Infection Control Today

MAR 2019

ICT delivers to infection preventionists & their colleagues in the operating room, sterile processing/central sterile, environmental services & materials management, timely & relevant news, trends & information impacting the profession & the industry

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13 March 2019 ICT cover story by ASHRAE standard 188, many still believe this CDC document has precedence; that should not be the case. Some believe because Joint Commission came out with an environment-of-care standard in 2001 requiring all Joint Commission-accredited facilities have a risk management plan in place for waterborne pathogens and then apparently did little to enforce this standard, that it wasn't important." Keane continues, "Because of issues created by CDC and Joint Commission, there is probably no industry with more misperceptions about Legionella than healthcare. The CMS memo, however, has clearly addressed the issue and requires that all healthcare facilities have a Legionella risk management plan and all inspection agencies are required to check for that plan, no longer allowing Joint Commission to give short shrift to the issue. The problem now is that many of these agencies now required to check for implementation of a Legionella risk management plan per CMS don't know what to look for." On July 6, 2018, the Centers for Medicare and Medicaid Services (CMS), issued the aforementioned revision (via QSO-17-30- Hospitals/CAHs/NHs) to clarify expectations for healthcare providers, accrediting organi- zations and sur veyors, reiterating that "facilities 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." The policy memorandum applies to hospitals, critical-access hospitals (CAHs) and long-term care (LTC) facilities, and supercedes the June 2, 2017 memo. To review, the bacterium Legionella can cause a serious type of pneumonia in persons at risk. Those at risk include persons who are at least 50 years old, smokers, or those with underlying medical conditions such as chronic lung disease or immunosuppression. Outbreaks have been linked to poorly maintained water systems in buildings with large or complex water systems including hospitals and long-term care facilities. Preventing Waterborne Pathogen Transmission By Kelly M. Pyrek R esearchers have emphasized that hospital water distribution systems m i g ht b e t h e m o s t ove r l o o ke d, impor tant and controllable source of healthcare-associated infections (HAIs). As Kanamori, et al. (2016) remind us, "Hospital water and water-related devices as well as moist environments and aqueous solutions can serve as a reservoir of waterborne pathogens in healthcare settings. The hospital environment may allow contamination by waterborne pathogens, in part because water temperatures are suitable for bacterial growth, and the complex structure of hospital water systems often leads to stagnation, corrosion, and biofilm formation. A variety of water reservoirs have been linked to nosocomial outbreaks including potable water, sinks, faucet aerators, showers, tub immersion, toilets, dialysis water, ice and ice machines, water baths, fower vases, eyewash stations, and dental-unit water stations. Waterborne pathogens have included Legionella, other Gram-negative bacilli, nontuberculous mycobacteria (NTM), fungi, protozoa, and viruses. Transmission of these pathogens from a water reservoir may occur by direct and indirect contact, ingestion and aspiration of contaminated water, or inhalation of aerosols. Waterborne outbreaks caused by these pathogens and reservoirs have occurred among patients in healthcare settings and have been a serious threat to high-risk patients, especially critically ill patients and immunocompromised hosts, leading to substantial morbidity and mortality." "The issue is real and serious," says Tim Keane, a consultant with Philadelphia area-based Legionella Risk Management, Inc. "Many in the healthcare industry have a perception that the issue is overblown, many have looked at comments in the CDC 2003 Environmental Infection Control Guideline and taken out of context the recommendations to conclude that if you test the water you will fnd Legionella, if you fnd Legionella you have to do something, so the best thing to do is nothing. Although what is stated in CDC 2003 EIC is largely incorrect and superseded

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