvh9x Total loading time: 0 Render date: 2024-07-18T20:47:11.454Z Has data issue: false hasContentIssue false

A Comprehensive Water Management Program for Multicampus Healthcare Facilities

Published online by Cambridge University Press:  10 May 2016

Dale A. Krageschmidt
Affiliation:
Mayo Clinic, Rochester, Minnesota
Allen F. Kubly
Affiliation:
Mayo Clinic, Rochester, Minnesota
Mark S. Browning
Affiliation:
Mayo Clinic, Rochester, Minnesota
Alan J. Wright
Affiliation:
Mayo Clinic, Rochester, Minnesota
Jon D. Lonneman
Affiliation:
Mayo Clinic, Rochester, Minnesota
Martin J. Detmer
Affiliation:
Phigenics, Naperville, Illinois
William F. McCoy*
Affiliation:
Phigenics, Naperville, Illinois
*
1701 Quincy Avenue, Suite 32, Naperville, IL 60540 (wmccoy@phigenics.com)

Abstract

Objective.

Develop and implement an effective program for hazard analysis and control of waterborne pathogens at a multicampus hospital with clinics.

Design.

A longitudinal study. Several-year study including analysis of results from monitoring and tests of 26 building water systems.

Setting.

Outpatient and inpatient healthcare facilities network.

Methods.

The hazard analysis and critical control point (HACCP) process was used to develop a water management program (WMP) for the hospital campuses. The HACCP method systematically addressed 3 questions: (1) What are the potential waterborne hazards in the building water systems of these facilities? (2) How are the hazards being controlled? (3) How do we know that the hazards have been controlled? Microbiological and chemical tests of building water samples were used to validate the performance of the WMP; disease surveillance data further validated effective hazard control.

Results.

Hazard analysis showed that waterborne pathogens were generally in good control and that the water quality was good in all facilities. The hospital network has had several legionellosis cases that were identified as presumptive hospital acquired, but none was confirmed or substantiated by water testing in follow-up investigations. Building water system studies unrelated to these cases showed that pressure tanks and electronic automatic faucets required additional hazard control.

Conclusions.

Application of the HACCP process for long-term building water systems management was practical and effective. The need for critical control point management of temperature, flow, and oxidant (chlorine) residual concentration was emphasized. The process resulted in discovery of water system components requiring additional hazard control.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Centers for Disease Control and Prevention (CDC). Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking—United States, 2005–2006. MMWR CDC Surveill Summ 2008;57(SS-9)3962.Google Scholar
2. CDC. Waterborne diseases could cost over $500 million annually in U.S. 2010 press release, http://www.cdc.gov/media/pressrel/2010/rl00714.htm.Google Scholar
3. Anaissie, EJ, Kuchar, RT, Rex, JH, et al. Fusariosis associated with pathogenic Fusarium species colonization of a hospital water system: a new paradigm for the epidemiology of opportunistic mold infections. Clin Infect Dis 2001;33:18711878.CrossRefGoogle ScholarPubMed
4. Anaissie, EJ, Stratton, SL, Dignani, MC, et al. Pathogenic Aspergillus species recovered from a hospital water system: a 3-year prospective study. Clin Infect Dis 2002;34:780789.CrossRefGoogle ScholarPubMed
5. Short, DPG, O'Donnell K, , Zhang, N, Juba, JH, Geise, DM. Widespread occurrence of diverse human pathogenic types of the fungus Fusarium detected in plumbing drains. J Clin Microbiol 2011;49(12)42644272.CrossRefGoogle ScholarPubMed
6. Kohlenberg, A, Brümmer, S, Higgins, PG, et al. Outbreak of car-bapenem-resistant Acinetobacter baumannii carrying the car-bapenemase OXA-23 in a German university medical centre. J Med Microbiol 2009;58(11)14991507.Google Scholar
7. Looney, WJ. Role of Stenotrophomonas maltophilia in hospital-acquired infection. Br J Biomed Sci 2005;62(3)145154.Google Scholar
8. Vaerewijck, MJ, Huys, G, Palomino, JC, Swings, J, Portaeis, F. Mycobacteria in drinking water distribution systems: ecology and significance for human health. FEMS Microbiol Rev 2005;29(5):911934.Google Scholar
9. Birnbaum, HG, Morley, M, Greenberg, PE, Cifaldi, M, Colice, GL. Economic burden of pneumonia in an employed population Arch Intern Med 2001;161:27252731.CrossRefGoogle Scholar
10. McCoy, WF. Preventing legionellosis with hazard analysis and control systems. In: Cianciotto, N, Abu Kwaik, Y, Edelstein, P, Fields, B, Harrison, T, Ratcliff, R, Stout, J, eds. Legionella: state of the art 30 years after its recognition. Washington, DC: American Society for Microbiology, 2006 538542.Google Scholar
11. World Health Organization (WHO). Legionella and the prevention of legionellosis. Geneva: WHO, 2007.Google Scholar
12. Dewettinck, T, Van Houtte, E, Geenens, D, Van Hege, K, Verstraete, W. HACCP (hazard analysis and critical control points) to guarantee safe water reuse and drinking water production: a case study. Water Sci Technol 2001;43(12)3138.CrossRefGoogle ScholarPubMed
13. Dyck, A, Exner, M, Kramer, A. Experimental based experiences with the introduction of a water safety plan for a multi-located university clinic and its efficacy according to WHO recommendations. BMC Public Health 2007;7:34. http://www.biomedcentral.com/content/pdf/1471-2458-7-34.pdf.Google Scholar
14. CDC. Procedures for the recovery of Legionella from the environment. Atlanta: National Center for Infectious Diseases, Division of Bacterial and Mycotic Diseases, Respiratory Diseases Laboratory Section; 2005.Google Scholar
15. International Standards Organization (ISO). Water quality: detection and enumeration of Legionella. ISO 11731. Geneva: ISO, 1998.Google Scholar
16. Lucas, CE, Taylor, TH, Fields, BS. Accuracy and precision of Legionella isolation by US laboratories in the ELITE program pilot study. Water Res 2011;45(15)44284436.Google Scholar
17. McCoy, WF, Downes, EL, Leonidas, LF, et al. Inaccuracy in Legionella tests of building water systems due to sample holding time. Water Res 2012;46(2012)34973506.Google Scholar
18. McDaniels, AE, Bordner, RH, Gartside, PS, Haines, JR, Brenner, KP, Rankin, CC. Holding effects on coliform enumeration in drinking water samples. Appi Environ Microbiol 1985;50(4)755762.CrossRefGoogle ScholarPubMed
19. Baumann, P. Isolation of Acinetobacter from soil and water. J Bacteriol 1968;96:3942.Google Scholar
20. Boliet, C, Davin-Regli, A, De Micco, P. A simple method for selective isolation of Stenotrophomonas maltophilia from environmental samples. Appi Environ Microbiol 1995;61:16531654.CrossRefGoogle Scholar
21. Pope, M, Bussen, M, Feige, M, et al. Assessment of the effects of holding time and temperature on Escherichia coli densities in surface water samples. Appi Environ Microbiol 2003;69(10): 6201-6207.Google Scholar
22. Jawad, A, Hawkey, PM, Heritage, J, Snelling, AM. Description of Leeds Acinetobacter medium, a new selective and differential medium for isolation of clinically important Acinetobacter spp., and comparison with Herellea agar and Holton's agar. J Clin Micriobiol 1994;32:23532358.CrossRefGoogle Scholar
23. Miyamoto, H, Yamamoto, H, Arima, K, et al. Development of a new seminested PCR method for detection of Legionella species and its application to surveillance of legionellae in hospital cooling tower water. Appi Environ Microbiol 1997;63(7)24892494.CrossRefGoogle ScholarPubMed
24. American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). Minimizing the risk of legionellosis associated with building water systems. Guideline 12-2000. Atlanta: ASHRAE; 2000.Google Scholar
25. Department of Labor, Occupational Safety and Health Administration (OSHA). OSHA technical manual. Legionnaires' disease. Sec III, chap 7. http://www.osha.gov/dts/osta/otm/otm_iii/otm_iii_7.html#l; 1999.Google Scholar
26. Fields, BF, Moore, M. Control of legionellae in the environment: a guide to the US guidelines. ASHRAE Trans 2006;112(1)691699.Google Scholar
27. Kool, JK, Bergmire-Sweat, D, Butler, JC, et al. Hospital characteristics associated with colonization of water systems by Legionella and risk of nosocomial Legionnaires' disease: a cohort study of 15 hospitals. Infect Control Hosp Epidemiol 1999;20(12): 798805.Google Scholar
28. CDC. Guidelines for preventing health-care-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Morb Mortal Wkly Rep 2004;53(RR-3):136.Google Scholar
29. Emily, RM, Sydnor, ERM, Bova, G, Gimburg, A, Cosgrove, SE, Perl, TM, Maragakis, LL. Electronic-eye faucets: Legionella species contamination in healthcare settings. Infect Control Hosp Epidemiol 2012;33(3)235240.Google Scholar
30. Walter, Z, Pittet, D. Electronic-eye faucets: curse or blessing? Infect Control Hosp Epidemiol 2012;33(3)241242.Google Scholar