The California Department of Health has issued an All Facilities Letter requiring hospitals, critical access hospitals, and skilled nursing facilities to reduce the risks of Legionella in facility water systems. Facilities must develop and adhere to policies and procedures that inhibit microbial growth in building water systems to reduce the risk of growth and spread of Legionella and other opportunistic pathogens in water. A facility risk assessment must be conducted to identify where pathogens could grow and spread in the facility water system. Facilities must develop and implement a water management program that considers the ASHRAE industry standards and the CDC toolkit. Testing protocols and acceptable ranges for control measures must be specified, and results of testing and corrective actions must be documented. Facilities must maintain compliance with other applicable federal, state, and local requirements. Skilled nursing facilities must have a water management plan available for review. Facilities unable to demonstrate measures to minimize the risk of Legionnaires' disease are considered out of compliance.

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