How to Protect Against Legionella

07/24/2012 | By Jennie Morton

Is your water safe? A new standard can help safeguard against a Legionella outbreak

It can lurk in your cooling towers, piping systems, showerheads, hot tubs, sauna rooms, and decorative fountains. It causes flu-like symptoms, hospitalizations, lingering neurological issues, and death. Legionella bacteria begin as a microscopic presence in your water systems and can balloon into a tarnished business image, a CDC investigation, and lengthy lawsuits.

“Though some facilities are proactive with water management, many building teams struggle with documentation or do not have a clearly identified team responsible for the water system,” observe ASHRAE members Bill McCoy of Phigenics and William Pearson of Southeastern Labs. The forthcoming ASHRAE Standard 188, Prevention of Legionellosis Associated with Building Water Systems, is a significant step toward formalized Legionella prevention.

The standard will require a new process to document proactive measures against Legionella with a Hazard Analysis and Critical Control Point (HACCP) risk management plan. The goal is to establish which control and monitoring measures your building has in place.

“We know how to analyze and control this hazard. But we need a standardized practice to specify for facility managers and owners exactly what to do in their facilities to control the hazard in a systematic and scientifically defensible way,” McCoy and Pearson explain. “ASHRAE Standard 188P is intended to fulfill this need.”

Whether you choose to adhere to the standard or not, preventing Legionella from breeding in your water system requires a proactive stance. Remember that building water safety and quality are not within the jurisdiction of the public water utility – the responsibility is yours. Use these three components of the standard to fulfill your General Duty Clause. 

1) Know Thy Enemy
Legionella is a type of bacteria that causes two forms of pneumonia – Legionnaires’ disease and Pontiac Fever (collectively referred to as Legionellosis). Both conditions develop when the bacteria is inhaled through water droplets or vapor. The disease is not communicable and does not occur if Legionella is ingested.

According the Center for Disease Control (CDC), anywhere from 8,000 to 18,000 cases are reported in the U.S. each year. Because the disease is hard to distinguish from community-acquired pneumonia and the onset of symptoms occurs several days after contact, many more incidences may go unnoticed. The bacteria are most likely to affect those with weakened immune systems, including children, those with diminished lung capacity, the elderly, and people with autoimmune disorders.

The CDC estimates that 5-30% of Legionnaires’ victims perish. Many patients recover with the aid of antibiotics, but some require hospitalization for days. A growing number of reports also show that victims can have lasting neurological damage, largely affecting memory and muscle control.

Along with other waterborne diseases such as giardiasis and cryptosporidiosis, Legionella costs the healthcare system up to $539 million annually, according to CDC research. By using insurance claims, the CDC calculated that Legionnaires’ disease places a $101-321 million burden on patients, insurers, and taxpayers. For example, a single hospitalization for Legionnaires’ averages more than $34,000.

Are You At Risk?

While all commercial buildings are vulnerable to Legionella, the following risk factors can increase the likelihood of contamination:

  • Multiple housing units with one or more centralized water heaters
  • More than 10 stories high (including any levels that are below grade)
  • An inpatient healthcare facility
  • Occupants who are primarily 65 years or older
  • One or more whirlpools and/or spas
  • Any water features or devices that release aerosols, such as ornamental fountains, misters (atomizers), air washers, or humidifiers
  • Total residual halogen concentration of the incoming potable water supply is less than 0.5 mg/L (0.5 ppm) as Cl2 (chlorine).


Unlike a slip and fall incident, there’s no specific statute of limitations for Legionella. Time is of the essence for a victim to medically document the disease and connect the source of contamination to a specific location.

But once an incidence has been traced back to your building, many more reports can follow in its wake. It is the likelihood of a severe reaction to Legionella that requires the proactive attention of building managers.

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