Are you in control of what might be in those waterpipes?

July 27, 2017

Introduction

Who would have thought that there could be so many risks associated with water or rather what attaches itself to water? Dirty water can, if the conditions are right, conduct electricity; however nearer to home, legionella bacteria can be found in water droplets for shower heads, bath taps, sink taps, cooling systems etc. Suspended in the air, the small droplets of water create fine aerosols, which if inhaled, increase the risk of getting legionella, providing the conditions are right to support the disease growth.

According to Aqua Legion (UK) Ltd “Legionella is a naturally occurring bacteria wide spread in nature. When the bacteria enter water systems in the built environment, conditions can often favour and encourage significant growth and reproduction to levels which can cause bacterial pneumonia and be fatal to humans.”

What are the right conditions for legionella growth?

Like with most bacterial growth they need the right conditions for growth, which is typically between 20 – 45°C. Water tanks generally heat water to 60 -65°C, thus this would kill off any bacteria growth, however, water to taps and other outlets are controlled by thermostatic mixer valves (TMV), set to no more than 44°C, to prevent scalding in care homes. Water systems and their pipework where water is stored, if the conditions are right, can cause bacteria to form and multiply. As with all water systems, there is a risk of rust, sludge, scale and other deposits which the bacteria can attach itself too. Resident bedrooms which are not occupied are one area which is at risk to both maintenance staff and the new resident occupying the room, if the water system does not receive attention.

Who is at risk from getting the disease?

Legionella disease can strike anyone who inhales the aerosols created by the droplets in which the bacteria is carried. Staff who administer personal care to residents i.e. bathing and washing, maintenance staff and residents all are at risk. At the present time, there is no evidence to suggest that the disease can be passed from human to human. Residents in nursing care contracting the disease are at greatest risk due to their physical condition which can result in unwarranted death through poor risk management.

What are the signs of legionella?

According to Aqua Legion (UK) Ltd the symptoms of Legionnaires’ disease, pontiac fever and loichgoilhead fever are all similar to the symptoms of very severe flu. As a result, legionellosis often goes undetected:

High temperature, feverishness and chills
Cough
Sputum
Muscle pains
Headache
Pneumonia
Diarrhoea
Signs of mental confusion

Case Study

Given that a significant number of residents in nursing or residential care are older persons, the risk of them getting legionella which could result in life threatening circumstances is significantly higher, as their immune system is less able to cope than a healthy and younger person.

On 1^st November 2012, an elderly gentleman died of pneumonia related to legionella. Reports suggest (as reported on the HSE website), that following chest pains and difficulty breathing, the care home took the gentleman to hospital were test results identified legionella.

The court found that the home’s handyman was inadequately trained or supervised. Showers were not descaled and disinfected quarterly as required; flushing of little-used outlets was reliant on one member of staff and there was no procedure for this to be done in the absence of that member of staff.

Reading Borough Council, Civic Offices, Bridge Street, Reading admitted breaching Section 3(1) of Health and Safety at Work etc. Act 1974 and was fined £100,000 with £20,000 costs in Reading Crown Court.

This case demonstrates that lack of training and supervision along with poor systems to monitor and control the risk of legionella which resulted in this needless death.

What systems need to be in place at my care home?

Managers of any social care establishment need to ensure that staff receive adequate awareness training in legionella, what to look out for and how to respond.
Robust systems and procedures need to be in place and embedded in practice through monitoring.
A legionella risk assessment (see the next section)
Regular checks on taps, showers, baths, spars through flushing and descaling systems to prevent traces of legionella in water systems.
Managers to ensure that water spray is controlled, that systems are clean and that water stagnation is not encouraged as this can harbour the growth of legionella
Managers to ensure that staff who carry out these checks document them and that monthly management checks equally check that this occurs including staff demonstrating visually they know what it required i.e. flushing at above 50C for at least 2 minutes. (Remember that TMVs need to be reset at below 44C).
Don’t forget that unoccupied bedrooms etc. can be a breeding ground for legionella and thus must be included in checks.

Risk Assessment and routine inspection

Completing a legionella risk assessment is generally outsourced by a specialist contractor who will likewise annually inspect the housing stock for any risk areas (including taking samples) as well as reviewing the risk assessment. The risk assessment will consider the associated risks and control measures (like monitoring, flushing, descaling) needed. For more information on the HSE website click here. Section 28 (page 11) of the ACOP L8 requires a suitable and sufficient assessment to identify risk of exposure and measures in place to control and monitor.

As with most risk assessments, they should be reviewed every 2 years or sooner should anything significant occur i.e. refurbishments, an outbreak of the disease etc. Section 47 (page 14) of the ACOP L8 requires the risk assessment be reviewed and outlines:

Changes to water systems or their intended use
Building changes where the system was installed
New information on risk or control measures in place or required
Staff changes
Outbreak or a case of legionella from the associated water systems

Show me the legislation

There is a raft of legislation applicable to legionella which include:

The Health and Safety at Work Act 1974
The Management of Health and Safety at Work Regulations 1999 (risk assessment section 3
The Control of Substances Hazardous to Health 2002
The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013
The Approved Code of Practice (ACOP) – Legionella Disease L8 and the technical guide from the HSE – HSG274 which is split into 3 parts: Part 1 Evaporative cooling systems, Part 2 Hot and cold water systems and Part 3 Other risk systems.

Key within the legislation is section 2 & 3 of the Health and Safety at Work Act 1974.

Section 2 of the act refers to employer’s duty to his/her employees and section 3 of the act refers to those not in the employer’s employment (i.e. residents) but affected by the employers (landlord or agent i.e. home manager) actions in respect of their health and safety.