Water Management for Construction: Evidence for Risk Characterization in Community and Healthcare Settings: A Systematic Review

Abstract

Construction activities are a known risk contributing to the growth and spread of waterborne pathogens in building water systems. The purpose of the study is to integrate evidence for categorizing construction activity risk factors contributing to waterborne disease in community and healthcare settings, establish severity of such risk factors and identify knowledge gaps. Using a systematic review, the inclusion criteria were: (1) studies with disease cases suspected to be associated with construction activities and waterborne pathogens, and (2) active construction work described in a community or healthcare setting. Each construction activity risk factor was correlated across all studies with the number of disease cases and deaths to establish risk severity. The eligibility review and quantitative synthesis yielded 31 studies for inclusion (community, n = 7 and healthcare, n = 24). From 1965 to 2016, a total of 894 disease cases inclusive of 112 deaths were associated with nine construction activity risk factors and waterborne pathogens. The present study findings support the need for building owners, water management teams and public health professionals to address construction activity risk factors and the analysis of current knowledge deficiencies within the scope of an ongoing water management program. The impact of construction activities on waterborne disease is preventable and should no longer be considered incidental nor accidental.

Variable Legionella Response to Building Occupancy Patterns and Precautionary Flushing

“…The sharp increase in L. pneumophila observed during winter break 2019 may rather be linked to uncontrolled and undocumented events related to construction associated with a new building adjacent to the study site. Construction activities, depressurization (maintenance, failures), and water treatment failures have been linked to elevated levels of Legionella occurrence and/or Legionnaires’ disease incidence [ 48 , 49 , 50 , 51 ]. While it is impossible to retrospectively link these events, such connections should not be ruled out and should be the subject of future research.…”

Reimagining Construction and Renovation of Health Care Facilities During Emergence from a Pandemic

“…Scanlon and colleagues 40 recently analyzed the literature on risks associated with construction and waterborne infection. They describe that activity “associated with the most waterborne disease cases and deaths was inadequate commissioning of the building during beneficial occupancy (i.e., while preparing for the building opening to the public).” In addition, gaps in prevention strategies were identified, and they identified several risk factors that can be modified when construction or renovation is undertaken.…”

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

“…Construction activities are a known risk factor contributing to disease cases and deaths in community and healthcare settings from waterborne pathogen growth and spread in a building water distribution system (BWDS) [ 1 , 2 , 3 ]. Construction activity risk factors associated with the BWDS include excavation, re-pressurization, demolition activities, efficiency design, underground utility connections, construction equipment with water reservoirs, water main breaks, vibration activities, and commissioning the building water system [ 1 ]. Public health officials and healthcare providers have reported disease cases ( n = 894) and deaths ( n = 112) from waterborne pathogens associated with construction activities from events dating back to 1965 and summarized through 2016 [ 1 ].…”

“…Construction activity risk factors associated with the BWDS include excavation, re-pressurization, demolition activities, efficiency design, underground utility connections, construction equipment with water reservoirs, water main breaks, vibration activities, and commissioning the building water system [ 1 ]. Public health officials and healthcare providers have reported disease cases ( n = 894) and deaths ( n = 112) from waterborne pathogens associated with construction activities from events dating back to 1965 and summarized through 2016 [ 1 ]. These events are likely underreported.…”

“…These events are likely underreported. The lack of appropriate commissioning activities in a building water system prior to occupancy is the highest construction activity risk factor resulting in disease cases ( n = 472) and deaths ( n = 68) [ 1 ].…”