Infection preventionists (IPs) should be a key member of these water management teams, but almost half the facilities consulted by Legionella experts did not have an IP on the committee, said Laura Morris, MT (ASCP), CIC, education coordinator at the Special Pathogens Laboratory (SPL) in Pittsburgh.

“IPs have that knowledge of microbiology, so I am really stressing that the importance of you being on that team,” Morris said recently in Philadelphia at the annual conference of the Association for Professionals in Infection Control and Epidemiology (APIC).

Morris and colleagues analyzed data from healthcare facilities with which the SPL has consulted since June 2017 — after the initial CMS memo — to assess water safety programs, perform risk assessments, and test for Legionella. They found that of 83 healthcare facilities, IPs were involved in water safety plans at only 43.2 In 71 of the water safety teams, the facilities management (i.e., engineering) was represented. Overall, 73% of the consultations were performed in acute care facilities. Overall, 87% of facilities had a “proactive,” ongoing water management plan, Morris said. However, 13% of the facilities established a water management plan only after identifying patient infections.

“They were developed due to an outbreak or a case,” Morris said. “The alarming part is that of 42% of these ‘reactive’ teams did not have an IP on their team…”

…IPs can play key roles on water management teams with insights into medical devices, procedures, and construction and renovation that could contribute to waterborne infections, Morris said.

“When you are looking through your daily surveillance, you may identify Legionella and other waterborne pathogens through clinical tests,” she said. “Are you noticing trends, or do you have a cluster? When your hospital is considering new procedures, think ‘Will this contain water or use water?’”

The value of IP input has shown time and again in hospital construction and renovations, as patients could be vulnerable to dustborne fungal infections and other threats. This relationship with facility management and prior collaborations could be leveraged to be involved in the water management team, she noted.

“We are really emphasizing the need to build that relationship,” Morris said. “Visit their world, learn their language, and ask questions.”

Likewise, IPs should be aware of water treatments and any Legionella testing. “If they are testing for Legionella, what tests are they using?” she asked. “Are they using a quick test or the gold standard of culture? This is an area where you as an IP need to have input…”

“…No one should die from a preventable disease caused by a bacterium in water,” Morris said. “It can and should be prevented. This might require you to go your C-suite to make the business case, as with our many of our infection prevention initiatives. The most important point is that this is a patient safety initiative.”

Discuss the cost of a water safety management program with proactive testing compared to an outbreak, she recommended.

“Once the health department gets involved, there is a lot of testing and a lot of measures that they will have you do. That can exceed $100,000,” she said. “There is also loss of business, public relations, and possible litigation.”

(Excerpt from Hospital Infection & Prevention)