Legionnaire’s disease has once again made headlines with nearly 90 cases of illness and 10 fatalities in Flint, Michigan. Last summer, a Legionnaires’ outbreak in New York killed 12 people and sickened more than 100 others. Two months later, in Illinois 12 people died and 54 became ill, and that same month dozens of inmates at San Quentin Prison in California fell ill. In late fall of 2015, several articles were published with claims that “Legionella is the new asbestos” citing the significant spike in litigation against facility owners and operators related to the disease. According to OSHA, it is estimated that over 25,000 cases of the illness occur each year and cause more than 4,000 deaths. Outbreaks of the disease are associated with exposure through building water systems and the key to prevention is careful design, construction, maintenance, and repair of building water and infrastructure systems
What is Legionella/Legionnaire’s Disease?
Legionnaire’s disease is a respiratory disease with pneumonia symptoms. A less severe version of the disease is called Pontiac Fever, which results in flu-like symptoms but no pneumonia. It is caused by bacteria Legionnella pneumophila which is found naturally in the environment and present widely in fresh water sources such as ponds and lakes. The bacteria survives and multiplies in amoeba and thrives in warm water temperatures.
The disease was first identified in 1976 in Philadelphia at an American Legion Convention. It caused 34 deaths and over 200 people became ill. Many of the conventioneers were elderly with underlying medical issues placing them in a population susceptible to the disease. Underlying medical issues which increase risk are:
How is Legionnaire’s Disease Contracted?
The disease is transmitted by the inhalation of water droplets from a contaminated source, e.g. fountains, pools, hot tubs, misters, air conditioners, etc. A contaminated source of water that is aerosolized can cause disease through inhalation. It is not transmitted from person to person.
What Can Building Owners and Managers Do to Reduce Risks?
New York City passed new legislation to regulate the testing of cooling towers. This makes NYC the first major city in the US to regulate cooling towers. Other parts of the country haven’t established regulatory requirements, and there is no federal requirement for risk management for building water systems yet. There are, however, a variety of guidance documents available from various sources which provide information on how to investigate and test water systems as well as mitigation procedures.
While these documents provide some direction they do not include a comprehensive program for managing water systems. The documents have been developed by the following: American National Standards Institute (ANSI), American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE), OSHA, several different state and local public health agencies around the country, and Los Angeles County Department of Public Health.
The most recent risk management document came from ANSI/ASHRAE in Summer 2015 (summarized below). ANSI/ASHRAE 188-2015: Legionellosis: Risk Management for Building Water Systems.
It is not a law regulated in the Code of Federal Regulations (CFR). It outlines best practice and provides a standard of care for managing and reducing the risk associated with Legionella in building water systems. It includes standard recommendations for risk management applicable to commercial, institutional, industrial and residential (but not single family homes) buildings. It provides guidelines for design, installation and commissioning water systems.
An ongoing water management program includes the following elements:
Building owners and managers can prevent risks by implementing the guidance presented in the ASHRAE document. Alta regularly conducts environmental audits for buildings and facilities to assess the risks, and provide recommendations for mitigation or prevention.
Geeky Science Side-Note
The outbreak of Legionella in Flint, Michigan may be correlated to the rapid corrosion of the pipes due to the nature of the water. This theory states that the iron released during corrosion would support a rapid increase of growth of the bacteria in buildings. “The higher rates of iron corrosion will produce: 1) higher iron in water, and 2) lower levels of free chlorine. Both of these factors were confirmed to be present in Flint during our field sampling, and have been shown to dramatically increase Legionella regrowth in recently published laboratory research utilizing simulated distribution systems.” (Masters, S., and M. Edwards. Increased Lead in Water Associated with Iron Corrosion. Environmental Engineering Science, (2015), 32 (5), 361-369. Masters, S.M., Wang, H., A. Pruden and M. Edwards. Redox Gradients in Distribution Systems Influence Water Quality, Corrosion, and Microbial Ecology. Water Research, (2015), DOI: 10.1016/j.watres.2014.09.048.)
Proper management and maintenance of all water systems, including fountains, cooling towers, HVAC, hot tubs, and storm water capture devices is critical to the prevention of disease outbreak in buildings and facilities. If you have questions, want more information, or an environmental assessment and recommendations for your facilities please call us at 888-608-3010.