032 – Legionella: A Manageable Risk for Health Systems | Dave Purkiss and Joseph Cotruvo | Legionella 2018

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032 – Legionella: A Manageable Risk for Health Systems | Dave Purkiss and Joseph Cotruvo | Legionella 2018

Today we're talking about a widespread issue that's extremely important to the business of healthcare, and probably not on your radar: Legionella. And more specifically Legionellosis, which is the most…
February 21, 2018

032 – Legionella: A Manageable Risk for Health Systems | Dave Purkiss and Joseph Cotruvo | Legionella 2018

Today we’re talking about a widespread issue that’s extremely important to the business of healthcare, and probably not on your radar: Legionella. And more specifically Legionellosis, which is the most significant waterborne disease in the U.S.

Legionellosis accounts for thousands of hospital admissions and many deaths. It has a 10% mortality rate for those infected and that rate goes up as high as 25% in a healthcare setting.

The good news is, it’s controllable. In fact, it’s largely an engineering problem that has known, low-tech controls.

Related: Checkout our entire Infection Prevention and Control series 

Given the prevalence of the issue, the high mortality rate and increased risk in healthcare settings (especially in LTC), CMS now says that Hospitals must develop water management policies to prevent Legionnaires’ disease. They’re calling for hospitals to do a risk assessment, implement a water management program and specify testing protocols. The approach sounds like it would be in line with that of a good HIPAA or cyber-security program. That is, you must build a culture of control and manage the issue for the long haul.

On this episode, Dave Purkiss and Joseph Cotruvo tell you what Legionella is, how it can be controlled and why health systems should prioritize the issue. Most importantly, they’ll tell you about the standards, tools and approaches that’ll help you implement a sound water management program, keep your patients safe, and avoid a non-compliance citation from CMS.

Dave and Joe also tell us about the Legionella 2018 conference coming up May 9-11, 2018 in Baltimore, MD (they are co-chairs).  The conference will bring together many of the experts working in this space to give you a 360 degree look at what the problem is, why it’s important and what you can and should do about it today.

On this episode you’ll learn:

  • What is Legionella?
  • Why was it largely unknown prior to 1976?
  • Why does Legionellosis have such a high mortality rate?
  • Can we control the issue and prevent outbreaks?
  • What is the CDC doing to track outbreaks and promote the appropriate measures to control it?
  • How much of a problem is Legionella for U.S. Hospitals?
  • Are Hospital leaders aware of the issue?
  • Why are Long-Term Care (LTC) facilities at a greater risk?
  • Are healthcare leaders aware of the tools that exist to properly manage water systems and control Legionella?
  • When did CMS begin to regulate the issue?
  • How does CMS validate that the health systems are properly managing their water systems?
  • Why should a healthcare organization prioritize this issue?
  • What advice would you give a health system leader for getting started with a water management program?
  • How can health systems use tools like the NSF 444 standard and ASHRAE 188 to guide them?
  • Is there a potential for a CMS audit and are there any financial penalties involved?
  • The Legionella 2018 conference: Who’s it for? What you’ll learn? What are the goals of the conference?
  • How does a good water systems control program relate to a HIPAA program or a cyber security program?


About Dave Purkiss

Dave Purkiss was recently appointed to the position of Vice President, Global Water Division at NSF International.

In his new role, Purkiss leads NSF International’s global water programs, including certification programs that help ensure the quality and safety of products used in municipal water treatment, water distribution, residential drinking water treatment, plumbing, pools and spas, and wastewater treatment.

Reporting directly to NSF International’s President and CEO, Purkiss is responsible for strategy development, innovation, growth of water programs and teams, and alignment with NSF International’s mission, strategy and goals. He leads a global team with locations in the United States, Canada, Belgium, China, India, Japan, Korea, Thailand and the United Kingdom.

Most recently, Purkiss served as interim Director of NSF International’s Global Water Division and General Manager of the Plumbing Products Program. During his 30 years at NSF International, he has worked in all areas of water treatment and distribution. His previous leadership roles include General Manager of Municipal Water Products, General Manager of Drinking Water Additives and Managing Director of NSF International’s UK Water team, formerly known as NSF-WRc. He began his career at NSF International working as an hourly employee in the engineering laboratory.

During his time at NSF International, Purkiss has worked on several major initiatives in the water industry, including assisting in the development of NSF/ANSI 223: Conformity Assessment Requirements for Certification Bodies that Certify Products Pursuant to NSF/ANSI 60: Drinking Water Treatment Chemicals – Health Effects. This standard establishes minimum requirements for certification organizations that evaluate and certify products to NSF/ANSI 60. He also played a key role in the launch and development of NSF International’s water products testing service in the UK to provide independent testing and certification services to Europe’s water product industries.

Purkiss is a member of the American Water Works Association (AWWA) and has chaired both the AWWA Polyelectrolytes and the AWWA Utility Quality Management Committees. He holds a bachelor’s degree in biochemistry from Michigan State University.

About Joseph Cotruvo

Joseph is Board Certified in Environmental Science, and president of Joseph Cotruvo and Associates, LLC, Water, Environment and Public Health Consultants.

He was the first Director of USEPA’s Drinking Water Standards Division that produced the first regulation of TTHMs in drinking water as well as many existing drinking water standards, and initiated USEPA’s Drinking Water Health Advisory Program.

He has participated in the World Health Organization Drinking Water Guidelines development process for over 20 years. WHO work includes producing monographs on Health Aspects of Plumbing, Pathogenic Mycobacteria, Heterotrophic Plate Counts, Calcium and Magnesium in Drinking Water, Waterborne Zoonoses, Health and Environmental Aspects of Desalination Technology, and Potable Water Reuse Guidelines.

His work also includes drinking water quality and risk evaluations, water treatment technology, direct and indirect potable water reuse, and international and national regulatory assessments. He has initiated and managed toxicological research on bromate, water system decontamination, and studies on trihalomethanes. He served as chair of the Water Quality Committee of the Board of Directors of the Washington DC Water and Sewer Authority. He received a PhD in Physical Organic Chemistry from The Ohio State University.

About NSF International

NSF International is an independent, global organization that writes standards, and tests and certifies products for the water, food, health sciences, and consumer goods industries to minimize adverse health effects and protect the environment. Founded in 1944, NSF is committed to protecting human health and safety worldwide. With operations in more than 170 countries, NSF International is a Pan American Health Organization/World Health Organization (WHO) Collaborating Center on Food Safety, Water Quality and Indoor Environment.

NSF International’s Global Water programs provide risk assessments, testing, inspection and certification services for the water industry from source to tap. NSF led the development of the American National Standards for all materials and products that treat or come in contact with drinking water to help protect public health and the environment and minimize adverse health effects. In 1990, the U.S. EPA replaced its own drinking water product advisory program with these NSF standards.

Mentioned on the podcast is a Pan-Access journal that extends globally and touches locally. is: Free to Publish. Free to Access and provides Accessible Scientific Services.

National Science Foundation



American Water Works Association


Check out our series on Infection Prevention and Control (IPAC):

Infection Prevention and Control with Niall Wallace and Michael Diamond

Using Barrier Technology to Stop the Spread of Infectious Disease with Rik Heller

Why Hand Hygiene Matters with Tamás Haidegger

Shining a Light on C. diff with Christian John Lillis

Lessons on Infection Control and Healthcare Sales from the Man with the High-Tech Pillow  with David Woolfson

Redefining Sepsis with Michael Ackerman

Understanding Infectious Agents in the Environment with Dr. Syed Sattar and Bahram Zargar

The Patient Hot Zone | Darrel Hicks

HITS Conference Preview w/ Dr. Christine Greene and Dr. Kelly Reynolds

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