1. LEGIONELLA MANAGEMENT & CONTROL NUQPR024 V1.0 210212

2. IS IT WORTH WORRYING ABOUT?
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4. 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
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5. LEGIONELLA Temperature range 20 - 50°C Proliferates at 37 °C
Requires nutrients
Slow moving / stagnant water
Poorly managed water system
= perfect environment
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6. 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
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7. CASES BY YEAR
Barrow Outbreak
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8. ‘AT RISK’ GROUPS
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9. EU SURVEILLANCE
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10. ENVIRONMENTAL FACTORS
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11. WHERE IS IT ACQUIRED?
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12. CHAIN OF EVENTS Bacteria present in water system
Slow moving / stagnant water
Adequate food source
Temperature range 20-50°C
Aerosol formed
People present
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13. OUTBREAKS
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14. SHOWERS Operate at ideal temps Poor hygiene Infrequently used
Prone to scaling
Create aerosol
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15. DEAD LEGS Stagnant water Ambient temps Breeding ground
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16. STORAGE TANKS Over capacity Stagnation Out of sight Poor flow
Ambient temps
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19. CALORIFIERS Can run at critical temps Thermal stratification
Sludge build up
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20. COOLING TOWERS Run at ideal temps Open to elements
Contamination via water supply
Intermittent use
Drift affects wide area
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21. CASE HISTORY Hospital outbreak - Glasgow 1992 1 patient died
Source = fire hose
‘Deadleg’
Need for awareness
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22. 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
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23. RESPONSIBILITY - ACOP Identify & assess sources of risk
Prepare scheme to prevent/control the risk
Implement & manage control programme
Keep Records
Appoint a responsible person
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24. 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
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25. CAUSES OF OUTBREAKS
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26. 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
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27. 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
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28. 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
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29. RISK MANAGEMENT Risk assessment Regular monitoring Temperature control
Water Treatment
Maintenance & Cleaning
Annual review
Awareness
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30. 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
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31. 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
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32. 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
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33. LEGIONELLA MONITORING
Programme for continual risk assessment
Early identification of problem areas
Demonstrate effective control
Visual inspection – cleanliness / operation
Compliance with current guidance
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34. 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
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35. 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
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36. IS IT WORTH WORRYING ABOUT?
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