ATTACHMENT QUARTERLY SAMPLING PLAN EXAMPLE.docx

Gulf Coast VA Health Care System Legionella Prevention Program Sampling Plan

FY24

FY25 Q1 Quarter Sampling Plan, prepared by Misty Madison, Industrial Hygienist, Water Safety Program Manager Gulf Coast VA Healthcare System prepared on October 22, 2024.

As part of an integral Water Safety Management Plan, in accordance with VHA 1061, Prevention of Health Care-Associated Legionella Disease and Scald Injury from Water Systems (February 2021), the following Sampling Plan is set forth to provide guidance to sampling personnel and ensure sampling integrity and compliance.

Biloxi campus VA buildings which meet the criteria for required sampling locations are 3, 5, 14, 15, 19, 25, and 30. No less than 20 samples shall be taken per building, with at least 2 of those 20 samples being collected from a pure cold water source (water fountain, ice machine) and at least 2 of those samples being collected from a pure hot water source, (water heater or the hot side of sink or shower-no mixing valve). Samples must fill a container of 250 milliliter (mL) or greater.

Note: Bldg. 30 2nd floor Oncology section shall be sampled each quarter.

Parameters which must be recorded at each sampling point are: sample volume, biocide level, pH, and water temperature. When collecting samples from a fixture, the sample must represent one sample per fixture. It is not acceptable to take more than one sample from the same sink, shower, or other type of collection source.

Note: Sampler and VA representative will ensure samples are collected from areas which most accurately representative the building’s overnight patient care or overnight resident/employee areas.

The minimum detection limit for potable water system is 0.4 colony forming units (CFU) per milliliter (mL) and 5 CFU/mL for non-potable/utility water system.

Bldg. 3 and Bldg. 30, focus will be in the overnight areas such as the Emergency Department, ICU, and 30-4.

pH range: 6.5 to 8.5 (Any readings < 6.4 or > 8.6, notification to Engineering must be made prior to end of sampling event) Chlorine range: 0.2 ppm to 2 ppm Chlorine shall be measured first catch following legionella sample collection. Any readings < 0.1 or > 3.5 ppm, notification must be made to Engineering at once.

Temperature range: hot < 110° Fahrenheit (F) and cold temps < than 67°F (due to location, this temperature might be > 67°F, but notification should be made to Engineering when out of range.

VHA 1061, Sampling Guide, for collection of legionella, follow these steps: Guidance Document Routine Legionella Testing for Buildings_April 2021.pdf (va.gov) GD.1061, April 2021

4.1 Order of Taking Samples For routine testing in accordance with VHA Directive 1061, sampling at each outlet is for the purpose of determining the presence of Legionella, as well as understanding water temperature, level of residual biocide and pH in water at/to the outlet.

The following order should be used for collection of samples to determine those parameter levels:

1) collect 250 mL water sample for legionella analysis. Collect the water sample immediately after opening the outlet without flushing water first.

2) collect the next immediate water sample (i.e. no flushing) to take the biocide residual reading.

3) After taking the sample for the biocide reading, run the water for 60 seconds. Collect a water sample to measure water temperature and pH. If hot water temps are below 110°F, run water additional 60 seconds, record temperature, and notify Engineering immediately.

4) Following collection of 140 samples (20 per building), the samples shall either be shipped overnight to the lab (any samples damaged in transit must still be analyzed) for analysis or kept on ice until the sampler returns to lab location.

5) Fill out chain of custody COMPLETELY. Mark sample source, such as sink, shower, ice machine, water fountain and note whether source is before or after mixing valve (if hot water sample)

6) If any sample parameters are out of range, notify Engineering personnel prior to departing the facility.

The chart below outlines rooms that should be used as a guide for the sampler, to ensure overnight patient care rooms are being sampled/analyzed. The room listing can be chosen from, as long as the 20 samples per building are taken, with the 2 pure cold (ice machine & water fountain) and 2 pure hot (hot water tank & hot water outlet with no mixing valve). While some room locations may be repeated each quarter, the goal will be to review the previous quarter’s sampling locations to determine if there is the need for repeated sampling, and to maximize variety of locations on each end of each building, to ensure representative sampling is being conducted.

Bldg. 3

Second Floor:

Nuclear Medicine

Third Floor:

Lab

(hot) Sterile Processing Rm. 3D113 Right Rear Sink

Dialysis Storage 4D122 sink

4B102 Patient room 4B103

Ante Room 4B104 Patient room 4B105 4B106 Ice Machine

Ice Machine: 1F-129, 4B106 Water Fountain: near 1B-105, near 1F-112 Bldg. 5 (Residential quarters for VA medical students and/or facility employees staying overnight)

1) Sink

2) Shower

Ice Machine: none in Bldg. 5 Water Fountain: by stairs, near elevator

Bldg. 14 (Blind Rehabilitation Unit) A&B Sides

Ice Machine: 2A143 Water Fountain: near 1B-137, near 2A-143, and C2-9B Bldg. 15 (CLC) Collect 2 samples per neighborhood from 2 different locations/rooms First Floor Neighborhoods: Rio Grande – 1C, Yellowstone – 1E , Niagara – 1F, Delaware – 1H Second Floor Neighborhoods: Sacramento – 2C Columbia – 2E, Potomac – 2F, Mississippi – 2H

Sink

shower

shower

1C-121A shower

Ice Machine: 1D103 (kitchen between Rio Grande & Yellowstone), 1G103 (kitchen Niagara & Delaware Water Fountain: 2nd Floor near vending machines ***Note that Sacramento has been closed for construction and will need to be flushed daily to prevent dead leg water build up.*** Bldg. 19 Domiciliary/RRTP (currently unoccupied) First Floor Mostly social work offices 1A-116A Office restroom 1A-114A restroom

Ice Machine: 3B126 Water Fountain: near 1B-113, near 3A-116 Bldg. 25 Behavioral Health Acute Inpatient

Ice Machine: 1A-146, 1B-110 Water Fountain: Next to 2A100 Bldg. 30

2G139 Sample this location every quarter

4F-124A

Ice Machine: 1J-171 near elevators, 2G-140, 3F111, 4G-122, 4F-138A Water Fountain: 1st Flr near 1H-102, 2ndFlr near CT Scan Rm, 3rd Flr near 2H100 Floor Plan of Oncology: Collect samples from nourishment kitchen water fountain/ice machine and any other potential fixture that would dispense water for patients.

COOLING TOWERS (Utility-Non Potable Water) The minimum detection limit for non-potable water is 5 CFU/mL Biloxi VA Cooling Towers are located in Bldg. 3. Sample collection must be coordinated through COR and M&O Supervisor so Boiler operator can open supply and return ports for chiller, condenser, and Tower Tech (cooling tower 1) Collect 8 samples total.

Cooling Tower 1 (Tower Tech) samples are collected from Bldg. 3 Rm 1A177. Collect one sample from condenser return and one sample from condenser supply.

Cooling tower 2 & 3 are out of service. Cooling Tower 4,5,6 are the 3 big towers above the chiller plant ;Take one Sample from each sump Prior to sampling Chiller, contact M&O Supervisor at 228-523-5757 to find out which chiller to sample from.

1 Tower Tech Bldg. 3 1A177 (green and blue room)

CH1

Collect one sample from condenser return (spigot is marked for sample collection) Collect one sample from condenser supply (spigot is marked for sample collection)

1Collect one sample from Chiller Return from CH2, CH3, CH4, CH5 in Bldg.3 Rm.1A185 SAMPLE FROM CHILLER THAT IS ONLINE AND 2Collect one sample from Chiller Supply from CH2, CH3, CH4, CH5 in Bldg. 3 Rm. 1A185 SAMPLE FROM CHILLER THAT IS ONLINE image1.png