Impact of ASHRAE 188Originally published on June 10, 2015 and updated July 9, 2015.

On June 26th, ASHRAE 188P dropped the “P” and became ANSI/ASHRAE Standard 188-2015. What will be its impact on cases of Legionnaires’ disease, the number of lawsuits and litigation related to the disease, laws, and water-related products and services? And how will it impact costs for some businesses versus others?

Here are possibilities to ponder:

1. Legionnaires’ disease
Legionella control measures really work. Minimizing Legionella in water systems reduces disease. Scientific literature is replete with examples. If ASHRAE 188 is implemented by building operators, evidence indicates there would be a drastic reduction in cases of Legionnaires’ disease.

2. Number of lawsuits
When someone is diagnosed with Legionnaires’ disease and suspects a building water system as the source of Legionella that caused the infection, it is not uncommon for that person or his or her loved ones to file a lawsuit claiming the building owner was negligent in maintaining water systems to minimize Legionella bacteria.

The number of lawsuits is related to the number of diagnosed cases of Legionnaires’ disease. According to the Centers for Disease Control and Prevention (CDC), only about 10 percent of Legionnaires’ cases are diagnosed among hospital patients. The percentage is even lower among cases acquired outside of hospitals—less than 5 percent. Although ASHRAE 188 should reduce the actual number of Legionnaires’ disease cases due to better water system management, it could increase the percentage of diagnosed cases due to heightened physician awareness and more patient testing. Theoretically, then, the number of diagnosed cases could increase even though the number of actual cases decreases. Bottom-line: It’s hard to predict the effect ANSI/ASHRAE 188 would have on the number of Legionnaires’–related lawsuits.

3. Litigation
Whether or not the defendant met the “standard of care” in managing its building water systems is a key issue in litigation related to Legionnaires’ disease. Plaintiffs and defendants argue about it based in large part on existing guidelines and standards related to Legionella. ANSI/ASHRAE Standard 188 will very likely become the primary document on which standard of care is argued based on whether the defendant fully implemented a comprehensive water management plan for Legionella control, and how well the plan was validated.

ANSI/ASHRAE Standard 188 will also impact litigation with respect to notice. Most owners of one or just a few buildings have not been privy to Legionella guidance because they do not have employees who subscribe to engineering or facility management publications or attend conferences where Legionella is discussed. An example is the operator of a Mexican restaurant where an outbreak of Legionnaires’ disease was linked to an ornamental fountain in the restaurant waiting area. Since the restaurant owner did not employ anyone dedicated to engineering or facilities management, and Legionnaires’ disease had not been discussed in publications directed to restaurateurs, he was not aware that ornamental fountains should be maintained for Legionella control. Now that 188 is a standard, Legionella prevention could be more widely publicized, putting essentially all building operators on notice for Legionella prevention.

4. Laws
ASHRAE makes standards, not laws, but 188 could affect laws or be adopted as law, particularly since it is an ANSI regulation-ready standard. It has already been proposed for adoption into the International Plumbing Code and the International Mechanical Code and if accepted could become part of the codes by 2018. Health departments might also adopt ANSI/ASHRAE 188 into regulations.

5. Water-related products and services
If building operators follow ASHRAE 188, they will need help in developing, implementing, and validating a water management plan which could require site surveys, management plan development, water treatment, training, maintenance, sampling services, laboratory testing, disinfection equipment, and filters. To meet the demand, engineering firms, water treatment companies, and industrial hygiene firms will need to train employees related to the services they want to offer.

6. Costs
Managing building water systems for Legionella control increases building maintenance costs and lowers healthcare costs.

Among building operators, hospitals would fare best because their cost of increased facility maintenance would be offset by savings in reduced healthcare acquired infections. (For a detailed discussion of costs associated with water system management, see “How Much a Facility Really Pays for a Legionella Risk Management Program.”)

Question: What do you think will be the impact of ASHRAE 188?

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