Legionellae Control in Health Care Facilities
A Guide for Minimizing Risk

Highlights of Contents

Establishing an Action Plan

  • Evaluating your facility: six test questions to ask

  • Lawsuit data: verdict and settlement amounts, how to determine the strength of a plaintiff's case

  • Deciding how much money to spend to reduce your risk

  • Communication

  • When to disinfect systems

Preventive Measures for Plumbing systems

  • New equipment purchases

  • Recommendations for pipes, fixtures, and tanks

  • Regulating water temperatures, mixing valves

  • What not to do: procedures that are a waste of time and money

Preventive measures for cooling towers

  • Operating and maintenance recommendations

  • Avoiding conditions conducive to legionellae

  • Drift control

  • Checklist of preventive measures

  • Disinfection

Preventive measures for other equipment

  • HVAC humidifiers, ductwork, and drip pans

  • Decorative fountains

Water sampling

  • Deciding whether or not to sample routinely

  • Collecting samples yourself vs hiring a consultant

  • What equipment to sample

  • Five high-priority locations

  • Number of samples to collect each screening

  • Frequency of screenings

  • What other hospitals do (summary table)

  • Comparing methods

  • Using an in-house versus an outside laboratory

  • Screening prospective laboratories:  14 questions

  • Methods and prices of three experienced labs

  • How to test the proficiency of a laboratory

  • Supplies to buy for sampling

  • Annual cost of routine sampling

How to Collect Environmental Samples

  • Scheduling each screening

  • Checklist to review two weeks before sampling

  • Collecting samples and recording data

  • Checklist for shipping samples to the laboratory

  • Interpreting results

Disinfecting domestic water systems

  • Comparison of heat shock, chlorine, UV, ozone, copper-silver: advantages, disadvantages, costs

  • Getting advice from other hospitals: 11 questions to ask

  • Screening manufacturers of disinfection units:  four questions to ask

  • How to avoid overspending: practical points to consider before taking action

Responding to an Outbreak

  • Key aspects of an investigation

  • Getting outside help: paid versus free help

  • Screening and selecting consultants

Source directory

  • Hospital contacts willing to give advice by telephone

  • Consultants and manufacturers

  • Laboratories worldwide that specialize in Legionella

  • Government agencies

  • Attorneys experienced in Legionnaires' cases

  • Professional societies

References, Bibliography, Handout, Logs, Index