Session 7: Problems with Hotels Facilitator notes: Legionnaires’ disease: Risk assessment, outbreak investigation and control Session 7: Problems with Hotels ECDC, 2012

Problems with Hotels - Overview 20% of detected Legionella cases considered as travel related 1999 figures for Europe: travel association in 21% of cases 90% of these, associated with hotels or apartment rest with camp sites, private homes, cruise ships and other sources Approximately 60% of hotel-associated cases are sporadic !

Problems with Hotels When did it all start? Bellevue Stratford Hotel, Philadelphia, 1976 First hotel implicated (or confirmed) as implicated in cases. Over 200 implicated cases – many of whom stayed at the hotel A large hotel with over 1000 rooms

Problems with Hotels What’s in a Hotel? Complex water systems – including potable water and showers etc Leisure facilities on site – used by residents/visitors (in various states of health) Cooling towers – on the building (or in fact on neighbouring buildings) Water features – within the building Other water on site – laundries,

Problems with Hotels Water Systems Poor design of the systems on site Over-capacity of stored water Poor temperature control of hot- and cold water systems

Problems with hotels Water Systems Poor management of the water system Poor circulation Calorifiers not maintained Anti stratification pumps ineffective TMVs not maintained

Problems with Hotels; Recreational Water Poor management of recreational etc water Poor cleaning regimes in pools and associated facilities such as changing rooms Poor management and maintenance of pool water treatment Poor training of staff

Problems with Hotels; Cooling Towers Poor management of the cooling/air conditioning systems Difficulties in identifying sources in outbreak situations Towers – not always registered Many cooling towers in city areas

Problems with Hotels - solved ! Good system design Effective management Effective maintenance Robust risk assessments Robust water safety plans Review of water safety plan Don’t forget water features

Facilitator notes: Acknowledgements The creation of this training material was commissioned in 2010 by ECDC to Health Protection Agency (UK) and the University of Chester (UK) with the direct involvement of Louise Brown, Janice Gidman, Emma Gilgunn-Jones, Ian Hall (on behalf of the ECDC Legionnaires Disease Outbreak Toolbox Development Group), Tim Harrison, Rob Johnston, Carol Joseph, Sandra Lai, John Lee, Falguni Naik, Nick Phin, Michelle Rivett, and Susanne Surman-Lee. The revision and update of this training material was commissioned in 2017 by ECDC to Transmissible (NL) with the direct involvement of Arnold Bosman and Kassiani Mellou.