Key Objectives:
- Discuss the importance of preventive maintenance in building water systems for the prevention of legionellosis.
- Identify strategies for encouraging the implementation of preventive maintenance among building owners and operators.
- Discuss possibilities for leveraging regulatory or licensing activities based on preventive maintenance strategies in building water systems at the state and local levels.
- Provide a forum for state-based epidemiologists to share strategies for collaborating with environmental health staff for the purposes of primary prevention of legionellosis and outbreak response.
Brief Summary:
In June 2015, the American Society for Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE) released a new Standard (ASHRAE 188-2015), providing a framework for the prevention of Legionella amplification in building water systems. Transmission of legionellosis depends completely on environmental sources rather than person-to-person spread. As such, legionellosis outbreak investigations require substantial environmental health expertise; so, too, does legionellosis prevention. When legionellosis outbreaks are investigated in the United States, lapses in routine maintenance of aerosol-generating devices like cooling towers and whirlpool spas can almost always be identified. As an environmental pathogen, Legionella poses a substantially lower risk to humans if controlled in building water systems. Implementation of preventive maintenance strategies in building water systems can interrupt the amplification, aerosolization, and transmission of Legionella to people, thereby reducing incidence of disease. The intervention, if properly implemented, should ultimately reduce incidence of disease, particularly when combined with an understanding of common environmental deficiencies that can lead to legionellosis. The implementation of legionellosis prevention strategies in building water systems can be achieved via the application of ASHRAE 188-2015. The success of implementation could potentially be bolstered by the incorporation of legionellosis prevention strategies into state and local regulatory or licensing activities. We would like to discuss the feasibility of implementing and enforcing such strategies at state and local levels with roundtable participants. Outbreak investigations benefit from the full involvement of both epidemiology and environmental health staff; however, engaging environmental health expertise around legionellosis has been difficult for many jurisdictions. We would like to identify barriers to full collaboration and consider, with roundtable participants, ways to address these barriers at the local, state, and federal levels.