In this article the healthcare water safety specialists at Water Treatment Services look at the control of legionella and other waterborne pathogens in hospitals and healthcare premises. The article considers what the risks are and the legal responsibilities for managing them, latest codes of practice and technical guidance, effective control measures; and concludes by reviewing the role of the Water Safety Group and effective risk management through detailed planning.
Controlling legionella in healthcare premises
Although outbreaks of Legionnaires’ disease are often associated with factories, offices, hotels and large leisure centres, this serious health condition can also pose a serious threat to people in healthcare settings such as hospitals, health centres, and residential care homes.
Monitoring and controlling legionella risks in healthcare premises can be more challenging than in a factory or office environment because of a number of factors including the size and complexity of the water systems involved, and importantly, the increased numbers of people considered to be more susceptible to the effects of Legionnaires’ disease.
What is legionella?
Legionella is a bacterium which can be found naturally in many water sources such as ponds, lakes and rivers. In such natural environments legionella doesn’t tend to cause problems for people. However, once the bacteria enter manmade water systems such as those found within buildings, including healthcare premises, given the right conditions the bacteria can begin to multiply quickly to potentially cause serious risks to the health of people exposed to the water in those engineered systems.
What are the risks from legionella in healthcare premises?
The risk of Legionella bacteria growing in a building’s water system is that someone contracts Legionellosis, this is the umbrella term for a range of illnesses caused by Legionella bacteria.
People catch Legionellosis by inhaling microscopic droplets of water, often called an aerosol which are contaminated with Legionella bacteria. Once the bacteria enter into the lungs, they can begin to multiply and spread to cause disease.
There are several forms of Legionellosis but the most dangerous one is called Legionnaires’ disease. This is a serious type of pneumonia which can prove fatal, especially in more susceptible individuals.
How dangerous is Legionnaires’ disease?
The mortality rate for Legionnaires’ disease varies between countries, and in different settings, healthcare, including hospitals and care homes being particularly vulnerable. In the UK, mortality rates for Legionnaires’ disease tend to vary between 8 and 15%.
How is Legionnaires’ disease treated?
The main drug treatment for Legionnaires’ disease is with antibiotics as the condition is caused by a bacterial infection. However, people who survive the illness can be left with permanent lung damage. Because of the long-lasting effects of this disease, the emphasis is on prevention rather than cure.
Is controlling legionella a legal responsibility?
Employers, business owners, landlords and managers responsible for the safety of people in buildings are legally obliged under the UK’s Health and Safety at Work Act to manage the risk to the general public, customers and their employees… and this includes protecting them from exposure to Legionella bacteria and Legionnaires’ disease.
In the UK the primary safety regulator, the Health and Safety Executive publish a number of important documents that deal specifically with the control of legionella in business settings:
Approved Code of Practice and guidance L8 – ACOP L8 – Legionnaires’ disease. The control of legionella bacteria in water systems.
Technical Guidance HSG274 – Legionnaires’ disease:
The Department of Health also provide additional guidance covering water safety and the control of legionella specifically for healthcare environments:
HTM 04-01 – Safe water in healthcare premises – The design, installation, commissioning, testing, monitoring and operation of water supply systems in healthcare premises.
What are the main legionella risk factors to watch out for?
The code and guidance from both the Health and Safety Executive and Department of Health will help you work out which steps to take to minimise the risks from exposure to legionella. This involves avoiding the conditions which can lead to the bacteria multiplying, and reducing aerosol sprays.
The main risk factors to watch out for when controlling the growth of Legionella bacteria in man-made water systems are:
- Hot and cold water temperatures are poorly controlled – cold water must be below 20oC, hot water above 55 oC at outlets.
- Water is allowed to stagnate – low water flow or stagnation encourages bacterial growth.
- Deposits such as scale, rust or sediment are uncontrolled – deposits like these can provide nutrients for bacterial growth.
Start with a legionella risk assessment
Any effective legionella risk management programme starts with a water safety or legionella risk assessment to identify any potential problems. Once this is completed, operators can develop a strategy and procedure to control risk in the premises under their control.
Who’s more vulnerable to Legionnaires’ disease?
Legionella doesn’t affect everyone equally, and there are some groups which are more vulnerable than others. Older people with existing lung conditions are at greater risk, as are those with compromised immune systems. Healthcare settings by their very nature are more likely to have a higher concentration of these vulnerable groups, especially on oncology wards where patients receive treatment for cancers.
Why is water temperature key to controlling legionella in healthcare?
One of the most significant differences when controlling legionella in healthcare settings is around the control of water temperatures. Hot water in healthcare premises should be delivered to outlets at 55 centigrade, compared with 50 centigrade in non-healthcare buildings. This is because water temperature is one of, if not the most important way of managing water safety risk in healthcare settings, whereas in other settings, water system disinfectants (biocides) may be seen as being important. That’s not to say that disinfectants are not used in healthcare settings, but they are typically considered to be secondary to temperature control measures. Additionally, there are added complications in using disinfectants to treat the water used in hospitals – it can’t be used in kidney units, for example.
The role of the hospital Water Safety Group or WSG
Responsible hospitals and healthcare property providers deal with water safety and legionella risk by setting up a Water Safety Group (WSG). This group of multi-disciplinary experts then develops, implements and manages a Water Safety Plan (WSP) to control water related risks within the buildings under their control.
The WSG is usually a large, multi-disciplinary group made up with a representative from all relevant hospital departments such as housekeeping, microbiology, nursing, estates and facilities management, and any clinical departments which have special water use needs. The WSG would also include an independent water safety specialist, referred to as the Authorising Engineer (Water) or simply AE (Water). The AE’s role is to advise the group on relevant water safety and engineering matters.
Initially, the members of the WSG should collaborate to draw up the hospital’s Water Safety Plan (WSP), which should cover the safe management of the site’s water systems. A good WSP should be based on a detailed risk assessment and list all of the potential water safety hazards on the site. It should also detail which control measures should be used to minimise risk to patients, staff and visitors to the facility.
All hospital Water Safety Plans should be reviewed regularly to make sure they are still addressing the right risks and remain effective… having the desired effect on controlling risks from legionella and other waterborne pathogens.
Specialist legionella risk management solutions
Water Treatment Services offer a range of specialist legionella and water safety management solutions to support the business owners, the Duty Holder, Responsible Person and those responsible for the safety of water systems in the healthcare envirionemts.
Contact us today to learn how our water safety experts can help you manage your water systems, maintain regulatory compliance and so keep people safe.
With offices in London serving the South and South East England, Manchester (North West), Birmingham (Midlands), Bristol (South East England and Wales), Leeds (North and North East) and Glasgow (Scotland), supported by regional teams of specially trained technicians and engineers we can offer specialist legionella risk assessments, training, water testing and other risk management solutions throughout the UK and Internationally.
Contact us today to learn how our expert legionella safety solutions can help you.
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