A tool in the fight against Legionella

To coincide with the release of their new healthcare training courses, leading Legionella specialists, Legionella Control International has published an excellent précis of the Department of Health’s HTM 04.
    
The précis summaries HTM 04 and forms a useful tool for anyone with responsibility for the control of Legionella in a healthcare environment, including senior executives, health professionals, estates and facilities managers; and contractors. Extracts from the précis are included below.

Controlling Legionella
HTM 04 or to give it its full title “Health Technical Memorandum 04-01: The control of Legionella, hygiene, “safe” hot water, cold water and drinking water systems” was first published by the Department of Health in 2006 replacing HTM 2027 and HTM2040. HTM 04 builds on the HSE’s primary Legionella control document “L8” but provides additional guidance to those involved with the control of Legionella in healthcare environments.

Epidemiology
In the UK Legionella pneumophila serogroup 1 is the commonest cause of Legionnaires’ disease and is also the cause of Pontiac fever. To date over 45 species of Legionella have been identified.
    
The risk of healthcare associated Legionellosis depends on a number of factors including:

• The presence of Legionella bacteria in sufficient numbers
• Conditions for suitable multiplication including temperatures between 20OC and 45OC
• A source of nutrients
• A means of creating and disseminating respirable droplets
• The presence of vulnerable persons exposed to an infected aerosol

Many if not all of these conditions are to be expected in healthcare premises.

Susceptibility of individuals
Previously healthy individuals may develop Legionnaires’ disease but the following factors can increase susceptibility:

• Increasing age, especially in those above 50 years. Children are rarely infected
• Men are three times more likely to be infected
• Those with existing respiratory ailments are more at risk
• Illness that weakens the bodies natural defences such as diabetes, cancer, kidney disease and alcoholism
• Smoking
• Immunosuppressant drugs, these inhibit the body’s natural defences

Systems at risk
Building services and other systems that pose a Legionella risk include any equipment containing water likely to exceed 20OC and which release an aerosol or spray, hot and cold water systems, laundry systems, sterile services departments, hydrotherapy pools, spa pools and birthing pools.

Management responsibilities
An organisation’s management team has overall responsibility to ensure the implementation of safe operational procedures.
    
A written scheme must be in place in respect of the control of Legionella in water systems as defined in the HSE’s Approved Code of Practice, L8. The statutory duty holder must appreciate the requirements and delegate to suitable persons to ensure compliance with this guidance. A risk assessment of the water services will be necessary.    
    
Risk assessments should be carried out by competent persons; if subcontracted it is recommended that such contractors should be a member of the Legionella Control Association or able to demonstrate appropriate levels of competency.
    
Management procedures should ensure continued compliance and demonstrate that corrective/preventative actions are in place and that these plans are implemented.
    
This guidance should be applied to all healthcare premises where there is a duty of care under the Health and Safety at Work Act 1974.
    
New healthcare premise should have their water storage, supply and distribution services assessed at the design stages.
    
All regular tests should be carried out even if they cause minor disruption to hospital services.

Action in the event of an outbreak of Legionellosis
Legionnaires’ disease is not notifiable under public health legislation in England and Wales, although in Scotland it is.
    
The Public Health Laboratory Services has defined an outbreak as more than two cases occurring in the same locality in a period of six months. Outbreaks should be notified to the Local Authority.
    
Local Authorities maintain an incident plan to investigate any outbreaks which may include:

• Shutting down of any process which may generate an aerosol
• Take water samples from the system prior to any disinfection being undertaken
• Provide staff records to establish if there are any further undiagnosed cases to come

Emergency treatment of the defective system should also be carried out as soon as possible.

Legionella Control International
Legionella Control International is a leading firm of Legionella and environmental hygiene specialists offering a range of consulting services, delivered through teams of experts with national and international reputations for unambiguous and impartial advice.
   
Services include advice on strategy, Legionella risk management, crisis and emergency management, expert witness and litigation support, Legionella training, water and environmental hygiene services; and facilities management.

For information
For more information, contact John Dobson on 0161 877 0586 or e-mail j.dobson@legionellacontrol.com. Alternatively visit www.legionellacontrol.com
To obtain your free copy of this HTM 04 précis call 0161 877 0586 or e-mail htm04@legionellacontrol.com.