Reducing the Risk of Healthcare Associated Infections from Legionella and Other Waterborne Pathogens Using a Water Management for Construction (WMC) Infection Control Risk Assessment (ICRA) Tool

Abstract

Construction activities in healthcare settings potentially expose building occupants to waterborne pathogens including Legionella and have been associated with morbidity and mortality. A Water Management for Construction—Infection Control Risk Assessment (WMC-ICRA) tool was developed addressing gaps in building water management programs. This enables healthcare organizations to meet the requirements of ANSI/ASHRAE Standard 188 referenced in numerous guidelines and regulations. A WMC-ICRA was modeled after the ICRA required for prevention and control of airborne pathogens to reduce the risk of healthcare associated infections. The tool allows users to evaluate risk from waterborne pathogen exposure by analyzing construction activities by project category and building occupant risk group. The users then select an appropriate level of risk mitigation measures. Technical aspects (e.g., water age/stagnation, flushing, filtration, disinfection, validation testing), are presented to assist with implementation. An exemplar WMC-ICRA tool is presented as ready for implementation by infection prevention and allied professionals, addressing current gaps in water management, morbidity/mortality risk, and regulatory compliance. To reduce exposure to waterborne pathogens in healthcare settings and improve regulatory compliance, organizations should examine the WMC-ICRA tool, customize it for organization-specific needs, while formulating an organizational policy to implement during all construction activities.

Managing Building Water Disruptions in a Post-COVID World: Water Quality and Safety Risk Assessment Tool for Academic Institutions and School Settings

“…Compliance is typically verified by the infection preventionist assigned to the hospital's construction project. Scanlon et al [50] recently published a novel ICRA for waterborne pathogens for healthcare construction activities pulling together a similar 4 × 4 cell RDM by citing the latest evidence, guidance, or standards used in prevention.…”

“…The water management framework from healthcare construction will be modified for water-disruptive events by focusing on disruption types and reducing the number of categories from four to three (i.e., A, B, and C) similar to other RDMs for water and public health impact [17]. The key parameters involve principles of water age [56] and defining the scope of the water disruption event (e.g., duration of disruption, number of building shutdowns, low occupancy, repair, maintenance, renovation, or newly constructed BWDSs) [50].…”

“…The categories (A, B, and C) define plumbing and BWDS components based on the water-disruptive event's complexity and invasiveness into the BWDS [50]. For instance, modifications to a shower room are likely less complicated than replacement of a central water heating system (e.g., a boiler in a central utility plant) that impacts the total building area and potentially all building occupants.…”

“…Risk mitigation strategies are the equivalent of determining appropriate control measures within a WMP. The WMC framework [50] categorized and prescribed a list of control measures that defined a systematic course of action appropriate for a construction project scope and the patient population at risk. Mitigation strategy implementation methods (i.e., hazard control options) are suggested based on water management industry guidance [28,29,[56][57][58], standards [28], and evidence-based practices [12,20] that are subsequently grouped into WQSRA risk mitigation strategies; the technical aspects of these mitigation strategies are described in detail in Scanlon et al [50] (pp.…”

“…For example, a response to water disruptions or construction activity meeting the definition of RML-2 would include RML-1 controls such as baseline water parameter readings prior to the water disruption event, enabling comparison to post-event measurements to return the building water system to normal operating conditions. The RMLs were modified from the healthcare WMC-ICRA 4 x 4 cell format [50] to a non-healthcare 3 × 3 cell format for academic institutions and schools. Figures 6 and 7 summarize the RML-1, 2, and 3.…”