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© 2015 Ecolab USA Inc. All rights reserved. © 2015 Ecolab USA Inc. All rights reserved.

ASHRAE STANDARD 188 Legionellosis: Risk Management

for Building Water Systems

Helping you TAKE ACTION in accordance with

© 2015 Ecolab USA Inc. All rights reserved. 2

YOUR PARTNER IN

WATER SAFETY

Central/Western US

Paul Fenton EHS Business Manager

+1 (702) 496-8128

[email protected]

Corporate Contact:

Ron Bernard EHS Business Manager, North America

+1 (860) 287-1452

[email protected]

© 2015 Ecolab USA Inc. All rights reserved.

Legionella, a bacteria, causes a uniquely 20th century disease due to engineered water

systems

Domestic water services (Heaters,

Showers, Sinks)

Open cooling water

systems

Pools and Spas Water Features

Ice Machines

3


Dangers to my people – deaths from recognized causes

Bacterial agents in food – 3,000 per year

FDA costs $2.4 billion per year

Fires in 2010 – 2,640

Workplace in 2010 – 4,547

Businesses spend $35 billion annually to comply with federal workplace safety standards

Legionnaires’ Disease

OSHA Technical Manual:

Approximately 1,000 cases are reported annually to the CDC, but it is estimated that over 25,000 cases of the illness occur each year and cause more than 4,000 deaths.

Cases reported annually increased 217%, from 1,110 in 2000 to 3,522 in 2009.


Dangers to my organization

The Risks:

Public Health Risk

Public Image and Business Risk

Regulatory Risk

Legal Risk

• Bad publicity with damage to company and brand image

• Accidents and incidents with associated injuries and deaths

• Litigation

• Legal costs

• Employee dissatisfaction and demotivation


What is Legionellosis?

• It is the condition of being infected by Legionella − Inhaled as an aerosol or water mist (typically <5-10 micrometers)

− Drinking contaminated water does NOT cause legionellosis

− But aspirating contaminated water or ice chips has caused disease

− It is not contagious

• Pontiac Fever (Humidifier Fever) − An acute, febrile, self-limiting illness lasting up to five days

− Characterized by fever, fatigue, muscle pain

− Illness is caused by several Legionella spp.

• Legionnaires’ Disease (LD, legionellosis) − A severe respiratory pneumonia treatable with antibiotics

− Characterized by malaise, anorexia, myalgia, headache, cough, fever

− 90% of cases are caused by L. pneumophilia SG1

− Other species have been linked…

micdadei, longbeachae, dumoffii, bozmanii

Legionella in

water

Transmission Inhalation, aspiration

Susceptible

host

6


Susceptible Population

Conditions that increase risk of causing harm…

Pathogen Proliferation

Aerosol Release

Risk of Causing Harm

Stagnation

Protozoa

Biofilms

Deposits

pH

Temperature

Biocides

Age

Smokers

Function/Use

Defects

Wind

Water

Flow

Immunocompromised

Gender

Construction projects

Pressure shocks

Vacancies

Dead-legs

Water main breaks

7


Te

mp

era

ture

, °

F /

°C

Disinfection Range

158 - 176°F (70 - 80°C)

Slowly Die

122-158°F (50-70°C) • 131°F (55°C); die within 5-6 hours

• 140°F (60°C); die within 32 minutes

• 151°F (66°C); die within 2 minutes

Growth Range

77 - 122°F (25 - 50°C)

95 - 115°F (35 - 46°C) optimum

Do Not Grow Well

68-77°F (20-25°C)

Dormant

<68°F (<20°C)

Cold Water Storage

Mains Cold Water

212 / 100

176 / 80

68 / 20

104 / 40

140 / 60

32 / 0

Proliferation Risk

Cold Water Services

Hot Water Services

Spas & Bathing Showers

Hot Water Storage

Domestic Services - Design Intent Temperature vs. Proliferation Risk

8


Domestic Water Service Hazards

9


Waterborne Pathogens Can Flourish In Building Water Systems

10

Conditions conducive to biofilms:

System Age & Complexity

Poor Temperature Controls

Lack of Residual Disinfectant

Water Stagnation Legionella is known for colonizing biofilms


RISK OF CAUSING HARM

Growth Potential

• Temperature

• Biocides

• Stagnation

• Biofilms

• Deposits

Exposure Potential

• Function/Use

• Defects

• Wind

• Water Flow

Population Potential

• Density

• Smokers

• Immune suppressed

• Age


LEGIONELLOSIS

• Legionellosis cases have increased by over 200% in last 10 years*

• Legionnaires’ Disease (LD)

Atypical pneumonia

Hospitalization common

Incubation period of 2-14 days after exposure

8,000 – 18,000 cases in United States each year

Case-fatality rate more than 10%

• Pontiac Fever

Less-severe influenza-like illness

Incubation period of 24-72 hours after exposure

Self-limiting, hospitalization uncommon

12

Risk continues to be a concern.

Legionellosis is the

condition of being infected

by Legionella

• Inhaled as an aerosol or water

mist

• Aspirating water or ice chips has

caused disease (rare cases)

• Drinking contaminated water

does NOT cause legionellosis

• Not contagious

* Source US Centers for Disease Control


ASHRAE Standard 188 – Approved June 26, 2015

13

American Society of Heating, Refrigerating, and Air-Conditioning Engineers

Defines the minimum

legionellosis risk management

requirements for building

water systems.

Development Began 2005

HACCP Removed 2011

Impact If Codified


ASHRAE Standard 188 – Scope

14

Mandates building owners and

managers to establish a

“water management

program”

Applies to almost every type of

human-occupied building

(excluding single-family

residential buildings)

Intended for those involved in

the design, construction,

installation, commissioning,

operation, maintenance, and

service of building water

systems

Intended for use by owners

and managers of buildings


Compliance Determination

15

Building Owner Requirements

“The building owner shall survey each existing building,

new building, and any renovation, addition, or modification to

an existing building and its water systems as described in

Section 5.

- There are similar requirements for building designers.

The survey and conformance with the compliance

requirements of Section 4 must occur prior to occupancy of a

new building and before construction begins on renovations,

additions, or modifications to existing buildings.”


Section 5 - Building Survey

16

If the building and associated property has…

(a) any of the building water systems

listed in §5.1, then all of those building

water systems shall comply.

Systems listed in §5.1

a. open- and closed-circuit cooling towers

or evaporative condensers that provide

cooling and/or refrigeration for the

HVAC&R system or other systems or

devices in the building;

b. whirlpools or spas, either in the building

or on the site; or

c. ornamental fountains, misters,

atomizers, air washes, humidifiers, or

other non-potable water systems or

devices that release water aerosols in

the building or on the site.

(b) any of the factors listed in §5.2, then all potable

building water systems and all building water systems

listed in §5.1 shall comply.

Factors listed in §5.2

a. Multiple housing units with one or more centralized

potable water-heater systems.

b. More than 10 stories high (including any levels that are

below grade).

c. Health care facility where patient stays exceed 24 hrs.

d. A building for the purpose of housing or treating

occupants receiving treatment for burns, chemotherapy

for cancer, or solid organ transplantation or bone

marrow transplantation.

e. A building for the purpose of housing or treating

occupants that are immunocompromised, at-risk, are

taking drugs that weaken the immune system, have

renal disease, have diabetes, or have chronic lung

disease.

f. A building identified for the purpose of housing

occupants over the age of 65 years.


DO YOU HAVE A PLAN?

PROGRAM TEAM DEVELOPMENT & IMPLEMENTATION

DESCRIBE WATER SYSTEMS & FLOW DIAGRAMS

ANALYSIS OF BUILDING WATER SYSTEMS

1 2 3

4 5 6 7

CONTROL MEASURES

MONITORING & CORRECTIVE ACTIONS

CONFIRMATION DOCUMENTATION

Elements of a water management program per ASHRAE Standard 188


1

PROGRAM TEAM

• Responsible for developing and implementing the Program

• Facilities management staff familiar with the building water systems

• Healthcare sites: infection preventionist certified in infection control (CIC) or equivalent


2

DESCRIBE WATER SYSTEMS & FLOW DIAGRAMS

Describe the potable and non-potable water systems and develop simple water system schematic (not engineered drawings):

• Water supply sources

• Water supply service entrances

• Water treatment systems and control measures including disinfection and filtration

• Water processing steps including receiving, conditioning, storing, heating, cooling recirculating and distributing

• Areas where hazardous conditions may contribute to Legionella amplification

• Water end use points


3

ANALYSIS OF BUILDING WATER SYSTEMS

Evaluate where hazardous conditions may occur and determine where control measures can be applied:

• Formal Risk Management Plan must be developed and maintained/updated as systems change

• Include details and actions to effectively control hazardous conditions throughout the building water systems


4

Determine locations where control measures must be applied and maintained:

• Identify problem areas

• Apply control measure as indicated

• Test to assure control limits are re-established and maintained

• Establish and maintain documentation for all efforts/actions/test results

CONTROL MEASURES


Establish procedures for monitoring whether control measures are operating within established limits and, if

not, take corrective action

MONITORING & CORRECTIVE ACTION

5


6

Establish procedures to confirm that:

• The program is being implemented as designed (verification)

• The program effectively controls the hazardous conditions throughout the building water systems (validation)

CONFIRMATION Legionella Testing

Program Team shall determine

(1) if testing shall be performed

and if so how test results will be

used to validate the program, and

(2) shall determine the testing

approach including:

• Sampling frequency

• Number of samples

• Locations and sampling methods


7

Establish documentation and communication procedures for all

activities of the program

DOCUMENTATION


Compliance Determination

25

Potable Water Systems

Cooling Towers & Evaporative Condensers

Whirlpools or Spas Ornamental

Fountains & Other Water Features

Aerosol Generating Misters, Atomizers, Air Washers & Humidifiers

AT-RISK WATER SYSTEMS

FOCUS ON ENGINEERING CONTROLS

Keep it Simple


NALCO WATER SAFETY EXPERTISE

Global Experts in

Water Safety

25+ years

We have boots

on the ground

everywhere.

Local service delivered

by 12,000 employees in the US.

Our Legionella lab is a

charter member of CDC-ELITE

proficiency program

Starting in

1999 80,000 tests per

year globally

Disinfection of

1 billion+ gallons of potable water annually

Independent Hygiene Specialists

SECONDARY

DISINFECTION

EXPERTISE

1,000+ Water Safety

Plans Implemented Research

Healthcare, Hospitality,

Education, Commercial,

F&B, Manufacturing,

Industrial

Your Partner in Water Safety

Microbiologists,

Scientists &

Engineers


The AQUAPATH™ Program

27

A systematic and integrated

water safety program

for building water systems to help

REDUCE RISK ASSOCIATED WITH

WATERBORNE PATHOGENS.


NALCO WATER SAFETY CAPABILITIES

Developed Water

Safety Plans for

RISK MANAGEMENT

» Water Safety Plans

» AQUAPATH 360

‒ Web-Based Data Management & Exception Reporting

» AQUAPATH Sensing

‒ Water Quality Monitoring

» Consulting & Support

‒ Plan Design, Implementation & Training

‒ Verification & Validation

» Legionella Culture Testing per ISO11731

» Certified CDC-ELITE Proficient for Legionella

» Interpretation & Consulting

» Testing Plans for Program Confirmation

» Other Waterborne Pathogen Testing

‒ Pseudomonas aeruginosa

‒ Acinetobacter spp

‒ Mycobacteria

» Secondary Disinfection

‒ ENVIROX Chlorine Dioxide Systems NSF60/61 Approved

‒ EPA Regulatory Guidance per SDWA

» Point-of-Use Water Filters

‒ A Barrier for Waterborne Pathogens

‒ Validated Up to 31-Days or 62-Days per ASTM F838-05 for 0.2 μm Sterilizing Grade Filters

» Remedial Cleaning & Disinfection Services

‒ Cooling Tower Water Systems

‒ Potable Water Storage Systems

‒ Potable Water Distribution Systems

‒ Decorative Water Features & Fountains

‒ Firewater Storage Tanks

‒ Ice Machines

» Emergency Remediation Services

‒ Hyperchlorination Protocols

PATHOGEN ANALYTICAL

REMEDIATION

SUPPLEMENTAL CONTROL

© 2015 Ecolab USA Inc. All rights reserved. 29

YOUR PARTNER IN

WATER SAFETY

Central/Western US

Paul Fenton EHS Business Manager

+1 (702) 496-8128

[email protected]

Corporate Contact:

Ron Bernard EHS Business Manager, North America

+1 (860) 287-1452

[email protected]

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