By William F. McCoy, Ph.D. and John H. Tillotson, M.Sc. Eng.
From the September 2014 issue of Today’s Facility Manager
In order to achieve success in building water management, facility managers (fms) need to be smart about their water systems. Many fms assume that the water in their buildings is safe. But that assumption is often dead wrong. Disease-causing microorganisms in water systems harm hundreds of thousands of people each year in the United States. Those harmed include of course dependent family members and employers of those who have been injured by dangerous microorganisms in building water systems. Increasingly, people who have been harmed, or their loved-ones, are bringing lawsuits.
Every case of disease or injury from dangerous microorganisms in building water is the result of exposure to a poorly managed building water system. The problem results from the way water is processed and used in the building. Legionella, Pseudomonas, Stenotrophomonas, Acinetobacter, Elizabethkingia, Mycobacterium, Alcaligenes, and Aspergillus cause the most serious diseases associated with building water systems.
For example, every year another 4,000 people in the U.S. will die from Legionnaires’ disease caused by Legionella in building water systems1. According to Centers for Disease Control and Prevention (CDC), fewer people (about 3,000) die in the U.S. each year from food poisoning. The number of legionellosis outbreaks in the U.S. has now surpassed the number of waterborne outbreaks of gastrointestinal disease2. Hospitalization costs exceed $34,000 per case in the U.S., and the annual direct healthcare cost of legionellosis is hundreds of million dollars3.
But the indirect cost in the U.S. is far greater. For every direct healthcare dollar spent, about $12 of indirect cost is incurred due to lost productivity, absenteeism, and disability. Therefore, the annual cost of the many thousands of legionellosis cases associated with building water systems is in the billions of dollars.
But Legionella is just one of the microbial hazards transmitted to people from building water systems; there may be at least as many disease cases of pneumonia caused by Pseudomonas, for example.
Many fms, facility engineers, infection prevention personnel, epidemiologists, insurance professionals, and other facility stakeholders are increasing their focus on how to ensure water safety. The great news is that best practices for building water systems have proven that it is possible to both solve the above described water safety issues while also reducing operational costs in a given facility or portfolio of facilities.
Best practices for what must be done to prevent disease and injury from building water systems have been given by WHO4, CDC, NSF International5 and is already in practice by hundreds of facility management teams such as at the Mayo Clinic6.
Best practices are scientific and time tested principles of hazard analysis and control applied to building water system management. Use of this risk management system provides a means for fms to make defensible decisions about what must be done to operate their building water systems safely.
HACCP: Creating A Process
Water management programs based on HACCP (Hazard Analysis Critical Control Point) principles are established by first empowering a water management team at the facility. The team then systematically describes the way water is processed and used in the building. From this, an analysis of hazardous conditions in the building water system can be documented. Without this systematic analysis of hazardous conditions, defensible hazard control cannot be applied cost-effectively.
Finally, independent tests to prove that hazard control has been effective (validation) and independent confirmation that the program has been implemented (verification) must be documented. It is through this process that fms determine the state of their building water systems and then make science based, cost-effective decisions about how best to ensure defensibly that the entire building water system is safe.
The key word here is “defensibility.” In today’s world, it is essential that fms’ decisions and actions can stand up to scrutiny from every quarter. Implementing a water management program based on sound scientific principles is a systematic process to make decisions; it is the best defense if there is ever an accusation of negligence about the management of a building water system.
The Disinfection Factor
In many cases, facility teams are discovering that their building water systems are not adequately disinfected. In some cases building water systems have become contaminated with biofilms, protozoa, Legionella, and other pathogenic bacteria. In such cases, chlorine in the water supply is consumed before it can reach all parts of the building water system. Supplemental disinfection may then be necessary.
Supplemental (secondary) disinfection of drinking water is regulated in the U.S. in accordance with the Safe Drinking Water Act. Therefore, fms must be aware of regulatory requirements if treatment of drinking water is undertaken.
Fms should also be aware that there is a great deal of commercially conflicted information about what products and services should be purchased to address the real or perceived problem of microbial hazards in building water systems. In many cases, there is no need to add supplemental disinfection on-site. If the guidance comes from a supplier of disinfection chemicals, fms should beware of commercially conflicted advice. One will be in a much better position to make informed, data driven decisions that lack commercial bias, if the advisor does not sell disinfection chemicals.
Second, there is a great deal of confusion about Legionella testing when facilities have not yet decided to implement a HACCP-based water management program. The best course of action is to follow best practices as defined by the NSF International course “HACCP for Building Water Systems.” These courses, conducted at locations throughout the U.S., include a certificate of completion.
In order to be smart about water systems, fms should develop and implement a water management program based on the scientific principles of hazard analysis and control that includes independent validation and verification. This will not only ensure that water systems are safe, but it may also serve to reduce operating expenses. And that is smart water management.
1 Department of Labor, Occupational Safety and Health Administration (OSHA). 1999. OSHA Technical Manual. Legionnaires’ Disease. Section III: Chapter 7. See “Incidence”; www.osha.gov/dts/osta/otm/otm_iii/otm_iii_7.html#1
2 Centers for Disease Control and Prevention (CDC). 2008. Surveillance for waterborne disease and outbreaks associated with drinking water and water not intended for drinking—United States, 2005–2006. MMWR Surveillance Summary (Vol. 57, No. SS-9); www.cdc.gov/mmwr/preview/mmwrhtml/ss5709a4.htm
3 Centers for Disease Control and Prevention (CDC). 2010. “Waterborne Diseases Could Cost over $500 Million Annually in U.S.” www.cdc.gov/media/pressrel/2010/r100714.htm
4 WHO (World Health Organization). 2011. Water Safety in Buildings. Published by the World Health Organization ISBN 978 92 4 154810 6; www.who.int/water_sanitation_health/publications/2011/9789241548106/en/
5 NSF International. 2014. HACCP for Building Water Systems. http://www.nsf.org/ervices/by-industry/water-wastewater/haccp-building-water-systems/
6 Krageschmidt, DA, et. al. 2014. A Comprehensive Water Management Program For Multi-campus Healthcare Facilities. Inf. Control and Hosp. Epidemiology, May 2014, Vol. 35, No.5, pp. 556-563.