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    Chapter 1: Introduction
    1.0 Introduction.
    1
    1.1 Purpose
    1
    1.2 Scope
    1
    1.3 Approaches to Preventing and Controlling Legionnaires’ Disease (Risk Assessment)
    1
    1.3.1 Industrial Hygiene Approach to Source Assessment and Prevention
    1
    1.3.2 Public Health Approach to Source Assessment and Prevention
    2
    Chapter 2: Background on Legionella
    2.0 Background on Legionella
    3
    2.1 History
    3
    2.2 Bacterium & Disease
    3
    2.3 Ecology
    3
    2.4 Epidemiology
    4
    2.5 Existing Guidance
    4
    Chapter 3: Assessing Legionella Risks
    3.0 Assessing Legionella Sources
    7
    3.1 Goal
    7
    3.1.1 Routine Assessment of Legionella Sources
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    3.1.2 Investigative Assessment of Legionella Sources
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    3.1.3 Assessment Steps
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    3.2 Inventory of Water Systems
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    3.3 Assessing Building Water Systems
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    3.3.1 Cooling Towers and Evaporative Condensers
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    3.3.2 Hot Tubs, Whirlpools and Spas
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    3.3.3 Decorative Fountains and Water Features
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    3.3.4 Humidifiers and their Associated Water Sources or Water Storage
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    3.3.5 Potable Water
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    3.3.6 Fire Suppression Sprinklers, Emergency Eyewash Stations and Safety Showers
    11
    3.3.7 Industrial Processes
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    3.4 Legionella Sampling
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    3.4.1 Developing a Sampling Strategy and Plan
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    3.4.2 Sample Collection
    12
    3.4.3 Laboratory Analysis
    13
    3.4.4 Evaluating Data Results and Interpretation
    13
    Chapter 4: Evaluating Prevention, Control, and Remediation Efforts
    4.0 Prevention, Control, and Remediation
    17
    4.1 Preventive Measures
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    4.2 Water Treatment Measures
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    4.2.1 Mechanical Cleaning
    17
    4.2.2 Thermal Treatment
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    4.2.3 Chemical Treatment
    17
    4.2.4 Biofilm Control
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    4.3 Remediation Plan
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    4.3.1 Remediation in Specific Areas of the Building Water System
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    4.3.2 Interim Measures / Water Treatment / System Modifications
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    4.3.3 Precautions
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    4.4 Verifying and Validating Remediation and Control Efforts
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    4.4.1 Verifying Remediation Procedures
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    4.4.2 Validating Long-Term Control Measures
    21
    Chapter 5: Additional Considerations
    5.0 Additional Considerations
    23
    5.1 Competent Professionals
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    5.1.1 Definition of Competent Professional
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    5.1.2 Definition of Competent Technician
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    Appendix 1 – Definitions and Acronyms
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    Appendix 2 – Water Treatment Technologies
    27
    Appendix 3 – Existing Guidance Documents
    31
    Figures and Tables
    Figures
    Figure 2.1 – Legionnaires’ Disease Chain of Causation
    4
    Tables
    Table 3.1 – Data Interpretation Guidelines
    14
    Table 3.2 – Recommended Actions
    15
    Table 3.3 – Suggested Frequencies for Sample Collection
    16

    Recognition, Evaluation, and Control of Legionella in Building Water Systems


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