Are you a healthcare facility?^*

Are you accredited by The Joint Commission?^*

Does your facility receive funding from the Centers for Medicare and Medicaid Services (CMS)?^*

Are you located in any of these states?^*

Does your building(s) primarily house people older than 65 years (like a retirement home or assisted-living facility?^*

Does your building have multiple housing units and a centralized hot water system (like a hotel or high-rise apartment complex)?^*

Does your building have more than 10 stories (including basement levels)?^*

Does your facility have a hot tub or spa that is not drained after each use, decorative water feature, or any other device that can emit aerosols (such as a mister, atomizer, air washer or humidifier)?^*

Does your facility have a cooling tower?^*

Do you currently sample for Legionella bacteria?^*

Have you had positive Legionella bacteria samples?^*

Do you regularly monitor oxidant levels of your incoming water supply and/or at various outlets throughout your facility?^*

Do you have sufficient oxidant levels at your incoming water supply and/or at various outlets throughout your facility (greater than 0.5 ppm free chlorine)?

Do you currently use supplemental disinfection in your domestic/drinking water system(s)?^*

Are you interested in learning more about supplemental disinfection and the services that Barclay can provide?

Do you make sure outlets such as faucets and showers are flushed at least weekly?^*

Your Name:^*

Email Address:^*

Company:^*

City^*

State^*

How did you find this Legionella Risk Assessment tool?^*

Did you know that as of January 1, 2022 all hospitals, critical access hospitals and nursing homes that are accredited by The Joint Commission must implement a Water Management Program that complies with EC.02.05.02?

Per QSO-17-30-Hospitals/CAHs/NHs, initially released in June 2017, all hospitals, critical access hospitals and long-term care facilities that receive CMS funding must develop and adhere to policies and procedures that inhibit microbial growth in building water systems that reduce the risk of growth and spread of Legionella and other opportunistic pathogens in water. These facilities must have water management plans and documentation that, at a minimum, ensure each facility conducts a facility risk assessment to identify where Legionella and other opportunistic waterborne pathogens (e.g. Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas, nontuberculous mycobacteria, and fungi) could grow and spread in the facility water system; develops and implements a Water Management Program that considers the ASHRAE industry standard and the CDC toolkit; specifies testing protocols and acceptable ranges for control measures, and document the results of testing and corrective actions taken when control limits are not maintained; maintains compliance with other applicable Federal, State and local requirements.

New York: (Volume A (Title 10), Part 4 – Protection Against Legionella, Subpart 4-2 – Healthcare Facilities 

Michigan: R 325.45303 Water Supply System Rule 303 (7-9) 

Illinois: Public Act 102-0004 

According to ASHRAE Standard 188, healthcare facility buildings that house patients for more than 24 hours should implement at Water Management Program. The longer a person is exposed to common sources of Legionella bacteria, the higher the risk of transmission. Additionally, patients admitted to a hospital are often immunocompromised, increasing their odds of developing Legionnaires’ disease if they are exposed to the bacteria

According to ASHRAE Standard 188, buildings that primarily house people older than 65 years (such as a retirement home or assisted-living facility) should implement at Water Management Program. People over the age of 55 years are at greater risk of developing Legionnaires’ disease when exposed to Legionella bacteria when compared to younger people. Buildings that primarily house these populations increase the likelihood of a susceptible person becoming exposed.

According to ASHRAE Standard 188, buildings that have multiple housing units and centralized hot water system (like a hotel or high-rise apartment complex) should implement at Water Management Program. Legionella bacteria can amplify in hot water systems where the temperature is not well-controlled and/or if hot water tanks are not routinely cleaned and disinfected. If a centralized hot water system has these types of conditions that allow bacteria to amplify, many people throughout the building (with various and possibly unknown varying levels of susceptibility) can become exposed to Legionella bacteria.

According to ASHRAE Standard 188, buildings that are 10 stories or taller should implement at Water Management Program. Tall buildings often have complex piping that can increase the likelihood of dead legs and water stagnation, two conditions that are associated with Legionella bacteria amplification. Water temperature and oxidant residual are often difficult to maintain in tall buildings, which can also increase Legionella bacteria amplification.

According to ASHRAE Standard 188, facilities that have any combination of cooling towers, hot tubs or spas that are not drained after each use, decorative water fountains, and/or devices that can emit aerosols (such as misters, atomizers, air washers, humidifiers) should implement a Water Management Program. These devices release aerosolized water droplets. The transmission route of Legionella bacteria is via aerosolized water droplets. People are exposed to the bacteria (and can become sick from) inhaling contaminated water droplets.

The Occupational Safety and Health Administration (OSHA) recommends cleaning cooling towers to reduce the likelihood of Legionella bacteria exposure. According to OSHA, facilities should consider cleaning and disinfecting their cooling towers at least twice a year. Normally, this maintenance is performed before initial start-up when the cooling season begins and after shut-down in the fall. However, systems with heavy biofouling or high Legionella bacteria levels in samples may require additional cleaning. OSHA also recommends cleaning and disinfecting cooling towers that have been out of service for an extended period. New systems should also be cleaned and disinfected.

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Additionally, cooling towers in the State of New York must comply The New York State Sanitary Code Title 10: Part 4 – Protection Against Legionella, Subpart 4.1 - Cooling Towers. This law requires registration, the creation of a Maintenance Program and Plan, 90-day Legionella bacteria sampling and inspection, chemistry dosing and monitoring, for each cooling tower. Cooling towers must be cleaned and disinfected if left stagnant without circulating water for five or more consecutive days. If located in New York City, there are additional requirements in accordance with Local Law 77 of 2015 and Chapter 8 of the Rules of the City of New York.

Sampling for Legionella bacteria helps to validate a Water Management Program (WMP), which is a required process in ASHRAE Standard 188. Did you know that CDC now recommends routine, environmental sampling for Legionella bacteria in both potable and utility water systems? In the CDC’s Toolkit for Controlling Legionella in Common Sources of Exposure (Legionella Control Toolkit), it is noted that testing may be useful for establishing a baseline measurement for performance indicators, validating a Water Management Program, evaluating potential growth and transmission sources, confirming success or failure of remedial treatment, and investing potential sources of environmental exposure for persons with disease.

Great job! Knowing the disinfectant levels coming into your facility and comparing it to other various outlets throughout the facility allow you to better understand the relative risk of Legionella amplification. Though disinfectant level is only a part of a larger strategy to control Legionella, identifying areas of your facility with comparatively low disinfectant levels may allow you the opportunity to apply additional control measures in those areas, such as increased flushing.

ASHRAE Guideline 12-2020 – Managing the Risk of Legionellosis Associated with Building Water Systems states that generally, the lower the concentration of disinfectant residual in the supply water entering the building, the more likely it contains microorganisms, including Legionella. It is important to consult with the water utility to determine the intended disinfectant level and confirm the actual level coming into the building. Keep in mind that even if the water received into the building does contain a consistent, measurable disinfectant residual, the residual may dissipate while in the plumbing before reaching the points of use. The rate at which disinfectants decay varies from one disinfectant to another and is affected by several factors, including water quality, organic matter, time, pH, plumbing materials and water temperature. Measuring disinfectant residuals at various outlets throughout the facility can help you understand how well the disinfectant carries throughout the building and identify areas with comparatively low disinfectant levels where you then may want to apply additional control measures such as increased flushing.

Nice! Ensuring fresh water is introduced at least weekly at outlets throughout the facility helps to minimize water age and increase disinfectant residuals in those areas. The CDC recommends flushing low-flow piping runs and dead legs at least weekly and to flush infrequently used fixtures as-needed to maintain water quality parameters within control limits.

Ensuring fresh water is introduced at least weekly at outlets throughout the facility helps to minimize water age and increase disinfectant residuals in those areas. The CDC recommends flushing low-flow piping runs and dead legs at least weekly and to flush infrequently used fixtures as-needed to maintain water quality parameters within control limits.

That’s great! Sampling for Legionella bacteria helps to validate a Water Management Program (WMP), which is a required process in ASHRAE Standard 188. The CDC now recommends routine, environmental sampling for Legionella bacteria in both potable and utility water systems. In the CDC’s Toolkit for Controlling Legionella in Common Sources of Exposure (Legionella Control Toolkit), it is noted that testing may be useful for establishing a baseline measurement for performance indicators, validating a WMP, evaluating potential growth and transmission sources, confirming success or failure of remedial treatment, and investing potential sources of environmental exposure for persons with disease.

Sampling for Legionella bacteria helps to validate a Water Management Program (WMP), which is a required process in ASHRAE Standard 188. Did you know that CDC now recommends routine, environmental sampling for Legionella bacteria in both potable and utility water systems? In the CDC’s Toolkit for Controlling Legionella in Common Sources of Exposure (Legionella Control Toolkit), it is noted that testing may be useful for establishing a baseline measurement for performance indicators, validating a Water Management Program, evaluating potential growth and transmission sources, confirming success or failure of remedial treatment, and investing potential sources of environmental exposure for persons with disease.

ASHRAE Guideline 12-2020 – Managing the Risk of Legionellosis Associated with Building Water Systems states that generally, the lower the concentration of disinfectant residual in the supply water entering the building, the more likely it contains microorganisms, including Legionella. It is important to consult with the water utility to determine the intended disinfectant level and confirm the actual level coming into the building. Keep in mind that even if the water received into the building does contain a consistent, measurable disinfectant residual, the residual may dissipate while in the plumbing before reaching the points of use. The rate at which disinfectants decay varies from one disinfectant to another and is affected by several factors, including water quality, organic matter, time, pH, plumbing materials and water temperature. Measuring disinfectant residuals at various outlets throughout the facility can help you understand how well the disinfectant carries throughout the building and identify areas with comparatively low disinfectant levels where you then may want to apply additional control measures such as increased flushing.