To date no other US state has passed Legionella prevention legislation as potentially powerful as New Jersey Senate Bill 2188.
The New Jersey Legionella bill was passed by both the Assembly and Senate on June 28, 2024 and was signed by the governor on September 12, 2024. It includes requirements for public water utilities, New Jersey Department of Health (DOH), New Jersey Department of Environmental Protection (DEP), and building owners.
Below is a summary of the bill’s key requirements, discussion of its significance, and prediction of two factors that will affect its potential for Legionella prevention.
Summary of New Jersey Senate Bill 2188
Key requirements of New Jersey Senate Bill 2188 are as follows for public water utility owners or operators, New Jersey Department of Health (DOH), and building owners or operators:
Public water utilities
New Jersey Senate Bill 2188 requires public water utilities to:
- Maintain a minimum of 0.3 mg/L (ppm) free chlorine or 1.0 mg/L (ppm) of monochloramine in all active parts of the public water system at all times.
- Based on requirements to be outlined by DEP, develop a distribution maintenance plan to discourage the growth and potential distribution of pathogens such as Legionella.
- Notify the Department of Environmental Protection (DEP) of a change in the water treatment process, unplanned events that disrupt system operations, a change in the source water, or other conditions that could potentially lessen water quality and increase the risk of exposure to Legionella or other pathogens. (DEP will post a list of disruptions on a publicly accessible section of its website.)
- Based on requirements to be outlined by DEP and DOH, notify customers of increased risk of Legionella and ways to reduce exposure.
New Jersey Department of Health (DOH)
For every reported case of Legionnaires’ disease, New Jersey Senate Bill 2188 requires the DOH to:
-
- Conduct an epidemiologic investigation.
- Review any disruptions in the public water system
- Inspect water systems as potential Legionella sources at places where the person(s) who contracted Legionnaires’ disease were in the 14 days preceding infection, including the individual’s residence.
- Post information about all reported cases of Legionnaires’ disease on a publicly accessible section of its website.
DOH can require the owner of a building suspected as the Legionella source to notify potentially exposed individuals, test for Legionella, and remediate water systems to DOH’s satisfaction.
In collaboration with DEP, DOH must also establish a Legionella public awareness campaign.
Building owners or operators
Building owners or operators must implement Legionella water management programs for the following:
- whirlpool spas
- swimming pools
- cooling towers
- evaporative condensers
- indoor ornamental fountains
- misters, atomizers, air washers, humidifiers
- other non-potable water systems or devices that release water aerosols in the building or on the property
In the following types of buildings in New Jersey, a Legionella water management plan and program must be implemented for all water systems – including the plumbing system – and any of the device types listed above:
- Healthcare facilities
- Nursing homes
- Correctional facilities, hotels, residential buildings with 6 or more floors, and senior housing that have a centralized potable water heating system
- Buildings that DOH has determined to have been associated with an outbreak of Legionnaires’ disease
The Legionella water management program must include sampling for Legionella pneumophila if the site has been associated with an outbreak of Legionnaires’ disease or if the CDC has recommended sampling. ASHRAE and CDC recommendations must be followed in responding to Legionella test results.
A notice that a WMP has been implemented must be posted on the building premises.
The owner must document implementation of the Legionella water management plan and program.
Two Reasons New Jersey Senate Bill 2188 is so Significant
New Jersey Senate Bill 2188 is the first state regulation to require Legionella water management programs for all building types and water systems per ASHRAE 188. New York State requires comprehensive Legionella water management plans only for healthcare facilities – other building types need a program only for cooling towers. Virginia requires water management plans only for schools. A few other states require Legionella water management plans only in healthcare facilities.
Also unique and significant is the requirement that the New Jersey DOH investigate every case of Legionnaires’ disease. In other states, investigations are conducted only if two or more cases (an outbreak) are confirmed. The increase in investigations by DOH is likely to put pressure on building owners to implement prevention measures. If done well, the investigations will also generate helpful data that can be used to recommend better Legionella preventive measures.
Will New Jersey Senate Bill 2188 be Successful in Reducing Legionnaires’ Disease?
The success of New Jersey Senate Bill 2188 in minimizing Legionella infections will depend in part on two important factors:
Compliance by building owners and operators
A 2021 study of more than 900 water management plans (WMP) showed that Legionella decreased as implementation of the plan’s control measures (preventive procedures) and water testing increased. The data indicates the premise of ASHRAE Standard 188 is sound – fully implementing a comprehensive Legionella water management program will reduce Legionnaires’ disease.
Unfortunately, however, a very small percentage of facilities that meet the risk factors outlined in ASHRAE Standard 188 have established a Legionella water management plan. Even fewer have fully implemented a comprehensive program – hence the reason that New Jersey and some other states are establishing mandates.
Establishing a law requiring Legionella water management plans is not enough to reduce Legionella risk. There must be compliance. The New Jersey Legionella regulation will be only as effective as the state’s system for enforcing it. Checking 10 or so key WMP metrics remotely and frequently will likely yield more prevention than checking 50 specific procedures onsite only every year or two – and cost the state less, too. Focus on the big rocks.
DOH’s definition of “centralized potable water heating system”
How “centralized potable water heating system” is defined is another factor for the success of New Jersey Senate Bill 2188 in reducing Legionnaires’ disease.
An example of a typical centralized potable water heating system is a building with one or more water heaters on the lowest floor that supply hot water to all points of use in the building, with a hot water return line back to the heaters, continuously circulating hot water. Some high-rise buildings have multiple centralized hot water systems, each serving a set of floors (“zones”).
An example of what is not a centralized potable water heating system is a building in which the hot water at faucets is heated right at the point of use, without water storage. Cold water is piped to restroom sinks and typically heated by an instantaneous, tankless heater installed just under or next to the sink (see Figure 1).
FIGURE 1. POINT-OF-USE TANKLESS WATER HEATER
Some buildings have water heating systems that are not considered centralized but have significant potential for Legionella risk.
An example is a four-story office building in New Jersey that I inspected after an otherwise healthy man in his 50s who worked in the building became ill with Legionnaires’ disease. The building did not have a typical centralized water heating system with recirculation. Each floor had a small (e.g., 40-gallon) electric water heater that supplied hot water to the faucets in the men’s and women’s restrooms on each floor (see Figure 2).
More than 750 colony forming units per milliliter (CFU/mL) of Legionella pneumophila serogroup 1 was found in the hot water collected from the restroom sink the man used – the same Legionella species and serogroup found in the man. Based on other places the man had been in the two weeks prior onset of illness, he almost certainly contracted the Legionella infection from the faucet he used at work.
After five days of shaking, chills, and high fever, the man was admitted to a hospital. Less than 5 weeks later, he was dead.
FIGURE 2. 40-GALLON WATER HEATER IN AN OFFICE BUILDING CEILING. The heater supplies hot water to the mens and womens restrooms on one floor. Similar water heaters supply hot water to the restrooms on the other three floors.
It is not uncommon to find Legionella in small, electric water heaters like the one shown in Figure 2, even though they are typically not part of centralized hot water systems.
In samples I collected from an apartment building in Maryland where residents had been diagnosed with Legionnaires’ disease, Legionella was found in all of the non-centralized water heaters sampled – some at high concentrations – but was not found in the centralized heaters that served the common areas.
Each apartment unit had its own small, electric water heater that supplied water to the bathroom and kitchen (see Figure 3). Legionella was found in all 7 apartment water heaters sampled – three of which had concentrations of 52, 168, and 1660 CFU/mL. Legionella was not detected or < 1 CFU/mL in 17 of the 21 other samples collected from the building, with a highest concentration of 30 CFU/mL.
FIGURE 3. 30-GALLON WATER HEATER. The heater supplies hot water to an apartment bathroom and kitchen. Similar heaters are located in the other apartment units in the building.
The above two examples suggest that not requiring Legionella water management plans and programs in buildings that have tank-type electric water heaters without recirculation could result in missed opportunities to prevent Legionnaires’ disease.
Kudos to the New Jersey leadership in being the first state to pass legislation requiring Legionella water management programs for many building and water system types per ASHRAE Standard 188. With effective execution and implementation, the regulation could do much in protecting health and life.
What are your thoughts about the New Jersey Legionella regulations? Please comment below.
Great article as always! Congratulations to the state of NJ for setting a bar. It will be interesting to see how compliance is enforced going forward. A few questions come to mind:
How will public water utilities adapt their operations to meet the new chlorine and monochloramine requirements?
Furthermore what challenges are anticipated in implementing this across systems both large and small?
Thanks for your comments, Will. Steps taken by public water utilities will likely vary among them depending on their existing systems. Some may find it challenging to meet the disinfectant requirements without exceeding EPA TTHM and HAA5 limits. Properties, whether large or small, should have no problem setting up and successfully implementing a good water management plan if they have the right software and help.
I am happy to see my neighboring state of New Jersey is taking the Legionella issue seriously. I was completely disregarded by the Commonwealth of Pennsylvania when I contracted Legionaries’ Disease from a filthy carwash because I was a sporadic case. Keep in mind Legionnaires Disease is often undetected. This is a deadly disease and I only survived because of my age and otherwise good health. I was one of the lucky ones.
Kerry, I’m thankful you survived and are doing well. Thanks for commenting.
The big takeaways here are clearly that this is the first state to expand the building requirements of having a WMP in alignment with ASHRAE 188 criteria. In addition, the expansion of the investigation requirement based upon a single case of LD will hopefully facilitate increased detection prior to continued risk exposure and water system deterioration. What remains to be seen is how they will enforce compliance and whether facilities will actually utilize their WMPs to improve water quality and decrease the incidence of disease, but a very good regulatory start.
Thanks Russ! Your comments are always thoughtful.
As I’m in Canada these regulations are far more stringent (other than Quebec) than what we deal with. It’s probably a result of our less litigious society. Eventually it will come here.
Overall, it is the way to go as it will eventually save lives. Once again the incidence of Legionellla outbreaks are not the cooling towers (which officials and the public are fixated on since they can see them) but the domestic hot water systems.
I was recently at the AWT conference in Kentucky and attended your lecture. It was very informative. Question? Why does the AWT basically ignore Copper Silver systems and push chemical ones?
Thanks for commenting, Bill. The City of Vancouver has established Legionella regulations and may expand them to be more comprehensive. Perhaps the Vancouver regulations will become a model for all of Canada or at least certain provinces.
The Legionella position and guidance documents produced by AWT seem pretty balanced on domestic (potable) disinfection methods. The conference presentations are, of course, based on what the presenter is most familiar with. If you have data from field studies of copper silver systems, you should consider submitting an proposed abstract for next year’s conference.
Thank you Matt, and the City of Vancouver requires regular testing. For cooling towers, Legionella pneumophila results > 10 CFU/mL were halved in 2023 compared to 2022. See graphs posted at vancouver.ca/operating-permit/#program-results.
Thanks Chris! It’s great that you are tracking and reporting outcomes. Keep up the good work!
Hello-
On line 42-48 of the NJ Bill, it indicates “or on the property upon which the building is located”. I am thinking this may also include outdoor ornamental fountains in addition to the internal fountains. Thoughts?
That’s a good question, Grace. Although it mentions indoor fountains specifically, it does seem that “any other device that releases water aerosols in the building or on the property” could include an outdoor fountain. Hopefully, building owners will do what makes sense and is the right thing. An outdoor fountain should be managed to minimize Legionella risk.
I think what the state of New Jersey has proposed is great. My hope is that other states will follow New Jersey’s lead. As an individual that has been in the water treatment business for several years and is ASSE 12080 Certified, I see more need in regulating Legionella. Some hospitals will not test – not because of the cost, but they are afraid of the test results. We find it difficult to sell a WMP to facilities that should have one because it is not a priority to them. Thank you for sending this to me and keep up the good work.
Thanks for commenting, Jerry. Keep up the good work!
This is great news and a step in the right direction. Are there any other states currently working on this type of legislation?
I also agree that risk factors are present in all types of systems, not just those with centralized heating systems. The focus on the centralized heating systems is a little misguided, since water quality issues are often a result of the system set up and the maintenance (or lack thereof) of said system. Regardless of the type of heating system, a plumbing system with low use is more likely to have long periods of stagnancy and higher biofilm prevalence, which contribute to Legionella persistence.
Katie, if you have access to LAMPS Training Notes, see 3.014. It lists all state regulations, passed and pending. It also lists bills that are dead. If you don’t have access, the short answer is that 7 states have regulations. Two states, Nevada and Pennsylvania, have regulations pending. We have an article on state regulations – https://hcinfo.com/blog/state-regulations-reducing-legionella/ – but it needs to be updated. Thanks for the reminder to do that!
Focus should not just be confined to systems with centralized water systems. Many hotels and apartment buildings have individual heating systems that are very prone to contamination. Low temperature settings (due to the need for energy savings) and uneven usage that leads to stagnant water in the droplegs are very common. So, one needs to be careful to create an incorrect awareness that only the centralized water systems are prone to Legionella.
Educating the owners on the various types of systems and the associated legionella risks they have on their premises is key for them to create a relevant water management plan.
Good points, Wendy. Thanks!
All in all, I think it’s a very good start; perfection is always the goal, but if you don’t start the journey, the goal is unattainable. It will be interesting to see how facility managers impacted by the law “sell” this to facility owners. I agree with your assessment of the challenges (again, that journey to perfection) – to a fair degree, non-centralized water systems are the greater risk – hopefully the move to include those in the mix will be quick and effective. Thanks for the summary – I always look forward to your take on these matters.
Good point that getting started is sometimes more productive than waiting for perfection. Thanks Steve!
New Jersey has produced another baby step in developing a nation wide response. I echo Matt’s concern that only centralized doemstic hot water systems are included. I also agree with past comments from Matt and in my own experience that people have to be actively working the WMP. Knowing that DOH will most likely not have the manpower to enforce participation until after the fact, insurance companies could be an active way of implementation in that for Legionella coverage to be in effect, you have to have an active WMP. If people would do the easy step first – insure you have disinfectant throughout the water systems, that would mitigate most problems. I do think healthcare, nursing facilites, and senior citizen facilities should be required to test because those are your most vulnerable people.
I know your comments are based on many years of experience, Dave, so thanks for taking the time to contribute.
On September 12, 2024, New Jersey Governor Phil Murphy signed Senate Bill 2188 into law, setting New Jersey on a path to address the health risks posed by the presence of Legionella bacteria in water supplied by community water systems. Legionella bacteria is found in surface water and can be introduced into drinking water supplies, where unless proper disinfection is performed the bacteria can multiply. Inhaling aerosolized Legionella bacteria can result in Legionnaire’s disease, a serious form of pneumonia that poses a significant risk of mortality for elderly and immune-compromised patients.
The new law sets multiple deadlines for the New Jersey Departments of Environmental Protection and Health, requiring those departments to create and implement multiple systems and management practices to address the potential presence of Legionella in water supplied by community water systems and at buildings that match the state’s criteria.
The new law gives the NJDEP one year, until September 2025 to establish best management practices for public community water systems to use in dealing with Legionella. Once the NJDEP has promulgated these best management practices, public community water systems will have six months to develop and implement a distribution system maintenance plan. The NJDEP shall also establish a data management system to track any disruptions to public community water systems that might lessen the quality of water delivered.
By September 2026, the NJDEP, in consultation with the NJDOH, is required to adopt rules and regulations establishing requirements for Legionella management by public community water systems. These rules and regulations contain criteria to be used by public community water systems to develop distribution system maintenance plans, including (but not limited to) the frequency of required disinfectant (such as chlorine) residual monitoring. The legislation also requires the NJDOH or local health officer to conduct an epidemiological investigation of each reported diagnosis of Legionnaire’s disease in the state.
By September 2025, the owner or operator of buildings meeting the law’s criteria shall develop a water management program to address the potential for Legionella growth in the building’s water system. The buildings affected by this requirement include:
General or specialty hospitals
Buildings with whirlpools, spas, pools, HVAC cooling towers, ornamental fountains, with other features that release water aerosols
Correctional facilities
A residential high-rise structure with six or more floors and one or more centralized potable water-heater systems.
Hotels and motels with centralized potable water-heater systems and 25 or more units
Subsidized housing facilities for individuals older than 62 or with disabilities, that have centralized potable water-heater systems and 25 or more units
Any residential, commercial, institutional, or industrial building or facility which has been determined by the NJDOH or local health officer to have been associated with an outbreak of Legionnaire’s disease.
By September 2025, the NJDOH shall make available guidance documents for the development and implementation of water management programs.
By December 2027, owners of buildings meeting the law’s criteria are to have fully implemented the water management programs developed for their properties.
Finally, the law also requires the NJDOH to develop a public awareness and education program to educate consumers about the dangers of Legionella.
Thanks for the additional information, Richard!
Great article Matt and as happy as I may be for the state of New Jersey, I know we must continue our efforts with our stakeholders in the state to help make the case for professional qualifications. The ASSE 12000 Professional Qualifications Standard for Water Management and Infection Control Risk Assessment for Building Systems helps ensure that water management teams are accountable for managing and protecting the safety of our building water systems. This is a step in the right direction and hope that continuing education and professional qualification will support these efforts with actionable guidance.
Thanks for commenting, John. I agree that training is very important and should be encouraged even if it’s not required by law.
This is a great article. As a Legionnaires’ survivor myself I think this is a major step in the right direction aimed at addressing the health risks stemming from waterborne legionella bacteria commonly found in water systems that can lead to Legionnaires’ disease. Kudos to New Jersey DOH for requiring that every case of Legionnaires’ disease is investigated. This resonates with me as I was considered a “sporadic” case so there was no investigation required or done. While I am sure it will be work in progress, this is a fantastic start and perhaps it can service as a blueprint for national legislation. This makes me question what can be done to keep to momentum on the this so ALL states have a bill similar to NJ Bill 2188?
Thanks for your comments, Jill. And thanks for all you’re doing to help other Legionnaires’ survivors!
Interesting story about water heaters that aren’t central. But I think the success of the new, ambitious regulation will depend more on the resources invested in her implementation. The expertise of building owners will need to be developed. Water quality management plans will have to include control measures in the event of positive samples. And there will be positive samples. Plenty of them. In addition, the issue of confirming clinical strains in patients in order to confirm environmental sources should also be addressed. Finally, if an evaluation (economic or otherwise) of the implementation of this regulation is made, I’d be very interested to know the results. Bravo to NJ for this promising initiative!
Translated with DeepL.com (free version)
Good points, Dr. Hout! Thank you
Being new to the field of Legionella, I will comment on common issues with my background in environmental regulation in general.
Experience has demonstrated a regulation without adequate means to monitor and enforce is basically a guidance document with minimum standards to those who have a desire to do things correctly anyway. Well defined metrics, such as how to effectively document compliance for public supply systems disinfection levels throughout the system and detailed record keeping and reporting requirements by qualified personnel, are all positive steps to a good outcome and assist in review for enforcement.
Advancing attention to the issue with proper regulatory process is a positive and should be applauded.
Thanks for your input, RJ!
What is the basis for the 1ppm chloramine minimum?
Good question, Corey. I don’t know whether it was based on a particular study. If anyone reading this has a link to documentation for the 1 ppm monochloramine decision, please reply with it here.
Great article, looks like New Jersey is moving forward with governmental regulations that can have an impact and potential to reduce the risks of Legionella. However, as we know, there has been and continues to be a strong push to reduce regulations and government interference in the private sector. As we have learned over the years, regulations without an adequate means to implement, monitor, and enforces is nothing more than guidance. While cost should not be a guiding factor in protecting the public health, safety, and welfare; we know it is always a consideration. Yes, this is a step in a positive direction, I saw nothing in the legislation that established who was ultimately responsible for oversight and enforcement. Nor was there any discussion of funding or cost recovery for such efforts. As we know or should know, there is no free lunch; someone will have to cover these costs associated with implementing, monitoring, and enforcing any requirements imposed on the owners and operators.
Advancing the fight to reduce and minimize Legionella through a regulatory process is a move in the correct direction and should be applauded.
Thanks for the thoughtful comments, David. For the bill’s fiscal estimate, see https://pub.njleg.gov/Bills/2024/S2500/2188_E1.PDF.
Well, this is great! I always suspected that some of the legionella cases in NYC could be traced to cooling towers in NJ on the west side of the Hudson River. With established WMPs, this will prevent those types of infections.
What I really like is holding the water utilities accountable. NYC will never admit that the source for the legionella in buildings is their own water supply.
Thanks for commenting, Mitchell!