Water Safety and Management Plans: A Patient Safety Initiative That Needs Infection Preventionists

To minimize the growth and spread of Legionella and other waterborne pathogens (WBPs) in healthcare building water systems, many organizations including the Centers for Medicare & Medicaid Services, the American Society of Heating, Refrigerating and Air-Conditioning Engineers, and the Centers for Disease Control and Prevention recommend or require the creation of a facility-specific water safety and management plan (WSMP). These standards and guidelines recommend a multidisciplinary program team which includes individuals with knowledge of Legionella and building water systems, which, in healthcare environments, should include infection preventionists (IPs). We wanted to study these teams and their WSMPs to evaluate the role IPs play in water management. We analyzed data from healthcare facilities we have consulted with since June 2017, to provide WSMPs, risk assessments, and Legionella testing to determine: how many teams had IP involvement, how many performed risk assessments, and how many were proactive versus reactive in WSMP development. We found that of 83 healthcare facilities, only 43 (52%) had IP involvement in WSMP development. However, in 71 (86%) WSMPs, the facilities management group was represented. In 72 (87%) facilities WSMP creation was proactive versus 11 (13%) facilities which were reactive to identification of a case of Legionnaires’ disease. A key element in an effective water management program is the creation of a multidisciplinary water safety team responsible for the program development and implementation. In healthcare facilities, IPs fill the gap for knowledge of water management as it relates to the risk of Legionella and other WBPs and their absence from the team creates unnecessary risk. We will discuss how IPs can more effectively bridge the gap and provide their expertise in the critical areas of microbiology, epidemiology, patient risk factors, and medical devices and procedures which can contribute to the growth and spread of Legionella and other WBPs.