Academy of Architecture for Health

Read this interesting article about the link between hostpial's water wall and Legionnaires' disease.  The Washington Post article documents hospital in Wisconsin where eight people contracted the disease in 2010. 

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Dan Noble FAIA, FACHA, LEED AP
HKS, Inc.
Dallas TX
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Dan,
Very interesting article.
It sounds like they are discouraging the design of fountains, probably not a bad idea. But I am curious as to whether they could keep the fountains and their typical cleaning habits (or perhaps even better cleaning habits) and find a way to address it Mechanically, with more air changes per hour to help with air borne / bacteria issues.
I know that water fountains can be a very nice relaxing feature in healthcare environments, I hate to see them disappear because of a lack of design professionals efforts to find a solution to the problem. Assuming one can be found.
Definitely something to ponder as design professionals.
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Michael E. Mitscher, AIA, NCARB
Project Manager
The McKinney Partnership Architects, PC
3600 West Main
Suite 200
Norman, Oklahoma 73072
405.360.1400 p
405.364.8287 f
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Show Original Message -------------------------------------------
Original Message:
Sent: 01-11-2012 09:30
From: Dan Noble
Subject: Link found between hostpial's water wall and Legionnaires' disease
Read this interesting article about the link between hostpial's water wall and Legionnaires' disease. Thehttp://www.washingtonpost.com/national/health-science/hospital-fountain-linked-to-legionnaires-outbreak/2012/01/10/gIQAyLwEpP_story.html documents hospital in Wisconsin where eight people contracted the disease in 2010.
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Dan Noble FAIA, FACHA, LEED AP
HKS, Inc.
Dallas TX
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Hi Micheal,

Thanks for your response to Dan's post. This is an important discussion. While I was working in a major New York hospital we had been diagnosed by CMS as being Legionnaire "positive," and we worked hard to eradicate all the sources (even removing abandoned water pipes behind walls that could breed bacteria through stagnant water.)

Despite this appraisal by CMS, we were able to get approval to install a large fish tank/aquarium in the newly renovated pediatrics unit. In my experience, it is possible to work with hospital administration and the authority having jurisdiction, to retain these water features that are so helpful in clinical settings by identifying all the relevant precautions.

The link below helps to identify precautions that should be taken in the design of ornamental features like fountains and aquariums. There may also be an updated document.
http://www.legionellae.org/guidelines/guidelines.htm

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Avani Parikh
Avani Parikh Architecture PC
New York NY

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Show Original Message -------------------------------------------
Original Message:
Sent: 01-15-2012 22:48
From: Michael Mitscher
Subject: Link found between hostpial's water wall and Legionnaires' disease


Dan,

Very interesting article.
It sounds like they are discouraging the design of fountains, probably not a bad idea. But I am curious as to whether they could keep the fountains and their typical cleaning habits (or perhaps even better cleaning habits) and find a way to address it Mechanically, with more air changes per hour to help with air borne / bacteria issues.
I know that water fountains can be a very nice relaxing feature in healthcare environments, I hate to see them disappear because of a lack of design professionals efforts to find a solution to the problem. Assuming one can be found.
Definitely something to ponder as design professionals.

-------------------------------------------
Michael E. Mitscher, AIA, NCARB
Project Manager

The McKinney Partnership Architects, PC
3600 West Main
Suite 200
Norman, Oklahoma 73072
405.360.1400 p
405.364.8287 f


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Micheal,

There is a great demand for water features in healthcare environments. I have worked on several projects that incorporated them. There are details that can be incorporated into water features that were obviously not incorporated in the water feature in the article. The water needs to be circulated through filters and purifiers that will kill the contaminants/pathogens (like a UV purifier). I doubt water features will go away in healthcare environments. Rather, better technologies and more education will make them safer. Consulting an experienced design professional also helps.

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Brian Leonard Assoc. AIA
Edmond OK
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Show Original Message -------------------------------------------
Original Message:
Sent: 01-16-2012 09:24
From: Avani Parikh
Subject: Link found between hostpial's water wall and Legionnaires' disease

Hi Micheal,

Thanks for your response to Dan's post. This is an important discussion. While I was working in a major New York hospital we had been diagnosed by CMS as being Legionnaire "positive," and we worked hard to eradicate all the sources (even removing abandoned water pipes behind walls that could breed bacteria through stagnant water.)

Despite this appraisal by CMS, we were able to get approval to install a large fish tank/aquarium in the newly renovated pediatrics unit. In my experience, it is possible to work with hospital administration and the authority having jurisdiction, to retain these water features that are so helpful in clinical settings by identifying all the relevant precautions.

The link below helps to identify precautions that should be taken in the design of ornamental features like fountains and aquariums. There may also be an updated document.
http://www.legionellae.org/guidelines/guidelines.htm

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Avani Parikh
Avani Parikh Architecture PC
New York NY

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-------------------------------------------
Original Message:
Sent: 01-15-2012 22:48
From: Michael Mitscher
Subject: Link found between hostpial's water wall and Legionnaires' disease


Dan,

Very interesting article.
It sounds like they are discouraging the design of fountains, probably not a bad idea. But I am curious as to whether they could keep the fountains and their typical cleaning habits (or perhaps even better cleaning habits) and find a way to address it Mechanically, with more air changes per hour to help with air borne / bacteria issues.
I know that water fountains can be a very nice relaxing feature in healthcare environments, I hate to see them disappear because of a lack of design professionals efforts to find a solution to the problem. Assuming one can be found.
Definitely something to ponder as design professionals.

-------------------------------------------
Michael E. Mitscher, AIA, NCARB
Project Manager

The McKinney Partnership Architects, PC
3600 West Main
Suite 200
Norman, Oklahoma 73072
405.360.1400 p
405.364.8287 f


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Although there are certain positive aspects of water features in healthcare applications, the risks involved far outweigh them, as exemplified in the article.  Soft music, artwork, and natural light are other options that do not pose an infection control problem.

The CDC Guidelines for Environmental Infection Control in Health-Care Facilities,  "Recommendations - Water (paragraph I-E), they state that water features not be put in patient care areas, and if they are in public areas, then a strict maintenance and disinfection program must be undertaken.  APIC carries the same recommendation in their 2003 "Guidelines for Environmental Infection Control in Health-Care Facilities."  Please see the link below:

http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5210a1.htm

Considering above, best advice is to steer clear of these features.



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Jeffrey O'Neill AIA
Senior Planner
University of Pennsylvania Health System
Philadelphia PA
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Show Original Message -------------------------------------------
Original Message:
Sent: 01-15-2012 22:48
From: Michael Mitscher
Subject: Link found between hostpial's water wall and Legionnaires' disease


Dan,

Very interesting article.
It sounds like they are discouraging the design of fountains, probably not a bad idea. But I am curious as to whether they could keep the fountains and their typical cleaning habits (or perhaps even better cleaning habits) and find a way to address it Mechanically, with more air changes per hour to help with air borne / bacteria issues.
I know that water fountains can be a very nice relaxing feature in healthcare environments, I hate to see them disappear because of a lack of design professionals efforts to find a solution to the problem. Assuming one can be found.
Definitely something to ponder as design professionals.

-------------------------------------------
Michael E. Mitscher, AIA, NCARB
Project Manager

The McKinney Partnership Architects, PC
3600 West Main
Suite 200
Norman, Oklahoma 73072
405.360.1400 p
405.364.8287 f


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See "Effective Engineering Solutions to Eng'g System Pathogens" atwww.Legionellae.org
Also 'Water Features in Healthcare Applications: Proper Design Guidelines to Meet Infection Control Requirements" by Bluworld of Water www.bluworldusa.com

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Garth Compton, AIA
SAMSO Facility Architect
Saudi ARAMCO
Dhahran, Saudi Arabia
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