New Requirements to Prevent Legionella Infections

Last month, the Centers for Medicare and Medicaid Services (CMS) posted information regarding new requirements for preventing Legionella infections/outbreaks in long term care nursing facilities. State 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 new requirements are due in part to the significant increase in reported cases of Legionella between 2000 and 2014.

Pertinent regulations include, but are not limited to, the following:

42 CFR 483.80 for skilled nursing facilities and nursing facilities:

“The facility must establish and maintain an infection prevention and control program designed to provide a safe, sanitary, and comfortable environment and to help prevent the development and transmission of communicable diseases and infections.”

CMS expects Medicare certified health care facilities to have water management policies and procedures in place to reduce the risk of growth and spread of Legionella and other opportunistic pathogens in building water systems. The CDC has also developed a toolkit to help facilities facilitate the implementation of these new standards. Environmental, clinical, and epidemiologic considerations for health care facilities are outlined in the toolkit.

During survey, surveyors will review policies, procedures, and reports documenting water management implementation results to verify that facilities:

• Conduct a facility risk assessment to identify where Legionella and other opportunistic waterborne pathogens could grow and spread in facility water systems;
• Implement a water management program that considers the ASHRAE industry standard and the CDC toolkit, and includes measures such as physical controls, temperature management, disinfectant level control, visual inspections, and environmental testing for pathogens; and
• Specify testing protocols and acceptable ranges for control measures, and document the results of testing and corrective actions taken when control limits are not maintained.

Health care facilities are expected to comply with these new CMS requirements to protect the health and safety of their residents. Facilities found out of compliance will be at risk for citation with the CMS Conditions of Participations.

Contact: Karen Puglisi, kpuglisi@leadingageny.org, 518-867-8383 ext. 145