Presented by:Helen Cerra and Bill Jones

Ch T t IChemTreat, Inc.October 24, 2012

• Legionella Basics

• Cooling Technology institute (CTI) Update 

P t/f t t t• Present/future states

• ASHRAE Standard 188P

• Present/future states

• What to do?• What to do?

Quebec City, Quebec

Edinburgh, Scotland

Chicago, Illinois

Blanes, Spain

• There are more than 40 species

• Species, “pneumophila” accounts for the majority of illnesses.ajo y o esses

• 14 serogroups or strains of pneumophilaspecie

• Serogroups 1 4 and 6 commonly associatedSerogroups 1, 4 and 6 commonly associated with human illness

• Legionella is active atLegionella is active at temperatures between 68–122F.

• The optimum ptemperature range for the growth of the bbacteria is 95–115F.

• What is it?• Respiratory infection that strikes susceptible individuals exposed to Legionella pneumophila

• Who is at a greater risk? • Smokers 

• Those with suppressed immune systems 

• chronic respiratory diseases  p y

• Infection is contracted by inhaling airborne water droplets or mist containing Legionella bacteria

• Dose required to cause infection not definitely known

• Mortality rate >10% 

• 2‐10 day incubation

• Symptoms of Pneumonia• Coughg

• Fever

• Chest painChest pain

• Headache

• Not Penicillin!!!!

• Ciprofloxacin

• Erythromycin• Erythromycin

• Quinolones

• Severe cases ‐ Rifampin

Amoeba (protist host cell) Legionella (parasites)

Legionella (parasites) typically grow very inefficiently outside their natural host butLegionella (parasites) typically grow very inefficiently outside their natural host, but grow rapidly in their host, Protozoa.

• In water systems Legionella tend to proliferate in biofilms and i hi ( b ) hi h f d bi filwithin protozoa (amoebae) which feed on biofilms

• Biofilms create conditions favorable for growth and amplification of Legionella

• Dead‐legs and stagnant or slow moving water areas most common environments

• Legionella released into water in large numbers when• Legionella released into water in large numbers when biofilms/biodeposits break loose

• Legionnaires disease is under‐reportedg p

• Potable water sources account for most of the• Potable water sources account for most of the cases

• Latest cases – fountains and cooling tower

• Guideline: Best Practice for Control of Legionella (2008)

• Maintain continuous low level residual of free halogen (chlorine or bromine)(chlorine or bromine)

• If continuous halogenation not possible, intermittent use of halogen necessary for minimizing riskBi di b d id i i d• Bio‐dispersant can be used to aid in penetration and effectiveness of biocides

• Periodic addition of non‐oxidizing biocide as required to maintain clean conditions for both continuous and intermittent 

Parameter Dipslides Agar Pour or

Microscopic Examor

PetrifilmExam

Planktonic Counts

<10,000 CFU/ L

<10,000 CFU/ L

No higher lif fCounts

(Bulk Water)CFU/mL CFU/mL life forms

Sessile Counts

<100,000 CF / 2

<100,000 CF / 2

No higher lif fCounts

(Surfaces)CFU/cm2 CFU/cm2 life forms

Deposits NA NA No higher Deposits NA NA No higher life forms

• Design• Tower placement

• Public area 

• Air intakeAir intake

• Stagnant areas ‐ low/no flow

• Maintenance• Drift eliminators

• Air filters 

• Minimize Process Leaks/ContaminationMinimize Process Leaks/Contamination

• Effective water treatment program

• Maintain effective bio‐control practices• Regular and Proper addition of biocides

• Routine monitoring of microbiological control

• Guideline: Best Practice for Control of Legionella

• Working on producing a Standardg p g• Expect release in 2013

• Expect testing for Legionellap g g

• ASHRAE Guideline 12‐2000

Minimizing the Risk of LegionellosisAssociated with Building Water Systems

• Covers all building water 

systemssystems

• Minimize microbial growth

• Minimize scaleMinimize scale

• Minimize corrosion

Mi i i di /d i i f lid• Minimize sediment/deposition of solids (organic or inorganic) on heat transfer 

fsurfaces  

• Maintain clean system

• Use a biocidal treatment program

• Water treatment specialistWater treatment specialist

• Standard SPC188 – Prevention of Legionellosis Associated with Building Water Systems g y

• Status Draft Standard has had two public• Status ‐ Draft Standard has had two public reviews‐• Third Public review Fall 2012• Third Public review Fall 2012

Purpose ‐ Present practices for the prevention of l i ll i i t d ith b ildi tlegionellosis associated with building water systems.

Based on Hazard Analysis Critical Control Point (HACCP)Risk Management for US Armed Forces  gNASAFood industry to control infectious organism transfer

• Sections 1‐9Sections 1 9

• Section 5 – Risk

• Section 6 – SurveySection 6  Survey interval

• Section 7 ‐ HACCPSection 7  HACCP

• Section 8 ‐requirements  for specific water systems

• Section 9 ‐ References

• Provides methods of risk management for ti L i ll i ith t li dpreventing Legionellosis with centralized 

industrial and commercial building water systemssystems

• Human occupied buildings.T b d b th i l d i• To be used by those involved in ownership/design/construction/installation/ management/operation/maintenance andmanagement/operation/maintenance and servicing  

• Build the team

• Survey• Survey

a) Multiple housing units with one/more central water heaters.

b) Building more than 10 stories tall (includes ) g (below grade).

c) Inpatient healthcare facility.c) Inpatient healthcare facility.

d) Occupants ages >65 or receiving chemo for cancer or bone marrow transplantcancer or bone marrow transplant.

e) One or more whirlpools and/or spas.

f) One or more aerosol releasing water featuresf) One or more aerosol‐releasing water features or devices (ornamental fountains, misters (atomizers) air washers or humidifiers)(atomizers), air washers or humidifiers) within it or located on premises.

) I i t bl t t t l id lg) Incoming potable water – total residual halogen = <0.5 mg/l as Cl2. 

• Does the building have one or more cooling towers and/or evaporative condensers that provides cooling and/or refrigeration for the HVAC&R systems?  

Survey Results Preventive MeasuresNO – Section 5.2 and NO – Section 5.3

Repeat Section 5, survey 1/yr 

YES to Section 5.2  Comply with Sections 7 and  8 for all bldg h dd d dwater systems except those addressed under  

Section 5.3

YES to Section 5.3 Water system treatment and management y gprogram shall be in place that meets/exceeds HACCP  requirements of Section 8.2, consistent with Guideline 12 

Process for Determining ASHRAE Std. 188 Compliance

Form Team

Survey Facility

Document survey findings

Are there risk 

factors?

Repeat survey  each year

Develop HACCP  Plan

NoYes

Hazard Analysis Critical Control Point

A PROCESSA PROCESS 

1 Conduct hazard analysis1. Conduct hazard analysis2. Determine critical control points (CCP)3 Establish critical limits for each CCP3. Establish critical limits for each CCP4. System to monitor control of CCP5. Corrective action if CCP not under control6. Procedure to verify HACCP is effective7. Documentation of procedures and record

• Select a Team

• Process Flow Diagram

• Perform Hazard Analysis identify hazard• Perform Hazard Analysis –identify hazard

• Validation Criteria – quantitative control

• Establish Validation Summary

• Establish Verification Schedule 

• Select a Team

• Person with an understanding of HACCP

• Owner/President/AdministratorOwner/President/Administrator

• Facilities Chief/Manager

EHS• EHS

• Risk Management

• Hospital – Infection Control Officer

• Identify end point uses of H2O Systems• Potable 

• Utility

• Develop two process flow diagrams

• Illustrate how water is received deliveredIllustrate how water is received, delivered, processed

• Walk the lines!• Walk the lines!

• Inventory buildings and location

• Water systems and sources 

• EquipmentEquipment

• Tools – Camera/pictures

• Identify critical control points  • A point where control can be applied to prevent or eliminate a safety hazard or reduce it to an 

bl l lacceptable level.

• Indicate on the process flow diagrams

• Establish critical control limits for each CCP

• Develop Hazard Analysis Summary Document  

ProcessStep

System Hazard Risk Rating

Basis for Risk

Control CCP 

Cooling Coolingtower

Legionella yes Located near walk way

Control MB,Corrosion, deposition. 2x/yr cleaning

yes

y 2x/yr cleaning

• Set up a monitoring procedure 

• Set up frequency of monitoring

• Establish Corrective Actions when CCPEstablish Corrective Actions when CCP deviates from the limit

• Validate CCP limit corrective action• Validate CCP, limit, corrective action • CTI Guideline for MB 

S i tifi f id• Scientific reference, evidence

• Test for Legionella

• Establish verification procedures• Activities, other than monitoring that determines the validity of the analysis and control system and h d h lthe system is operating according to the plan.

• Establish documentation and record keeping procedures 

• Produce a single document of the plan• Flow diagrams• Hazard Summaries• Monitoring schedule• Equipment maintenance procedure q p p• Validation summary• Verification scheduleVerification schedule• Plan for water disruption

• Design, Maintenance , and Operations Controls

• Reference ASHRAE Guideline 12

• Section 8.1 Potable Water

• Section 8.2 Cooling Towers and Evaporative Condensers

• Section 8.3 Whirlpool Spas

• Section 8.4 Decorative Fountains and OtherSection 8.4 Decorative Fountains and Other Water Features

• Section 8 5 Aerosol Generating Air Coolers• Section 8.5 Aerosol Generating Air Coolers, Humidifiers, Air Washers

• Referencee e e ce• ASHRAE Guideline 12• ASHRAE “Handbook of Fundamentals” Chapter 49, Service Water  Heating

• Construction/renovation• Startup/Shutdown• Maintenance/Monitoring temp and Cl• Emergency Disinfections

• Hot/Cold water systems  

• Equipment Placement/Start‐up plan ‐new

• Written system maintenance plan

• Written water treatment plan for control ofWritten water treatment plan for control of microbiological activity, scale, and corrosion.• Solids evaluationSolids evaluation

• Shutdown and start‐up plan

Di i f i d (2)• Disinfection procedures (2)• Remedial on‐line and emergency

• Reference ASHRAE Guideline 12

• ASHRAE Handbook – applications chapter onASHRAE Handbook  applications chapter on Water Treatment

• Cooling Technology Institute• Cooling Technology Institute

• Association of Water technologies (AWT) 

• Reference – state and local codes for public swimming pools and spas.

• If none apply, follow voluntary consensus std APSP 11‐ Standard for Water Quality in Public Q yPools and Spas.

• No references

• Siting of equipment• Contamination

• Access to pumps, filters, etc

• External heat sources

• Operation/Maintenance

R f ASHRAE G id li 12• Reference ASHRAE Guideline 12

• Placement ‐ Contamination, Access

• New System Startup

• Maintenance/Water treatment planMaintenance/Water treatment plan

• Shutdown and Startup plans

Di i f ti• Disinfection

• ASHRAE Standard Guideline12‐2000, “ i i i i h i k f i ll i“Minimizing the Risk of Legionellosis Associated with Building Water Systems” –

li / /lib /li / liwww.spxcooling.com/en/library/list/cooling/papers‐and‐reports/

• “Legionellosis ‐ Best Practices for Control of gLegionella,” Cooling Technology Institute, download from CTI web site (www.cti.org)

• CDC Guideline for Legionella prevention, download from CDC web site (www.cdc.gov,  search Legionella)

Questions and AnswersQuestions and AnswersQuestions and AnswersQuestions and Answers

• HC Info‐113 West G Street #541113 West G Street #541San Diego, CA 92101760‐494‐3063  www.hcinfo.com

• Phigenics LLC –1701 Q i A STE 321701 Quincy Ave STE 32Naperville, IL 60540630‐717‐7546  www.phigenics.com

• Special Pathogens Laboratory ‐1401 Forbes Avenue Suite 209Pittsburgh, PA 15219877‐775‐7284www.specialpathogenslab.com