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