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)
Centers for Disease Control and Prevention
Federal Register Volume 82, Issue 159 (August 18, 2017)
| Page Range | 39439-39440 | |
| FR Document | 2017-17491 |
[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] ----------------------------------------------------------------------- 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. ----------------------------------------------------------------------- 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. --------------------------------------------------------------------------- \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. --------------------------------------------------------------------------- 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: --------------------------------------------------------------------------- \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. --------------------------------------------------------------------------- \3\ https://www.cdc.gov/legionella/downloads/toolkit.pdf. --------------------------------------------------------------------------- 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
![Federal Register / Vol. 82, No. 159 / Friday, August 18, 2017 / Notices 39439
ESTIMATED ANNUALIZED BURDEN HOURS
Number of Avg. burden
Number of Total burden
Type of respondents Form name responses per per response
respondents (in hours)
respondent (in hours)
Women with recent births .................. Maternal hospital-based question- 2,990 1 25/60 1,247
naire.
Fathers with recently born infants ..... Father hospital-based questionnaire 1,790 1 15/60 448
Women with live births 2–10 months Follow-up phone questionnaire ......... 3,070 1 15/60 768
prior.
Total ............................................ ............................................................ ...................... ........................ ........................ 2,463
Leroy A. Richardson, • Mail: Laura Cooley, National Center of Legionella in building water systems.
Chief, Information Collection Review Office, for Immunization and Respiratory Water management programs (WMPs)
Office of Scientific Integrity, Office of the Diseases, Division of Bacterial Diseases, identify hazardous conditions and take
Associate Director for Science, Office of the Centers for Disease Control and steps to minimize the growth and
Director, Centers for Disease Control and Prevention, 1600 Clifton Road NE., MS spread of Legionella and other
Prevention. C25, Atlanta, GA 30329. waterborne pathogens in building water
[FR Doc. 2017–17518 Filed 8–17–17; 8:45 am] Instructions: All submissions received systems. Developing and maintaining a
BILLING CODE 4163–18–P must include the agency name and water management program is a multi-
Docket Number. All relevant comments step process that requires continuous
received will be posted without change review.
DEPARTMENT OF HEALTH AND to http://regulations.gov, including any In 2015, ASHRAE (formerly known as
HUMAN SERVICES personal information provided. For the American Society of Heating,
access to the docket to read background Refrigerating, and Air-Conditioning
Centers for Disease Control and
documents or comments received, go to Engineers) published a consensus
Prevention
http://www.regulations.gov. standard for the primary prevention of
[Docket No. CDC–2017–0069] FOR FURTHER INFORMATION CONTACT: Legionnaires disease,2 which calls for
Laura Cooley, National Center for the development and implementation of
Effective Methods for Implementing WMPs in buildings with large or
Immunization and Respiratory Diseases,
Water Management Programs (WMPs) complex water systems and in buildings
Division of Bacterial Diseases, Centers
To Reduce Growth of Transmission of that house people who are particularly
for Disease Control and Prevention,
Legionella spp. susceptible to Legionnaires disease.
1600 Clifton Road NE., MS C25, Atlanta,
AGENCY: Centers for Disease Control and GA 30329. Email: ASHRAE recommends WMPs for the
Prevention (CDC), Department of Health travellegionella@cdc.gov. Phone: (404) following buildings and devices:
and Human Services (HHS). 639–2215. • Healthcare facilities where patients
ACTION: Request for information. SUPPLEMENTARY INFORMATION: stay overnight
Background: CDC assists state and • Buildings that house or treat people
SUMMARY: The Centers for Disease local health departments with who have chronic and acute medical
Control and Prevention (CDC) in the Legionnaires disease response and problems or weakened immune
Department of Health and Human prevention efforts by providing systems
Services (HHS) announces the opening technical assistance and developing • Buildings that primarily house people
of a docket to obtain information on resources focused on preventing and older than 65 years (like a retirement
effective methods for achieving investigating cases and outbreaks of home or assisted living facility)
implementation of water management • Buildings that have a centralized hot
Legionnaires disease (https://
programs (WMPs) intended to reduce water system (like a hotel or high-rise
www.cdc.gov/legionella/).
Legionella growth and transmission in apartment complex)
Legionnaires disease, a severe, • Buildings 10 stories or more
buildings at increased risk. The sometimes fatal pneumonia, can occur
information will inform CDC efforts to (including basement levels)
in persons who inhale aerosolized • Devices that have been linked to
prevent Legionnaires disease in the droplets of water contaminated with the
United States. Information gathered transmission of Legionella:
bacterium Legionella. The rate of Æ Cooling towers
should also inform CDC efforts to reported cases of Legionnaires disease Æ Hot tubs (or spas) that are not
prevent disease due to other in the United States has increased more drained between each use
opportunistic waterborne pathogens than four-fold since 2000.1 Legionella Æ Decorative fountains
(e.g., Pseudomonas, Acinetobacter, and other waterborne pathogens can Æ Centrally-installed misters,
Burkholderia, Stenotrophomonas, multiply in large, complex building atomizers, air washers, or
nontuberculous mycobacteria, various water systems where there are gaps in humidifiers
species of fungi, and Naegleria). water system maintenance; thus, the Additionally, stakeholders can use
DATES: Written comments must be most effective strategy for prevention of
mstockstill on DSK30JT082PROD with NOTICES
CDC’s toolkit, Developing a Water
received on or before October 17, 2017. Legionnaires disease is through control Management Program to Reduce
ADDRESSES: You may submit comments,
Legionella Growth & Spread in
identified by Docket No. CDC–2017– 1 Garrison LE, Kunz JM, Cooley LA, et al. Vital
Buildings: A Practical Guide to
0069 by any of the following methods: signs: Deficiencies in environmental control
identified in outbreaks of Legionnaires disease—
• Federal eRulemaking Portal: http:// North America, 2000–2014. MMWR Morb Mortal 2 ASHRAE 188: Legionellosis: Risk Management
www.regulations.gov. Follow the Wkly Rep 2016; 65:576–84. https://doi.org/ for Building Water Systems June 26, 2015.
instructions for submitting comments. 10.15585/mmwr.mm6522e1. ASHRAE: Atlanta. www.ashrae.org.
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![39440 Federal Register / Vol. 82, No. 159 / Friday, August 18, 2017 / Notices
Implementing Industry Standards.3 This the prevention of Legionella growth and DEPARTMENT OF HEALTH AND
toolkit is dedicated to developing and transmission? HUMAN SERVICES
implementing WMPs and can inform (2) Are there other standards or
conversations with building owners and guidance for the prevention of Centers for Medicare & Medicaid
managers on how to reduce the risk of Legionella growth and transmission that Services
Legionella growth and transmission in you would find useful but do not exist [Document Identifier: CMS–10437 and CMS–
their building water systems. or are not currently available to you? If 10652]
so, what information should those
Information Needs
standards or guidance contain? Agency Information Collection
While a consensus standard and (3) What is your organization’s role, Activities: Submission for OMB
guidance exist regarding development and your role within the organization, Review; Comment Request
and implementation of WMPs, there are in achieving implementation of WMPs
gaps regarding the most effective by owners and managers of buildings at AGENCY: Centers for Medicare &
methods to encourage WMP increased risk for Legionella growth and Medicaid Services, HHS.
implementation. A variety of transmission? ACTION: Notice.
stakeholders (e.g., public health (4) In your organization’s experience,
partners, industry leaders, accreditation what are the principal barriers to SUMMARY: The Centers for Medicare &
or licensing bodies) routinely work with implementation of WMPs by building Medicaid Services (CMS) is announcing
building owners and managers on owners and managers? an opportunity for the public to
WMPs or on related policies. However, (5) Where there are barriers, what has comment on CMS’ intention to collect
successful communication and your organization done to overcome information from the public. Under the
implementation of WMPs can be these barriers? Paperwork Reduction Act of 1995
challenging, and more information is (6) Where implementation of WMPs (PRA), federal agencies are required to
needed on how implementation of has gone smoothly, what factors (e.g., publish notice in the Federal Register
WMPs can be improved. CDC seeks resources, guidance, activities) concerning each proposed collection of
public comments in response to the contributed to this success? information, including each proposed
following questions to guide best (7) Has your organization had extension or reinstatement of an existing
practices, especially regarding the experience with approaches to WMP collection of information, and to allow
dissemination and implementation of implementation that are specific to a second opportunity for public
WMPs. The information gathered will certain settings (e.g., hotels, hospitals) comment on the notice. Interested
be used to guide best practices regarding or devices (e.g., cooling towers, potable persons are invited to send comments
effective strategies to prevent water)? If so, have you learned anything regarding the burden estimate or any
Legionnaires disease in the United from these different approaches that other aspect of this collection of
States. Information gathered can also could be used to improve WMP information, including the necessity and
inform efforts to prevent disease due to implementation? Have you looked for or utility of the proposed information
other waterborne pathogens. experienced any unintended collection for the proper performance of
Please feel free to respond to any or consequences related to a WMP? the agency’s functions, the accuracy of
all of the questions. Possible domains to (8) A limited number of jurisdictions the estimated burden, ways to enhance
consider in answering these questions have implemented regulations to reduce the quality, utility, and clarity of the
include (but are not limited to): the risk of Legionella growth and information to be collected, and the use
of automated collection techniques or
• Local knowledge about Legionnaires transmission (e.g., New York, New York
City). In your state or local jurisdiction, other forms of information technology to
disease, Legionella growth, and
should building codes or other types of minimize the information collection
prevention strategies
• Stakeholder engagement (key public health regulation or legislation be burden.
supporters and opponents) used to help prevent Legionnaires’ DATES:Comments on the collection(s) of
• Feasibility of WMP implementation disease? Why or why not? information must be received by the
• Costs and benefits of WMP (9) Are there other approaches to OMB desk officer by September 18,
implementation reducing the risk of Legionnaires’ 2017.
• Availability of effective disease that your organization has found
to be useful besides implementation of ADDRESSES: When commenting on the
communication strategies
proposed information collections,
• Possible impact of proposed solutions WMPs?
(10) What additional considerations please reference the document identifier
including unintended consequences
are relevant to developing guidance for or OMB control number. To be assured
such as degradation of plumbing
preventing Legionnaires disease? consideration, comments and
infrastructure or pathogen
(11) Has your organization recommendations must be received by
substitution (e.g., remediation
implemented specific approaches to the OMB desk officer via one of the
directed at one pathogen, such as
reducing the risk of disease due to other following transmissions: OMB, Office of
Legionella, leading to increases in a
opportunistic waterborne pathogens Information and Regulatory Affairs,
second pathogen, such as
besides Legionella? If so, please explain. Attention: CMS Desk Officer, Fax
nontuberculous mycobacteria)
• Historical context in which a WMP Do these approaches conflict in any way Number: (202) 395–5806 OR, Email:
was or was not adopted with your approaches to reducing the OIRA_submission@omb.eop.gov.
• Influence of local regulations To obtain copies of a supporting
mstockstill on DSK30JT082PROD with NOTICES
risk of Legionnaires disease?
statement and any related forms for the
Questions Dated: August 15, 2017. proposed collection(s) summarized in
Sandra Cashman, this notice, you may make your request
(1) What existing standards or
guidance does your organization use for Executive Secretary, Centers for Disease using one of following:
Control and Prevention. 1. Access CMS’ Web site address at
3 https://www.cdc.gov/legionella/downloads/ [FR Doc. 2017–17491 Filed 8–17–17; 8:45 am] http://www.cms.hhs.gov/
toolkit.pdf. BILLING CODE 4163–18–P PaperworkReductionActof1995.
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Document Created: 2017-08-18 07:41:03
Document Modified: 2017-08-18 07:41:03
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Request for information. | |
| Dates | Written comments must be received on or before October 17, 2017. | |
| 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. | |
| FR Citation | 82 FR 39439 |
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