Effective Methods for Implementing Water Management Programs (WMPs) To Reduce Growth of Transmission of Legionella spp., 39439-39440 [2017-17491]

Download as PDF 39439 Federal Register / Vol. 82, No. 159 / Friday, August 18, 2017 / Notices ESTIMATED ANNUALIZED BURDEN HOURS Number of responses per respondent Number of respondents Avg. burden per response (in hours) Total burden (in hours) Type of respondents Form name Women with recent births .................. Maternal hospital-based questionnaire. Father hospital-based questionnaire Follow-up phone questionnaire ......... 2,990 1 25/60 1,247 1,790 3,070 1 1 15/60 15/60 448 768 ............................................................ ...................... ........................ ........................ 2,463 Fathers with recently born infants ..... Women with live births 2–10 months prior. Total ............................................ Leroy A. Richardson, Chief, Information Collection Review Office, Office of Scientific Integrity, Office of the Associate Director for Science, Office of the Director, Centers for Disease Control and Prevention. [FR Doc. 2017–17518 Filed 8–17–17; 8:45 am] BILLING CODE 4163–18–P DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention [Docket No. CDC–2017–0069] Effective Methods for Implementing Water Management Programs (WMPs) To Reduce Growth of Transmission of Legionella spp. Centers for Disease Control and Prevention (CDC), Department of Health and Human Services (HHS). ACTION: Request for information. AGENCY: The Centers for Disease Control and Prevention (CDC) in the Department of Health and Human Services (HHS) announces the opening of a docket to obtain information on effective methods for achieving implementation of water management programs (WMPs) intended to reduce Legionella growth and transmission in buildings at increased risk. The information will inform CDC efforts to prevent Legionnaires disease in the United States. Information gathered should also inform CDC efforts to prevent disease due to other opportunistic waterborne pathogens (e.g., Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas, nontuberculous mycobacteria, various species of fungi, and Naegleria). DATES: Written comments must be received on or before October 17, 2017. ADDRESSES: You may submit comments, identified by Docket No. CDC–2017– 0069 by any of the following methods: • Federal eRulemaking Portal: https:// www.regulations.gov. Follow the instructions for submitting comments. mstockstill on DSK30JT082PROD with NOTICES SUMMARY: VerDate Sep<11>2014 17:47 Aug 17, 2017 Jkt 241001 • Mail: Laura Cooley, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE., MS C25, Atlanta, GA 30329. Instructions: All submissions received must include the agency name and Docket Number. All relevant comments received will be posted without change to https://regulations.gov, including any personal information provided. For access to the docket to read background documents or comments received, go to https://www.regulations.gov. FOR FURTHER INFORMATION CONTACT: Laura Cooley, National Center for Immunization and Respiratory Diseases, Division of Bacterial Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE., MS C25, Atlanta, GA 30329. Email: travellegionella@cdc.gov. Phone: (404) 639–2215. SUPPLEMENTARY INFORMATION: Background: CDC assists state and local health departments with Legionnaires disease response and prevention efforts by providing technical assistance and developing resources focused on preventing and investigating cases and outbreaks of Legionnaires disease (https:// www.cdc.gov/legionella/). Legionnaires disease, a severe, sometimes fatal pneumonia, can occur in persons who inhale aerosolized droplets of water contaminated with the bacterium Legionella. The rate of reported cases of Legionnaires disease in the United States has increased more than four-fold since 2000.1 Legionella and other waterborne pathogens can multiply in large, complex building water systems where there are gaps in water system maintenance; thus, the most effective strategy for prevention of Legionnaires disease is through control 1 Garrison LE, Kunz JM, Cooley LA, et al. Vital signs: Deficiencies in environmental control identified in outbreaks of Legionnaires disease— North America, 2000–2014. MMWR Morb Mortal Wkly Rep 2016; 65:576–84. https://doi.org/ 10.15585/mmwr.mm6522e1. PO 00000 Frm 00036 Fmt 4703 Sfmt 4703 of Legionella in building water systems. Water management programs (WMPs) identify hazardous conditions and take steps to minimize the growth and spread of Legionella and other waterborne pathogens in building water systems. Developing and maintaining a water management program is a multistep process that requires continuous review. In 2015, ASHRAE (formerly known as the American Society of Heating, Refrigerating, and Air-Conditioning Engineers) published a consensus standard for the primary prevention of Legionnaires disease,2 which calls for the development and implementation of WMPs in buildings with large or complex water systems and in buildings that house people who are particularly susceptible to Legionnaires disease. ASHRAE recommends WMPs for the following buildings and devices: • Healthcare facilities where patients stay overnight • Buildings that house or treat people who have chronic and acute medical problems or weakened immune systems • Buildings that primarily house people older than 65 years (like a retirement home or assisted living facility) • Buildings that have a centralized hot water system (like a hotel or high-rise apartment complex) • Buildings 10 stories or more (including basement levels) • Devices that have been linked to transmission of Legionella: Æ Cooling towers Æ Hot tubs (or spas) that are not drained between each use Æ Decorative fountains Æ Centrally-installed misters, atomizers, air washers, or humidifiers Additionally, stakeholders can use CDC’s toolkit, Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings: A Practical Guide to 2 ASHRAE 188: Legionellosis: Risk Management for Building Water Systems June 26, 2015. ASHRAE: Atlanta. www.ashrae.org. E:\FR\FM\18AUN1.SGM 18AUN1 39440 Federal Register / Vol. 82, No. 159 / Friday, August 18, 2017 / Notices mstockstill on DSK30JT082PROD with NOTICES Implementing Industry Standards.3 This toolkit is dedicated to developing and implementing WMPs and can inform conversations with building owners and managers on how to reduce the risk of Legionella growth and transmission in their building water systems. Information Needs While a consensus standard and guidance exist regarding development and implementation of WMPs, there are gaps regarding the most effective methods to encourage WMP implementation. A variety of stakeholders (e.g., public health partners, industry leaders, accreditation or licensing bodies) routinely work with building owners and managers on WMPs or on related policies. However, successful communication and implementation of WMPs can be challenging, and more information is needed on how implementation of WMPs can be improved. CDC seeks public comments in response to the following questions to guide best practices, especially regarding the dissemination and implementation of WMPs. The information gathered will be used to guide best practices regarding effective strategies to prevent Legionnaires disease in the United States. Information gathered can also inform efforts to prevent disease due to other waterborne pathogens. Please feel free to respond to any or all of the questions. Possible domains to consider in answering these questions include (but are not limited to): • Local knowledge about Legionnaires disease, Legionella growth, and prevention strategies • Stakeholder engagement (key supporters and opponents) • Feasibility of WMP implementation • Costs and benefits of WMP implementation • Availability of effective communication strategies • Possible impact of proposed solutions including unintended consequences such as degradation of plumbing infrastructure or pathogen substitution (e.g., remediation directed at one pathogen, such as Legionella, leading to increases in a second pathogen, such as nontuberculous mycobacteria) • Historical context in which a WMP was or was not adopted • Influence of local regulations Questions (1) What existing standards or guidance does your organization use for 3 https://www.cdc.gov/legionella/downloads/ toolkit.pdf. VerDate Sep<11>2014 17:47 Aug 17, 2017 Jkt 241001 the prevention of Legionella growth and transmission? (2) Are there other standards or guidance for the prevention of Legionella growth and transmission that you would find useful but do not exist or are not currently available to you? If so, what information should those standards or guidance contain? (3) What is your organization’s role, and your role within the organization, in achieving implementation of WMPs by owners and managers of buildings at increased risk for Legionella growth and transmission? (4) In your organization’s experience, what are the principal barriers to implementation of WMPs by building owners and managers? (5) Where there are barriers, what has your organization done to overcome these barriers? (6) Where implementation of WMPs has gone smoothly, what factors (e.g., resources, guidance, activities) contributed to this success? (7) Has your organization had experience with approaches to WMP implementation that are specific to certain settings (e.g., hotels, hospitals) or devices (e.g., cooling towers, potable water)? If so, have you learned anything from these different approaches that could be used to improve WMP implementation? Have you looked for or experienced any unintended consequences related to a WMP? (8) A limited number of jurisdictions have implemented regulations to reduce the risk of Legionella growth and transmission (e.g., New York, New York City). In your state or local jurisdiction, should building codes or other types of public health regulation or legislation be used to help prevent Legionnaires’ disease? Why or why not? (9) Are there other approaches to reducing the risk of Legionnaires’ disease that your organization has found to be useful besides implementation of WMPs? (10) What additional considerations are relevant to developing guidance for preventing Legionnaires disease? (11) Has your organization implemented specific approaches to reducing the risk of disease due to other opportunistic waterborne pathogens besides Legionella? If so, please explain. Do these approaches conflict in any way with your approaches to reducing the risk of Legionnaires disease? Dated: August 15, 2017. Sandra Cashman, Executive Secretary, Centers for Disease Control and Prevention. [FR Doc. 2017–17491 Filed 8–17–17; 8:45 am] BILLING CODE 4163–18–P PO 00000 Frm 00037 Fmt 4703 Sfmt 4703 DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services [Document Identifier: CMS–10437 and CMS– 10652] Agency Information Collection Activities: Submission for OMB Review; Comment Request Centers for Medicare & Medicaid Services, HHS. ACTION: Notice. AGENCY: The Centers for Medicare & Medicaid Services (CMS) is announcing an opportunity for the public to comment on CMS’ intention to collect information from the public. Under the Paperwork Reduction Act of 1995 (PRA), federal agencies are required to publish notice in the Federal Register concerning each proposed collection of information, including each proposed extension or reinstatement of an existing collection of information, and to allow a second opportunity for public comment on the notice. Interested persons are invited to send comments regarding the burden estimate or any other aspect of this collection of information, including the necessity and utility of the proposed information collection for the proper performance of the agency’s functions, the accuracy of the estimated burden, ways to enhance the quality, utility, and clarity of the information to be collected, and the use of automated collection techniques or other forms of information technology to minimize the information collection burden. SUMMARY: Comments on the collection(s) of information must be received by the OMB desk officer by September 18, 2017. DATES: When commenting on the proposed information collections, please reference the document identifier or OMB control number. To be assured consideration, comments and recommendations must be received by the OMB desk officer via one of the following transmissions: OMB, Office of Information and Regulatory Affairs, Attention: CMS Desk Officer, Fax Number: (202) 395–5806 OR, Email: OIRA_submission@omb.eop.gov. To obtain copies of a supporting statement and any related forms for the proposed collection(s) summarized in this notice, you may make your request using one of following: 1. Access CMS’ Web site address at https://www.cms.hhs.gov/ PaperworkReductionActof1995. ADDRESSES: E:\FR\FM\18AUN1.SGM 18AUN1

Agencies

[Federal Register Volume 82, Number 159 (Friday, August 18, 2017)]
[Notices]
[Pages 39439-39440]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2017-17491]



-----------------------------------------------------------------------



DEPARTMENT OF HEALTH AND HUMAN SERVICES



Centers for Disease Control and Prevention



[Docket No. CDC-2017-0069]




Effective Methods for Implementing Water Management Programs 

(WMPs) To Reduce Growth of Transmission of Legionella spp.



AGENCY: Centers for Disease Control and Prevention (CDC), Department of 

Health and Human Services (HHS).



ACTION: Request for information.



-----------------------------------------------------------------------



SUMMARY: The Centers for Disease Control and Prevention (CDC) in the 

Department of Health and Human Services (HHS) announces the opening of 

a docket to obtain information on effective methods for achieving 

implementation of water management programs (WMPs) intended to reduce 

Legionella growth and transmission in buildings at increased risk. The 

information will inform CDC efforts to prevent Legionnaires disease in 

the United States. Information gathered should also inform CDC efforts 

to prevent disease due to other opportunistic waterborne pathogens 

(e.g., Pseudomonas, Acinetobacter, Burkholderia, Stenotrophomonas, 

nontuberculous mycobacteria, various species of fungi, and Naegleria).



DATES: Written comments must be received on or before October 17, 2017.



ADDRESSES: You may submit comments, identified by Docket No. CDC-2017-

0069 by any of the following methods:

     Federal eRulemaking Portal: https://www.regulations.gov. 

Follow the instructions for submitting comments.

     Mail: Laura Cooley, National Center for Immunization and 

Respiratory Diseases, Division of Bacterial Diseases, Centers for 

Disease Control and Prevention, 1600 Clifton Road NE., MS C25, Atlanta, 

GA 30329.

    Instructions: All submissions received must include the agency name 

and Docket Number. All relevant comments received will be posted 

without change to https://regulations.gov, including any personal 

information provided. For access to the docket to read background 

documents or comments received, go to https://www.regulations.gov.



FOR FURTHER INFORMATION CONTACT:  Laura Cooley, National Center for 

Immunization and Respiratory Diseases, Division of Bacterial Diseases, 

Centers for Disease Control and Prevention, 1600 Clifton Road NE., MS 

C25, Atlanta, GA 30329. Email: travellegionella@cdc.gov. Phone: (404) 

639-2215.



SUPPLEMENTARY INFORMATION:

    Background: CDC assists state and local health departments with 

Legionnaires disease response and prevention efforts by providing 

technical assistance and developing resources focused on preventing and 

investigating cases and outbreaks of Legionnaires disease (https://www.cdc.gov/legionella/).

    Legionnaires disease, a severe, sometimes fatal pneumonia, can 

occur in persons who inhale aerosolized droplets of water contaminated 

with the bacterium Legionella. The rate of reported cases of 

Legionnaires disease in the United States has increased more than four-

fold since 2000.\1\ Legionella and other waterborne pathogens can 

multiply in large, complex building water systems where there are gaps 

in water system maintenance; thus, the most effective strategy for 

prevention of Legionnaires disease is through control of Legionella in 

building water systems. Water management programs (WMPs) identify 

hazardous conditions and take steps to minimize the growth and spread 

of Legionella and other waterborne pathogens in building water systems. 

Developing and maintaining a water management program is a multi-step 

process that requires continuous review.

---------------------------------------------------------------------------



    \1\ Garrison LE, Kunz JM, Cooley LA, et al. Vital signs: 

Deficiencies in environmental control identified in outbreaks of 

Legionnaires disease--North America, 2000-2014. MMWR Morb Mortal 

Wkly Rep 2016; 65:576-84. https://doi.org/10.15585/mmwr.mm6522e1.

---------------------------------------------------------------------------



    In 2015, ASHRAE (formerly known as the American Society of Heating, 

Refrigerating, and Air-Conditioning Engineers) published a consensus 

standard for the primary prevention of Legionnaires disease,\2\ which 

calls for the development and implementation of WMPs in buildings with 

large or complex water systems and in buildings that house people who 

are particularly susceptible to Legionnaires disease. ASHRAE recommends 

WMPs for the following buildings and devices:

---------------------------------------------------------------------------



    \2\ ASHRAE 188: Legionellosis: Risk Management for Building 

Water Systems June 26, 2015. ASHRAE: Atlanta. www.ashrae.org.



 Healthcare facilities where patients stay overnight

 Buildings that house or treat people who have chronic and 

acute medical problems or weakened immune systems

 Buildings that primarily house people older than 65 years 

(like a retirement home or assisted living facility)

 Buildings that have a centralized hot water system (like a 

hotel or high-rise apartment complex)

 Buildings 10 stories or more (including basement levels)

 Devices that have been linked to transmission of Legionella:

    [cir] Cooling towers

    [cir] Hot tubs (or spas) that are not drained between each use

    [cir] Decorative fountains

    [cir] Centrally-installed misters, atomizers, air washers, or 

humidifiers



    Additionally, stakeholders can use CDC's toolkit, Developing a 

Water Management Program to Reduce Legionella Growth & Spread in 

Buildings: A Practical Guide to



[[Page 39440]]



Implementing Industry Standards.\3\ This toolkit is dedicated to 

developing and implementing WMPs and can inform conversations with 

building owners and managers on how to reduce the risk of Legionella 

growth and transmission in their building water systems.

---------------------------------------------------------------------------



    \3\ https://www.cdc.gov/legionella/downloads/toolkit.pdf.

---------------------------------------------------------------------------



Information Needs



    While a consensus standard and guidance exist regarding development 

and implementation of WMPs, there are gaps regarding the most effective 

methods to encourage WMP implementation. A variety of stakeholders 

(e.g., public health partners, industry leaders, accreditation or 

licensing bodies) routinely work with building owners and managers on 

WMPs or on related policies. However, successful communication and 

implementation of WMPs can be challenging, and more information is 

needed on how implementation of WMPs can be improved. CDC seeks public 

comments in response to the following questions to guide best 

practices, especially regarding the dissemination and implementation of 

WMPs. The information gathered will be used to guide best practices 

regarding effective strategies to prevent Legionnaires disease in the 

United States. Information gathered can also inform efforts to prevent 

disease due to other waterborne pathogens.

    Please feel free to respond to any or all of the questions. 

Possible domains to consider in answering these questions include (but 

are not limited to):



 Local knowledge about Legionnaires disease, Legionella growth, 

and prevention strategies

 Stakeholder engagement (key supporters and opponents)

 Feasibility of WMP implementation

 Costs and benefits of WMP implementation

 Availability of effective communication strategies

 Possible impact of proposed solutions including unintended 

consequences such as degradation of plumbing infrastructure or pathogen 

substitution (e.g., remediation directed at one pathogen, such as 

Legionella, leading to increases in a second pathogen, such as 

nontuberculous mycobacteria)

 Historical context in which a WMP was or was not adopted

 Influence of local regulations



Questions



    (1) What existing standards or guidance does your organization use 

for the prevention of Legionella growth and transmission?

    (2) Are there other standards or guidance for the prevention of 

Legionella growth and transmission that you would find useful but do 

not exist or are not currently available to you? If so, what 

information should those standards or guidance contain?

    (3) What is your organization's role, and your role within the 

organization, in achieving implementation of WMPs by owners and 

managers of buildings at increased risk for Legionella growth and 

transmission?

    (4) In your organization's experience, what are the principal 

barriers to implementation of WMPs by building owners and managers?

    (5) Where there are barriers, what has your organization done to 

overcome these barriers?

    (6) Where implementation of WMPs has gone smoothly, what factors 

(e.g., resources, guidance, activities) contributed to this success?

    (7) Has your organization had experience with approaches to WMP 

implementation that are specific to certain settings (e.g., hotels, 

hospitals) or devices (e.g., cooling towers, potable water)? If so, 

have you learned anything from these different approaches that could be 

used to improve WMP implementation? Have you looked for or experienced 

any unintended consequences related to a WMP?

    (8) A limited number of jurisdictions have implemented regulations 

to reduce the risk of Legionella growth and transmission (e.g., New 

York, New York City). In your state or local jurisdiction, should 

building codes or other types of public health regulation or 

legislation be used to help prevent Legionnaires' disease? Why or why 

not?

    (9) Are there other approaches to reducing the risk of 

Legionnaires' disease that your organization has found to be useful 

besides implementation of WMPs?

    (10) What additional considerations are relevant to developing 

guidance for preventing Legionnaires disease?

    (11) Has your organization implemented specific approaches to 

reducing the risk of disease due to other opportunistic waterborne 

pathogens besides Legionella? If so, please explain. Do these 

approaches conflict in any way with your approaches to reducing the 

risk of Legionnaires disease?



    Dated: August 15, 2017.

Sandra Cashman,

Executive Secretary, Centers for Disease Control and Prevention.

 [FR Doc. 2017-17491 Filed 8-17-17; 8:45 am]

BILLING CODE 4163-18-P
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