1. Legionnaire Disease and Healthcare Facilities Healthcare Facilities Management Society of New Jersey May 21, 2009 LINDEN E. WITHERELL, P.E., M.P.H., J.D., D.E.E. © 2001 Linden E. Witherell

2. The Most Important Information That I Can Provide – Always Know Your Consultant’s Training and Experience!!! OK – WHAT IS MY TRAINING AND EXPERIENCE? FIRST - I HAVEN’T HAD A SERIES OF MID- LIFE CRISES! IT ALL FITS TOGETHER! FIRST - I HAVEN’T HAD A SERIES OF MID- LIFE CRISES! IT ALL FITS TOGETHER!

3. Commissioned Corps United States Public Health Service

4. EXAMPLES OF UNFORTUNATE CHOICES OF CONSULTANTS FIRST - BEWARE OF THE INTERNET!!!! FIRST - BEWARE OF THE INTERNET!!!!  Los Angeles Hospital BEWARE OF THE INCORRECT BACKGROUND BEWARE OF THE INCORRECT BACKGROUND  GSA Building New York City KNOW YOUR REFERENCES KNOW YOUR REFERENCES  A Compilation of the Good, Bad & Ugly

5. INTRODUCTION TO LEGIONNAIRES’ DISEASE BRIEF HISTORY OF DISEASE BRIEF HISTORY OF DISEASE THE ORGANISM– Legionella THE ORGANISM– Legionella THE NATURAL ENVIRONMENT THE NATURAL ENVIRONMENT ANTHROPOGENIC DISEASE ANTHROPOGENIC DISEASE GROWING INCIDENCE OF LITIGATION GROWING INCIDENCE OF LITIGATION POPULATIONS AT RISK POPULATIONS AT RISK

6. LEGIONELLOSIS PONTIAC FEVER PONTIAC FEVER LEGIONNAIRES’ DISEASE LEGIONNAIRES’ DISEASE SOURCES SOURCES COOLING TOWERS HOT WATER SYSTEMS OTHER OTHER FACILITIES AT RISK FACILITIES AT RISK HOSPITALSHOSPITALS NURSING HOMESNURSING HOMES MOTELS/HOTEL, ETC.MOTELS/HOTEL, ETC.

7. POTENTIAL PROBLEMS WITH TESTING SAMPLING AND ANALYSIS ISSUES SAMPLING AND ANALYSIS ISSUES RESULTS - WHAT DO YOU DO WITH A POSITIVE? RESULTS - WHAT DO YOU DO WITH A POSITIVE? WHOM DO YOU TELL? WHOM DO YOU TELL? USE TESTING TO MONITOR CONTROL!!! USE TESTING TO MONITOR CONTROL!!!

8. START WITH LEGIONELLA RISK AUDIT ENVIRONMENTAL ENVIRONMENTAL  Cooling Towers  Domestic Hot Water Systems  Other INFECTION CONTROL INFECTION CONTROL ADMINISTRATIVE COORDINATION ADMINISTRATIVE COORDINATION

9. CONTROL OF LEGIONELLA BEWARE THE BLACK BOX SOLUTION BEWARE THE BLACK BOX SOLUTION WATER SYSTEMS WATER SYSTEMS COOLING TOWERS COOLING TOWERS OTHER OTHER MUTIPLE BARRIER CONCEPT MUTIPLE BARRIER CONCEPT LEGIONELLA CONTROL TEAM LEGIONELLA CONTROL TEAM

10. Domestic Hot Water Systems Source Water Source Water Sediment Control Sediment Control Plumbing Materials and Devices Plumbing Materials and Devices Thermal Treatment Thermal Treatment Overview of Chemical Treatment Choices Overview of Chemical Treatment Choices Supplemental Chlorination Supplemental Chlorination

11. Source Water Work with supplier Work with supplier Normal Quality Normal Quality Repairs Repairs Flushing Flushing Notification Notification

12. Pipe Repairs Isolation Isolation Repair Repair Flush Flush Disinfection Disinfection Flush Flush Test Test

13. Sediment Control “Dead Legs” “Dead Legs” Tanks Tanks Unused Fixtures Unused Fixtures Aerators Aerators

14. Tanks Sediment Traps Sediment Traps Need to Flush Need to Flush

15. Overview of Treatment Choices Thermal Treatment Thermal Treatment Copper Silver Ions Copper Silver Ions Supplemental Chlorination Supplemental Chlorination Chlorine Dioxide Chlorine Dioxide Monochloramine Monochloramine

16. Supplemental Chlorination Design Design Construction Construction Operation Operation Control Control Checking Checking

17. Supplemental Chlorination Safety Goggles Safety Goggles Record Book Record Book Sink Sink Eye Wash Station Eye Wash Station

19. Cooling Towers Brief Overview Brief Overview Primary Need for Treatment Primary Need for Treatment Methods for Legionella Control Methods for Legionella Control

20. Brief Overview Heat Exchange Heat Exchange Water to Air Exchange Water to Air Exchange Operating Temperatures Operating Temperatures Aerosols Aerosols

21. Primary Need for Treatment Corrosion/Scale Control Corrosion/Scale Control  Blow Down  Inhibitors Heat Exchange Heat Exchange  Algae  Fungi  Testing

22. Primary Need for Treatment Corrosion/Scale Control Corrosion/Scale Control Algae Algae Fungi Fungi

23. Methods for Legionella Control Operating Temperature (Pan Temperature) Operating Temperature (Pan Temperature) Sediment Control Sediment Control  Start-up  Blow Down  Routine Cleaning Drift Control Drift Control

24. Need for Drift Control Note Air Intake Note Air Intake

25. Sediment Control Start-up Start-up  Wisconsin Protocol Blow Down Blow Down  From Low Point  Shut Out w/ chemical addition Cleaning Cleaning

26. Decorative Fountains