Legionella ashrae standard 188

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The Legionella Standard 188 proposed by the American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) can have a widespread affect on not only how healthcare operations run but also the overall safety of employees and patients alike. Below are a few facts that organizations should know about this pending Standard.

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Legionella ashrae standard 188

  1. 1. LEGIONELLA & ASHRAE STANDARD 188WWW. AM I ENVI RO NM ENTAL. CO M
  2. 2. BIO AMI Environmental  AMI Environmental is a full-service environmental consulting and remediation firm, specializing in facility-based environmental problems affecting facility operations, renovation and demolition activities. Established in 1986 and headquartered in Omaha, Nebraska, AMI services clients nationally and internationally. Jamie Hilger Industrial Hygiene Professional A.S Liberal/Health Sciences (2008) B.S. Environmental Studies –University of Nebraska (2011) Member – American Society for Healthcare Engineering ASHE Infection Control Training (2012)WWW. AM I ENVI RO NM ENTAL. CO M
  3. 3. OBJECTIVES  Introduction  Legionella  ASHRAE Standard 188P  Summary  Q&AWWW. AM I ENVI RO NM ENTAL. CO M
  4. 4. WHAT IS LEGIONELLA? • Pathogenic gram negative bacterium common in many environments • Primarily warm water environments • Approx. 50 species 70 serogroups • Include species that cause LegionellosisWWW. AM I ENVI RO NM ENTAL. CO M
  5. 5. LEGIONELLOSIS • Legionellosis: any illness caused by exposure to legionellae. Legionnaires disease and Pontiac fever most common types. • Legionnaires’ disease: multisystem illness including deadly type of pneumonia. • Pontiac fever: flulike illness, without pneumoniaWWW. AM I ENVI RO NM ENTAL. CO M
  6. 6. LEGIONELLOSIS (CONT.) • 80 - 90% of all cases of legionellosis are caused by a single species: Legionella pneumophila – 65 – 70% serotype 1 • One of the top three causes of community- acquired pneumonia • Transmission is not person to personWWW. AM I ENVI RO NM ENTAL. CO M
  7. 7. DISCOVERY OF LEGIONELLA • July 1976 • American Legion Convention • Bellevue Stratford Hotel in Philadelphia • 221 fell ill, 34 died • 1965 St. Elizabeth Hospital • 81 patients developed pneumonia,14 died • Frozen specimens confirm Legionella 12 yrs laterWWW. AM I ENVI RO NM ENTAL. CO M
  8. 8. LEGIONELLOSIS (CONT.) • 8,000 – 18,000 US (cases/year) • Death rate: 5 – 30% • Many infections are not diagnosed or reportedWWW. AM I ENVI RO NM ENTAL. CO M
  9. 9. LEGIONELLOSIS (CONT.)  Risk Factors  Age  Highest risk in elderly >65  Not common in people <50  Very rare in people <20  Smoking  Pre –existing COPD, or diabetes  Compromised immune systemWWW. AM I ENVI RO NM ENTAL. CO M
  10. 10. HEALTHCARE COSTS  Waterborne diseases cost over $500 million annually in the U.S.  Legionnaire’s disease $101 – 321 million  $34,000 per caseWWW. AM I ENVI RO NM ENTAL. CO M
  11. 11. LEGIONNAIRES’ DISEASE OUTBREAKSWWW. AM I ENVI RO NM ENTAL. CO M
  12. 12. HOW IS LEGIONELLA TRANSMITTED? • Inhalation: Airborne water droplets containing legionellae are inhaled. • Aspiration: contaminated water or liquid enter the lungs.WWW. AM I ENVI RO NM ENTAL. CO M
  13. 13. HOW IS LEGIONELLA TRANSMITTED? (CONT.) Contaminated Source Transmission Susceptible HostWWW. AM I ENVI RO NM ENTAL. CO M
  14. 14. COMMON SOURCES OF LEGIONELLA Typical manmade water sources: • Plumbing systems • Cooling towers • Humidifiers • Showers • Hot tubs • Decorative fountains • Evaporative condensers • Misters, air washers Environmental Sources include freshwater ponds, rivers, and creeksWWW. AM I ENVI RO NM ENTAL. CO M
  15. 15. LEGIONELLA GUIDELINES • ASHRAE 2000 • CDC 2003 • AIA 2001 • EPA 1991 • WHO 2007 • OSHA 1996 • JCAHO 2001 • UK L8 2000WWW. AM I ENVI RO NM ENTAL. CO M
  16. 16. WHAT IS ASHRAE STANDARD 188P? • A standard that presents methods for the prevention of legionellosis associated with building water systems.WWW. AM I ENVI RO NM ENTAL. CO M
  17. 17. WHY IS ASHRAE 188P DIFFERENT? • Standard vs. Guideline Law • Consensus Standard GuidelineWWW. AM I ENVI RO NM ENTAL. CO M
  18. 18. ASHRAE STANDARD 188P • “Prevention of Legionellosis associated with building water systems” • Purpose: identify specific practices in prevention of Legionellosis • Scope: it provides methods of risk management for the prevention of legionellosis associated with centralized industrial and commercial building water systems. • Intended for: facility owners/managerWWW. AM I ENVI RO NM ENTAL. CO M
  19. 19. STANDARD 188 REQUIRES HACCP WATER PLAN FOR BUILDING WITH ANY OF THESE FACTORS: • Centralized hot water heater • More than 10 stories high • Inpatient healthcare facility • Occupants over age >65 • Whirlpool/spa • It has one or more water features • Free chlorine <0.5 ppm • Cooling towers and or evaporative condensersWWW. AM I ENVI RO NM ENTAL. CO M
  20. 20. WHAT TO DO? Does your building have any of the risk factors No Yes Resurvey Establish a annually HACCP water planWWW. AM I ENVI RO NM ENTAL. CO M
  21. 21. HACCP PRINCIPLES - risk management method that prevents hazards form harming people. 1. Conduct hazard analysis 2. Identify critical control points 3. Establish critical limits for each ccp 4. Establish critical control point monitoring 5. Establish corrective action 6. Verify and validate 7. Document the planWWW. AM I ENVI RO NM ENTAL. CO M
  22. 22. ACTIONS INVOLVED IN DEVELOPING AN HACCP WATER PLAN: 1. Form a water management team – One who understands HACCP – Building water system – Employees – Suppliers – ConsultantsWWW. AM I ENVI RO NM ENTAL. CO M
  23. 23. 2. DEVELOP FLOW DIAGRAMS Objectives: • Identify end-point uses and processing steps in the water systems • Construct at least two flow diagrams • Confirm accuracyWWW. AM I ENVI RO NM ENTAL. CO M
  24. 24. PROCESS FLOW DIAGRAMSWWW. AM I ENVI RO NM ENTAL. CO M
  25. 25. 3. HAZARD ANALYSIS SUMMARIES  HACCP requires hazard analysis summaries that identify the chemical, physical, or biological hazards. For each of the water systems. Chemical Biological Physical Hazard AnalysisWWW. AM I ENVI RO NM ENTAL. CO M
  26. 26. HAZARD ANALYSIS SUMMARIES EXAMPLEWWW. AM I ENVI RO NM ENTAL. CO M
  27. 27. 4. ESTABLISH CRITICAL CONTROL POINTS (CCP’S)  CCP’s are points at which legionella control measures can and should be applied.  Use process flow diagrams and hazard analysis summaries to identify pointsWWW. AM I ENVI RO NM ENTAL. CO M
  28. 28. 5. CONTROL MEASURES • Monitoring frequency, critical limits, and corrective actions at the ccp’s. • Measures must be – Evidence based – Up to date – Reasonable in cost – Simple and practical – Clearly written Include measures for: routine maintenance of applicable water systems, design/construction, and incidents.WWW. AM I ENVI RO NM ENTAL. CO M
  29. 29. 6. DEVELOP VALIDATION, VERIFICATION, AND DOCUMENTATION PROCEDURES  Validate  Verify  DocumentWWW. AM I ENVI RO NM ENTAL. CO M
  30. 30. ASHRAE STANDARD 188P 2ND PUBLIC REVIEW DRAFT  https://osr.ashrae.org/Public%20Review%20Draft%20Standards%20Lib/St d-188P-PPR2%20Final%206%2010%202011.pdfWWW. AM I ENVI RO NM ENTAL. CO M
  31. 31. RECAP  Legionella  Steps to ASHRAE Standard I88 Compliance  Water management team  Process flow diagrams  Hazard analysis summaries  Critical Control Points  Control measures  Validate, Verify, and Document  How AMI can helpWWW. AM I ENVI RO NM ENTAL. CO M
  32. 32. REFERENCES  ASHRAE Guideline 12-2000, “Minimizing the Risk of Legionellosis Associated with Building Water Systems”, American Society of heating, Refrigerating and Air-Conditioning Engineers, Inc.  Center for Disease Control and Prevention. “Legionellosis Resource Site” July 23rd 2012. http://www.cdc.gov/legionella/  American Society for Healthcare Engineering. “Prevention of Legionellosis Associated with Building Water Systems” , February 23, 2012 http://www.ashe.org/resources/pdfs/HACCP_Plan_Legionellosis_Building_ Water_Systems.pdf  Freije, Matthew .“Legionella Control in Healthcare Facilities” A Guide for Minimizing Risk. 1997WWW. AM I ENVI RO NM ENTAL. CO M
  33. 33. WWW. AM I ENVI RO NM ENTAL. CO M
  34. 34. WWW. AM I ENVI RO NM ENTAL. CO M

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