WRF Webcast. Customer Messaging on Opportunistic Pathogens in Plumbing Systems (WRF 4664) January 17, 2019

Transcription

1 WRF Webcast Customer Messaging on Opportunistic Pathogens in Plumbing Systems (WRF 4664) January 17, 2019 No part of this presentation may be copied, reproduced, or otherwise utilized without permission.

2 Three Webcast Series on Legionella! 1. Webinar #1: Understanding Analytical and Monitoring Methods for Legionella in Building Water Systems (held September 18, 2018) 2. Webinar #2: Management Technologies for Prevention and Mitigation of Legionella (held October 25, 2018) 3. Webinar #3: Legionella Management and Guidelines (held December 4, 2018) Recordings of three webcasts in the series are available for on-demand viewing. Waterrf.org Resources Webcasts View Webcasts on Demand

3 WRF Research Area:Waterborne Pathogens in Distribution and Premise Plumbing Systems Research Plan for Management of Emerging Pathogens Associated with Distribution Systems (WRF 4606) Method(s) for Detecting and Differentiating Opportunistic Premise Plumbing Pathogens (OPPPs) to Determine Efficacy of Control and Treatment Technologies (WRF 4721) Approved Customer Messaging on Plumbing Issues (WRF 4664) Appropriate Sampling and Monitoring Strategies for Opportunistic Pathogens in Drinking Water Distribution Systems (WRF 4911)

4 WRF 4664 Report and Resources FAQ Samples materials Project Report Compiled Guidelines from different organizations

5 Speakers Jennifer Clancy, PhD, MS Law - Environmental Science, Policy, and Research Institute (ESPRI) Samantha Villegas - Savi PR, LLC Mark LeChevallier, PhD - Dr. Water Consulting, LLC

6 Housekeeping Items Submit questions through the question box at any time! We will do a Q&A near the end of the webcast. Survey at the end of the webcast. Slides and a recording of the webcast will be available at

7 The Water Research Foundation Project 4664 WRF Manager Grace Jang PAC Members: Gary Burlingame - Philadelphia Water Department Paul Rochelle - Metropolitan Water District of Southern California Alison Albert - Centers for Disease Control and Prevention Melissa Elliott - Raftelis Project Team ESPRI Jennifer Clancy - PI Corona Environmental Consulting Sheldon Masters SaVi PR, LLC Samantha Villegas Co PI American Water Zia Bukhari and John-Paul Anderson Dr. Water Consulting Mark LeChevallier Co PI 12 participating utilities Other participants CDC and Philadelphia Dept. of Health

8 WRF 4664 Project Goal Conduct Research to Develop Guidance For Utilities to: Increase customer awareness of the potential for pathogens to grow in building water systems and the associated risks they pose. Provide customers with steps they can take to reduce or minimize pathogen growth in their plumbing. Develop clear and simple messages and sample communications materials water utilities can use for: proactive communication about pathogen growth in a building water system reactive communication about a pathogen outbreak in a building water system

9 WRF 4664 Project Tasks Task 1. Identify the target audiences, routes of communication, and messages based on a series of interviews, workgroups, and literature review of existing guidelines. This task culminated in an expert workshop. Task 2. Refine the message(s) and route(s) of communication developed in Task 1 based on the workshop feedback, and then test the message(s) through pilots in at least three geographical market to gauge the effectiveness of the communication campaign. Task 3. Based on the feedback of the pilot tests, the final approach and communication process will be developed and the final report prepared.

10 Reluctance to communicate about Legionella If there is no issue, why stir it up Topic too complex Desire from management to keep information private Legal issues Inaccurate media coverage Differing expert opinions Current level of knowledge on it not sufficient Varying standards for premise chlorine residual

11 Sharing With You Today Why Should We Care and Communicate about Legionella? Project goals, scope How to Contact the Target Audiences What are the Message Materials Bill Stuffer, Articles, CCR Text, Social Media Text Letter/ , Website What was the Response to the Message

12 Why Should We Care and Communicate about Legionella?

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14 What is Legionellosis? Legionnaire's disease - acute, sometimes fatal Pontiac fever Causes 8,000-18,000 infections/year. Peaks in summer. About 4-5% of all pneumonia. Mortality 5-30% Infection acquired through inhalation

15 Where does Legionella Come From? Fresh water environments lakes, rivers, groundwater (Source: Carter, A. 2009) Engineered systems Drinking water, reclaimed water systems, hot-water systems, cooling towers, hot tubs

16 New Water Paradigm New Paradigm A set of beliefs that replaces another set which is believed no longer to apply SDWA designed to provide safe water to all customers Water that is safe to drink may not be safe to breathe The water that the utility sends to its customers is often not what is found at the tap in the building Because the building design and operations exerts its own effects on water quality every building is a dead end

17 Overview: Customer Education Not all customers may be aware that the Legionella problem primarily resides within their premise plumbing The greatest issue is for commercial/industrial and health care buildings CDC recently issued a tool box for risk management: ASHRAE Standard 188 Self assessment questionnaire Legionella water management plan Customers look to their water utilities as an authoritative voice on water issues

18 Who are the target audiences? Hospital/Healthcare Engineers/Facility Managers Commercial and Industrial Facility Managers Residential Property Managers Apartment Tenants Single Family and Townhome Customers

19 Research Methods ID audiences, Routes of Communications and Messages We surveyed 16 water utilities by phone Handful of trade groups by phone Handful of Facility Managers, by phone 100 Facility Managers, by We conducted an extensive internet search & compilation We tested messages with key audiences, via mail and phone

20 How Best to Reach Target Audiences? Website Social media CCR text Billing insert Article FAQs for Customer Service Reps Single Family Home Owner Commercial, Institutional, Industrial (CII) or Multi-Family Letter or to direct contact Website Regular face-to-face meetings Outreach from IFMA Local Community Group/Affiliated Group Hospital or Healthcare Customer Letter or to direct contact Website Sample article/fact sheet In person meetings Letter or to direct contact Website Outreach from ASHE

21 How Best to Reach Target Audiences? Hospital or Healthcare Customer Letter or to direct contact Website Outreach from ASHE

22 How Best to Reach Target Audiences? Letter or to direct contact Website Regular face-to-face meetings Outreach from IFMA Commercial, Institutional, Industrial (CII) or Multi-Family

23 How Best to Reach Target Audiences? Single Family Home Owner Website Social media CCR text Billing insert Article FAQs for Customer Service Reps

24 How Best to Reach Target Audiences? Local Community Group/Affiliated Group Letter or to direct contact Website Sample article/fact sheet In person meetings

25 Outreach to Local and/or Regional Groups/Partners Children State/local childcare association Daycares School system Private schools Elderly Elder care AARP Council on Aging Nursing union Local nursing homes/assisted living Facility/Technical/Trade Plumbers/HVAC unions/assns Cooling tower manufacturers Water management consultants Commercial real estate firms/assns Property management firms/assns Pool and spa associations Tourism/Hospitality Local/regional hotel association Tourism Board

26 Outreach to Local and/or Regional Groups/Partners Government American Public Health Association Local public health office FEMA, OSHA Local League of Cities Public/private colleges/universities Health Rehab facilities Physical therapy facilities Gyms and Health clubs National Environmental Health Association Infection control at hospital Doctors organizations/practices Housing Local associations for housing or apartments Housing departments e.g. HUD or department of buildings US Green Building Council Home Insurance offices/association Home inspector groups Legal Risk managers Law offices specialty in business risk

27 Sample Materials Bill Stuffer Sample Article CCR Text Sample Social Media Text Letter/ to large users Website

28 Sample CCR Text Water Quality and Your Plumbing Safe water is our top priority and a responsibility we share with you. The water we deliver to your property meets all federal and state regulations and water quality standards, but water quality can change once the water leaves our network of pipes and enters your building or home s plumbing. Residents and facility managers have an important role to maintain the quality of water after it leaves our pipes. Guidance is available at [INSERT UTILITY WEBSITE].

29 Sample Social Media The following are sample Facebook or Twitter messages that can be used anytime, but in particular (1) when Legionella is a part of the national news cycle due to an outbreak or a sickness reported somewhere or (2) when you are promoting water quality. Did you know that Legionella accounts for 66% of all drinking water outbreaks in plumbing systems? Learn more. [link to your web page] You have a role in maintaining the quality of water inside your home. Learn more. [link to your web page] The water we deliver to you is disinfected, but once inside your home, your plumbing has an impact on its quality. Learn more. [link to your web page] Legionella was in the news today, find out whether your home or business is at risk. [link to your web page]

30 What Information Should Be Shared and When? Proactive Reactive BEFORE AFTER an outbreak an outbreak

31 Proactive Messages for All Audiences What is Legionella? Our utility cares about your health and wants to help you and our entire community to understand how to minimize your exposure to Legionella. Legionella is a type of bacteria found naturally in freshwater environments, like lakes and streams. Legionnaires disease, the illness caused by the Legionella bacterium, is the most common type of waterborne disease in the United States. You get it primarily by inhaling not drinking water mist that contains Legionella. You can get Legionnaires disease by inhaling the air surrounding the spray of water off faucets, showerheads, fountains, spas, and pools. How and why does Legionella become an issue in a plumbing system? The water delivered from a water treatment facility to a home or business is disinfected to meet all federal and state standards for public health. Once drinking water leaves the public system and enters a home or business property, a new water environment exists. Legionella can grow within a building s plumbing fixtures, such as faucets and showerheads, hot water heaters, cooling towers, decorative water fountains, spas or pools. Legionella becomes a health risk when it grows in warm, wet environments, and is then dispersed in water droplets. Legionella is more likely to occur in the plumbing system of large buildings than in single family homes or townhouses. What is the risk for developing Legionnaires disease? Most healthy adults and children who are exposed to Legionella do not get sick. Those most at risk from Legionnaires disease are: People over 50 Current or former smokers Individuals with chronic lung disease People with weak immune systems If you are unsure about your risk, consult your doctor.

32 Proactive Messages For Facility Managers of CII and Healthcare Facilities How to reduce the risk of Legionella (for CII, including healthcare facilities) Healthcare facilities need to manage Legionella risk due to the increased number of people who may be susceptible to infection. For this reason, it is important for health care facilities managers to create and implement a water management plan in accordance with the Centers for Disease Control Toolkit ( The Centers for Disease Control and Prevention (CDC), the Environmental Protection Agency (EPA) and the American Society of Heating, Refrigeration, and Air Conditioning Engineers (ASHRAE) provide excellent recommendations for the assessment, prevention and treatment of Legionella in building water systems. Additionally, in June of 2017, the Centers for Medicare & Medicaid Services (CMS) of the U.S. Department of Health & Human Services directed all Medicare certified healthcare facilities to have water management policies and procedures to reduce the risk of growth and spread of Legionella and other opportunistic microbes in building water systems.

33 Proactive Messages For Facility Managers of CII and Healthcare Facilities The CDC says a water management plan should be developed for: Healthcare facilities where patients stay overnight, or where there are treatment areas for people with chronic or acute medical problems or weak immune systems Residents older than 65 years Multiple residential units with a centralized hot water system More than 10 stories including basement and parking levels Cooling towers Spa, hot tub, Jacuzzi, or a spa that is not drained between uses Decorative fountain or other water features Mister, atomizer, air washer, or humidifier Even if a healthcare facility does not contain any of the above features, it is still best practice to have a water management plan.

34 Proactive Messages For Facility Managers in General Managing the water quality and plumbing in your building is a responsibility we share with you, and we are offering some guidance on steps you can take. Contact us at [INSERT NUMBER] to set up a time to meet with you to discuss the development of a water management plan for your building or determine how we might be of further assistance to you.

35 Proactive Messages for Homeowners Controlling Legionella Growth in the Home Hot Water Heaters Water Filters Humidifiers Evaporative Cooling Fans Showers and Faucets

36 How to reduce the risk of Legionella Proactive Messages for Homeowners Managing the water quality and plumbing in your home is a responsibility we share with you. The most effective steps you can take include regularly cleaning shower heads and faucet aerators and flushing the hot water tank in your home after long periods of time or lack of use. Details for cleaning showerheads and faucets are at [INSERT WEBSITE]. A licensed plumber should be contacted for flushing your hot water heater. For more information, contact us at [PHONE] or [WEBSITE] and click on LINK].

37 Reactive Messaging for ALL Audiences Effects of Exposure to Legionella How Exposure Happens Who is at Risk What to Do if Exposed Pneumonia Cough Fever Chills Fatigue Abdominal pain Muscle aches Diarrhea Headache People can be exposed to Legionella by breathing in water droplets containing the bacteria. Legionella bacteria live in water and have been found in showers, building cooling towers, humidifiers, whirlpool spas, respiratory therapy devices, and decorative fountains, among other sources. Legionnaires disease is not generally spread person to person. For most cases, the source of infection is not usually found. Persons above the age of 50 are more likely to get Legionnaires disease. Cigarette smokers Those with chronic lung disease, diabetes, Those with any other condition that weakens the immune system such as cancer or a recent organ transplant. If you think you have Legionnaires disease, you should contact your doctor and discuss your symptoms.

38 Reactive Messages for Facility Managers How to Address a Legionella Outbreak in Your Plumbing The Centers for Disease Control (CDC) offers information of steps to consider during a potential outbreak at Actions We re Taking As your water utility, we are available to assist you and public health officials in the monitoring or testing of water samples from your property, through the remediation process. We are consulting with public health officials on the remediation process We are prioritizing communications of this issue with all customers to help prevent other outbreaks Resources for Assistance Our website at [INSERT WEBSITE] offers information about Legionella control on your property. We also encourage you to contact your local public health officials who can advise you further on response actions you can take. The Centers for Disease Control (CDC) offers Legionella information at

39 Web-Based Customer Information Structured so that utilities can use information and apply to their websites Actionable information and methods Supporting messages, bill stuffers, articles, etc.

40 Homeowners Low Risk Customer Actions Cleaning Showerheads and faucet aerators Hot Water Heater temperature Performing a hot water tank flush Water Treatment and Filtration Humidifiers

41 Multi-Dwelling Same messages as to homeowners but includes additional features Hot tubs/ Jacuzzis / spas Pools and shower facilities Indoor or outdoor fountains or water features Central water heaters distributed water lines/pipes Cooling towers Water reservoir tanks Solar water systems

42 Industrial/Commercial Emphasizes the American Society of Heating, Refrigerating and Air- Conditioning Engineers (ASHRAE) standard for risk management in large building water systems (ANSI/ASHRAE Standard ). 7 step program

43 Health Care Facilities Refer to the CDC Toolkit: A healthcare facility where patients stay overnight or have chronic or acute medical problems or weakened immune systems. People older than 65 years Centralized hot water system Has more than 10 stories (including basement) Has a cooling tower Has a hot tub, Jacuzzi, or a spa not drained between each use Has a decorative fountain Has a centrally-installed mister, atomizer, air washer, or humidifier Typical Members of a Water Management Program Team Building owner Building manager/administrator Maintenance or engineering employees Safety officers Equipment or chemical suppliers Contractors/consultants who are water treatment professionals Certified industrial hygienists Microbiologists Environmental health specialists State or local health officials

44 Supporting Pages Legionella Ecology Health Effects Your Utility Water Quality National and International Guidelines The Center for Disease Control Toolkit Disinfection Methods Legionella Testing Other Plumbing Pathogens Useful Links

45 Other Plumbing Pathogens Ecology, health risks, disinfection methods Mycobacterium avium Pseudomonas aeruginosa Aeromonas Naegleria folweri Acanthamoeba

46 Valuable Resources American Society for Microbiology ASHRAE Centers for Disease Control and Prevention Cooling Technology Institute Department of Environmental Conservation Department of Health (NY, PA, FL) Energy.gov Environmental Protection Agency Health and Safety Executive Ministry of Health National Sanitation Foundation Legionella.org Occupational Safety & Health Administration Public Health Ontario U.S. National Library of Medicine World Health Organization

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55 Customer Surveys Objective was to test the website messages and materials Meshed with the utility program to reach out to large customers 1. Phone survey for large customers in 3 states (east, west, central) 2. Mailing of a brochure based on the website information in 1 state (east)

56 Summary of Phone Survey Number Responding Are familiar with or have heard of Legionella Are familiar with the conditions that favor the growth of Legionella in building plumbing Have a building water management plan Multi Dwelling Commercial / Industrial Hospital / Health Care All

57 Survey Findings: Facility Managers By , 100 responses 87% aware of issue 50% in the education and hospitality sectors aware of ASHRAE % in healthcare aware of the CDC Toolkit 33% communicate with their water utility monthly (41% quarterly) 54% prefer and 30% prefer phone 35% Education 42% Healthcare 23% Hospitality

58 Concluding Thoughts Customers surveyed were already aware of Legionella issues and appreciated the outreach and guidance provided by the water utilities Contact by the water utility spurred many to become more educated and to initiate actions towards implementing a building water management system Recommend utilities contact their CII customers personally, to develop relationships with facility managers The results refute the water utility perception that outreach to customers would cause undue alarm

59 Q & A No part of this presentation may be copied, reproduced, or otherwise utilized without permission.

60 THANK YOU! Jennifer Clancy, Ph.D, M.S. Law - ESPRI Samantha Villegas - Savi PR, LLC Mark LeChevallier, Ph.D - Dr. Water Consulting, LLC H. Grace Jang, Ph.D The Water Research Foundation Michelle Suazo The Water Research Foundation No part of this presentation may be copied, reproduced, or otherwise utilized without permission.