The role of facility sanitation and industrial hygiene is critically important in preventing and controlling infection. It is an area that is now a strategic focus for long-term care facilities during the COVID-19 pandemic. Below are some resources to promote effective hygiene and sanitation.

Category 3 Water

(Black Water or Sewage Water)

Know the origin of your flood water so you know how to respond appropriately

General information:

  • Category 3 water is:
    • Water from beyond a plumbing trap in fixtures such as toilets, sinks or shower drains (sewage or wastewater)
    • Water that came in contact with soil such as flood water that enters a building through a door or wall (surface water runoff)
  • Category 3 water can make staff, occupants, and vendors sick.
  • Category 3 water is presumed to contain a variety of chemical contaminants (e.g., fertilizer, pesticides, etc.) and/or pathogens (feces, blood, etc.). Testing for ALL potential hazards is not practical, so the presence of hazards is presumed.
  • Disinfecting items touched by Category 3 water may not always be appropriate.
    • Many disinfectants are not effective in “killing” the entire array of potential pathogens.
    • Many of the organisms found in sewage water are toxic or allergenic even when those organisms are killed.
    • Disinfection is ineffective against chemical contaminants.

Tips and tricks to know AND hurdles to avoid:

  • Restrict access in the flood area to prevent slips and falls and to prevent tracking of contaminants.
  • For all water intrusions, identify the water source and stop the water if possible. Document the water source in writing and in photos. If flood is the result of a broken fixture, keep the broken part.
  • Porous building materials such as drywall, pressed wood cabinets/furniture, carpet, carpet pads, etc., that are wetted by Category 3 water should not be cleaned and dried, but instead should be removed and replaced.
  • Time is of the essence. The difference between drying or replacing many building materials could be a matter of hours.
  • If you need help, call a professional remediation firm and/or an industrial hygienist. The sooner you call, the faster the mitigation starts.

Photos with descriptions:

Resources to learn more:

Web links to and descriptions of relevant laws, standards, guidelines or books

Category 3 Water Fact Sheet (PDF)
Legionella and Legionnaire’s Disease

Background

In nature, Legionella bacteria live in fresh water and rarely cause illness. In man-made water environments, Legionella bacteria can grow and flourish in the right conditions if the water source is not properly maintained. These man-made water sources become a health problem when small droplets of water that contain the bacteria get into the air and people breathe them in (see example photo below from CDC CS267416-A document). Some common ways water becomes aerosolized in health care settings include: showers, humidifiers, aerators, nebulizers, spas, misting systems, cooling towers and decorative water fountains.

Prevention

Breathing GraphicIn health care settings the primary way to prevent Legionella bacteria growth is to maintain your water sources properly. Steps to maintaining your building water sources include:

  • Store hot water above 140°F with a minimum delivered temperature of 124°F. Health care settings must consider scalding issues and regulatory requirements for maximum delivered temperatures. If maintaining high temperatures is not feasible, consider periodic temperature spikes followed by flushing.
  • Cold water should be stored and distributed at 68°F or lower. This may not be feasible in hot locations such as central Arizona.
  • Evaluate water piping systems and eliminate dead legs where water may sit for prolonged periods before mixing with delivered water. For example, a drinking fountain that has been taken out of service may serve as a dead leg for water to stagnate.
  • Health care settings are notorious for low water turnover, which results in chlorine in the standing water losing its potency. Without new chlorinated water being pulled through the system, stagnation occurs. Periodically thoroughly flush all plumbing supply fixtures. Don’t forget to flush water through infrequently utilized fixtures (e.g., safety showers, eye wash stations, etc.).
  • Clean and maintain cooling tower systems regularly. Periodic physical removal of scale/slime buildup and use of a biocide are recommended.
  • Use sterile water to fill and/or clean respiratory devices (e.g., humidifiers, nebulizers, etc.). Isopropyl alcohol may also be used for cleaning and disinfecting these items followed by thorough drying.
  • Clean/disinfect on a regular basis all mechanical devices that are connected to a water source and that may be prone to the accumulation of dirt, scale or biological material. Examples include sink aerators, humidifiers, decorative fountains, shower heads, mister system heads, etc.
  • Contract a third party industrial hygiene firm to perform periodic testing within facilities to help monitor for the presence of Legionella bacteria in your water systems.
  • Develop a water management plan (WMP) to track and schedule these recurring maintenance operations. This plan should be in compliance with ANSI/ASHRAE Standard 188-2018, Legionellosis: Risk Management for Building Water Systems.

More Information

Legionella and Legionnaire’s Disease Fact Sheet (PDF)
Nuisance Birds

Nuisance birds, such as rock doves (pigeons) and starlings, can threaten human health and safety.

General information:

  • More than 60 diseases are attributed to nuisance and domestic bird and bird dropping exposure, including examples such as:
    • Bacterial: salmonellosis, listeriosis
    • Viral: encephalitis, meningitis
    • Fungal: histoplasmosis, blastomycosis
    • Protozoal: toxoplasmosis

Routes of exposure:

  • Food and water contaminated with feces
  • Inhalation of contaminated dust
  • Transference by parasites (fleas, ticks, mites and other ectoparasites)
  • Direct contact with feces

Other issues caused by droppings, feathers, carcasses and nests:

  • Roofs – Accumulations of droppings, nests and carcasses block roof drains, impede water drainage and collapse roofs.
  • Ventilation Systems – Airflow blockage by feathers and debris reduces the efficiency of mechanical systems, increasing energy costs and reducing system lifespan. Combustion exhaust vent or make up air blockage causes carbon monoxide poisoning. Ventilation systems impacted by bird debris deliver odors and pathogens throughout a building.
  • Fire Hazard – Bird nests located on top of security lights can burst into flame. Nests inside lighted signs or other electrical equipment can start fires.
  • Corrosion – Bird droppings are very acidic and degrade construction materials.

Nuisance bird reduction strategies:

An integrated pest management (IPM) strategy should be employed to ensure the least impact on human health and the environment, while achieving the desired pest control.

  • Reduce habitat opportunities
    • Structural reduction of nesting/perching sites
    • Perching deterrents (spike strips, shock strips, etc.)
    • Nesting barriers (exclusion, fencing, etc.)
    • Reduce/eliminate water/food sources
  • Scare tactics
    • Flags
    • Reflective spinners
    • Predator calls
    • Ultrasonic deterrents
  • Removal
    • Trapping
    • Extermination

Clean-up considerations:

  • Nuisance bird waste can contain bacteria, virus, fungi, and parasites. Nuisance birds are often attracted to high or precarious locations. Issues such as ladder safety, fall protection, respiratory protection and the like must be carefully considered before cleaning up messes left by nuisance birds. Please consult with a licensed pest control firm, an industrial hygienist and/or a biohazard remediation firm.

Photos with descriptions:

Resources to learn more:

Web links to and description of relevant laws, standards, guidelines or books

Nuisance Birds Fact Sheet (PDF)