121 Transcript

121 Another One with Dr. Janet Stout Part 2


Transcript Disclaimer: This Transcript is provided and copied from YouTube, grammar and mistakes are present.


0:00.0

0:07.0
Scaling UP! Nation I am so excited that
the rising tide mastermind has started
0:07.0

0:13.6
and it is a huge success being a water
treater is a difficult job and it’s so
0:13.6

0:17.4
much more difficult when you are by
yourself
0:17.4

0:23.0
there’s one thing that we all know for
sure doing life by ourselves is not
0:23.0

0:28.2
something easy to do and folks were not
designed to do it that way having a
0:28.2

0:34.7
trusted group of advisers that you can
share ideas and issues with is key for
0:34.7

0:41.5
successful people to become more
successful I urge you to look into seen
0:41.5

0:46.8
if the rising tide master mind is right
for you the rising tide mastermind
0:46.8

0:52.9
includes weekly video calls with your
group of like-minded peers a quarterly
0:52.9

1:00.9
book discussion one to ones with me a
live event and so much more folks go to
1:00.9

1:08.0
https://scalinguph2o.com/mastermind to see if this exciting group
1:08.0

1:20.3
is right for you
1:20.3

1:25.1
welcome to Scaling UP! h2o the podcast
where we’re Scaling UP! on knowledge so
1:25.1

1:30.1
we don’t Scale UP! our systems
hello Scaling UP! Nation Trace Blackmore
1:30.1

1:36.1
here your host for the water treaters
favorite podcast Scaling UP!p h2o and
1:36.1

1:43.1
folks happy new year can you believe
it’s 2020 and how many of us have
1:43.1

1:48.2
already broken our new year’s
resolutions that’s just how it goes and
1:48.2

1:54.4
the reason for that is I don’t think
people put a lot of thought into their
1:54.4

2:01.1
new year’s resolutions they just simply
say that I’m going to quit X and most of
2:01.1

2:07.0
us think that way well I read something
not too terribly long ago that says the
2:07.0

2:13.6
brain cannot process the word not so you
have to think in a positive mindset now
2:13.6

2:17.4
folks I don’t know if this is true or
not but if you are like me I will take
2:17.4

2:23.5
any advantage that I can get so rather
than saying I’m going to stop eating
2:23.5

2:29.0
poorly I would then tell my brain that
I’m going to start eating nutritious
2:29.0

2:33.7
meals that will ultimately lead to
weight loss or being more healthy or I’m
2:33.7

2:38.5
going to be more healthy instead of
somebody saying I want to stop being so
2:38.5

2:44.5
sick this year again I don’t know if
that stuff works but I think we can take
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2:50.0
every little bit of advantage that we
can the other reason that I think that
2:50.0

2:55.4
resolutions fail is no planning puts in
to them the last couple of shows we
2:55.4

3:02.0
talked about planning and folks if you
do not plan to succeed on whatever your
3:02.0

3:08.2
goal is you are planning to fail so a
lack of plan is a plan to fail I know
3:08.2

3:13.9
you’ve heard that before but it’s so
true when you can think of your plan and
3:13.9

3:17.9
then know where you are because you’ve
assigned metrics to it and you can look
3:17.9

3:22.4
at where you’re supposed to be each and
every week that’s when things are going
3:22.4

3:27.2
to get done now I’ve talked a lot about
goal planning in the last couple of
3:27.2

3:31.6
episodes because year end and your
beginning that’s when most people do
3:31.6

3:34.8
that well now
it’s up to you you need to go out there
3:34.8

3:39.6
you need to make that stuff happen so I
hope some of the things that you’ve
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3:43.7
learned in the last few episodes have
helped you with that
3:43.7

3:49.5
I know learning them have helped me so
let’s talk about some things that are
3:49.5

3:55.4
coming up very shortly nation as you
know I am an advocate for the
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3:59.8
Association of Water Technologies and I
want to let you know about a couple of
3:59.8

4:05.3
things that the AWT has coming up for
you so you can get these items on your
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4:11.1
calendar the first one is the AWT
business owners meeting folks this is
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4:15.7
where business owners come together to
share ideas they’re going to be having
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4:20.4
the business owners meeting February
10th and 11 at the Hyatt Regency
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4:27.1
Clearwater resort in Clearwater Florida
folks Florida in February why wouldn’t
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4:32.2
you want to go there you can find out
more by going to AWT org forward slash
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4:36.8
business meeting
20 and of course the other item that I
4:36.8

4:43.8
want to bring to your attention is one
of my favorite events each and every
4:43.8

4:50.6
year it is the AWT training seminars
we’re going to be at the Hyatt Regency
4:50.6

4:58.0
Lake Washington Resort in Seattle
Washington February 26 through 29th
4:58.0

5:05.6
folks this is where you can go to bone
up on water treatment knowledge I cannot
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5:11.6
think of another place that is so
comprehensive with all of the
5:11.6

5:17.4
information that we talked about at the
AWT training seminars now you have a
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5:21.3
second shot to do that on the East Coast
that’s going to be at the Cleveland
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5:27.2
Marriott downtown hotel in Cleveland
Ohio and that will be on March 18th
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5:34.4
through 21st if you want to find out
more information about the AWT 2020
5:34.4

5:40.5
training seminars go to the AWT website
to find out more
5:40.5

5:47.4
nation it has been a while since we last
heard from my next guest she was one of
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5:52.8
my original guests when I started
Scaling UP! h2o and her episode has been
5:52.8

6:01.7
one of my most listened to episodes in
my podcast library I know that the water
6:01.7

6:08.2
treatment community is very confused
about Legionella so I have once again
6:08.2

6:14.2
asked Janet’s style of special pathogens
laboratory to come back and talk with
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6:20.9
the Scaling UP! Nation so we can learn
even more about Legionella so Scaling UP!
6:20.9

6:27.4
Nation please help me welcome Janet
style Scaling UP! Nation I am so excited
6:27.4

6:34.1
today we have a returning guest we have
none other than Legionella expert Janet
6:34.1

6:39.3
stout Janet how the heck are you I’m
great and it’s just wonderful to be with
6:39.3

6:45.4
you and Scaling UP! Nation well we are
lucky and fortunate to have you I love
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6:48.4
talking with you in fact you were one of
my first guests
6:48.4

6:53.0
episode 9 can you believe that yes I
can’t believe two years has gone by I
6:53.0

7:00.5
believe your episode aired July 2nd of
2017 so it has been well over 2 years
7:00.5

7:07.1
when are you up to 95 or more episodes
now so here’s the deal so now you’ve
7:07.1

7:11.3
dated the episode because I pre record
the episodes so thank you for letting
7:11.3

7:15.1
that secret out of the bag but no it’s
fine you did we are recording this right
7:15.1

7:20.3
at 95 but I am getting ready to
celebrate episode 100 and you were
7:20.3

7:24.6
probably going to be released after that
because we do pre record our episodes so
7:24.6

7:29.8
when you go out you might be 105 or 110
or something like that so how about that
7:29.8

7:34.4
oh it’s very exciting to be part of such
a wonderful service to the water
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7:39.2
treatment community well I appreciate
that and I think today’s episode is
7:39.2

7:43.6
going to be a service to the water
treatment community we’ve done several
7:43.6

7:47.6
shows on Legionella I think you’ve done
a couple of talks on your own about
7:47.6

7:53.4
Legionella but still the water treatment
community heck the entire community
7:53.4

7:58.5
is confused when it comes to Legionella
so I’m hoping we can clear a few of
7:58.5

8:03.5
those items up today nobody better to do
it than you and me I am up for the
8:03.5

8:09.0
challenge and I know you are too so I
gotta ask what sense we got together on
8:09.0

8:17.1
July 2nd 2017 what’s new with Legionella
since then well I wish I wish I could
8:17.1

8:23.8
tell you that we have solved this
problem but we we haven’t yet so that I
8:23.8

8:29.6
guess that’s job security for you and me
but the the issue is really not so much
8:29.6

8:35.3
what’s new but what remains to be a
continuing problem we week after week
8:35.3

8:39.4
after week hear about outbreaks of
Legionnaires disease throughout our
8:39.4

8:44.9
communities which just tells us that our
work is not done and so this opportunity
8:44.9

8:51.4
to talk to your audience and and how
partner together to prevent Legionnaires
8:51.4

8:56.6
disease and in fact it’s special
pathogens laboratory we are seeking to
8:56.6

9:02.9
end Legionnaires disease and we can do
that with the help of your audience and
9:02.9

9:09.1
others well I look forward to that end
and I love this show title that you came
9:09.1

9:14.8
up with you said to please call this one
the one about Legionella prevention
9:14.8

9:19.6
beginning with the end in mind I love
that I’m such a seven Habits fan that’s
9:19.6

9:24.3
habit two and that’s what we’re doing
we’re ending Legionella and that’s the
9:24.3

9:30.2
beginning that we have in mind yes and
Stephen Covey the author of 7 habits of
9:30.2

9:34.8
highly effective people probably never
thought this iconic phrase would be used
9:34.8

9:39.2
to describe a public health problem like
Legionnaires disease but that’s what I
9:39.2

9:43.6
mean with the extent to which you begin
with the end in mind he said often
9:43.6

9:47.8
determines whether or not you’re able to
create a successful enterprise or
9:47.8

9:53.5
outcome so when we say end Legionnaires
disease and that’s our mission we know
9:53.5

9:58.3
that it’s possible and that’s the end we
have in mind and when we’re done with
9:58.3

10:02.4
our podcast today everyone will
understand how we can and Legionnaires
10:02.4

10:07.3
disease together yeah I’m pretty sure I
can speak for a lot of people that
10:07.3

10:12.2
they’re listening to the show they’re
scared they don’t want to test for it
10:12.2

10:17.0
because oh my goodness what happens if I
find it so maybe it’s just better that I
10:17.0

10:21.9
keep the blinders on there’s so many
misconceptions about LD about
10:21.9

10:27.1
Legionnaires disease I know we’re going
to do some good today I know we are too
10:27.1

10:32.1
and this is the value that you bring
Trace it’s fantastic well it’s because
10:32.1

10:36.2
of great guests like you and now we’ve
said how awesome each other are so we
10:36.2

10:42.9
can move so I’m just thinking that who
doesn’t know who Janet stout is I just
10:42.9

10:47.7
can’t imagine that but I’m sure there’s
maybe one or two people out there in the
10:47.7

10:51.7
Scaling UP! Nation so can you tell us a
little bit about yourself and what you
10:51.7

10:56.3
do my pleasure
so I’m a microbiologist trained in
10:56.3

11:01.6
infectious diseases who has spent more
than 30 years studying Legionella all
11:01.6

11:06.1
aspects of it prevention detection and
control treatment and so what I always
11:06.1

11:11.3
say is when an infectious disease
microbiologist studies Legionella for
11:11.3

11:16.1
all that time I’m not just a
microbiologist I’m a legion L ologist
11:16.1

11:20.6
and I’m probably the only Legionella
ologist you and your your audience will
11:20.6

11:26.5
ever meet and it’s been my pleasure to
really go across the globe not just the
11:26.5

11:30.3
United States but all over the world
talking about preventing this deadly
11:30.3

11:36.0
disease and that’s my mission and I hope
at the end of our podcast today people
11:36.0

11:41.2
have learned a lot I have no doubt that
they will and let’s just start there so
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11:47.7
what does every body need to know about
Legionnaires disease well I think the
11:47.7

11:51.4
the two most important things that
people need to understand about this
11:51.4

11:56.6
form of bacterial pneumonia so
Legionella is a bacteria and for many
11:56.6

11:59.9
years at the beginning of the Legionella
story you know shortly after it was
11:59.9

12:05.1
discovered in 1976 the focus was on
cooling towers and in the presence of
12:05.1

12:09.7
this bacteria in the drifts from cooling
towers and people being infected through
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12:15.7
inhalation of that drift or mist well
what we showed back in the 1980s and has
12:15.7

12:18.0
been shown over and over and over again
is
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12:22.7
that it’s in the water distribution
system of the hospital or the building
12:22.7

12:28.1
is the primary cause or source of
Legionnaires disease so this bacteria is
12:28.1

12:33.9
a normal inhabitant of natural waters
like streams and lakes and then it goes
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12:37.7
through the water treatment plant it’s
not completely killed because it has a
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12:42.2
higher tolerance for chlorine comes into
our buildings and when you turn on the
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12:48.2
faucet or the shower just some people
not everyone have high risk for getting
12:48.2

12:52.9
Legionnaires disease which is a very
severe form of pneumonia very very high
12:52.9

12:59.2
fever dry cough often very difficult to
diagnose because the physician treating
12:59.2

13:03.8
you doesn’t think about Legionella
because it’s fairly rare only about two
13:03.8

13:07.6
to five percent of the pneumonias that
occur in the and the community are
13:07.6

13:12.6
caused by Legionella so a combination of
it being in in the water
13:12.6

13:17.0
physicians missing the diagnosis
contributes to the fact that it’s very
13:17.0

13:22.5
deadly so if you get it in the community
15 percent of the time you will die from
13:22.5

13:26.6
that pneumonia caused by Legionella but
if you get it while you’re in the
13:26.6

13:30.3
hospital for something else which is
called hospital-acquired pneumonia
13:30.3

13:36.8
Legionnaires disease the risk of death
is as high as 30% so it’s really all
13:36.8

13:43.5
about preventing this deadly infection
why is the leap so great when you get it
13:43.5

13:48.3
in a hospital well people in hospitals
have things done to them you know they
13:48.3

13:52.4
have tubes put in them sometimes those
tubes get rinsed in tap water that has
13:52.4

13:57.1
Legionella the reason that you’re in the
hospital is you have something going on
13:57.1

14:01.8
so you have some conditions some health
conditions and over the years these
14:01.8

14:06.7
conditions that are called risk factors
have been linked to the increased chance
14:06.7

14:10.5
of becoming infected if you’re exposed
so the important thing people are
14:10.5

14:14.7
exposed to Legionella bacteria all the
time but a small percentage that have
14:14.7

14:21.9
chronic lung disease or on high-dose
steroids have cancer my the highest risk
14:21.9

14:26.3
group is transplant patients that they
are receiving treatment that suppresses
14:26.3

14:31.1
their immune system one thing that this
calls to mind in my mind that many of
14:31.1

14:35.3
your listeners
relate to is the idea that devices get
14:35.3

14:39.7
rinsed in tap water that has Legionella
and one of the devices it’s very
14:39.7

14:45.3
commonly used is called a CPAP device
which is you know pressurized air going
14:45.3

14:48.8
down your airway and there’s actually
documented cases of Legionnaires disease
14:48.8

14:53.7
from rinsing those devices and tap water
so the first pearl for the listeners
14:53.7

14:58.6
today is don’t rinse your CPAP devices
and tap water you may get Legionnaires
14:58.6

15:03.3
disease wow that’s something I’ve never
even considered I guess people will use
15:03.3

15:07.7
that if they have sleep apnea yes well
there you go your first public service
15:07.7

15:12.8
announcement on Scaling UP! h2o today so
what should every water treater know so
15:12.8

15:17.6
they can properly inform their customers
about Legionnaires disease well one of
15:17.6

15:24.3
the things that we have said for decades
is basically condensed into three words
15:24.3

15:30.9
tests to protect so you have to test for
Legionella in water distribution systems
15:30.9

15:35.2
and buildings and in cooling towers in
order to know whether or not there’s
15:35.2

15:40.7
risk so might surprise people listening
that only about half of the buildings
15:40.7

15:45.2
even hospitals that are tested have
Legionella in them it’s not everywhere
15:45.2

15:50.5
it’s not ubiquitous and the same is true
for our cooling towers about 30 percent
15:50.5

15:55.2
or less of the cooling tower samples
that we culture for Legionella here in
15:55.2

15:59.3
the laboratory are positive so the first
thing you need to know in order to
15:59.3

16:03.4
assess risk and this is what you’re
telling your clients is you have to test
16:03.4

16:08.0
for Legionella and you don’t have to be
afraid of the result and one of the
16:08.0

16:13.3
things that that we want to make sure
people understand is that there’s very
16:13.3

16:18.8
simple ways to manage the presence of
Legionella and that thereby reduce the
16:18.8

16:22.9
risk of disease transmission but you
can’t control that risk if you don’t
16:22.9

16:28.3
know it’s there so that’s the keystone
to prevention so many people out there
16:28.3

16:33.4
are scared to test because they might
find a positive and that leads me to
16:33.4

16:37.1
believe that they think that absolute
zero
16:37.1

16:44.2
Legionella detection is what the goal is
no it’s not it’s sort of what people
16:44.2

16:48.7
would like right
people serve leg it to be either black
16:48.7

16:53.4
or white it’s either there or it’s not
and that means that if it’s there
16:53.4

16:58.1
there’s a risk and if it’s not there
then there’s no risk and certainly you
16:58.1

17:04.4
know if we could get to zero Legionella
in our water distribution systems and
17:04.4

17:10.1
cooling towers that would certainly be
the goal but as I said before it’s a
17:10.1

17:15.6
naturally occurring organism so it’s in
our water and when it’s present not
17:15.6

17:21.6
always present then we we test for it we
find out how to manage it and and so
17:21.6

17:26.9
that I think the the the issue is
education and communication I think the
17:26.9

17:32.1
role of the water treatment professional
is to help their clients understand that
17:32.1

17:37.0
this is really necessary both for the
protection of the building occupants and
17:37.0

17:42.2
patients of your healthcare facility but
also for the institution or the building
17:42.2

17:48.0
itself its reputation and also it
protects the individual doing the
17:48.0

17:52.5
testing because they are demonstrating
proper due diligence and to avoid
17:52.5

17:58.1
something that is so well documented
really almost borders on negligence in
17:58.1

18:03.7
my opinion I’ve heard you say and Bill
Pearson say that really the goal is to
18:03.7

18:08.7
take the negligence off the table so
we’re doing a due diligent program yes
18:08.7

18:13.4
and and I think one of the one of the
things I think about when I try to put
18:13.4

18:17.2
myself in the shoes of the water
treatment professional is I ask myself
18:17.2

18:23.9
knowing that Legionella is a very it’s a
very litigious situation a lot of
18:23.9

18:29.4
lawsuits when Legionnaires disease is
detected and what you want to do is you
18:29.4

18:35.8
want to be responsible guide the client
to the right information but you have to
18:35.8

18:41.2
ask yourself at what point do I stop do
I say this is the limit of my expertise
18:41.2

18:46.7
as a water treatment professional and do
I want to step over that line into being
18:46.7

18:51.8
more of an advisor or a consultant when
it comes to Legionella prevention and
18:51.8

18:56.1
there are ways to do that responsibly
but I think it’s an important decision
18:56.1

19:01.2
that your audience needs to ask them
earlier you made a statement that I
19:01.2

19:04.7
think everybody listening has heard at
one time or another
19:04.7

19:10.8
Legionella is Ubiquiti where did that
come from and why do we continue to say
19:10.8

19:17.4
that that’s a great question and I have
to say we are to blame for this and and
19:17.4

19:23.2
it it was totally an unintentional thing
so back in 1982 as I mentioned when we
19:23.2

19:28.7
first made the link of Legionella
exposure from water when you when the
19:28.7

19:32.6
patients in the hospital turned on the
faucets and the showers we published in
19:32.6

19:37.1
the New England Journal of Medicine an
article describing this finding and it
19:37.1

19:40.6
was a paradigm shifting discovery
because everybody was focused on cooling
19:40.6

19:45.3
towers and blaming cooling towers for
all of our Legionella problems so this
19:45.3

19:51.7
comes out and the title of that article
was the ubiquitousness of Legionella in
19:51.7

19:56.7
a hospital with Legionnaires disease
endemic Legionnaires disease mean it was
19:56.7

20:01.2
going on all the time people didn’t know
it and when I went around with the
20:01.2

20:07.1
plumber his name is Lou Tedesco he and I
arm in arm– Florida floor sink to
20:07.1

20:11.7
saying he’s got a sawzall or cutting the
pipes and I’m finding Legionella
20:11.7

20:17.5
virtually in every part of the hospital
so in that hospital Legionella was
20:17.5

20:21.9
virtually everywhere and it was causing
an outbreak of Legionnaires disease in
20:21.9

20:26.0
our patients
so it was ubiquitous there but what
20:26.0

20:31.2
people did with that word is they
misused it since then they say
20:31.2

20:36.4
Legionella is everywhere meaning every
building every cooling tower and they
20:36.4

20:41.4
use it as an excuse not to test religion
Ella and not to deal with the issue of
20:41.4

20:46.3
prevention of this disease and so it’s
kind of been one of my missions is to
20:46.3

20:52.7
dispel that myth it’s a myth that
Legionella is everywhere we at special
20:52.7

20:56.7
pathogens laboratory are all about
science and evidence-based
20:56.7

21:01.5
recommendations all the recommendations
we give and all the methods we use are
21:01.5

21:06.4
evidence-based so the data does not
support that Legionella is everywhere
21:06.4

21:11.3
the answer to your question is why do we
still here it is it’s a convenient
21:11.3

21:16.6
excuse and it’s not accurate and it’s
untrue and I really hope that after
21:16.6

21:22.7
today we dispel that myth for the last
time I have definitely heard firsthand
21:22.7

21:27.8
people tell me it’s all around us
so why test for it so I’m right there
21:27.8

21:32.1
with you right and and you know this is
the one of the roles of the water
21:32.1

21:37.6
treatment professional is to in effect
not let people get away with that
21:37.6

21:41.9
you can say you know I can understand
why you may think that but let me share
21:41.9

21:45.3
with you what the data shows it’s
actually not true
21:45.3

21:50.3
you know 56 percent of the cases
investigated and outbreaks by the CDC
21:50.3

21:54.4
we’re linked to potable water not
cooling towers only half of the
21:54.4

21:58.1
buildings are positive less than 30
percent of cooling towers are positive
21:58.1

22:01.7
and it’s important for people to
understand that testing for Legionella
22:01.7

22:07.6
is not a we’re not assessing a health
risk we’re assessing the performance of
22:07.6

22:12.8
the water treatment program as important
feedback to make adjustments in that
22:12.8

22:17.4
program and so if you don’t have that
piece of information you don’t know if
22:17.4

22:23.9
the combination of oxidizing biocides
and non oxidizing biocides and and
22:23.9

22:28.6
dispersants is actually controlling
Legionella and and that happens all the
22:28.6

22:34.3
time and in the absence of testing for
Legionella you are not able to make the
22:34.3

22:38.4
adjustments to the program that are
necessary to make the operation of those
22:38.4

22:43.2
water systems safer Jen you just
mentioned that there are more cases
22:43.2

22:48.5
reported from potable water than the
cooling tower but the cooling tower is
22:48.5

22:52.7
always where we look for it first it’s
always what gets the press why is that
22:52.7

22:55.7
well this there’s probably two reasons
for that
22:55.7

23:00.7
one is that when it’s a cooling tower or
a utility water system not drinking
23:00.7

23:06.8
water you have more freedom to put
chemicals in there to disinfect and
23:06.8

23:11.7
control the microbial populations like
Legionella so you can put more bromine
23:11.7

23:15.8
in there and you can put more
glutaraldehyde or I saw thiazole in but
23:15.8

23:20.0
when it comes to potable water systems
the hot water distribution system you’re
23:20.0

23:23.8
more limited in what you can do it
becomes more difficult a little bit more
23:23.8

23:29.2
applicated and so for that reason you
know people focus on cooling towers and
23:29.2

23:35.0
then the other reason I think is that
Legionnaires disease is going on
23:35.0

23:40.5
throughout our communities and many of
the cases are not detected not diagnosed
23:40.5

23:46.0
but most of them are associated with
potable water and the way that those
23:46.0

23:51.7
cases occur is sort of one here one
there and there’s never a link to one
23:51.7

23:57.1
source but when a outbreak associated
with a cooling tower happens it’s a very
23:57.1

24:03.7
explosive event lots of cases in a short
period of time associated with one
24:03.7

24:08.4
location gets a lot of press and so we
hear a lot about cooling tower
24:08.4

24:14.5
associated outbreaks like the one in the
Bronx in the summer of 2015 138 cases
24:14.5

24:19.2
and I think it was 16 deaths but most of
the cases of Legionnaires disease that
24:19.2

24:23.6
are occurring in the United States and
around the world are associated with the
24:23.6

24:27.7
building water distribution systems and
particularly the warm water systems
24:27.7

24:33.4
you’ve probably already answered my next
question but according to you what is
24:33.4

24:38.4
the biggest misconception about
Legionnaires disease the biggest
24:38.4

24:43.4
misconception about Legionnaires disease
you know I think when I consider that
24:43.4

24:49.9
question I think people say well it’s
it’s not happening I’ve never heard of a
24:49.9

24:55.3
case of Legionnaires disease it’s not a
problem and in health care we often hear
24:55.3

25:01.5
you know we’ve got all these other
infections going on Mirza and
25:01.5

25:06.1
Clostridium difficile and there’s many
many more cases well people don’t
25:06.1

25:10.2
realize how many cases of Legionnaires
disease are actually occurring
25:10.2

25:17.1
so the minimum estimate and I emphasize
the word minimum is 30,000 cases per
25:17.1

25:21.9
year and that’s based on about 600,000
cases of pneumonia requiring
25:21.9

25:26.1
hospitalization occurring every year and
about five percent of those being
25:26.1

25:31.5
Legionnaires disease but there are many
many more cases that occur than are
25:31.5

25:36.0
recognized and and we talked about that
earlier the the fact that the physician
25:36.0

25:40.4
is not thinking about it
or during the diagnostic tests and and
25:40.4

25:44.1
then the other misconception about
Legionnaires disease is that it’s just
25:44.1

25:49.6
this one event Legionnaires disease
isn’t a pneumonia you get treated you
25:49.6

25:53.9
get better or not and then you go on
with your life and one of the things
25:53.9

25:58.9
that has come out over time as
physicians follow patients that have had
25:58.9

26:04.1
Legionnaires disease is that they have
problems with breathing for long periods
26:04.1

26:09.8
of time after the initial infection and
sometimes that goes on for more than a
26:09.8

26:14.2
year after the initial infection so it’s
a serious infection it’s a deadly
26:14.2

26:18.7
infection and because my glass half-full
person trays it’s a preventable
26:18.7

26:23.1
infection and we can do more to prevent
this infection and I think we’re going
26:23.1

26:28.0
to talk of what we can do more as we
continue this interview it’s not that
26:28.0

26:33.1
hard really well let me ask you this so
fill in the blank a Legionella test
26:33.1

26:38.5
result without an action plan is you
know when you say that what I really
26:38.5

26:44.2
want to do is sort of turn it around
okay what you really want to do is have
26:44.2

26:50.2
a Legionella test result and the plan
because when you have a plan without
26:50.2

26:57.0
Legionella testing I’ll say something
very radical it’s meaningless because
26:57.0

27:04.3
even if you follow what’s in the ASHRAE
standard 188 document in my opinion you
27:04.3

27:10.1
will not prevent Legionnaires disease
because that standard does not say test
27:10.1

27:15.1
for Legionella it gives you some options
to test but it doesn’t say test for
27:15.1

27:20.6
Legionella and you cannot prevent this
disease without knowing whether
27:20.6

27:26.7
Legionella is present or not right I
mean it’s common sense and what I really
27:26.7

27:33.5
have a hard time understanding is why
people keep avoiding that key element of
27:33.5

27:38.8
your water management plan you don’t
want to not test for Legionella as part
27:38.8

27:43.6
of your water management plan if and
here’s an important if Trace if you
27:43.6

27:48.9
really want to do something to prevent
this disease if all you want to do is
27:48.9

27:53.7
check a box
written the plan then it doesn’t matter
27:53.7

27:57.8
but of course you’re talking to the
person that wants to end Legionnaires
27:57.8

28:04.2
disease so that plan should actually do
something towards that end so you really
28:04.2

28:09.8
want to be testing for Legionella so a
test result without a plan it should be
28:09.8

28:16.0
a plan without a test result is really
meaningless one of the comments that I
28:16.0

28:20.8
get from several of my listeners is they
do try to talk to their customers about
28:20.8

28:25.6
Legionella we have to do something to
take negligence off the table and they
28:25.6

28:28.8
say fine just test for Legionella well
if we test for something and we don’t
28:28.8

28:32.6
know what we’re going to do if we find
it or when we find it what do we do then
28:32.6

28:36.7
so we need to figure out now what we’re
going to do before we test and they say
28:36.7

28:40.7
no no we just want to test and hopefully
we’ll find zero what advice do you have
28:40.7

28:45.6
for them and what should they be saying
to their customers you want to have a
28:45.6

28:51.8
plan to deal with whatever the result is
of the testing that you perform so for
28:51.8

28:58.6
example it’s a health care facility and
it’s somewhere around 200 beds and if
28:58.6

29:02.2
it’s in New York State the
recommendation is a minimum of ten
29:02.2

29:08.7
outlets plus a hot water tank and you’re
looking to see whether or not more than
29:08.7

29:12.9
three out of those ten or more than 30%
of the faucets or showers that you’ve
29:12.9

29:19.7
tested are positive and if it is then
you need to have a plan for what to do
29:19.7

29:24.1
in response to that so this kind of
speaks to a couple of different issues
29:24.1

29:31.0
one is the laboratory partner that you
have can help you interpret what those
29:31.0

29:34.9
results mean and if it’s if it’s special
pathogens one of the things I always say
29:34.9

29:40.7
to water treaters is I’m happy to get on
a call with you and your client and talk
29:40.7

29:44.8
about what the meaning is of these
results and it gets complicated because
29:44.8

29:49.8
what kind of Legionella is it how
extensive is the positivity what is the
29:49.8

29:53.9
relationship to disease risk these are
all things that I’ve sort of spent my
29:53.9

29:59.4
entire life developing a foundation for
prevention around and that goes back a
29:59.4

30:03.8
long way and so I think that it is
important to have this
30:03.8

30:09.3
discussion with the client that what are
the action steps in response and luckily
30:09.3

30:18.7
in 2019 we have the ASHRAE standard 188
we have CMS we have a WT we have CTI we
30:18.7

30:25.8
have a body of documents that we can
point the client to and say here are
30:25.8

30:30.9
some examples that we can draw from in
terms of response I really like the New
30:30.9

30:37.4
York state public health regulation for
healthcare because it follows our 30%
30:37.4

30:42.9
metric for assessing when the risk is
increasing for healthcare patients what
30:42.9

30:47.2
got incorporated into the New York City
guidance document is based on an
30:47.2

30:52.2
Australian New Zealand standard which
has logarithmic changes you know tenfold
30:52.2

30:57.6
changes and Legionella concentration and
your cooling tower water and steps what
30:57.6

31:02.1
to do in response to those positive
results so I think if you have a client
31:02.1

31:06.4
and you have that kind of conversation
with that client about how you can help
31:06.4

31:12.4
them get good information from experts
on how to to manage that situation
31:12.4

31:17.7
should it occur then I’d say probably
nine times out of ten they would be
31:17.7

31:23.4
positively responsive to that guidance
and so this also sort of speaks to when
31:23.4

31:29.0
the water treatment provider provides
guidance to their client directs them to
31:29.0

31:35.7
information and that’s an added service
that’s really important and I don’t know
31:35.7

31:39.6
if you’ve ever heard this Trace but
sometimes you have clients that you want
31:39.6

31:44.5
to donate to your competition
surely not and if after all of that
31:44.5

31:49.4
discussion where you’re really trying to
help them both in terms of a public
31:49.4

31:53.7
safety issue or a patient’s safety issue
but also for their own good they
31:53.7

31:57.8
continue to reject that some water
treatment professionals have those
31:57.8

32:05.4
clients sign I’ve been been made aware
of the offer you know for testing for
32:05.4

32:10.7
Legionella and I respectfully decline
and they sign their name and the date
32:10.7

32:15.0
and that’s I thought was a brilliant
thing to incorporate into that
32:15.0

32:20.6
relationship for two reasons it protects
the water treatment professional it
32:20.6

32:24.5
documents that you’ve provided this
information and this option to your
32:24.5

32:29.5
client and provides documentation that
they’ve refused because as I said
32:29.5

32:34.6
earlier Legionella cases get litigated
more often than many other infections I
32:34.6

32:39.7
get calls every week from lawyers right
and so you have to protect yourself from
32:39.7

32:44.3
that risk and then it also puts that
client kind of going well this is
32:44.3

32:48.4
probably a little more serious than I
thought and maybe I should do it
32:48.4

32:52.9
and and you want to preach the you know
don’t be the Pennywise and pound-foolish
32:52.9

32:58.4
person where you’re saving a few hundred
dollars here but when the case and the
32:58.4

33:02.6
public health people come knocking at
your door now you’re spending five
33:02.6

33:07.3
hundred thousand dollars in an outbreak
investigation so those are very powerful
33:07.3

33:11.3
messages that can be delivered to the
clients to help them make the right
33:11.3

33:15.9
decision and the one I think that most
of your audience wants them to me Jenna
33:15.9

33:19.9
you just mentioned ashtrays 188 and when
we had you on the show
33:19.9

33:27.1
back in 2017 we were dealing with the
2015 version we’ve since had an update
33:27.1

33:35.2
to the 2018 version what did they update
the changes in the 2018 version are were
33:35.2

33:41.3
really intended to make it enforceable
with code intended language so the
33:41.3

33:47.6
original way that it was written would
not be transferable into code and that’s
33:47.6

33:53.6
really the goal for ASHRAE is because
it’s a voluntary standard until it is
33:53.6

33:58.4
incorporated into code people have the
option of doing it or not doing misc
33:58.4

34:03.7
management of building water systems to
prevent Legionella and so the most of
34:03.7

34:08.8
the changes in the 2018 document are
really about moving that into code
34:08.8

34:14.1
intended language I really like how the
CDC put together their toolkit to
34:14.1

34:19.4
explain ASHRAE 188 I’ve used that with
clients numerous times I just love how
34:19.4

34:23.4
they visually break that down do you
like that document as well the
34:23.4

34:28.1
way that I think about it is it makes it
much more understandable for the non
34:28.1

34:32.8
technically inclined person so most of
the people that you’re dealing with are
34:32.8

34:36.8
probably going to be pretty comfortable
with ASHRAE standard 188 as it is I
34:36.8

34:41.1
agree with you that that visually
there’s a lot of nice graphics and
34:41.1

34:46.2
things like that but I you know I always
say I’m not going to get cynical in my
34:46.2

34:52.0
old age right and but I have to say that
it’s and you can detest to this as well
34:52.0

34:58.5
I’m sure it’s very hard to get people to
read and really delve into something and
34:58.5

35:04.4
so I think it’s commendable that you
point them towards the the toolkit as an
35:04.4

35:10.3
aid to help them understand what ASHRAE
standard 188 is really about and as an
35:10.3

35:15.8
educational tool but I really think it’s
that one-on-one with the client and and
35:15.8

35:19.8
the information that you’re conveying
personally to that client that’s really
35:19.8

35:24.3
going to help them understand what
legionella risk management is all about
35:24.3

35:29.6
totally agree that’s why customers hire
is not that we’re the legionella experts
35:29.6

35:34.4
but we can absolutely let them know more
than they do know and point them to the
35:34.4

35:38.9
right direction so they can start
understanding LD a little bit better
35:38.9

35:45.1
nation Genet just has so much to share
with us I couldn’t pack it all into one
35:45.1

35:52.0
episode so we’re gonna have Janet back
next week to share even more about this
35:52.0

35:58.3
complex topic legionella
and in the meantime if you have not gone
35:58.3

36:03.6
to the special pathogens laboratory and
looked at their resource pages you are
36:03.6

36:08.8
missing out because if you can go there
you will find so much information about
36:08.8

36:15.1
Legionella that I promise will clear up
some of the questions that you have in
36:15.1

36:21.3
the meantime between next week and this
week I want you to be thinking about
36:21.3

36:28.9
what you want Scaling UP!p h2o to bring to
you this year so many people out there
36:28.9

36:34.7
in the Scaling UP! Nation have told me
what they want me to talk about
36:34.7

36:39.1
questions they’ve had
guess they want me to interview well if
36:39.1

36:44.2
you haven’t done that you are missing
out folks you can make this show your
36:44.2

36:49.5
very private show just let me know what
you want me to talk about and we will
36:49.5

36:54.1
try to get those items on the air now to
do that you’ve got two ways to do that
36:54.1

36:59.1
you can email me directly you can go to
the Scaling UP! h2o
36:59.1

37:06.0
dot-com a web page and you can record
your own voice and then I will play your
37:06.0

37:11.3
voice asking your very own question and
then we’ll get that answered or you can
37:11.3

37:16.7
just leave me a message on the show
notes page folks thank you so much for
37:16.7

37:22.6
listening and I look forward to speaking
with Janet one more time next week on
37:22.6

37:34.0
Scaling UP! H2O Nation one of the goals
when I started this podcast was to
37:34.0

37:38.9
create a community for us
water treaters I believe that the
37:38.9

37:46.1
scheming up nation has received that and
we now have a community for ourselves
37:46.1

37:52.1
I’ve gone even deeper and I’ve created
the rising tide mastermind and the
37:52.1

37:58.1
rising tide mastermind is to bring the
success that I have personally had with
37:58.1

38:07.7
my own mastermind groups and bring it
into the water treatment community the
38:07.7

38:14.1
rising tide mastermind is now meeting we
have active groups and we want you to be
38:14.1

38:20.6
a part of it go to https://scalinguph2o.com/mastermind to see if
38:20.6

38:25.6
the Rising Tide Mastermind is right for
you where we are serving both owners and
38:25.6

38:30.9
non owners folks you deserve it to
yourself to have a trusted group of
38:30.9

38:39.5

advisors that you can do life with go to

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