HACCP-Based Programs for Preventing Disease and Injury from Premise Plumbing: A Building Consensus
1.1. Building Water Systems are Comprised of a Series of Unit Processes
1.2. History of Hazard Analysis and Critical Control Point
- Conduct a Hazard Analysis;
- Determine the Critical Control Points;
- Establish Critical Limit(s);
- Establish a system to monitor control of the Critical Control Points;
- Establish Corrective Action(s) to be taken when monitoring indicates that a particular Critical Control Point is not within Critical Limits;
- Establish procedures to confirm that the HACCP system is working effectively; and
- Establish documentation of all procedures pertaining to these HACCP principles and their application.
- Establish a HACCP team;
- Describe the system;
- Identify intended use(s);
- Construct process flow diagrams;
- Confirm the accuracy of the process flow diagrams;
- List all potential hazards associated with each process step, conduct a hazard analysis and consider measures to control identified hazards at each step;
- Determine Critical Control Points, the locations where control must be applied to prevent hazards from causing harm;
- Establish Critical Limits for each Critical Control Point;
- Establish monitoring procedures for each Critical Control Point and specify frequency of monitoring;
- Establish corrective actions to be taken when monitoring indicates that conditions at a Critical Control Point are outside of Critical Limits;
- Establish procedures to confirm that the plan is being implemented as designed (verification) and is working effectively (validation); and
- Establish documentation and record keeping procedures.
2. HACCP for Protection of the Public Water Supply
3. HACCP-Based Programs for Preventing Disease and Injury from Building Water Systems
- They lacked documentation of building water systems and familiarity with water processes, especially in large, complex systems;
- They lacked a systematic program for identifying, monitoring and controlling factors known to affect microbial growth (e.g., water temperatures, disinfectant residual levels); and
- They lacked inter-disciplinary/inter-departmental communication, e.g., between facility managers and clinicians.
- HACCP-based methodology enjoys the benefit of extensive real-world use in mitigating a range of environmental risks, including microbial hazards associated with public water supplies.
- HACCP-based methodology is well suited to establishing and maintaining appropriate controls of temperature, disinfectant residual and other factors that can reduce environmental exposure of building occupants, especially susceptible persons, to large numbers of plumbing-associated pathogens.
- HACCP-based methodology provides a systematic, standardized framework that can accommodate substantial variation in buildings and building water systems, including differences in purpose, design and propensity for disease transmission.
- HACCP-based methodology provides a systematic, standardized framework for risk characterization, hazard prevention and validation but does not prescribe specific means or methods. It is designed to accommodate future scientific progress and new/improved methods.
- HACCP-based methodology provides a practical, resource-efficient way for the largest number of buildings to accomplish significant risk reduction at reasonable cost. It enables technically competent building personnel to implement an effective hazard-prevention plan without reliance on expensive consultants and other specialists.
- HACCP-based programs for management of water systems in buildings have been developed and proposed by government agencies (VHA), major industry groups (ASHRAE) and prominent public health organizations (NSF International). They share fundamental features of HACCP methodology, with small differences in terminology and level of prescription. Except where noted (Table 1), these programs use conventional HACCP terminology.
|Program Components||NSF Int’l * 444||WHO * WSP||VHA * Directive 1061||ASHRAE * 188|
|Interdisciplinary Team with authority & responsibility||+||+||+||+|
|Water system description (process flow diagrams)||+||+||+||+|
|Hazard analysis and risk characterization based on water system description||+||+ |
Note: Variously called hazard analysis or risk assessment
Note: Risk characterization includes assessment of clinical and environmental factors
|Critical Control Points are selected based on hazard analysis and risk characterization||+||+||+
Note: Controls are called “Engineering Controls”. Values are prescribed for temperature and oxidant residual levels
Note: Critical Control Points are called “Control Locations”
|Critical Limits are specified and monitored; Corrective actions are required||+||+||+||+
Note: Critical Limits are called “Control Limits”
|Confirmation that the plan is being implemented according to design (verification) is required||+||+||+||+|
|Confirmation that controls, when applied according to plan, are effectively controlling hazards (validation) is required||+
Note: Both initial and ongoing validation are required
Note: Validation is variously called monitoring or testing
Note: Requires validation by both environmental and clinical testing. Responses to test results are prescribed
3.1. WHO Water Safety Plans
3.2. VHA Directive 1061
3.3. ANSI/ASHRAE 188-2015
3.4. BSR/NSF 444
Negative Screening of Environmental Samples with the PCR for Legionella
|Binary Statistical Parameter||Total (Potable + Utility) Water Samples||Utility Water Samples||Potable Water Samples|
|Accuracy (%) 2||77.2||69.6||78.6|
|Specificity (%) 3||75.4||68.6||76.8|
|Sensitivity (%) 4||86.5||80.9||87.0|
|Positive Predictive Value (%) 5||40.5||18.5||44.6|
|Negative Predictive Value (%) 6||96.7||97.6||96.5|
Conflicts of Interest
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McCoy, W.F.; Rosenblatt, A.A. HACCP-Based Programs for Preventing Disease and Injury from Premise Plumbing: A Building Consensus. Pathogens 2015, 4, 513-528. https://doi.org/10.3390/pathogens4030513
McCoy WF, Rosenblatt AA. HACCP-Based Programs for Preventing Disease and Injury from Premise Plumbing: A Building Consensus. Pathogens. 2015; 4(3):513-528. https://doi.org/10.3390/pathogens4030513Chicago/Turabian Style
McCoy, William F., and Aaron A. Rosenblatt. 2015. "HACCP-Based Programs for Preventing Disease and Injury from Premise Plumbing: A Building Consensus" Pathogens 4, no. 3: 513-528. https://doi.org/10.3390/pathogens4030513