150 Transcript

The following transcript is provided by YouTube. Mistakes are present. To hear the podcast episode, click HERE.

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scaling up

[Music]

welcome to scaling up the podcast where

we’re scaling up on knowledge so we

don’t scale

up our systems scale up nation trace

blackmore here

your host for scaling up h2o

and nation it is august already

august 7th and wow what a

crazy ride we have all been on now

i’m going to do something special

it’s not been done before i’m going to

declare it at least for the scaling up

nation

but i am going to declare

august legionella awareness

month so everybody out there in the

scaling up nation

i know you have questions about

legionella

i know that you are talking with

customers

about legionella and i know for some of

us we have

more questions than we have answers now

i’ve done

several shows on legionella if you want

to go back and

listen to some of those shows

those numbers are number nine so right

when we were just starting the podcast

out

friend of show dr janet stout came on

and she talked to us

about legionella from the water treaters

perspective

and then we had matt fariji come on to

talk about water

management plans and things that we need

to consider on episode 83

and then our friend janet stout came

back on episodes 120 and 121

where we talked about some changes to

ashrae’s

188. since that time

i’ve received several questions about

legionella and i think when we go to

conferences

about legionella the speakers are

talking about the topic at

such a high level and in the water

treatment industry

we have people over all aspects of their

career

so if someone is just getting started in

their career

they may not have the base information

that they need to be able to participate

in some of those higher level

conversations

so what i hope to do today is i

hope to bridge that gap and we’re going

to talk

very simplistically about legionella

legionella 101 maybe even more

basic so that’s what’s in store for

today

now you might be wondering why we’re

talking about legionella

why we’re declaring that august is

legionella awareness month

and the reason i’m doing that is because

there is a conference that’s put on

at the end of every august by

the national health services and the

national

environmental health association now

because of

everything that we’re experiencing right

now most conferences

are going virtual well they decided

that they were going to hold their

annual conference

next year and not do a virtual

conference so it was supposed to be

august

19th through 21st it’s now rescheduled

for

january 20th through 22nd

it’s still going to be in chicago at the

sheraton

grand hotel right there by the riverwalk

so if you’re planning on going to that

you’re going to meet a whole bunch of

people that have been on this show

and you’re going to meet a bunch of

people that have

the same desire that you do

trying to end legionnaires disease what

are the things

that we can do as professional water

treaters

so our customers can make better

decisions about the equipment that they

own

so people don’t have to suffer getting

sick

with legionnaires disease well as i

mentioned earlier

we are going to do today’s show just on

legionella so very baseline

this might be too basic for some of the

people out there and that’s

okay if we can all get to the same level

where we can have a conversation

i think everybody will be fine with that

so that’s what today’s topic is it’s

about legionella it’s about

knowing and just like our friend g.i joe

said

knowing is half the battle i guess i

just dated myself there’s is

that that was a cartoon on when i was a

kid do they still say that is there

still a

action hero called gi joe do they still

do that anyway

let’s talk about guidelines because i’m

sure the one that you’re thinking of is

ashrae’s

188 and you’re thinking you know i

really don’t think we had any sort

of documentation before ashrae came out

with this 188 document

and that is simply not the case in fact

we’ve had

some sort of guideline now ashtray 188

is a standard it’s the first standard

we’ve ever had

it’s a voluntary standard we’re going to

talk about that in a second

but we have had some sort of guideline

that we could choose from

back since the early 90s

there’s been various things over the

globe the united states is pretty slow

to catch up with some of this

but if you live in canada especially

quebec there’s all sorts of

documentation

there of course in england and all other

parts of

europe you can find documentation there

in australia

people are dealing with legionella way

better than the united states

has been so ashrae did what they

thought was best and they came up with a

committee that committee

met for many years i want to say it was

about 10 years

and then finally ashrae’s document 188

was

published but before that a lot of

people forget that there was a

guideline that ashrae had called 12

2000 and it was a standard

entitled minimizing the risk of

legionellosis

associated with building water systems

so folks stuff like this has been out

there in fact

awt back in 2003

published the first legionella white

paper and that has since been

updated several times so folks

it’s not a new topic maybe you’re just

hearing about ashrae 188 but i assure

you there is documentation

all over now ashrae 188

came out in 2015

and the thing about ashrae 188 is it is

a voluntary standard that means

that there’s a standard out there but

you have to choose unless

some sort of law says that you have to

follow this

and that was published in 2015 but the

thing you need to know is it is a

living document now what the living

document means

is that as new information becomes

available

as they find out that they can write

things in a better way

so people understand it better or

they’re meeting all the needs that the

document needs to meet

they will update it and folks that

happened in 2018

so they did add i think pretty much

basically it was some

language for making the document

easier to put into code but it did

update so if you’ve read it once you

have to keep on

keeping up with it because you might be

behind the game

now you can find ashrae’s document on

their website and this used to be true

and i’m pretty sure it still

is you can read it online and it won’t

cost you a dime

if you want to download it so you now

own a copy

they will charge you for that so just so

you know i wanna we’ll put all that

information on the show notes page but

there’s no reason that you should not

know what ashrae’s

document 188 says another question that

i get

all the time about ashrae is there’s

mention

to ansi ansi is american national

standards

institute and people don’t understand is

it an ashtray document

is it an ansi document what exactly does

this mean well what ashrae did

was they did it in conjunction with ansi

it could fit right in to

our local laws and codes and

using the ansi format that allowed them

to do that nation i’m just going to

start out

with talking about what the heck

legionella is and legionella that’s a

funny word why do we call this bacteria

legionella so i’m going to go back to

the very first

time when we discovered legionella

bacteria so it was in 1972

in philadelphia pennsylvania during an

american legion convention now if you

can imagine

american legion there are all people

that have served in the armed forces

and a lot of the people were of

a higher age so in their

high 60s 70s 80s and because of this

they’re more susceptible to catching

some diseases now the other thing that

was going on

was the date was 1976

so that was the 200th anniversary of the

signing of the declaration of

independence

so this was a super well attended

convention it was at the bellevue

stratford hotel

and everybody had a great time they went

home

and people started getting sick in fact

34 people died

and they had no idea what was getting

these people

sick if you were to look back at some of

the magazine

articles during that day you would see

speculation that perhaps the russians

were doing something to harm the united

states

veterans of course that wasn’t the case

but nobody knew

what it was well they found that there

was a bacteria

that people inhaled and they didn’t have

a name

for it well they named it after the

people that helped them

find it the people who originally

contracted it

and they named it legionella so

legionella is what we call the

actual bacteria named after

the legionnaires that originally got the

disease

so even with that i know there are some

questions so legionella

is the bacteria and the one that we are

most susceptible to is called legionella

pneumophila now that is a

mouthful well let’s look at the word so

now we have some information and things

should start making sense to us so

legionella well we know that we know

that’s named after the legionnaires that

originally contracted it

pneumophila so if we were to look

at pneumo that’s the term for lung

if we were to look at phylla that means

loving

so legionella is a lung loving

bacteria now legionnaires disease

is what happens when the bacteria

causes pneumonia legionnaires disease

is the pneumonia form of the disease

now let’s say somebody gets the bacteria

they get sick but it doesn’t develop

pneumonia

well that’s called pontiac fever and

that’s more of flu-like symptoms

now for those people that have been in

water treatment for

a while it’s very likely that you’ve

caught some

form of pontiac fever

and you never really realized it you

thought it was a bad cold a bad flu

and maybe your body was able to get over

or maybe you went to the doctor and they

gave you

something like a zithromyosin that’s a

z-pack they might have given you

something like levaquin

they might give you something like

tetracycline

now those are some of the antibiotics

that are proven effective in

helping the body get rid of the

legionella bacteria

now earlier i mentioned legionella

pneumophila i think it’s important to

know that there’s over

58 species of legionella

so if you’ve ever done a legionella test

you know that you’ve gotten a report

back and it says

what kind of species it is now sarah

group

one is the most infectious

so of the legionello demophila the serra

group

one is the one that’s most recognized

for

causing legionnaires disease and by the

way

last time i checked there were over 15

subgroups or sarah groups of those 58

species

of legionella so this is a ever-changing

people are discovering new forms of

legionella but again normally we worry

about that

serra group one people wonder what are

some of the symptoms

of legionnaires disease well before i do

that i mentioned pontiac

fever so again that is when you get sick

from the bacteria but you don’t have

pneumonia

normally that appears after one to three

days of exposure and it lasts about

five days or so normally it does not

require

hospitalization because most people get

over it on their own

as i mentioned before if they do have

some issues they can go to the doctor

and and if they do choose the right

antibiotics that will help with that

and over 95

of the world’s population is susceptible

to pontiac fever now let’s talk about

legionellosis now that’s the first time

i use that term

i’ve been using the term legionnaires

disease well folks they’re the same

thing

legionellosis and legionnaires disease

are the exact same thing just a little

different way of saying it and what that

is that’s the pneumonia form

now this is the time where it gets

really serious because this is what

people

die from it starts affecting multiple

systems within the body

it makes it so people can’t get the

their lungs aren’t working properly

because they’re filled with fluid and

that’s what pneumonia is

symptoms are high fever chills muscle

pain

headache dry cough it could have

diarrhea vomiting

confusion delirium there’s a host of

things but these are all associated

with legionnaires disease now somebody

exposed to this

can start seeing symptoms two to ten

days after exposure

normally it does require hospitalization

and they estimate about five percent of

the world’s population

is susceptible to this

now there are some people that are more

susceptible than others

and we mentioned that the legionnaires

they were older

and the older population the geriatric

population definitely

is in this susceptible group

people that are immune suppressed so

maybe somebody that’s had a transplant

undergoing chemotherapy some sort of

cardiac disease

lung disease maybe they’re on a steroid

to fight inflammation or

some sort of treatment well that’s also

going to suppress

their immune system of course people

that are normally sick or in poor health

they’re going to be in this age group as

well

we mentioned elderly people that are in

the hospital

people that smoke folks when you smoke

that does some

damage to the insides of your body

especially

lungs so you smokers out there that

are water treaters i want you to know

that you are putting yourself

at a higher risk for catching

legionnaires disease

than somebody that is not smoking so if

you needed a reason to quit

smoking add that to the list please

and of course people with lung disease

generally speaking somebody with a

weakened immune

system is going to be more susceptible

so now let’s talk about how we get

legionnaires disease

there’s a lot of people that think a

bunch of things i can get it if somebody

coughs on me

sneezes on me maybe i touch a surface

that had legionella on it

folks it is not like that legionella is

actually

contracted in one way and what that is

it’s through contaminated water droplets

you have to inhale the water droplets

that have

legionella bacteria in them and that’s

how they get

into the body so when you look

at what are the devices that have the

potential

to vaporize or to throw a mist off

of contaminated water those are the

areas

that are you’ve got to look out for for

legionnaires disease and we’re going to

talk a little bit about that in a second

we’ve had janet stout come on to talk

about how she does

her testing but it’s important to know

that when we talk about testing for

legionella there’s really two types of

tests when you look at the

what’s being tested so one is the system

we can take a sample from the system

send that off and they can say yes the

system

has legionella bacteria

and it’s this species and sarah group

number whatever

so with all of that a lot of us are

doing that type of test right now and

there are a lot of companies that are

doing that type of testing what i’m

going to do

is i’m going to introduce you

to some different types of legionella

tests

later in this month now you’re probably

using the culture

right now that is the gold standard

that’s what’s

most legally defensible but folks there

are other tests out there

and just because they’re not the gold

standard right now it doesn’t mean that

maybe someday

that they will so i want to make sure

that you’re familiar with that but

that’s not today’s show that’s coming

up later in the month suffice it to say

that this is when we go out and we take

a test

in one of the systems that could

transfer

water droplets and we want to make sure

that legionella

is either not in the system or if it is

in the system we’re aware of it and

we’re doing something about it

the other type of tests is when somebody

gets infected with it

and a lot of times this starts out as an

x-ray x-ray says that the person has

pneumonia there’s fluid in the lungs and

then

they may take another test to see

if it’s legionella positive now there’s

a urine test that they can do that

and there’s also where they take a

sample

of the sputum though what somebody would

cough up

when they’re sick and they would run a

test on that i think they can also do a

lung biopsy

as well now you might be

thinking that the only place

you can get legionella is in a cooling

tower

and folks it seems like the whole world

thinks that

but that is not the case in fact

80 percent of all of the cdc’s

legionella cases has been found in

domestic water

domestic water folks the water that

we are drinking the water that we’re

taking

showers in only 20

see that was pretty hard math but i did

that for you only 20

of the cdc’s cases have been

in cooling towers now the thing

i did not mention in the very beginning

when i was telling you about the

bellevue stratford hotel with the

legionnaires convention

is they found the first sample

where that legionella was coming from in

the cooling tower so folks forever

the cooling tower is going to be blamed

because

that’s where it was associated with

first that’s where they found it

so from here on out the cooling tower

has to be

proven innocent and it is assumed

guilty for those of you that practice

the same type of water treatment that i

you need to make sure that you have

proper documentation to prove the

cooling towers

in a sense and i think that’s a great

way to look at it

so with all of that with all of that

background i want to get into

the documents that were we’re all

familiar with that we know we need to

get familiar with

and that is ashrae’s 188.

by the way it’s entitled ashrae 188

legionellosis

risk management for building water

systems

so that was released on june 26

2015 and for those of you that go to the

association of water technologies

you might know bill pearson bill pearson

is a fellow

past president of the association of

water technologies and he was

also the ashrae liaison

representative for the association of

water technologies

and i remember bill pearson standing up

since

early 2000s 2003 2004 2005 saying

ashrae is going to put this document

together and every single year

and every year after that he would get

up and present

to the general assembly of the awt

this is what we’re working on it’s going

to be passed and then next year would go

by it wasn’t passed he said this is what

we’re working on it’s going to be passed

well because bill was so diligent the

awt

not only had representation the awt

had voting representation through bill

pearson

and there was a lot of back and forth

with awt

and that committee there are a lot of

people that were on that committee that

are part of the awt besides

bill pearson but because of that

relationship awt was kept

very informed but then on june 26

2015 it almost seemed like the entire

organization of the association of water

technologies

was struck by surprise that now we have

this standard

on legionella and bill’s thinking wait a

second for the past 10 years i’ve been

telling you all about this

and i guess people just have a tendency

that if it’s not

right now i’m not going to worry about

it and i’ll worry about it when it

becomes an issue

well 2015 june happened and then

just one month later after that document

came out there was a legionella outbreak

in new york city in the bronx

and 12 people died over a hundred people

got sick and with

that of course people get upset they say

why are people getting sick shouldn’t

somebody

have done something and then they say

wait a second

there was a standard out there there

were people out there

that ignored this standard and it’s out

there even though it’s new

somebody should have used it and that

could have saved these people from

having to experience this

so almost immediately not quite a

month after ashrae’s 188

was put out to the world new york

adopted it as law

now i said earlier it was not even a

month it was a little bit over a month

they adopted that on

august 17 2015

and what they did they only included

parts

of the cooling tower now if you back up

a little bit in this podcast

i gave you the information that the cdc

shared with me

that over 80 percent of all the cases

for legionnaires disease

comes from the domestic water so

they reacted to the situation that was

going

on right then and they just

put law into effect from this document

that dealt with the cooling tower

to my knowledge to date there’s still

nothing in there that deals

with what produces 80

of the legionella cases and that is

potable water

so people in new york guess what it is

not a voluntary standard like i

mentioned at the top of the show

it is in your law and just to make it

fun

it is in the law for you to either

abide by new york city or new york

state and from what i have read

and people i’ve talked to it is almost

impossible

to do both at the same time so with that

you got to pick and choose

which one you’re going to use so again

whenever we’re putting things into law

there are always issues when it’s the

first time around new york city

new york state was their first people to

put this into law

but i know there’s legislation out there

throughout the united states

to put this into law

so we all need to know about it because

it could happen

tomorrow and now our customers are

expecting

us to know what to do about it in fact a

good friend of mine who owns a company

in new york he got a certified letter

i think it was on a thursday afternoon

and

after he opened that certified letter

it changed how he ran his water

treatment company

from that moment forward now

if you ask him what he could have done

differently or what advice that he would

give he would say

one to know this document and he was the

first

one to experience this or he was the

state was the first one to experience

the city was the first person to

experience it

so folks we can learn from their

experiences

there’s no reason you can’t go online

and read the code

that they have to make sure

stays upheld that will give us an idea

what our city might adopt and now

we have hindsight where the people in

new york

they didn’t have that so we’ve got time

now i’m going to recommend

you all figure out what you can do so

you don’t have to change the way you run

your company overnight again

i am going to underline this statement

it’s not

if a legionella law will be

passed where you live it’s when

folks it will happen and probably

unfortunately what’s going to happen is

somebody is going to get sick

somebody’s going to die and somebody’s

going to say

somebody should have done something

about it a legislator

is going to be aware of ashrae’s 188 and

they’re going to push that as their

platform

and get that adopted into law folks

please

be proactive with this now for those of

you

that deal with hospitals doctors offices

people that are dealing with the care of

patients there’s a document out there

that you might not be

aware of but you need to be it is the

center

for medicare and medicaid

services 1730

and it was a document that was published

on june

2nd 2017 and it said

if you are going to bill medicaid or

medicare

services for services rendered like you

go to the doctor

that person is under those benefits

and that doctor now bills to be

reimbursed

for those services if they did not have

a water management plan as per ashrae’s

188

they risk not getting reimbursed

so now there are some uh revisions of

that

document but i am shocked by

how many water treaters have never heard

of that document we’re going to have

these documents

up on our web page so you can get to

them so you can read them so you can be

proactive but folks our customers are

relying on us to know

about this and if we’re not keeping

ourselves up to date we’re not able to

give them the best information now i

want to make sure i make this clear

we cannot do legionella prevention

for them because we don’t own the

equipment we can only suggest

what best practices are and and give

them

examples of what they can do and then

they have to say

yes or no we can’t do it for them

because we do not own the equipment and

if you read ashrae’s 188 it is for the

building owners

and managers so we need to

act as a liaison if you will like bill

pearson was

with ashrae and the association of water

technologies

we need to work with those parties and

let them know that this stuff is out

there

and they need to make some decisions and

we can be part of the team to help give

them some information

but the decision is theirs and folks

you need to have these conversations and

above all else

you need to document these conversations

because years can go by something will

happen

and everybody forgets please don’t rely

on your memory make sure you document

that yes we did have these conversations

yes

we did agree to do this or no

the customer decided not to do this at

this time and i would have them sign off

on it

again it’s not passing the buck it’s

making sure everybody understands what

their responsibility is

and now we’re just having a paper trail

so we can revisit it later if need be

folks people change their jobs so there

might be somebody new

and you had the conversation with

somebody else have it with the new

person

i hope all of you are doing customer

reviews on a regular basis

for the simple fact is i know the water

treater out there

does not get credit for all of the

services that they do up and above

what the actual contract is folks that’s

what that customer contract review

is for give yourself credit for all the

great things all the value that you

are bringing to the table and

also include a legionella conversation

with that another great reason to have

this conversation

with your customer is your customers not

thinking about this because

it’s not an issue right now when it

becomes an issue

they are going to assume nine times out

of ten

that because they have a water treatment

contract

with you they automatically assume that

it includes legionella prevention

folks that is not the case and that’s

bad information that our customers are

potentially working from

we have to have that conversation with

them we need to let them know

that a program for water treatment

does four things it tries to

reduce the amount of corrosion that you

would have if you didn’t have a water

treatment program

we’ve talked on the show before water’s

the universal solvent

water against anything else eventually

water is going to corrode it so we want

to protect

all that expensive equipment that the

water is flowing through

water treatment is one of the ways we

can do that the second is scaling

water has all this dissolved stuff in it

and a lot of that stuff will come out at

heat transfer surfaces

if it does it acts as insulation that

makes it

more expensive for us to heat and cool a

facility

and that means the customers paying more

because they don’t have

good efficiency it also reduces the

capacity that the water has to flow in

thereby also reducing efficiency

dirt and debris comes in with the water

so we need to do something to make sure

that dirt and debris

doesn’t settle out somewhere now that

might be a system design not

not a 100 water treatment issue but

again we have to have that conversation

if i had my way every cooling tower on

the planet would have a

sand filter on it but nobody asked me uh

we’ve got to filter these things that

are in our systems

and then the last leg is where the

confusion comes from

and folks that’s microbial and

microbial people think well hey that’s

legionella

no no no no that is not what that means

when we look at a regular water

treatment program

and how we deal with microbial

it is about efficiency we don’t want

things to grow in that system

so we’re reducing the water capacity or

we’re making insulation

so now the system has to work harder to

heat or cool

whatever it’s going to heat or cool so

it’s all about

efficiency it’s not about

public safety that puts microbial

on an entirely different plane

and that’s the connection that our

customers don’t automatically get to

if somebody wants to go after a very

specific

species see if it’s in their system

test for it have parameters what we’re

going to do when we get tests back

and then procedures on how we’re going

to get a level

from a to b down to a certain level

that is so far and beyond

efficiency and longevity and i know

every water treater out there

they get it but folks if you’re not

having that conversation with your

customer

they do not get it and bad things happen

when people assume the other party

understands what the other is thinking

so please

please please have those conversations

a lot of people are intimidated by the

ashrae 188

now 218 document would you be surprised

if i told you it was

only 17 pages

only 17 pages and

honestly the bulk of that is in the

references

and the code descriptions that they have

in the annexes in the back there are

five pages that deal

with compliance with building survey

requirements requirements for building

systems

and then the design for buildings

just five pages so

don’t get intimidated with this document

read the document and talk with somebody

that understands it

but again your customer probably doesn’t

know about this document

so having these conversations really

helps

prevent a situation before

something happens and now everybody has

get everything in order because the

conversation

had never been had so if there’s an

underlying theme

it’s talk to your customers and the

secondary theme is document that you’re

having those conversations

there is a tool out there that

i absolutely love it

is a hundred percent free and it is the

document

in which i have all my legionella

conversations with my customers with and

because i am

such a great advocate of raising the bar

i am going to share with you what i use

again it’s free to you as well

it is the cdc toolkit and i put a link

on our show notes page so you can go to

cdc and you can search for it

but if you go to our show notes page

we’ll send you a link straight

to there and it is a very simple

document that allows you

to use pictures graphics

to have this conversation and make

ashrae’s 188

so easy to understand so

does a building need a water management

plan

so that’s a question we all have so does

this customer need one

does the other customer need one well

there’s four questions up front that

you’re going to ask

the first one is is your building a

health care

facility where patients are staying

overnight

okay well that’s one question second

question

does your building primarily house

people

65 years of age or older

question three does your building have

multiple

housing units and a centralized hot

water system

and number four does your building

have more than 10 stories and this has

to include

parking and basement levels now if you

answered

yes to any one of those questions

you need a water management plan well

trace you said it was voluntary

you’re right but there’s a standard out

there

somebody’s going to find it if something

were to happen

this is what you need to tell your

customer and because you

answered yes to one two three

or four of those questions you just have

to answer yes to one

you need a water management plan

now let’s say you answer no to that well

there’s four

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