1. Legionella Awareness East Anglia Construction Safety Group 23 April 2009

2. Background American Legion Convention 1976 Philadelphia, Bell Vue Stratford hotel 182 cases with 29 deaths Discovered by Dr Joseph McDade Bacteria common in water and soil

3. How legionella multiplies Favourable pH & temperature 20 – 45  C Ideal is 37  C (human body) Stagnation provides time for multiplication Key nutrients are free iron & L cysteine Biofilm protection

4. Single Bacteria

5. Facts About Legionnaires’ Disease Between 320-375 cases per year Under reporting is believed to occur Legionella Pneumophila accounts for most cases At least 50 other species are known

6. Legionnaires’ disease in residents of England and Wales by category of exposure 1980- 2004 Data from CDSC

7. Infection and symptoms Inhalation of Bacteria, size is important Incubation Period 2-10 Days Can be diagnosed but difficult to severe pneumonia: dry cough, diarrhoea, vomiting, breathing difficulty, high fever, chills, headache, some become confused or delirious Fatality rate is about 12% Can be treated effectively with antibiotics

8. Legionella colonising Amoeba

9. Susceptibility of Individuals Increasing age, especially over 45 Gender; men Smokers, alcoholics Chronic respiratory or kidney disease Diabetics, cancer sufferers

10. Types of System Cooling systems (if applicable) Domestic water services Hot water systems Cold water systems Spa Baths Other systems

11. Hot and cold water systems Cause the most cases

12. Cold Water Storage Tanks

13. Types of water heaters

14. Showers

15. Legionella Control Regulation & Legislation

16. Legislation Health & Safety at Work etc Act 1974 (HSAWA) Management of Health & Safety at Work Regulations 1999 (MHSWR) Control of Substances Hazardous to Health Regulations 2002 (COSHH) The Notification of Cooling Towers and Evaporative Condensers 1992 The Control of Legionella Bacteria in Water Systems Approved Code of Practice & Guidance 2001 ACoP L8 Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR)

17. Approved Code of Practice Identification and assessment of risk Prepare a scheme for preventing or controlling the risk Implement, manage and monitor precautions Keep records Appoint a person to be managerially responsible

18. Legionella Control Association Code of Conduct for Service Providers Allocation of Responsibilities Training & Competence of Personnel Control Measures Communication & Management Record Keeping Review Meetings Internal Auditing Subcontractors Distribution of the code

19. Risk assessment & control measures Why does it matter ? The HSE views Legionnaires’ Disease as preventable To satisfy regulation and legislation To show due diligence To protect employees and public

20. Schematics example

21. When should it be repeated? At least every 2 years or when NO longer valid e.g. Changes to the use of the building. Availability of new information. Control measures are no longer effective. Case of LD associated with system. Changes to the system or its use.

22. Typical written scheme: H & C Water Systems checks Weekly - flushing little used outlets Monthly – temperature checks Quarterly - shower cleaning Six monthly - CWS Tank temperatures Annually - CWS Tank inspections, calorifier checks Other systems as required

23. Dirty Tanks = clean & disinfection

24. Management & Training Inadequate management, lack of training and poor communication have all been identified as contributory factors in outbreaks of Legionnaires Disease. Those who are appointed to carry out control measures and strategies should be suitably informed, instructed, properly trained and their competency assessed.

25. Appropriate Records Responsible persons Significant findings of the risk assessment Written scheme of actions and control measures Results of any monitoring, inspection, test or check carried out

26. Typical log book records Training records Lines of communication Current state of operation Signature of person that did the work Plans or schematic drawings Visit log for contractors, council staff annual check

27. Why keep records? To demonstrate compliance with the law Show what control measures are being taken Monitor water temperatures, system cleanliness, bacteria levels (if appropriate) Show trend analysis learn more about the systems Review performance Provide evidence of reducing the risk

28. Open Forum