Healthcare Solutions: How to Reduce Waterborne Pathogen Risk
In healthcare settings, it is crucial to take every precaution to ensure patient safety and well-being, including the quality of water used throughout the facility. Waterborne pathogens, commonly present in building water systems, can pose serious health risks, particularly to individuals with weakened immune systems. This blog post will delve into common waterborne pathogens, their effects, and the preventive measures necessary to maintain safe water in healthcare environments. Understanding common waterborne pathogens and their impact Waterborne pathogens are microorganisms that thrive in water systems and can cause severe infections. Healthcare facilities, with their complex and extensive water systems, provide an ideal environment for these pathogens to proliferate. The presence of immunocompromised patients and the use of medical devices that rely on water further increase the risk of infections. Awareness and proactive management, including regular water testing, system maintenance, and the implementation of effective disinfection protocols, are essential to prevent outbreaks and protect patients and staff. Legionella Legionella bacteria can thrive in complex water systems, such as those found in hospitals. These bacteria can cause Legionnaires’ disease, a severe form of pneumonia. Legionella is primarily transmitted by inhaling small water droplets containing the bacteria, which can occur through showers, cooling towers, and decorative fountains. Aspiration of contaminated drinking water can also lead to infection. Regular assessment and maintenance of water systems are crucial to preventing Legionella growth. This includes routine cleaning and disinfection of cooling towers and decorative fountains. Copper-silver ionization, a method that continuously disinfects potable water, has proven effective in controlling Legionella populations. Having a robust outbreak response plan is essential. This includes rapid identification of suspected Legionnaires’ disease cases, patient testing, and environmental sampling for Legionella. Quick action can help contain the spread and prevent further infections. Pseudomonas Pseudomonas, particularly Pseudomonas aeruginosa, thrive in moist environments. It can be found on medical equipment and in water sources, posing significant risks to patients, especially those with weakened immune systems. In healthcare settings, Pseudomonas can lead to various infections, including pneumonia. Effective water management, monitoring, rigorous cleaning, and disinfection protocols are vital to controlling Pseudomonas. Regularly disinfecting sinks, showers, and medical devices that come into contact with water can significantly reduce the risk of infection. Ensuring that all equipment is thoroughly sterilized is also crucial. Healthcare providers should be vigilant for symptoms of Pseudomonas infections, particularly in critically ill or post-surgery patients. Early detection and prompt treatment can prevent complications and improve patient outcomes. Stenotrophomonas Stenotrophomonas maltophilia (S. maltophilia) is a growing concern in hospitals due to its multidrug resistance. This organism often causes healthcare-associated infections (HAIs), affecting patients with compromised immune systems or those with indwelling devices like catheters and breathing tubes. S. maltophilia’s resistance to many common antibiotics makes infections challenging to treat. Understanding its resistance patterns is crucial for effective treatment. Physicians must stay informed about the latest guidelines and treatment options. To limit the spread of S. maltophilia, implement effective water management strategies, perform strict environmental monitoring, and implement disinfection procedures. Hand hygiene and device sterilization play a significant role in preventing transmission. Regular audits and staff training can help maintain high hygiene standards. Acinetobacter Acinetobacter baumannii is notorious for its resilience against antibiotics. This highly antibiotic-resistant pathogen often affects patients in intensive care units (ICUs) or those with compromised immune systems, leading to severe infections. Rigorous infection control measures are necessary to combat Acinetobacter. This includes water management practices, regular handwashing, sterilizing equipment, and implementing isolation protocols for affected patients. Preventing outbreaks requires a coordinated effort from all healthcare staff. Proactive surveillance for Acinetobacter is critical. Regular screening and monitoring can help detect infections early. Judicious antibiotic use, guided by susceptibility testing, is also key to managing its spread and improving patient outcomes. Solutions for healthcare facilities Waterborne pathogens pose a significant threat to healthcare facilities, but with proper awareness, preventive measures, and a coordinated effort from all healthcare staff, their impact can be minimized. By understanding the risks and implementing effective strategies, like water management programs, regular maintenance of water systems, rigorous infection control protocols, and proactive surveillance, we can ensure safer water systems and improve patient and staff safety. Our solutions, including copper-silver ionization, are effective against a broad spectrum of pathogens, including those discussed here. Implementation of these strategies can significantly reduce the risk of infection from water sources. Learn more about how healthcare facilities partner with LiquiTech or contact us today to explore our water treatment solutions designed to protect your patients and staff.
The Future of Plumbing: Smart Technologies for Better Water Management
The plumbing industry is undergoing a technological transformation. Aging infrastructure, evolving regulations, and increasing health risks necessitate a shift toward smarter, data-driven water management solutions. These innovations can improve water quality, optimize system performance, and enhance occupant safety. This blog explores how smart plumbing technologies are shaping the future of building water systems, offering practical insights for implementation. Challenges facing building plumbing systems Source water quality often declines as it travels through a building’s plumbing system, impacted by factors like sediment, biofilm, temperature fluctuations, and disinfectant loss. Disruptive events—such as water main breaks, construction, or hydrant flushing—can stir up sediment and biofilm, introducing these contaminants into the building. Once inside, the situation can worsen due to aging infrastructure, inconsistent temperatures, and water stagnation. Pressure put on building water systems: Addressing these challenges requires proactive solutions grounded in strong water management principles. Key principles of effective water management A comprehensive water management strategy builds resilience, reduces risks, and ensures regulatory compliance. The core principles include: Risk assessment Control measures Monitoring and documentation Interventions and corrective actions These principles create a foundation for incorporating advanced smart technologies into plumbing systems. The role of smart technologies in building water management Smart technologies bring automation, real-time data, and predictive analytics to water management, making systems safer, more efficient, and easier to manage. Key innovations include: Smart sensors Programmable flushing devices Advanced water treatment technologies The following technologies offer real-time water management, adjusting automatically based on water conditions and ensuring optimal system performance. Benefits of smart plumbing systems The advantages of implementing smart plumbing technologies go beyond regulatory compliance: Get started with smart plumbing technologies Adopting smart technologies requires strategic planning. Here’s how to begin: Embracing the future of plumbing The plumbing industry is evolving, and smart technologies are leading the way. These tools empower facility managers and engineers to proactively address water system challenges, ensuring safer, more efficient, and compliant operations. Now is the time to invest in the future of water management. By adopting smart technologies, you can enhance occupant safety, optimize operations, and create resilient systems. Ready to step into the future? Contact LiquiTech today to explore how our smart technologies can transform your building’s water management.
Report: Gaps in Water Management Programs and Increased Risks
A well-structured and implemented water management program (WMP) is crucial in controlling Legionella and other waterborne pathogens. Recent research has identified common gaps in water system management that may increase the risk of Legionnaires’ disease outbreaks. By understanding these areas and applying proactive solutions, facility teams can strengthen their WMPs and better protect building occupants. Key findings from recent research A comprehensive study published in Microorganisms analyzed over 220 Legionnaires’ disease outbreaks and found that nearly 90% of cases were linked to preventable issues within building water systems (Dooling et al., 2021). This study, along with a recent CDC report, highlights areas where water management programs can be improved to better control Legionella growth (CDC, 2024). The research found that many outbreaks stemmed from a combination of system design flaws, operational lapses, lack of systemic documentation, and insufficient oversight. Specifically, the following challenges were identified: Facilities like healthcare institutions, hotels, senior living communities, and large commercial buildings are particularly at risk due to the complexity of their water systems and the presence of vulnerable populations. By recognizing these common challenges, organizations can take meaningful steps to enhance their water safety efforts. Strengthening water management programs Effective water management programs require consistent oversight to ensure that all activities are carried out as defined in the plan. When any part of a water management plan is not fully implemented, it may leave building occupants vulnerable to potential health risks and expose building owners to legal and reputational consequences in the event of a disease case or outbreak. The CDC and ASHRAE Standard 188 provide guidance on best practices, and applying these recommendations consistently can help mitigate risks. Key strategies for strengthening WMPs include: Strengthen your water management program A well-maintained and properly executed water management program is one of the most effective ways to prevent Legionnaires’ disease outbreaks. By proactively addressing gaps in water safety protocols, facilities can better protect their occupants and maintain compliance with public health standards. Ensuring the safety of building water systems requires ongoing effort and expertise. Schedule a consultation with LiquiTech today to learn how our proven solutions can help your facility strengthen its water management program and reduce Legionella risk. Sources
“Spring is here—and so is Legionella risk,” warns expert
As the weather warms up, many healthcare facilities prepare for seasonal changes in staffing, patient volumes, and operations. But one area that often gets overlooked during this transition is your building water system—and spring can bring a perfect storm of conditions that elevate the risk of Legionella and sediment-related issues. “Spring is here—and so is Legionella risk,” says Dave Pierre, building water safety expert at LiquiTech. “Warmer temperatures, shifting water demand, and municipal activity like hydrant flushing create ideal conditions for both bacterial growth and sediment intrusion in building water systems.” Five spring risk factors impacting water safety Here are five reasons why spring poses increased water safety risks: Warmer weather raises cold water temps With rising outdoor temperatures, cold water lines—especially those in sun-exposed or poorly insulated areas—can warm into the ideal Legionella growth range (77–113°F). Even in well-designed systems, this shift can allow bacteria to multiply in areas not typically considered high-risk. UV disinfection on the incoming water supply can help kill bacteria before it enters your building, while systemic disinfection methods such as copper-silver ionization can prevent bacteria from growing and spreading in warm, low-flow areas within your plumbing. Together, these technologies offer a multi-barrier solution to address both external and internal risks. Seasonal water quality changes increase microbial activity Spring runoff and heavy rains can significantly impact source water quality by increasing turbidity, organic matter, and nutrient load in the municipal supply. These changes can strain municipal treatment processes and often result in lower chlorine residuals and increased microbiological activity in the water entering your facility. This weakens your first line of defense against waterborne pathogens like Legionella. UV disinfection helps reduce microbial load before it enters the building, while systemic disinfection technologies provide ongoing protection throughout your plumbing system. Municipal disruptions introduce sediment Spring is prime time for municipal hydrant flushing and water main repairs. These activities can stir up sediment and contaminants in the public water supply, which then make their way into your building. Sediment doesn’t just reduce disinfectant effectiveness—it can also feed bacterial growth, damage water-bearing equipment, and even lead to pipe leaks or system failures. Sediment filtration on the incoming water supply helps prevent sediment from entering the building, protecting plumbing infrastructure and supporting overall water quality. Changing demand patterns stress plumbing Spring often brings changes in how different parts of a facility use water. Higher demand from increased patient volumes, reopened services, or seasonal water systems (e.g., cooling towers, irrigation systems, and outdoor water features) can cause pressure fluctuations and temperature shifts that disturb biofilm and mobilize bacteria. On the flip side, lower or inconsistent usage in certain areas can lead to stagnation, loss of disinfectant residuals, and unchecked Legionella growth—especially in places like handwashing sinks or infrequently used showers. Smart sensors throughout the plumbing system can help monitor these changes in real time, identifying abnormal flow patterns, temperature inconsistencies, and other early warning signs of system imbalance—so you can take corrective action before issues escalate. Stagnant water in underused areas Units that saw minimal use during the winter—like seasonal wings, outpatient areas, or overflow rooms—may still have stagnant water sitting in the plumbing. Without proper flushing and maintenance, that water can harbor biofilm and Legionella, and turning those outlets back on can send contaminated water into patient areas. Point-of-use filters offer immediate protection at faucets and showers, while flushing protocols guided by your water management program can help clear stagnant water safely. What to do next Spring is the ideal time to review your water management plan and ensure it addresses seasonal risk factors like temperature fluctuations, sediment intrusion, and changing water use patterns. A targeted water system risk assessment can help identify vulnerabilities and confirm that your plan includes the right preventive measures—such as flushing procedures, filtration strategies, monitoring points, and disinfection methods—for this time of year. Making these updates now can help reduce the risk of Legionella growth, protect your patients, and prevent costly equipment damage tied to sediment and system imbalances. Need support evaluating your water management plan this spring? Our team of water safety experts is here to help, contact LiquiTech today.
Update to Ohio Rule 3701-16-12: Water Management Programs and Case Investigations Now Required for Residential Care Facilities
Effective July 12, 2024, Ohio introduced updates to Rule 3701-16-12 of the Ohio Administrative Code, which requires residential care facilities to have protocols for investigating cases of Legionnaires’ disease and implementing a water management program to control Legionella and other waterborne pathogens. Water management program implementation Every residential care facility in Ohio must establish and implement an effective water management program to: Why this matters Waterborne pathogens, particularly Legionella, can cause Legionnaires’ disease, a severe type of pneumonia that spreads through contaminated water systems. Older adults and individuals with weakened immune systems—many of whom reside in assisted living facilities—are at higher risk of infection. Without proper water management, Legionella bacteria can grow in: An outbreak of Legionnaires’ disease can be deadly, cause legal liability for facilities, and damage trust with residents and their families. Legionnaires’ disease case investigation procedures Alongside prevention, facilities must be prepared to respond swiftly and effectively when a suspected or confirmed case of Legionnaires’ disease arises. The rule requires facilities to: These steps help contain the risk, prevent further infections, and strengthen the facility’s overall water safety strategy. How to comply with the requirements To comply with the water management program and case investigation requirements, residential care facilities should: A proactive approach to resident safety By requiring water management programs and case investigation procedures, Ohio’s updated Rule 3701-16-12 aims to reduce the risk of deadly waterborne infections in residential care facilities. Compliance with this rule is a critical safety measure that protects residents, staff, and visitors from illness. Ready to get started? Contact LiquiTech today to see how we can help your facility comply with Ohio Rule 3701-16-12 and protect your occupants.
Advancing Sustainability and Operational Efficiency in Healthcare
Water systems are critical to healthcare operations, but they also present significant challenges that affect energy use, infrastructure, and equipment performance. Issues like sediment buildup, biofilm formation, and poor system balance can drive up costs, waste energy, and compromise long-term sustainability. By addressing these challenges proactively, hospitals can improve efficiency, reduce expenses, and extend the lifespan of essential systems and equipment. Reducing energy waste Healthcare facilities rank among the most energy-intensive building types, with roughly 42.3% of their energy usage tied to reheating processes. Inefficient water systems—whether due to sediment buildup, poor insulation, or imbalanced flow—force pumps, boilers, and reheaters to work overtime. This increased workload leads to higher operating costs and strains organizational efforts to meet sustainability targets. By focusing on improvements in water quality and system design, hospitals can reduce energy consumption, cut costs, and extend the life of vital equipment. Key strategies include: Implementing sustainable water treatment technologies Advanced technologies that reduce contaminants and pathogens in building water improve safety, extend the lifespan of plumbing systems, and reduce the frequency of repairs, which helps conserve resources and reduce waste. Leveraging smart monitoring technologies Real-time monitoring tools have revolutionized water management strategies in healthcare. Smart sensors and remote monitoring technologies allow facilities to proactively identify and address inefficiencies, reduce waste, and maintain optimal conditions for patient care. Protecting water infrastructure for long-term sustainability Protecting the longevity of plumbing systems and water-bearing equipment is an often overlooked aspect of water management that significantly impacts sustainability. By preventing damage caused by sediment, corrosion, and scale, businesses can reduce the need for frequent repairs and replacements, lowering waste and extending the lifespan of their infrastructure. Supporting broader sustainability initiatives Water management is essential for organizations aiming to meet their broader sustainability objectives. Enhancing the efficiency of water infrastructure, reducing energy consumption, and adopting environmentally friendly water treatment technologies align with environmental, social, and governance goals. By leveraging advanced technologies and real-time monitoring, businesses can optimize water use, cut energy costs, conserve resources, and reduce carbon footprints, driving meaningful progress toward a sustainable future. Ready to get started? Contact LiquiTech today for a water management analysis to see how you can take your sustainability efforts to the next level.
Why Legionella Isn’t Just a Hot Water Problem: Risks in Cold Water
Legionella is a waterborne pathogen that contaminates nearly half of all building water systems. It typically enters through the municipal cold water supply and thrives in areas of the water system with sediment accumulation, stagnant water, warm temperatures, or where other microbes are present. While hot water is often seen as the biggest risk for Legionella growth, cold water systems can also harbor the bacteria, making it a hidden threat in many buildings. Legionella in hot water systems Potable hot water systems, particularly untreated ones, can act as major reservoirs for Legionella growth. The most suitable temperature for Legionella growth is between 90°F and 120°F, making hot water systems a high-risk environment for Legionella. Legionella in cold water systems Legionella can survive in water temperatures below 77°F, making cold water systems susceptible to colonization. In fact, a research article published by the CDC found as many as 47% of surveyed cold water taps were positive for Legionella. Although cold water systems typically present less favorable conditions for Legionella growth compared to hot water systems, certain factors—such as elevated cold water temperatures and high sediment levels—can create an environment conducive to its survival. In warmer regions where cold water temperatures tend to be higher, the risk of Legionella colonization increases significantly. Legionella species in cold water Several types of Legionella can survive and grow in low temperatures, including Legionella pneumophila, the species responsible for most cases of Legionnaires’ disease in the United States. This strain prefers higher cold water temperatures, while other species like Legionella anisa and Legionella longbeachae tend to survive in colder environments. Although these non-pneumophila species are less likely to cause illness, they’ve been linked to outbreaks of Pontiac Fever. Controlling Legionella in cold water Effectively controlling Legionella in cold water systems requires a strategic approach that combines proven methods. The right solution will depend on factors like the level of contamination, the building’s location, and the vulnerability of its occupants, but a combination of the below water treatment technologies is typically recommended. By combining these solutions, you can significantly reduce the risk of Legionella in cold water systems. Copper-silver ionization, UV disinfection, and sediment filtration together offer a complete and proactive approach to creating safer and healthier environments in buildings. References Garner E, Brown CL, Schwake D, Rhoads WJ, Arango-Argoty G, Zhang L, et al. Comparison of Whole-Genome Sequences of Legionella pneumophila in Tap Water and in Clinical Strains, Flint, Michigan, USA, 2016. Emerg Infect Dis. 2019;25(11):2013-2020. https://doi.org/10.3201/eid2511.181032 Wadowsky, R. M., R. Wolford, A. M. McNamara, and R. B. Yee. 1986. Effect of temperature, pH, and oxygen level on the multiplication of naturally occurring Legionella pneumophila in potable water. Appl. Environ. Microbiol. 49:1197-1205. Rogers, J., A. B. Dowsett, P. J. Dennis, J. V. Lee, and C. W. Keevil. 1994. Influence of temperature and plumbing material selection on biofilm formation and growth of Legionella pneumophila in a model potable water system containing complex microbial flora. Appl. Environ. Microbiol. 60:1585–1592. Mauchline WS, James BW, Fitzgeorge RB, Dennis PJ, Keevil CW. Growth temperature reversibly modulates the virulence of Legionella pneumophila. Infect Immun. 1994 Jul;62(7):2995-7. Soderberg, M.A., Dao, J., Starkenburg, S.R., Cianciotto, N.P. 2008. Importance of type II secretion for the survival of Legionella pneumophila in tap water and in amoebae at low temperatures. Appl. Environ. Microbiol. 74(17):5583-5588. De Giglio, O., D’Ambrosio, M., Spagnuolo, V., Diella, G., Fasano, F., Leone, C. M., Lopuzzo, M., Trallo, V., Calia, C., Oliva, M., Pazzani, C., Iacumin, L., Barigelli, S., Petricciuolo, M., Federici, E., Lisena, F. P., Minicucci, A. M., & Montagna, M. T. 2023. Legionella anisa or Legionella bozemanii? Traditional and molecular techniques as support in the environmental surveillance of a hospital water network. Environmental monitoring and assessment, 195(4), 496.
How Weather, Climate, and Water Sources Impact Waterborne Disease Hospitalizations
A recent study from Columbia University, published in the open-access journal PLOS Water, investigates how weather conditions, climate, and water sources affect hospital admissions for waterborne infectious diseases in the United States. The study examined 12 years of data from 516 hospitals in 25 states. Key findings on biofilm-forming bacteria Biofilm-forming pathogens, such as Legionella, Pseudomonas, and Nontuberculous mycobacteria (NTM), thrive in biofilms within water distribution systems and are responsible for respiratory infections, especially among vulnerable populations like individuals over 55 or those who are immunocompromised. During the study period, biofilm-forming bacteria were responsible for 81% of all waterborne disease hospitalizations. Geographical and environmental influences Conclusion The study identifies a clear link between meteorological conditions, drinking water sources, and hospitalization rates for waterborne diseases. With climate change potentially leading to more extreme weather events, the study highlights the need for improved water infrastructure and water management practices to mitigate the risk of these waterborne infections, particularly in urban areas and regions dependent on groundwater sources.
Legionella: What Is It and How to Control It
What is Legionella? Legionella is a bacterium that causes Legionnaires’ disease and Pontiac fever. It was named after the first known outbreak of Legionnaires’ disease in 1976 at an American Legion Convention. Legionnaires’ disease is a severe type of pneumonia. Pontiac fever is a less severe illness that typically resolves without hospitalization. Approximately 90% of Legionnaires’ disease cases are caused by Legionella pneumophila. Non-pneumophila species are responsible for fewer than 10% of cases. Where is it found? Legionella can be found in natural water sources. It can survive traditional municipal water treatment processes and be distributed to buildings from the municipal water supply. Once in building water systems, ideal conditions, like warm water, sediment, and other microorganisms, can cause it to proliferate. Potable water systems, especially hot water systems, are the highest concern for Legionella growth and transmission. High-risk non-potable systems include cooling towers, decorative water features, whirlpools, spas, and misters. More than half of outbreaks occur in healthcare facilities. Outbreaks have also been linked to nursing homes, hotels, workplaces, apartment complexes, and community sources. What are the health concerns? Legionnaires’ disease can be contracted through exposure to contaminated water, usually via inhalation of aerosolized particles or aspiration. Cases have also been linked to direct installation, such as nasogastric tubes. People with weakened immune systems, chronic lung disease, diabetes, cancer, transplants, steroid use, and the elderly are at higher risk of contracting the disease. However, roughly 25% of cases have no known risk factors. More than 95% of cases require hospitalization, and more than 30% require admission to the ICU. The disease fatality rate is over 10%. Healthcare facilities are the most common exposure setting, accounting for 57% of cases and 85% of deaths. How can Legionella be controlled? There are many strategies to reduce Legionella risk in building water systems. To start, Legionella testing should be conducted to identify if and where Legionella is present in the water system so evidence-based remediation strategies can be implemented. Continuous supplemental disinfection can be installed to remediate the entire water system and provide long-term Legionella control. The most effective is copper-silver ionization. It is highly effective against Legionella and other waterborne pathogens and does not have any negative side effects, like corrosion or harmful disinfection byproducts. Short-term remediation options, like chlorine shock treatments, have varying efficacy. If Legionella reduction is achieved, it is typically short-lived. Point-of-use filters can be installed on faucets, showerheads, and ice machines to prevent exposure to Legionella and other waterborne pathogens. However, they do not remediate the water system and require ongoing maintenance and costs, so they are usually deployed temporarily or in high-risk units. Engineering controls like circulation, flushing, and temperature can prevent favorable conditions but do not fully mitigate risk. These controls should be used in conjunction with other strategies. A water management plan and routine Legionella testing should be utilized to help evaluate and manage ongoing Legionella risks in building water systems. Download: Legionella fact sheet Fill out the form below to download our Legionella fact sheet to keep on hand or to share with your team.
Waterborne Pathogens a Growing Concern in US Drinking Water, CDC Report Shows
The Centers for Disease Control and Prevention (CDC) has released a report summarizing waterborne disease outbreaks in the United States between 2015 and 2020. The report Surveillance of Waterborne Disease Outbreaks Associated with Drinking Water includes data voluntarily reported by public health agencies to the CDC through the National Outbreak Reporting System (NORS). Data reported includes the waterborne pathogen implicated, outbreak-contributing factors (i.e., practices and factors that lead to outbreaks), and the setting of exposure (e.g., hospital or health care facility; hotel, motel, lodge, or inn). Outbreaks from drinking water During the surveillance period, 214 outbreaks associated with drinking water were reported, resulting in at least: The report found that 80% of outbreaks were linked to public water systems, including municipal water systems or water systems that serve an institution, camp, park, hotel, or business. The remaining outbreaks were linked to unknown water systems (10%), individual or private systems (8%), and other systems (.9%). Most implicated waterborne pathogen: Legionella Legionella caused 98% of biofilm-associated outbreaks, followed by nontuberculous mycobacteria (NTM) at 1% and Pseudomonas at 0.5%. Over the study period, the number of Legionella-associated outbreaks increased, with Legionella being the most common cause of public water system outbreaks, responsible for 92% of outbreaks, 97% of hospitalizations, and 97% of related deaths. Leading contributing factor: Building plumbing systems Building plumbing systems were the most cited contributing factor type for all biofilm-associated pathogen outbreaks. The most reported building plumbing contributing factors were: Out of 214 reported outbreaks, 183, or 86%, included information on water treatment. Among these outbreaks, 116 (54%) drinking water systems reported using disinfection as a water treatment method, 49 (23%) systems had an unknown water treatment, and 17 (8%) drinking water systems reported having no water treatment at all. Chlorine was the most used disinfection method and was used in 37% of all outbreaks. Chloramine was used in 6% of outbreaks, while the remaining outbreaks either used an unknown water disinfection method or the method was not listed. Most common exposure settings: Hospitals and hotels Healthcare facilities (e.g., hospitals, long-term care, assisted living, or rehabilitation facilities) were identified as the exposure setting in 53% of outbreaks, causing 66% of hospitalizations and 87% of deaths. Legionella was implicated in over half of the healthcare-associated outbreaks, causing 65% of hospitalizations and 85% of deaths. Hotels, motels, lodges, or inns were the second highest exposure setting for outbreaks. They were implicated in 16% of outbreaks, all of which were caused by Legionella. Importance of water treatment and management in preventing outbreaks The CDC report highlights the growing concern of waterborne pathogens in US drinking water. Legionella was identified as the most common waterborne pathogen, causing the majority of biofilm-associated outbreaks and being responsible for the highest number of public water system outbreaks, hospitalizations, and related deaths. Effective water treatment and management of building plumbing systems is critical to prevent outbreaks and ensure safe drinking water in healthcare and non-healthcare settings. ReferencesCenters for Disease Control and Prevention. (2024). Surveillance of Waterborne Disease Outbreaks Associated with Drinking Water — United States, 2015–2020. Morbidity and Mortality Weekly Report | CDC
