infection prevention
By Sylvia Garcia-Houchins , MBA , RN , CIC
Updating Standards to Improve Patient Safety : Water Management
7.2 million Americans get sick every year from diseases spread through water . Some of those illnesses occur while patients are receiving care within healthcare organizations ; however , quantifying the actual number of those that occur within healthcare organizations is difficult . These illnesses may or may not be recognized as resulting from a water source and , even if recognized , still may not be reported to public health because the causative agent is not Legionella . Legionella is nationally reportable while other causative agents are not specifically required to be reported by certain State Health Departments . For example , Washington State has specific reporting requirements for waterborne outbreaks while other states have general requirements for reporting clusters or outbreaks that do not specify known or suspected waterborne disease .
Once reported , state and local health departments have jurisdiction over investigations within their state and may choose not to provide aggregated data on the results of those investigations . However , media reports periodically highlight outbreaks across the United States . When invited to assist with an outbreak investigation , the CDC Division of Healthcare Quality Promotion ( DHQP ) 1 identified that 22 percent of consultations they conducted were water related . DHQP identified nontuberculous mycobacteria as the most frequently involved pathogen during their investigations ( 29.9 percent ) but it identified an additional list of 20 organisms , including those that are frequently identified in clinical specimens such as Pseudomonas spp ., Acinetobacter baumanii , and Enterobacter spp . The organization also found that the source of the outbreaks they investigated most often involved medical products ( 35.8 percent ), and most of these products were medical devices ( 83.3 percent ). DHQP findings emphasize the need to consider not only centralized water systems , but any devices that utilize water , as potential sources of waterborne disease . Patient waterborne infections identified by DHQP were determined to be preventable if the affected health care organization had utilized available information about prevention of waterborne pathogens and implemented an effective water management plan .
This illustration depicted a three-dimensional , computer-generated image of a group of Gram-negative , Legionella pneumophila bacteria . The artistic recreation was based upon scanning electron microscopic ( SEM ) imagery . Courtesy of CDC / Sarah Bailey Cutchin
biological agents in cooling towers , domestic hot- and cold-water systems , and other aerosolizing water systems was already being scored under standard EC . 02.05.01 EP 14 ( EP 6 for NCC ).
Almost four years later , accredited organizations are still being cited out of compliance . And , more importantly , patients continue to develop preventable waterborne infections . There are a lot of reasons ( e . g ., more pressing priorities , lack of knowledge , misunderstanding of the requirements ) for which organizations have not complied , developed , and implemented an effective water management program . As is the nation ’ s oldest and largest standards-setting and accrediting body in healthcare , the Joint Commission has evaluated the situation and identified an opportunity ensure that organizations implement processes to reach zero harm from preventable waterborne disease . In its current form , EC . 02.05.01 EP 14 ( EP 6 in the Comprehensive Accreditation Manual for Nursing Care Centers ) does not provide sufficient guidance and requirements to ensure organizations are implementing appropriate water management plans .
In October 2020 , the Joint Commission published draft water management program standards for field review . Positive comments received verified some existing suspicions . The majority of responding health care organizations had a water management plan ( 90 percent ) that addressed Legionella prevention but only 74 percent indicated that they addressed other waterborne pathogens . Based on feedback from field review and water experts at the CDC , the draft water management program standards were updated and approved by CMS , as required for deeming .
The new standard and EPs ( EC . 02.05.02 , EPs 1 through 4 ) will be published July 1 , 2021 in accreditation manuals for hospitals , critical access hospitals , and nursing care centers . This standard is effective Jan . 1 , 2022 , giving organizations time to ensure that they have developed and implemented a fully compliant water management program . The new standard incorporates