Hospitals and Healthcare Facilities


Healthcare facilities pose a special situation for managing Legionella risk due to the increased number of people who may be susceptible to infection. For this reason, it is important for health care facilities to create a water management plan in accordance with the CDC Toolkit. The criteria for when a water management plan is needed is similar to that for large Industrial/Commercial buildings, but includes the added consideration of the health status of the people present.

According to CDC, a water management plan is required when:

  • The building is a healthcare facility where patients stay overnight or where people are treated who have chronic or acute medical problems or weakened immune systems.
  • The building primarily houses people older than 65 years
  • The building has a centralized hot water system
  • The building has more than 10 stories
  • The building has a cooling tower
  • The building has a hot tub, Jacuzzi, or a spa) that is not drained between each use
  • The building has a decorative fountain
  • The building has a centrally-installed mister, atomizer, air washer, or humidifier

Even if a health care facility does not contain any of the above elements, a water management plan should be developed.

In addition to the water management team that might be established for a large Industrial/Commercial building, the health care facility should also include someone who understands the accreditation standards and licensing requirements for health care facilities, someone with expertise in infection prevention, a clinician with expertise in infectious diseases, and risk and quality management staff. It may be necessary to hire outside professionals with Legionella experience to have all the needed backgrounds.

It will be necessary to gather schematics of the building’s water flow diagrams to identify all areas where Legionella can grow and be transmitted. Control measures and corrective actions can then be taken and monitoring measures can be put into place. Once measures are established and running, it is important to document all activities of the water management plan to ensure all avenues are effective to safeguard the water system. Below are additional documents that can aid the process of developing the water management plan.

Typical Members of a Water Management Program Team

  • Building owner
  • Building manager/administrator
  • Maintenance or engineering employees
  • Safety officers
  • Equipment or chemical suppliers
  • Contractors/consultants who are water treatment professionals
  • Certified industrial hygienists
  • Microbiologists
  • Environmental health specialists
  • State or local health officials