By Dr. Janet Stout
From the October 2023 Issue
In a time of ever-evolving knowledge of the hidden risks within our water systems, knowing the dangers that may be lurking in your own building is essential.
The American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) created a standard for water systems known as ASHRAE-188. The standard was created to prevent outbreaks of a deadly illness known as Legionnaires’ disease. Legionella, the bacteria that causes Legionnaires’ disease, is still the largest threat in America’s water systems, as it is found in 50% of all large buildings. However, it is now compounded with other hazards that have emerged as public safety challenges. As a result, a new standard has been formed: ASHRAE-514.
This new standard takes what ASHRAE-188 does with Legionella and expands upon it, offering guidance on other threats that have long since flown under the radar. Adopting the new standard will further prevent unnecessary injury and death, creating safe and clean water for everyone.
The Impacts Of Legionella
Legionella are bacteria that thrive in man-made settings where warm water is present and are often associated with large complex water and HVAC systems found in hospitals, hotels, data centers, and cruise ships. While not transmissible from person to person, Legionella can be deadly when inhaled from the environment. They can cause Legionnaires’ disease, which mimics “typical” pneumonia with symptoms like high fever, coughing, and shortness of breath, except it can only be cured using antibiotics. Thus, the disease is often misdiagnosed, and many may die without the cause of their illness ever being diagnosed.
A single case in your facility may have the health department and media banging on your door, launching a full investigation, because where there is one case, there are more. Not to mention, your entire facility’s water system must be shut off, tested, and disinfected. Even worse, it’s hard to think that someone may die from something that could have been prevented.
Approximately 10%-15% of people who contract Legionnaires’ disease from their community environment will die, but that number jumps to 25%-30% if infected in a hospital or healthcare facility. To make matters worse, only 50% of hospitals test for Legionella, as there are no federal regulations for testing and only a handful of states have adopted requirements for testing. Systemic neglect is running rampant, leaving a wake of unnecessary lives lost and many more unaware of the dangers that could impact them.
ASHRAE-188 was put in place to provide facility executives with the tools they need to combat Legionella in their water systems. It provides risk management requirements for the design, operation, maintenance, repair, replacement, and expansion of new and existing buildings and their associated potable and non-potable water systems and components. ASHRAE-188 applies to human-occupied commercial, institutional, multiunit residential, and industrial buildings, but it explicitly excludes single-family residential buildings.
ASHRAE-188 also details provisions for a building survey, as well as general requirements necessary for any building that may need to make use of the standard’s guidance in reducing the risk of Legionella. Furthermore, the standard touches upon subjects that may be useful for certain users of its guidelines, such as provisions for healthcare facilities or cooling towers. These standards are imperative, but experts have found new threats lurking in water systems that also pose significant threats to the public, which inspired an additional set of standards known as ASHRAE-514.
The New Standard
ASHRAE-514 introduces facility risk management for physical hazards, chemical hazards, and microbial hazards other than Legionella. Physical hazards in large buildings typically concern temperature and scalding water that can cause serious injury. Supplemental disinfectants are a major chemical hazard. While it may seem contradictory, there is a balance between enough disinfectants to prevent disease and too much disinfectant. High concentrations of disinfection by-products in water can cause cancer and other health problems.
Finally, there are the microbial hazards beyond Legionella; other waterborne pathogens that can cause illness. Serious and potentially deadly bacteria like Pseudomonas aeruginosa, which features some of the most threatening antibiotic resistant strains of any bacteria, or nontuberculous mycobacteria, which form resilient, disinfectant-resistant biofilms that stick to surfaces, are often found in healthcare settings.
The Importance Of Water Testing
What does this all mean? Test your water systems. Choosing not to test is taking a gamble with people’s lives. There are no systematic requirements to test your facility for everything discussed above, or anything else that has not been mentioned. However, you won’t know whether these hazards pose a threat unless you test.
Some facility executives think they can cut corners and save money by doing the testing themselves. It is highly recommended that a trained professional administers each test to ensure it is conducted properly. It takes just 10-12 samples from places like faucets, hot water tanks, and recirculation lines to indicate whether your water system poses a risk or not. Each test costs approximately $100 through an accredited professional.
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To some, that may sound expensive, but the legal bills from a wrongful death lawsuit are much worse since Legionnaires’ disease is highly litigated. By implementing both the ASHRAE-188 and ASHRAE-514 standards, facility executives have a strong foundation to say that every precaution was taken per the industry standard and can fend off accusations of negligence.
Outbreaks and fatalities due to waterborne diseases will also be greatly reduced through these relatively easy and inexpensive means. Facility executives can further bolster their facilities by hiring a water management specialist to oversee day-to-day prevention tactics.
Cases of Legionella have increased by 200% in the past 10 years. Now is the time for action. Facility executives must place a new priority on water system management and take the necessary precautions outlined in ASHRAE-188 and expanded upon in ASHRAE-514. Test your facility’s water system now to prevent unnecessary disease and death.
Dr. Stout is Executive Vice President and Founder of Special Pathogens Laboratory, A Pace Laboratory, and a research associate professor at the University of Pittsburgh Swanson School of Engineering in the Department of Civil and Environmental Engineering. An infectious disease microbiologist, Dr. Stout is recognized worldwide for pioneering research in Legionella. Her expertise includes detection, prevention, and control strategies for Legionnaires’ disease in building water systems. Dr. Stout’s more than 30 years of research is embodied in book chapters and more than 100 articles published in peer-reviewed medical and scientific journals.
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