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ENVIRONMENT and ENERGY
25 plumbing systems . ASHRAE uses the term water management programme ( WMP ) to describe the risk management approach ( ASHRAE , 2015 ).
In 2016 , the CDC published guidance to help facility operators and owners develop and implement a water risk management programme to reduce risks of legionella growth and spread in premise plumbing systems . The guide can also help the target audience assess and strengthen any water risk management programme already in place by providing practical resources to help facility operators ensure that the programme is comprehensive , effective and in line with industry standards . The guide also highlights special considerations for healthcare facilities ( CDC , 2016 ).
The American Industrial Hygiene Association ( AIHA ) recommends using a risk management approach based on industrial hygiene principles and emphasises proactive routine assessments ( AIHA , 2015 ).
The American Society for Testing and Materials ( ASTM ) International D5952 guidance ( ASTM International , 2015 ) describes a process for identification of cases of legionnaires ’ disease or Pontiac fever and appropriate responses to water system contamination .
The Health and Safety Executive of the United Kingdom ( HSE ) has issued guidance ( HSE , 2013 ) to help employers and landlords comply with the Health and Safety at Work Act as it applies to legionella . The approved code of practice recommends identification and assessment of sources of risk , preparation of a plan , implementation of the plan ( including control measures as needed ), monitoring , record keeping and designation of a qualified person to assist with compliance .
Applications of risk management approaches The application of any risk management approach , such as WMP , HACCP or WSP , can be beneficial for the proper management of premise plumbing systems , to protect water quality and public health in general .
The EPA does not make any specific recommendation regarding the use of any particular approach . EPA advises facility operators and owners to determine which approaches may be more suitable to their specific needs or whether a combination of approaches is appropriate .
Water system managers have found success in implementing risk management approaches , such as WMPs , HACCP and WSPs , similar to the successes seen in the food industry for many years .
• In Iceland , an estimated 68 % of the population consumes drinking water from systems with WSPs . In a 2008 evaluation of water systems , the authors noted that compliance with drinking water standards improved considerably upon implementation of WSPs ( Gunnarsdóttir and Gissurarson , 2008 ).
• Five full-scale HACCP applications in Australian water distribution systems resulted in reductions in customer complaints and water quality incidents ( Martel et al ., 2006 ).
• Researchers in Japan have concluded that HACCP ensures safe and high quality drinking water ; they also have proven success with safe water through the previous uses of HACCP for bottled water and ice production ( Yokoi at al ., 2006 ).
Risk management approaches have proven to be effective for controlling the growth of significant pathogens in premise plumbing systems , as documented in the following case studies :
• In Minnesota , the Mayo Clinic used HACCP principles to build a water management programme for its multi-campus healthcare facilities ( Krageschmidt et al ., 2014 ). During implementation of the programme , the water management team identified and addressed corrosion and distribution piping design issues and differences in how hazards were controlled between buildings . The clinic found the application of these principles to be a practical and effective approach for improving management of water systems . Forming a multidisciplinary team to develop and implement the plan was productive and increased awareness of water quality issues .
• Evaluations of outbreaks of legionnaires ’ disease have shown system deficiencies to be contributing factors to outbreaks ( CDC , 2013 ). The implementation of risk management approaches may identify and help to correct these deficiencies .
• Cristino et al . ( 2012 ) reported the successful implementation of risk assessment-based water management plans to control legionella in long-term care facilities . Under baseline conditions , three hot water systems were colonised with L . pneumophila and one was colonised with L . londiniensis . Specific control measures ( for example , disinfection and environmental monitoring ) were implemented in each system , and no cases of hospital-acquired legionellosis occurred during the study period .
• In 2004 , a university clinic in Germany adopted the WSP concept . One immediate success this clinic noted was the correction of an infrastructural failure that was identified during the process . Three years after implementation , two additional improvements were noted : a lowered rate of sepsis in very low birth weight neonates and no cases of nosocomial legionnaires ’ disease since implementation ( Dyck et al ., 2007 ).
In addition to applying risk management concepts to existing premise plumbing systems , engineers can also use these concepts in the design phase for new premise plumbing systems to help reduce and control hazards ( NYDOH , 2016 ; Krageschmidt et al ., 2014 ; Facility Guidelines Institute , 2014 ). For example , designing a system to minimise water age and dead-end pipelines may limit the occurrence of waterborne pathogens . Another example is to exclude the use of decorative fountains or other water features that generate aerosols , which can be a source of legionella ( HSE , 2009 ). After reviewing published medical literature and external standards pertaining to health care facilities , the Veterans Health Administration ( VHA ) decided to prohibit the use of decorative fountains in its facilities ( VHA , 2014 ).
The Facility Guidelines Institute guidance document includes information on the planning , design and construction of hospitals and outpatient facilities and safety risk assessments ( Facility Guidelines Institute , 2014 ). The Occupational Safety and Health Administration ( OSHA ) recognises the importance of having controls for premise plumbing systems in place , as under certain conditions any water source can be a source of disease and illness ( OSHA , 1999 ).
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www . plumbingafrica . co . za March 2017 Volume 23 I Number 1