ASSE 12080 Legionella Water Safety and Management Personnel

Which ASHRAE standard establishes minimum legionellosis risk management requirements for building water systems?

• AASHRAE 90.1
• BASHRAE 188
• CASHRAE 62.1
• DASHRAE 55

Which species and serogroup of Legionella is responsible for the majority of clinically reported Legionnaires' disease cases?

• ALegionella micdadei
• BLegionella longbeachae
• CLegionella pneumophila serogroup 1
• DLegionella anisa

How is Legionnaires' disease most commonly transmitted to humans?

• ADrinking contaminated potable water
• BSkin contact with contaminated surfaces
• CInhalation of aerosolized water containing Legionella
• DPerson-to-person respiratory droplets

Which temperature range is most favorable for Legionella growth in building water systems?

• A0 to 10 deg C (32 to 50 deg F)
• B25 to 43 deg C (77 to 110 deg F)
• C60 to 70 deg C (140 to 158 deg F)
• D80 to 100 deg C (176 to 212 deg F)

Why is biofilm important in Legionella risk management?

• ABiofilm kills Legionella on contact
• BBiofilm shelters Legionella from disinfectant and supports its amoebic hosts
• CBiofilm is only a cosmetic concern
• DBiofilm has no relationship to Legionella

According to ASHRAE 188, what is the recommended minimum storage temperature for hot water to suppress Legionella?

• A43 deg C (110 deg F)
• B49 deg C (120 deg F)
• C60 deg C (140 deg F)
• D82 deg C (180 deg F)

What maximum temperature does ASHRAE 188 recommend for cold water to limit Legionella growth?

• A10 deg C (50 deg F)
• B20 deg C (68 deg F)
• C30 deg C (86 deg F)
• D40 deg C (104 deg F)

Which CDC document operationalizes ASHRAE 188 into a seven-step program for facilities?

• AMMWR Recommendations and Reports on healthcare-associated infections
• BCDC Toolkit for Developing a Water Management Program
• CNIOSH Cooling Tower Engineering Controls
• DCDC Yellow Book

Which step is the FIRST in the CDC seven-step water management program toolkit?

• ADecide where control measures should be applied
• BEstablish the water management program team
• CDocument and communicate program results
• DValidate the program through Legionella sampling

Which CMS document requires Medicare-certified hospitals and long-term care facilities to develop policies and procedures to reduce Legionella risk?

• ACMS S&C 17-30
• BCMS QSO-22-01
• CCMS 1135 waiver guidance
• DCMS S&C 12-04

Which VA directive specifically governs prevention of healthcare-associated Legionella disease in VHA facilities?

• AVHA Directive 1761
• BVHA Directive 1061
• CVHA Directive 1099
• DVHA Handbook 1106.01

What is the primary purpose of a building water system flow diagram in a water management program?

• AShow plumbing code compliance to inspectors
• BIdentify all components and locations where Legionella could grow or spread
• CCalculate the system's hydraulic friction loss
• DSpecify pipe diameters and pump curves

Which feature is MOST commonly identified as a Legionella hazard during building water system assessments?

• ACode-compliant air gaps at sinks
• BDead legs and rarely used outlets
• CPressure reducing valves on the cold water inlet
• DBackflow preventers on irrigation

Which of the following is NOT considered a HACCP-style 'critical control point' typically identified in a water management program?

• AHot water heater outlet temperature
• BCooling tower biocide residual
• CRecirculation loop return temperature
• DNumber of staff trained in CPR

Which document is the international reference method for culturing Legionella from water samples?

• AEPA Method 1604
• BStandard Methods 9215
• CISO 11731
• DAOAC 992.20

When sampling a faucet for Legionella using the CDC environmental method, what sample type is typically collected to assess the distal point of use?

• AFirst-draw (pre-flush) water sample plus a swab of the aerator/strainer
• BOnly a fully flushed cold-line sample
• CA grab sample of the building's incoming municipal water
• DA high-volume composite over 24 hours

Which secondary disinfectant is widely used in municipal supplies because it persists longer in distribution and inside large buildings?

• AFree chlorine
• BMonochloramine
• COzone
• DHydrogen peroxide

Which chemical disinfectant is most effective at penetrating mature biofilm in premise plumbing?

• AFree chlorine at 0.2 mg/L
• BChlorine dioxide
• CSodium thiosulfate
• DPhosphoric acid

Copper-silver ionization controls Legionella primarily by which mechanism?

• AFiltering out the bacteria mechanically
• BReleasing copper and silver ions that disrupt cell membranes
• CHeating water above 60 deg C
• DAdjusting water pH to below 4

Which point-of-use device provides immediate protection against Legionella at a single fixture for an immunocompromised patient?

• AAerator-type flow restrictor
• B0.2-micron point-of-use filter
• CBackflow vacuum breaker
• DThermostatic mixing valve

Which step is required during a thermal shock (pasteurization) for Legionella remediation of a potable hot water system?

• AReduce water heater set point to 49 deg C
• BRaise temperature to at least 71 deg C and flush every outlet until that temperature is h…
• CDisconnect the water heater entirely for 24 hours
• DAdd bleach to the cold water main only

Hyperchlorination shock treatment for a potable system typically targets which free chlorine residual at distal taps?

• A0.1 mg/L for 5 minutes
• B0.5 mg/L for 30 minutes
• C10-50 mg/L for at least 1-2 hours of contact
• D200 mg/L for 24 hours

Which building element is the single largest aerosol-generation source typically addressed in a water management program?

• AToilet flushing
• BCooling towers and evaporative condensers
• COutdoor irrigation
• DStainless-steel cookware in kitchens

A cooling tower's drift eliminators primarily serve which Legionella-related function?

• AIncrease evaporation rate
• BReduce the amount of aerosolized water leaving the tower
• CLower the tower's pH
• DIncrease basin water volume

Which control measure is required by ASHRAE 188 for open recirculating evaporative cooling systems?

• AMaintain water temperature at or above 60 deg C
• BImplement a treatment program (typically biocide + scale/corrosion inhibitor) with docume…
• CEliminate the use of drift eliminators
• DRun the tower only during heating season

Which water system component is commonly missed during initial WMP scoping but represents a high-aerosol Legionella risk for occupants?

• ARoof drains
• BDecorative fountains in lobbies and atria
• COutdoor air intake louvers
• DStorm sewer manholes

Hot tubs and spas are high-risk Legionella sources primarily because:

• AThey contain large volumes of cold water
• BThey are warm, aerosol-generating, and difficult to maintain disinfectant residual due to…
• CThey have no plumbing connections
• DThey use only municipal cold water and never re-circulate

Which type of humidifier should generally NOT be used in occupied spaces from a Legionella standpoint?

• ASteam-injection humidifier using boiled water vapor
• BCold-mist (ultrasonic or atomizing) humidifier filled from tap water without disinfection
• CWick (passive-evaporation) humidifier with deionized water that is dumped daily
• DDirect gas-fired steam humidifier

Eyewash stations and emergency showers can become Legionella hazards because:

• AThey use chemical waste water
• BThey are infrequently activated, allowing stagnation and biofilm growth in the supply line
• CThey are usually outdoors
• DThey have backflow preventers

ASHRAE 188 defines a 'dead leg' as:

• AA length of piping with continuous flow
• BA length of piping with infrequent or no flow that terminates without circulation
• CAny pipe smaller than 1/2 inch
• DA water heater drain valve

When a hospital's WMP team detects Legionella in patient-care areas, the FIRST action should be to:

• AWait 30 days to retest before responding
• BNotify the WMP team leader and infection prevention, then implement the program's pre-def…
• CShut down the entire building immediately without notice
• DIssue a press release

Process monitoring (e.g., daily temperature and chlorine residual checks) primarily serves to:

• AReplace the need for any Legionella culture sampling
• BDemonstrate that control measures are operating within established limits in real time
• CDetermine the species of Legionella present
• DSatisfy plumbing code

Validation monitoring (sometimes called verification of the overall program) typically refers to:

• ADaily faucet temperature checks
• BPeriodic Legionella culture sampling to confirm the program is effective
• CReading the water bill each month
• DVerifying that valves are labeled

When sampling cooling tower basin water for Legionella, which factor is MOST important to document at the point of collection?

• AVendor invoice number
• BDisinfectant residual, pH, and temperature at the time of sampling
• CTower paint color
• DOutdoor wind direction only

Which of the following is a standard rapid clinical diagnostic test for Legionnaires' disease?

• AHemoglobin A1c
• BUrinary antigen test for Legionella pneumophila serogroup 1
• CComplete blood count alone
• DSkin patch test

Which CDC step in an outbreak investigation comes BEFORE environmental sampling of suspected building water sources?

• AIssue a press release
• BCase finding and epidemiologic linkage of cases to a common exposure
• CReplace the building's main shutoff valve
• DHire a new building engineer

Which document type is the central piece of evidence that an ASHRAE 188-conformant water management program exists?

• AVerbal commitments from facility leadership
• BA written program document describing team, scope, hazards, controls, monitoring, correct…
• CSticky notes on the water heater
• DThe plumbing as-builts alone

What is the role of the WMP team leader?

• APersonally perform all water sampling and treatment
• BCoordinate the WMP team, ensure accountability and authority, and drive implementation an…
• CApprove building security plans
• DProvide medical diagnoses

Which disciplines are typically REQUIRED on a healthcare facility WMP team?

• AOnly the chief plumber
• BFacility engineering/maintenance, infection prevention/control, leadership representation…
• COnly the hospital CEO
• DOnly the local plumbing inspector

Which ASHRAE document supplements ASHRAE 188 with implementation guidance for minimizing legionellosis risk?

• AASHRAE Standard 62.1
• BASHRAE Guideline 12
• CASHRAE Standard 170
• DASHRAE Guideline 36

Which patient population is at HIGHEST risk of severe Legionnaires' disease?

• AHealthy young children
• BImmunocompromised adults (e.g., transplant recipients), older adults, smokers, and those…
• CElite athletes
• DRecreational swimmers

Which milder, self-limited illness is caused by Legionella exposure (typically without pneumonia)?

• AQ fever
• BPontiac fever
• CPsittacosis
• DTularemia

Which type of fixture is MOST likely to harbor biofilm in a hospital potable water system?

• AA pressure regulating valve at the service
• BAn infrequently used patient bathroom faucet or shower in a vacant room
• CAn outdoor hose bib in winter
• DA water meter

When a building has been unoccupied for several weeks (e.g., during construction shutdown), the BEST WMP response before reoccupancy is to:

• AOpen windows and air out the building
• BFlush the potable water system, verify temperatures and disinfectant residuals, and consi…
• CDo nothing — water is naturally safe
• DShut off the cooling tower without further action

Which factor BEST explains why thermostatic mixing valves (TMVs) at fixtures are scrutinized in a WMP?

• ATMVs are illegal under all plumbing codes
• BTMVs operate in the warm mixed-water range and can themselves harbor biofilm and Legionel…
• CTMVs reduce the need for any monitoring
• DTMVs are required to be at 80 deg C

Which AWWA / OSHA guidance covers worker exposure and engineering controls for cooling towers?

• AOSHA 1910.146
• BOSHA Technical Manual Chapter on Legionnaires' Disease
• CAWWA M14
• DOSHA 1910.95

A WMP team should review and update the program AT LEAST:

• AOnce every 10 years
• BAnnually, and whenever significant changes occur to the building water systems or occupan…
• COnly when an outbreak occurs
• DNever — programs are static