Legionella, 40 Years Later: What Have We Learned? FACS Takes Leadership Role in Outbreak Prevention

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On the heels of this week's news regarding recent Legionella bacteria findings, environmental health consulting firm urges changes to the standard of care for the prevention of Legionella-related illnesses

FACS

Leaders in Environmental and Occupational Health have to take an active role in providing tools for the professionals to investigate, control, and treat Legionella." -Dr. David Krause, Scientist, FACS

As news regarding occurrences of the deadly Legionella bacteria continues to make headlines, scientists at Forensic Analytical Consulting Services have announced that they are working with government and public health officials to promulgate new standards in the fight against Legionella. The proposed new regulations – representing a fundamental change in the way Legionella outbreaks are managed – seek to make preventative measures proactive, as opposed to the current protocol that dictates a reactionary stance.

Just this week alone, it was reported that the deadly Legionella bacteria was found at a nursing home in New York State and in the water supply in Flint, Mich. The news comes almost exactly 40 years since the Bellevue-Stratford Hotel in Philadelphia experienced a major Legionnaire's disease outbreak that first brought the subject – a major health concern associated with potentially contaminated aerosols generated from cooling towers and drinking water – into the public consciousness.

Despite efforts put forth by government entities, the public health community, and private interests, reported cases of the disease caused by the Legionella bacteria continue to rise. However, many cases may still remain unreported and the Centers for Disease Control and Prevention (CDC) estimates between 8,000 and 18,000 legionellosis hospitalizations occur in the U.S. annually – with fatality rates ranging from 10 to 30 percent.

As a result, during the past two years, there has been movement toward a fundamental change in the standard of care for prevention of Legionalla-related illness. Preventing outbreaks, instead of just reacting to them, is now recommended by public health agencies, occupational health professionals, and engineering associations. This change has increased pressure upon commercial entities – particularly those in healthcare and hospitality enterprises – to either become active in preventative efforts, or face increased risk of occupant illness and potential litigation.

Until recently, the recommended public health approach has been reactionary in nature, with no recommendations to take specific proactive measures or even determine the presence of waterborne pathogens in a building’s water system until two or more cases of disease have been identified. This reactionary approach has potentially contributed to the increasing incidence of Legionnaires’ disease, rising more than 350 percent in the past 15 years alone.

Supporting this changed stance is a new framework affecting the certification of professionals engaged in identifying, and remediating, sources of waterborne bacterial outbreaks. Guidance provided by the American Industrial Hygiene Association (AIHA) “Guidelines for Recognition, Evaluation and Control of Legionella” (May 2015), American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) “ASHRAE-188 Guidelines - Minimizing the Risk of Legionella Associated with Building Water Systems” (June 2015), Environmental Protection Agency “Technologies for Legionella Control” (November 2015), and the CDC, now embody the current recommended practices of prevention through proactive water management plans and periodic validation testing. Of great importance is the description of competencies and education a professional should have in order to provide reliable guidance on recognition, evaluation, and control of Legionella in building water systems.

Given all of this progress, one has to wonder: Why haven’t reported outbreaks of Legionella-associated illness been on the decline? In the past two years there have been several major reported outbreaks in New York City, where cooling towers in the South Bronx have been associated with 120 reported cases and 12 deaths. Additionally, Flint, Michigan, has also endured a spike in cases of Legionnaires’ disease and childhood lead poisoning associated with changes to the municipal water supplies. Poor water quality is believed to have contributed to the growth of Legionella bacteria in many building water systems throughout the city.

Two key factors are behind the continued rise of Legionella-related illness outbreaks. First, though the previously referenced standards hold promise, they are currently guidelines for best practice and remain voluntary until public health or municipal authorities promulgate rules that formally adopt these voluntary standards and guidelines into codes and statutes. The first step in codifying these guidelines has been taken by the state of New York, which adopted portions of ASHRAE 188-2015 in November of 2015. Although this represents a step in the direction toward standardization, the United States remains far from matching the strict enforcement of standards in places like the European Union and Australia.

Second, preventing Legionella growth is most often not an easy, one-time action. Instead, it generally requires implementation of a committed process by trained professionals. With a shortage in expertise in this area, this second factor may pose a challenge for some time to come.

“The standard of care has changed regarding Legionella. The protocol is complex and leaders in Environmental and Occupational Health have to take an active role in providing tools for the professionals to investigate, control, and treat Legionella,” says Dr. David Krause, a scientist at Forensic Analytical Consulting Services (FACS). Dr. Krause’s company has taken a leadership role in the public-private partnership that is focused on stricter Legionella controls. In addition to FACS and other private Environmental Health enterprises, agencies such as the Environmental Protection Agency (EPA), Centers for Disease Control (CDC) and the Association of State Drinking Water Administrators (ASDWA) continue to work to provide an overview of the regulatory context and a practical guide to implementing industry standards.

One of the most comprehensive resources to date, a toolkit distributed by the CDC, has resulted from this public/private partnership. Titled: Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings -- A Practical Guide to Implementing Industry Standards, this resource is available immediately to interested parties via free download.

Clearly, the time is now to make positive progress toward reducing, controlling, and eventually eliminating, the public health threat posed by Legionella bacteria. In addition to costing lives, outbreaks create a myriad of other challenges, including business disruption, damage to reputation, and liability for facilities managers, owners, and operators where these incidents occur.

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About Forensic Analytical Consulting Services (FACS): One of the country’s leading Environmental Health Consulting Services devoted to Environmental Risk Prevention and Assessment, Health and Safety, and Remediation Support. Services include professional management of asbestos, lead, mold and water intrusion, indoor environmental quality, environmental health and safety management and litigation support. These services are available to owners in key industry sectors including construction trades, healthcare, utilities, industrial, commercial, retail, insurance, hospitality, government, legal and other areas in which public health protection is valued.

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