It’s a battle of blurry edges…

By Steve MacArthur, Hospital Safety Consultant

Or is it one of those “sometimes you eat the bear; sometimes the bear eats you” things?

I feel like I would be remiss if I did not also include some of the stuff going on at the state and municipal levels ( ); there are a few things that are in the mix that might give you some bumps during state survey activities if you’re not familiar with the requirements (in place or pending):

Existing Regulations

Illinois (effective April 27, 2021) requires hospitals and nursing care facilities to develop a policy for Legionella testing and make the policy and test results available to the state health department upon request.

Michigan (effective Feb 21, 2020) requires health facilities to implement a water management program (WMP) per ASHRAE 188 and the CDC toolkit. The WMP must include a risk assessment, control measures, and ongoing verification. Facilities with a secondary (supplemental) domestic water treatment must register as a public water supplier and comply with the Michigan Safe Water Drinking Act.

New York State requires a maintenance program and plan for all cooling towers, including Legionella testing. Hospitals and residential health care facilities must implement a Legionella “Sampling and Management Plan” also for potable (domestic) water systems.

New York City requires cooling tower owners to implement a Maintenance Program and Plan (MPP) “that describes operational and administrative strategies and process control measures to be taken to prevent and control the growth of Legionella.” Legionella testing in cooling towers is required.

Proposed Regulations

California Senate Bill 1144 — the Safe and Efficient Water Act — would require a bunch of different items for certain buildings (it does not appear to extend to all healthcare facilities, but that may be subject to interpretation by regulatory authorities), including testing for contaminants in water systems, water features and cooling towers; a Legionella management plan; public and local health department notification for contamination events; and certification for at least one person on the water management program team.

Maryland Senate Bill 302 / House Bill 248 – Legionnaires’ Disease Prevention Act would require owners or operators of public buildings to implement a Legionella water management program that is consistent with ASHRAE Standard 188 and includes validation testing, effective Oct 1, 2022.

New Jersey Senate Bill 1006 would require public water systems to maintain a free chlorine residual of at least 0.3 ppm (mg/L) throughout the system at all times and to provide customers written notice of disruptions that could result in increased levels of Legionella bacteria. Building operators would be required to implement a Legionella water management program (WMP) per ASHRAE Standard 188.

North Carolina House Bill DRH30401-MGa-137A, the “Legionnaires’ Disease Prevention Act,” would require building owners and operators to implement a Legionella water management plan (WMP) and validation testing per ASHRAE Standard 188, by October 1, 2022. Public water system owners and operators would have to conduct routine sampling and testing for Legionella pneumophila.

Pennsylvania Senate Bill 1125, introduced March 9, 2022, would require building operators to implement a water management program per ASHRAE 188.

It does appear that folks in California may be dealing with the most complicated set of requirements, but I guess legislation can do some shapeshifting prior to final approval. That said, clearly there’s going to be a lot of eyes on the effectiveness of everyone’s water management program.

To close out this week’s missive, we should also touch on what can happen when your water systems become contaminated (it’s not just Legionella that’s a concern). Water can have an impact on operations in ways that aren’t always at the “tip of the tongue” – check it out:

About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Healthcare Safety Leader. Contact Steve at