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Planning is Critical to Managing Legionella and Other Waterborne Pathogen Risks in the Pandemic

> > infectioncontrol.tips/2021/02/05/legionella-special-session-2021/ <infectioncontrol.tips/2021/02/05/legionella-special-session-2021/> > > Planning is Critical to Managing Legionella and Other Waterborne Pathogen Risks in the Pandemic > > Chris Boyd (1) <infectioncontrol.tips/author/cboyd/>February 5, 2021 > <infectioncontrol.tips/wp/wp-content/uploads/2021/02/Planning-is-Critical-to-Managing-Legionella-and-Other-Waterborne-Pathogen-Risks-in-the-Pandemic.jpg> > Special Session of Legionella Conference Brings an Opportunity for Public Health and Industry Leaders to Work Together to Develop Emergency Plans and Water Safety Practices > > Abstract > > In 2018, the number of Legionnaires’ disease cases in the United States reached a record high of 9,933 , a nearly nine-fold increase since 2000. Public health leaders believe the number of actual cases may be as high as 70,000 because the disease is widely thought to be underdiagnosed. The sudden closures of tens of thousands of buildings in a COVID-19 social distancing prevention strategy has created new risks for the amplification of Legionella, which causes Legionnaires’ disease. Stagnant water, or the low-flow of water, within a building system creates an optimal atmosphere for the bacteria’s growth within biofilm. Federal, state and other public health organizations have issued guidance on managing this risk when reopening facilities. The March 9-10, 2021, special session of the annual Legionella Conference brings together public health experts and water industry professionals to discuss how to develop emergency plans and approaches for water safety to prevent further public health hazards. > > Main Article > > Background/Introduction > > Even before the COVID-19 pandemic gripped the world a year ago and forced the sudden, mass closures of businesses, schools, restaurants and a host of other types of public and commercial buildings, Legionella was considered a fast-growing public health threat. > > The number of Legionnaires’ disease cases reached a new high in the United States at 9,933 in 2018, the last recorded year, representing a nearly nine-fold increase since 2000, according to the U.S. Centers for Disease Control and Prevention <www.cdc.gov/legionella/downloads/fs-legionella-clinicians.pdf> (CDC).1 > > While the number of documented cases has been quickly rising, it is widely accepted by the public health community that Legionnaires’ disease is largely underreported. A 2020 National Academies of Sciences, Engineering and Medicine report <www.nap.edu/read/25474/chapter/1>2 estimated the actual number of undiagnosed cases could be as high as 70,000 each year. > > Legionnaires’ is an acute form of pneumonia caused by inhaling mist contaminated with Legionella bacteria. The COVID-19 pandemic has fueled a new concern, as Legionella growth can be an unintended consequence of low water demand and the stagnant or low-flow water caused by the sudden closures of tens of thousands of buildings. > > Although they are the number one cause of waterborne disease outbreaks in North America, Legionella outbreaks are largely preventable. A 2016 report <www.cdc.gov/vitalsigns/pdf/2016-06-vitalsigns.pdf>,3 “Legionnaires’ Disease: Use water management programs in buildings to help prevent outbreaks,” by the CDC indicated 90% of outbreaks could have been avoided had a proper water management plan been in place. > > Materials/Methods of Interventions > > The CDC <www.cdc.gov/coronavirus/2019-ncov/php/building-water-system.html>, EPA <www.epa.gov/sites/production/files/2020-05/documents/final_maintaining_building_water_quality_5.6.20-v2.pdf> and the European Legionella Working Group <www.escmid.org/research_projects/study_groups/study_groups_g_n/legionella_infections/>, along with many states and other public health organizations, have been sounding the alarm about the new risks since the beginning of the pandemic and have developed numerous guidance documents for return-to-work strategies. > > NSF Health Sciences and the National Environmental Health Association have called a special session of their annual Legionella Conference to bring together experts to discuss the COVID-19 impact on Legionnaires’ disease incidence, testing, reporting and the strategies employed to improve the management of building water systems during an emergent health crisis. Commander Jasen Kunz and epidemiologist Elizabeth Hannapel of the CDC will deliver the keynote address at the virtual conference, “Prevention of Disease and Injury From Waterborne Pathogens During an Emergent Health Crisis,” <www.marchsession.legionellaconference.org/> to be held March 9-10. They will present new tools developed by the CDC that support building owners and managers and help reduce the risk of Legionnaires’ disease contracted in buildings with low occupancy. > > Public health officials and industry leaders participating in the conference will discuss how infection prevention, facility managers, water utilities and public health agencies organized individual and collective responses to the risks associated with reduced occupancy, or no occupancy, across tens of thousands of buildings. We will learn how to develop emergency plans and approaches for water safety to prevent further public health hazards. Important topics will include Legionella sampling strategies and investigations during and after a shutdown, design and construction to prevent biofilm growth and other hazardous conditions, resiliency strategies for returning to normal operations, and case studies. > > Factors that can lead to Legionella growth include tepid water temperatures, lack of disinfection/infrequent use of fixtures and complex plumbing designs; comprehensive, site-specific water management plans will help building owners preemptively manage risks and maintain public safety. > > Practical infection prevention steps that facility owners and managers can implement immediately, as detailed by NSF <d2evkimvhatqav.cloudfront.net/documents/bw_covid_19_low_occupancy_buildings.pdf?mtime=20200623104153&focal=none>,4 include: > > Keep water flowing to reduce water age > Strategically monitor disinfectant residuals > Maintain routine treatment of cooling towers and other aerosol-generating water systems > Control water temperature ranges to reduce amplification of Legionella and other waterborne pathogens > Put in place water quality monitoring strategies (disinfectant residual, pH, temperature, microbiological analysis) > Keep your records updated and defensible (verification and validation) > Incorporate water safety into your business continuity plans; prior to returning to normal service, prepare a site-specific plan for evaluating and documenting the safety of water systems > Conclusion and Significance > > Risk management and prevention is critical not just to public health but to the economy as well. > > Legionnaires’ disease is fatal in 10% of community-acquired cases and 25% of hospital-acquired cases,5 according to the CDC. > > A recent study <wwwnc.cdc.gov/eid/article/27/1/19-1198_article>6 detailed the heavy economic burden of the disease, associating an estimated $835 million toll with Legionnaires’ in 2014. The CDC estimate includes lifetime productivity losses from the 995 premature deaths caused by the disease that year, as well as medical and hospitalization costs. > > Diligence in identifying risk factors and a dedication to surveillance strategies are critical in keeping us all protected from the potentially deadly unintended consequences of actions taken to slow and prevent the pandemic. The March 9-10 special session of the Legionella Conference is an important step in bringing together the public health, water industry and other stakeholder communities to prevent compounding public health hazards during times of crisis. > > TIPS is the Strategic Partner of the Legionella Conference > > Special session of annual Legionella Conference: Prevention of Disease and Injury From Waterborne Pathogens During an Emergent Health Crisis > > DATE: March 9-10, 2021 > > REGISTRATION: www.marchsession.legionellaconference.org/ <www.marchsession.legionellaconference.org/> > KEYNOTE: Commander Jasen Kunz <www.marchsession.legionellaconference.org/agenda/speakers/jkunz.php> and epidemiologist Elizabeth Hannapel <www.marchsession.legionellaconference.org/agenda/speakers/ehannapel.php> of the CDC > > TOPICS INCLUDE: > > Managing Legionella in Building Water Systems During COVID-19; > Public Health and Public Water Systems: A Comprehensive Collaboration on Response and Prevention; > Managing Water Systems in Hotels Used as Public Health Resources During the Pandemic; > Responding to Stagnation in Buildings With Reduced or No Water Use; > Legionella in Health Care Facilities; Intersection Between Distribution and Building Water Systems During Emergent Health Crisis; > Emerging Trends Impacting Premise Plumbing and How to Manage Risks in System Design; Water Age Mapping in Premise Plumbing for Infection Prevention and Compliance; > Do’s and Don’ts of Water Management Plans; > Impact of Temperature and Plumbing Material on the Integration of Environmental Strains of Legionella pneumophila in Drinking Water Biofilms; > Can Recommissioning After Extended Shutdown of Large Buildings Control Legionella?; > Short-Term Water: A History of Unintended Consequences; Emergency Response/Management of Water Systems During Heightened Presence of Waterborne Pathogens in the Time of Global Crises > VISIT THE LEGIONELLA WEBSITE <www.marchsession.legionellaconference.org/> > References > > 1: “What Clinicians Need to Know About Legionnaires’ Disease (U.S. Centers for Disease Control and Prevention, Feb. 24, 2020).” www.cdc.gov/legionella/downloads/fs-legionella-clinicians.pdf <www.cdc.gov/legionella/downloads/fs-legionella-clinicians.pdf> > 2: “Management of Legionella in Water Systems (The National Academies of Sciences, Engineering, and Medicine, 2020).” www.nap.edu/catalog/25474/management-of-legionella-in-water-systems <www.nap.edu/catalog/25474/management-of-legionella-in-water-systems> > 3: “Vital Signs: Legionnaires’ Disease: Use water management programs in buildings to help prevent outbreaks (U.S. Centers for Disease Control and Prevention, June 2016).” www.cdc.gov/vitalsigns/pdf/2016-06-vitalsigns.pdf <www.cdc.gov/vitalsigns/pdf/2016-06-vitalsigns.pdf> > 4: “COVID-19 And Its Effect on Your Building Water Health: Preventing the Amplification of Waterborne Pathogens in Low Occupancy Buildings in Times of National Crises (NSF Health Sciences, LLC, April 2020).” d2evkimvhatqav.cloudfront.net/documents/bw_covid_19_low_occupancy_buildings.pdf?mtime=20200623104153&focal=none <d2evkimvhatqav.cloudfront.net/documents/bw_covid_19_low_occupancy_buildings.pdf?mtime=20200623104153&focal=none> > 5: Soda, E.A.; Barskey, A.E.; Shah, P.P.; Schrag, S.; Whitney, C.G.; Arduino, M.J.; Reddy, S.C.; Kunz, J.M.; Hunter, C.M.; Raphael, B.H.; Cooley, L.A. (2017). Vital Signs: Health Care—Associated Legionnaires’ Disease Surveillance Data from 20 State and a Large Metropolitan Area – United States, 2015. Centers for Disease Control and Prevention. www.cdc.gov/mmwr/volumes/66/wr/mm6622e1.htm <www.cdc.gov/mmwr/volumes/66/wr/mm6622e1.htm> > 6: Baker-Goering, M.; Roy, K.; Edens, C.; Collier, S. (2021). Economic burden of Legionnaires’ Disease, United States, 2014. Centers for Disease Control and Prevention. wwwnc.cdc.gov/eid/article/27/1/19-1198_article <wwwnc.cdc.gov/eid/article/27/1/19-1198_article>

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