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

Problems with Ships - General Matters Many similarities with shore based systems such as hospitals. BUT differ significantly in many ways More akin to small city Always under attack Constant stress from vessels movement Aggressive routine treatments – corrosion Natural settlement and disturbance

Problems with Ships - Water Sources Shore No control of source quality Made on board Own disinfection regime necessary

Problems with Ships - Potable Water Drinking Ice Machines Food Preparation and cooking Lifeboats

Problems with Ships - Non Potable Personal Hygiene (Showers, WC) Swimming Pools/Hydro Pools Spa’s Beauty treatments Sprinkler system Washing down Laundry Water Features Air conditioning Engineering (Boilers, Engine Cooling) Bilge

Problems with Ships - Sea Water Ballast Fire system Swimming Pools Spa baths

Problems with Ships - Storage Over capacity i.e. More than 24 hours requirement guaranteed Difficult to control temperature Same supply for potable and non potable? Separate tanks for potable and non-potable supply not always assured Tanks often inter connected Tanks usage may change

Problems with Ships Complex systems – Schematic of Typical Water Storage and Distribution

Problems with Ships - Risks Contaminated source Poor design of pipe work and equipment Over provision of services- Backup and diversion valves Temperatures Inadequate disinfection Post disinfection contamination Alterations – stretching ships Running repairs

Problems with Ships - Temperature Control Tanks below decks Production by low temperature evaporation Commonly at or below waterline Often in hot atmosphere- Engine room Adjacent tanks for differing purpose i.e. Potable next to sprinkler feed likely to have prolonged storage and thermal gain. Coolers expensive

APHA/HPA Ships’ Water Survey Major Influences: Age of vessel * Crew Numbers * Tank Capacity Hoses & Couplings regularly disinfected Free chlorine levels Hose ownership Hoses capped between usage Hoses stored in own clean locker International routes Place of bunkering

Risks Contaminated source Poor design of pipe work and equipment Over provision of services-, backup-, and diversion valves Temperatures Inadequate disinfection Post disinfection contamination Alterations Running repairs

Hose Storage

Shore risks

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.