1. School of Civil and Building Services Engineering Department of Building Services Engineering “An engineering approach to legionella control in Health care Facilities” By Paul Cleary

2. Table of contents What is legionella How it affects people Legislation dealing with legionella Case studies Lessons learned The role of the Building Services Engineer

3. What is legionella ? Human Hair: 10ˉ⁶ m Legionella Bacteria: 10ˉ⁹m

4. Legionella related deaths Spain-Costa Blanca-January 2012-2 deaths Basildon Hospital-Essex- August 2011-1 death Spain-Murcia-July 2001-6 deaths Ireland-67 reported cases between 2001 and 2007 resulting in 5 deaths

5. Optimum growth conditions for legionella

6. Who is at risk ? Older people –over age 40- Males People who smoke People who drink to excess People with suppressed immune systems. For example HIV sufferers or organ transplant recipients People with underlying health problems such as diabetes, heart complaints and respiratory problems. People with impaired choking reflex such as stroke sufferers

7. Legionella related legislation The Safety, Health and Welfare at Work Act 2005 The Safety, Health and Welfare at Work ( General Application ) Regulations 2007 The Health Protection Surveillance Centre (HPSC) - The Management of legionnaires’ disease in Ireland (Endorsing HSC Approved Code of Practice);

8. Case Studies St Patrick’s University Hospital Basildon University Hospital I work there Directly involved with legionella prevention programme Access and permission to publish data-test results etc- In a neighbouring Country so relevant to Ireland Has suffered recent outbreaks of legionellosis Has been fined for legionella related deaths in the past

9. Lessons learned Independent risk assessment essential Design and build of hot and cold water storage and supply systems critical The role of chlorine dioxide Regular independent water sample testing Interaction with stakeholders

10. Cold water storage

11. Chlorine dioxide plant

12. Building Services Engineer Infection Control Committee Nursing Staff Household & Catering Staff Outside Agencies