In early July, the Centers for Medicare and Medicaid Services (CMS) issued a clarifying memorandum to certified healthcare facilities regarding CMS’s “expectations” for mitigation of legionella risks. Specifically, CMS’s letter revises a prior memorandum and clarifies expectations related to legionella risk mitigation.
Legionnaires’ disease is a serious type of pneumonia caused by a waterborne pathogen known as legionella. It is contracted when susceptible individuals inhale water droplets or mist containing elevated levels of legionella bacteria. The number of legionnaires cases reported to CDC has been on the rise since 2000. Health departments reported about 6,100 cases of Legionnaires’ disease in the United States in 2016. However, because legionnaires’ disease is likely underdiagnosed, this number may underestimate the true incidence. Obviously, susceptible individuals include the elderly. In recent years, nursing homes have been in the headlines due to outbreaks associated with legionella.
In response to the growing understanding of the risks of legionella bacteria and the developing standards to mitigate against the risk, CMS has issued guidance materials to facilities for at risk populations.
Specifically, citing 42 CFR 482.42, CMS indicated that it expects these facilities to employ “water management policies and procedures to reduce the risk of growth and spread of legionella” in the facilities’ water systems. The letter cites to ASHRAE 188 standards in guiding the facilities to “review policies, procedures, and reports documenting water management implementation.” Facilities are to (a) verify that they have conducted a “facility risk assessment” to identify areas in the system where legionella and other waterborne pathogens can spread; (b) provide for a water management program in consideration of the ASHRAE industry standards and CDC’s related toolkit; and (c) including testing protocols and control measures, along with relevant documentation of testing and any potential corrective actions.
The effective date of the new guidance is immediate. For nursing homes and facilities subject to the CMS guidelines, the consequences of failure to comply can be severe.