LEGIONELLA MANAGEMENT & CONTROL NUQPR024 V1.0 210212

IS IT WORTH WORRYING ABOUT? NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 2

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LEGIONELLOSIS Legionella = water-borne bacteria Naturally widespread in the environment Over 50 different species identified 20 known to cause disease in man Legionella pneumophila Legionnaire’s Disease Pontiac Fever / Lochgoilhead Fever NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 4

LEGIONELLA Temperature range 20 - 50°C Proliferates at 37 °C Requires nutrients Slow moving / stagnant water Poorly managed water system = perfect environment NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 5

INCIDENCE RATES 300+ cases/year - England & Wales Steady rise in cases since 2002 Studies show LP could be responsible for 2- 3% of community acquired pneumonia (approx 83,000 cases of CAP) so 2,500? Treatment is cheaper than testing 10-12% mortality rate Respiratory disease NUQPR024 V3.0 040313 Nemco Utilities Limited © NUQPR024 V1.0 210212 6

CASES BY YEAR Barrow Outbreak NUQPR024 V1.0 210212

‘AT RISK’ GROUPS NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 8

EU SURVEILLANCE NUQPR024 V1.0 210212

ENVIRONMENTAL FACTORS NUQPR024 V1.0 210212

WHERE IS IT ACQUIRED? NUQPR024 V1.0 210212

CHAIN OF EVENTS Bacteria present in water system Slow moving / stagnant water Adequate food source Temperature range 20-50°C Aerosol formed People present NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 12

OUTBREAKS NUQPR024 V1.0 210212

SHOWERS Operate at ideal temps Poor hygiene Infrequently used Prone to scaling Create aerosol NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 14

DEAD LEGS Stagnant water Ambient temps Breeding ground NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 15

STORAGE TANKS Over capacity Stagnation Out of sight Poor flow Ambient temps NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 16

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CALORIFIERS Can run at critical temps Thermal stratification Sludge build up NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 19

COOLING TOWERS Run at ideal temps Open to elements Contamination via water supply Intermittent use Drift affects wide area NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 20

CASE HISTORY Hospital outbreak - Glasgow 1992 1 patient died Source = fire hose ‘Deadleg’ Need for awareness NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 21

THE LAW Health & Safety at Work Act (1974) COSHH Regulations (2002) Notification of Cooling Towers Regulations (1992) Approved Code of Practice (1992) Revised ACOP January 2001 NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 22

RESPONSIBILITY - ACOP Identify & assess sources of risk Prepare scheme to prevent/control the risk Implement & manage control programme Keep Records Appoint a responsible person NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 23

RESPONSIBLE PERSON Managerially responsible for implementation & supervision Ensure all those involved are trained and competent Manage contractors and suppliers Maintain records Ensure regular reviews are carried out NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 24

CAUSES OF OUTBREAKS NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 25

KEY FACTORS Poor communication (internally) Responsibilities not defined Lack of training Failure to record meetings / conversations Insufficient contract documentation Poor advice / management Risk assessment not carried out NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 26

2012 OUTBREAKS Edinburgh – 101 cases, 3 deaths North British Distillery Company – HSE Improvement Notice (failure to devise & implement a sustained & effective biocide control programme in one cooling tower) Macfarlan Smith  – HSE Improvement Notices require thorough cleaning of one cooling tower & provision of access for inspection & maintenance. All three notices have been complied with, and the HSE has stressed that the notices do not mean that the cooling towers have been identified as the source of the outbreak Stoke on Trent – 21 cases, 2 deaths JTF discount warehouse in King Street, Fenton, where a hot tub on display was singled out as the probable source of the bug NUQPR024 V1.0 210212

COST TO BUSINESS Sick pay Loss of production / skills Cost of an investigation (FFI) Prosecution & Civil Action Bad publicity - loss of business Employee de-motivation NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 28

RISK MANAGEMENT Risk assessment Regular monitoring Temperature control Water Treatment Maintenance & Cleaning Annual review Awareness NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 29

RISK ASSESSMENT ‘Suitable & Sufficient’ - all water systems Reviewed regularly (bi-annually) and where: change to plant / water system or its use change to the use of the building new information about risks / control measures tests indicate control measure are ineffective Carried out by competent person NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 30

BS8580 Establish a standard approach to working Encourage risk assessment rather than ‘surveys’ Meet standards expected by the HSE / EHOs More emphasis on Appraisal of records and control measures Incidents of persistent non-compliance Training and competence of site personnel Timely completion of recommended remedial work NUQPR024 V1.0 210212

SCHEME FOR CONTROL Weekly flushing - infrequent use services Monthly temperature monitoring - sentinel taps & calorifiers Quarterly shower head disinfection / de-scaling 6 monthly storage inspections Annual review of scheme and risk level Bi-annual review of the risk assessment document Cleaning and disinfection as required NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 32

LEGIONELLA MONITORING Programme for continual risk assessment Early identification of problem areas Demonstrate effective control Visual inspection – cleanliness / operation Compliance with current guidance NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 33

CONTRACT MANAGEMENT Use registered suppliers – LCA BS 8580 / BS 8558 Check training records / CVs Ask for references Agree levels of service Agree areas of responsibility Review contract at quarterly intervals Check log book records regularly NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 34

FUTURE TRENDS Rise in susceptible individuals Increased installation of TMVs (new building regs – required on all baths / showers) MRSA / Swine flu – increased use of alcohol gel Office water coolers / boilers IR no touch taps (low flow areas) Increase in solar heating installations Global warming NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 35

IS IT WORTH WORRYING ABOUT? NUQPR024 V1.0 210212 NUQPR024 V1.0 210212 36