Guest Columns

How to evaluate Legionella risk in LTC

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Betty Norman
Betty Norman

Approximately 6,000 cases of Legionnaires' disease were reported in the United States in 2015. The Centers for Disease Control and Prevention found that 76% of these cases could be traced back to healthcare facilities. Of those cases, 80% were linked to long-term care facilities, 18% were linked to hospitals and 2% were linked to both. During a 2017 media briefing, CDC Acting Director Anne Schuchat, M.D., stated, “Legionnaires' disease in healthcare facilities is widespread, deadly and preventable.”

LD outbreaks are commonly associated with hospitals and long-term care facilities due to their complex water distribution systems and other aerosol-generating devices. In addition, these areas host a large number of people who are more susceptible to the disease. To help prevent the development and transmission of Legionnaires' disease, it is important for healthcare organizations to understand their Legionella risk.

Legionella is the bacterium that causes LD. Facilities should proactively implement ways to mitigate and possibly prevent Legionella growth.

Prevention and risk reduction

The key to preventing Legionnaires' disease is to inhibit the growth of Legionella. Legionella water management programs are the current industry standard for managing Legionella growth in large buildings in the United States. 

To provide guidance to building and facility managers on reducing the potential for Legionella growth, a voluntary consensus Standard, ASHRAE 188, was developed in 2015, aimed at preventing the growth and spread of Legionella. 

While this standard is not mandatory, the CDC has stated that, "following this Standard can help building and facility managers prevent many but not all cases of legionellosis." For additional information regarding ASHRAE 188, please visit

Water management program considerations

It is recommended that all healthcare facilities (including those not participating in the Medicare program) consider implementing a Legionella water management program. For the water management program to be effective, it is recommended that it should include the following activities:
  • Conduct a facility risk assessment to identify where Legionella may grow and spread within the facility water system.
  • Implement a water management program that considers the ASHRAE industry standard and includes control measures such as:
  1. Physical controls
  2. Temperature management
  3. Disinfectant level control
  4. Visual inspections
  5. Environmental testing for pathogens
  6. Specify testing protocols and acceptable ranges for control measures, with documentation of the testing results of testing along with corrective actions taken when control limits are not maintained.
If you haven't recently reviewed and updated your water management program, now might be a good time. Additional help with evaluating, designing and implementing a Legionella water management program is available through the CDC. 

Their free toolkit, “Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings: A Practical Guide to Implementing Industry Standards” is available here.

Betty Norman is the Director of Risk Control Services for Glatfelter Healthcare Practice, an insurance program manager.

Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.