FM Articles

Infectious Disease Prevention


Legionella pneumophila is a worldwide, waterborne bacteria that is extremely common and found naturally in the environment; it is also the cause of a severe form of pneumonia called Legionnaires Disease, which can be deadly. The number of people getting sick from Legionella bacteria in healthcare environments has been steadily and substantially increasing in the last decade as these facilities often house those who are most susceptible, such as the elderly and those with weakened immune systems.

Regulatory Agencies, as well as the public, have demanded something be done to protect patients in hospitals and healthcare environments. These regulatory agencies are pushing healthcare facilities to enhance their monitoring of risk factors, with auditable and actionable risk mitigation. Compliance is now necessary for continued hospital accreditation and Medicare / Medicaid funding.

To better contain the spread of infectious diseases and mitigate threats, such as legionella bacteria, more hospitals and health centers are focused on creating an environment that stops the rapid growth of infectious bacteria while maintaining the comfort and health of its patients. Water and air systems are at the core of these efforts, as small issues can quickly turn into larger concerns that could accelerate the spread of diseases across a hospital. To ensure water and air systems are not contributing to the spread of bacteria, smarter Continuous Monitoring-Based Commissioning Systems are becoming the standard to provide hospitals a real-time look at what issues exist in these systems and how to best address them.

Infectious Diseases Become a Problem for Public Health
According to Legionnaires Disease News, just in the last six months of 2018, Legionella bacteria was detected in multiple Hospitals and Recreational facilities in Maryland, Pennsylvania, New Hampshire, Rhode Island, Washington, Maine, Massachusetts, New York, and Wisconsin, just to name a few. These recent outbreaks resulted in thousands of sick people, as well as hundreds of deaths. The Public Health Insider reports that “about 1 out of 10 people who get Legionnaires’ disease will die from the infection”[1]

The CDC has reported that 9 out of 10 of the infections acquired in a health care setting could have been prevented with better water management.[2] Factors in water management that promote the growth of this bacteria include fluctuations in water temperature, humidity and pH; changes in water pressure; and water stagnation (low to no water flow).  These risk areas must be regularly monitored with predetermined actions to resolve when found.

As early as 2003, to aid in the prevention and control of healthcare-associated pneumonia, the CDC began recommending monitoring of the Ventilation system with Continuous Monitoring for air change rates and pressure fluctuations for any positive airflow area.[3] In 2017, the U.S. Centers for Medicare & Medicaid Services (CMS)[4] began enforcing a federal requirement to reduce the risk of this bacteria through monitoring of Water Management Systems.

Legionella Water Management programs are now an industry standard for large buildings in the United States. To reduce the risk of this bacteria, the recommended approach is the ASRAE Risk Management guidelines for Water Management Programs.[5]

The Joint Commission, in their surveys, look for evidence of compliance with the ASHRAE Standard 188 and the CDC’s recommendation for reducing Legionella Growth in Buildings; including Risk Assessments and having an existing Water Management program; including how the Water Management program monitors, tests, and acts against the findings. A lack of compliance can shut down areas within your facility or eliminate funding provided to the hospital.

Implementing Continuous Monitoring to Stay Compliant
The Joint Commission and CDC are now recommending that high risk areas have regular monitoring on leading indicators of potential issues including temperature, humidity, pressure, water flow, and air flow. The ability to have access to the right data at the right time, in context of how it’s used, is critical for providing an accurate diagnosis of an issue, which is necessary to enable the engineering and maintenance staff to more effectively correct it.

Basic Asset Monitoring, however, promotes a reactive approach to analysis; where data is accessible for diagnosis after a problem has already occurred, which all hospitals and healthcare facilities would prefer to avoid if possible. From a patient comfort or equipment efficiency standpoint, these problems can be a timely and costly inconvenience; however, from a patient safety and your reputation perspective, it can be devastating to a facility.

Moving from basic Asset Monitoring to Continuous Monitoring has started a more proactive approach in allowing the equipment to always communicate when thresholds are not as specified, informing and notifying people of the issues to diagnose. This is much more effective for getting immediate attention focused on the problem, however, Continuous Monitoring brought to life the realization that there were a lot more problems than expected. Managing the overwhelming amount of notifications was taking time away from investigating the real issues, and the sheer amount of notifications left many ignored. Continuous Monitoring was a great start to proactively identify issues, but the systems still had to be made smarter to eliminate the “noise”.

The first step in the “smarter” Continuous Monitoring System is making a move from continuously monitoring “equipment” to continuously monitoring the “system”. Monitoring all available system data from upstream and downstream contributors, as well as understanding the interaction of AHUs and their Terminal Devices; Heat Exchangers, Cooling Towers, as well as Hot-Water and Cold-Water Systems, ensures an understanding of the state of the working systems, not just the state of isolated equipment. This step moves us from having “data” for diagnosis, to providing us with real information. It really is the first big step toward infectious disease prevention in years, and many facilities are already there. Without smarter Continuous Monitoring Systems, facility managers and engineers will often spend more money and time than is necessary just finding the actual issue, and then more time chasing the cause of that issue. Every moment spent doing this can jeopardize the lives of patients, staff and visitors walking through the doors.

Incorporating Fault Detection to Identify Issues and Provide Solutions
Over the last several years, Continuous Monitoring-Based Commissioning systems with built in Commissioning metrics and analytics have started to become the standard. With these systems, hospital and healthcare facility management staff can identify the highest priority issues across all systems and constantly reap the benefits of any corrections. Using a Continuous Monitoring-Based Commissioning system should help keep equipment in control, lower maintenance and energy costs, increase the life of equipment, and ensure all aspects of HVAC systems are working properly together.

Healthcare facilities will receive a lot of operational benefits and energy savings from a Continuous Monitoring-Based Commissioning system, but for now the focus is on how to specifically provide information and actions to aid in controlling the growth of bacteria and the spread of infectious diseases through the facility. With new Fault Detection analytics, specifically designed for Infectious Disease Control and Air Optimization, these new Fault Detection systems allow the equipment to identify the problems, prioritize the issues, and recommend solutions to best address these issues – providing the balance between saving money and keeping patients safe. Furthermore, Continuous Monitoring and Fault Detection vendors can get your data and start monitoring almost immediately to help you quickly determine your risk.

When you have smart, predictive monitoring of all your critical systems, with analytics determining the desired state of those systems, including patient comfort, energy savings, and patient safety; only then can you make optimal (not just better) decisions. In addition to the efficiency benefits to your Operations teams and saving on energy and maintenance costs, hospitals and healthcare facilities can regain control over the facility environment and minimize the spread of infectious disease.

Rhonda Landis is Vice President of Operations at FacilityConneX.