82 FR 39439 - Effective Methods for Implementing Water Management Programs (WMPs) To Reduce Growth of Transmission of Legionella spp.

DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention

Federal Register Volume 82, Issue 159 (August 18, 2017)

The Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services (HHS) announces the opening of a docket to obtain information on effective methods for achieving implementation of water management programs (WMPs) intended to reduce Legionella growth and transmission in buildings at increased risk. The information will inform CDC efforts to prevent Legionnaires disease in the United States. Information gathered should also inform CDC efforts to prevent disease due to other opportunistic waterborne pathogens (e.g., Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas, nontuberculous mycobacteria, various species of fungi, and Naegleria).

[Federal Register Volume 82, Number 159 (Friday, August 18, 2017)]
[Notices]
[Pages 39439-39440]
From the Federal Register Online  [www.thefederalregister.org]
[FR Doc No: 2017-17491]


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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Centers for Disease Control and Prevention

[Docket No. CDC-2017-0069]


Effective Methods for Implementing Water Management Programs 
(WMPs) To Reduce Growth of Transmission of Legionella spp.

AGENCY: Centers for Disease Control and Prevention (CDC), Department of 
Health and Human Services (HHS).

ACTION: Request for information.

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SUMMARY: The Centers for Disease Control and Prevention (CDC) in the 
Department of Health and Human Services (HHS) announces the opening of 
a docket to obtain information on effective methods for achieving 
implementation of water management programs (WMPs) intended to reduce 
Legionella growth and transmission in buildings at increased risk. The 
information will inform CDC efforts to prevent Legionnaires disease in 
the United States. Information gathered should also inform CDC efforts 
to prevent disease due to other opportunistic waterborne pathogens 
(e.g., Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas, 
nontuberculous mycobacteria, various species of fungi, and Naegleria).

DATES: Written comments must be received on or before October 17, 2017.

ADDRESSES: You may submit comments, identified by Docket No. CDC-2017-
0069 by any of the following methods:
     Federal eRulemaking Portal: http://www.regulations.gov. 
Follow the instructions for submitting comments.
     Mail: Laura Cooley, National Center for Immunization and 
Respiratory Diseases, Division of Bacterial Diseases, Centers for 
Disease Control and Prevention, 1600 Clifton Road NE., MS C25, Atlanta, 
GA 30329.
    Instructions: All submissions received must include the agency name 
and Docket Number. All relevant comments received will be posted 
without change to http://regulations.gov, including any personal 
information provided. For access to the docket to read background 
documents or comments received, go to http://www.regulations.gov.

FOR FURTHER INFORMATION CONTACT:  Laura Cooley, National Center for 
Immunization and Respiratory Diseases, Division of Bacterial Diseases, 
Centers for Disease Control and Prevention, 1600 Clifton Road NE., MS 
C25, Atlanta, GA 30329. Email: [email protected]. Phone: (404) 
639-2215.

SUPPLEMENTARY INFORMATION:
    Background: CDC assists state and local health departments with 
Legionnaires disease response and prevention efforts by providing 
technical assistance and developing resources focused on preventing and 
investigating cases and outbreaks of Legionnaires disease (https://www.cdc.gov/legionella/).
    Legionnaires disease, a severe, sometimes fatal pneumonia, can 
occur in persons who inhale aerosolized droplets of water contaminated 
with the bacterium Legionella. The rate of reported cases of 
Legionnaires disease in the United States has increased more than four-
fold since 2000.\1\ Legionella and other waterborne pathogens can 
multiply in large, complex building water systems where there are gaps 
in water system maintenance; thus, the most effective strategy for 
prevention of Legionnaires disease is through control of Legionella in 
building water systems. Water management programs (WMPs) identify 
hazardous conditions and take steps to minimize the growth and spread 
of Legionella and other waterborne pathogens in building water systems. 
Developing and maintaining a water management program is a multi-step 
process that requires continuous review.
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    \1\ Garrison LE, Kunz JM, Cooley LA, et al. Vital signs: 
Deficiencies in environmental control identified in outbreaks of 
Legionnaires disease--North America, 2000-2014. MMWR Morb Mortal 
Wkly Rep 2016; 65:576-84. https://doi.org/10.15585/mmwr.mm6522e1.
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    In 2015, ASHRAE (formerly known as the American Society of Heating, 
Refrigerating, and Air-Conditioning Engineers) published a consensus 
standard for the primary prevention of Legionnaires disease,\2\ which 
calls for the development and implementation of WMPs in buildings with 
large or complex water systems and in buildings that house people who 
are particularly susceptible to Legionnaires disease. ASHRAE recommends 
WMPs for the following buildings and devices:
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    \2\ ASHRAE 188: Legionellosis: Risk Management for Building 
Water Systems June 26, 2015. ASHRAE: Atlanta. www.ashrae.org.

 Healthcare facilities where patients stay overnight
 Buildings that house or treat people who have chronic and 
acute medical problems or weakened immune systems
 Buildings that primarily house people older than 65 years 
(like a retirement home or assisted living facility)
 Buildings that have a centralized hot water system (like a 
hotel or high-rise apartment complex)
 Buildings 10 stories or more (including basement levels)
 Devices that have been linked to transmission of Legionella:
    [cir] Cooling towers
    [cir] Hot tubs (or spas) that are not drained between each use
    [cir] Decorative fountains
    [cir] Centrally-installed misters, atomizers, air washers, or 
humidifiers

    Additionally, stakeholders can use CDC's toolkit, Developing a 
Water Management Program to Reduce Legionella Growth & Spread in 
Buildings: A Practical Guide to

[[Page 39440]]

Implementing Industry Standards.\3\ This toolkit is dedicated to 
developing and implementing WMPs and can inform conversations with 
building owners and managers on how to reduce the risk of Legionella 
growth and transmission in their building water systems.
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    \3\ https://www.cdc.gov/legionella/downloads/toolkit.pdf.
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Information Needs

    While a consensus standard and guidance exist regarding development 
and implementation of WMPs, there are gaps regarding the most effective 
methods to encourage WMP implementation. A variety of stakeholders 
(e.g., public health partners, industry leaders, accreditation or 
licensing bodies) routinely work with building owners and managers on 
WMPs or on related policies. However, successful communication and 
implementation of WMPs can be challenging, and more information is 
needed on how implementation of WMPs can be improved. CDC seeks public 
comments in response to the following questions to guide best 
practices, especially regarding the dissemination and implementation of 
WMPs. The information gathered will be used to guide best practices 
regarding effective strategies to prevent Legionnaires disease in the 
United States. Information gathered can also inform efforts to prevent 
disease due to other waterborne pathogens.
    Please feel free to respond to any or all of the questions. 
Possible domains to consider in answering these questions include (but 
are not limited to):

 Local knowledge about Legionnaires disease, Legionella growth, 
and prevention strategies
 Stakeholder engagement (key supporters and opponents)
 Feasibility of WMP implementation
 Costs and benefits of WMP implementation
 Availability of effective communication strategies
 Possible impact of proposed solutions including unintended 
consequences such as degradation of plumbing infrastructure or pathogen 
substitution (e.g., remediation directed at one pathogen, such as 
Legionella, leading to increases in a second pathogen, such as 
nontuberculous mycobacteria)
 Historical context in which a WMP was or was not adopted
 Influence of local regulations

Questions

    (1) What existing standards or guidance does your organization use 
for the prevention of Legionella growth and transmission?
    (2) Are there other standards or guidance for the prevention of 
Legionella growth and transmission that you would find useful but do 
not exist or are not currently available to you? If so, what 
information should those standards or guidance contain?
    (3) What is your organization's role, and your role within the 
organization, in achieving implementation of WMPs by owners and 
managers of buildings at increased risk for Legionella growth and 
transmission?
    (4) In your organization's experience, what are the principal 
barriers to implementation of WMPs by building owners and managers?
    (5) Where there are barriers, what has your organization done to 
overcome these barriers?
    (6) Where implementation of WMPs has gone smoothly, what factors 
(e.g., resources, guidance, activities) contributed to this success?
    (7) Has your organization had experience with approaches to WMP 
implementation that are specific to certain settings (e.g., hotels, 
hospitals) or devices (e.g., cooling towers, potable water)? If so, 
have you learned anything from these different approaches that could be 
used to improve WMP implementation? Have you looked for or experienced 
any unintended consequences related to a WMP?
    (8) A limited number of jurisdictions have implemented regulations 
to reduce the risk of Legionella growth and transmission (e.g., New 
York, New York City). In your state or local jurisdiction, should 
building codes or other types of public health regulation or 
legislation be used to help prevent Legionnaires' disease? Why or why 
not?
    (9) Are there other approaches to reducing the risk of 
Legionnaires' disease that your organization has found to be useful 
besides implementation of WMPs?
    (10) What additional considerations are relevant to developing 
guidance for preventing Legionnaires disease?
    (11) Has your organization implemented specific approaches to 
reducing the risk of disease due to other opportunistic waterborne 
pathogens besides Legionella? If so, please explain. Do these 
approaches conflict in any way with your approaches to reducing the 
risk of Legionnaires disease?

    Dated: August 15, 2017.
Sandra Cashman,
Executive Secretary, Centers for Disease Control and Prevention.
 [FR Doc. 2017-17491 Filed 8-17-17; 8:45 am]
BILLING CODE 4163-18-P