1. Kate Brierley Nurse Consultant in Health Protection Cumbria and Lancashire Health Protection Unit NW Regional Lead for HCAI March 2012 Legionella in Residential Care Accomodation

2. What is legionella? Bacteria commonly found in water systems (both natural and artificial) Artificial systems e.g. storage tanks, pipework, shower heads, taps. Often associated with larger water systems, factories, cooling towers etc but can live in smaller water supply systems. Also spa and whirlpool baths, sprinkler systems, fountains

3. What is Legionnaires’ disease? Potentially fatal form of pneumonia Can affect anybody Higher risk – Over 45 yrs Male Smokers Heavy drinkers Chronic lung / kidney disease Immunocompromised Other conditions – Pontiac Fever, Lochgoilhead Fever

4. Approved Code of Practice Changes to the ACOP Removal of 300 litre limit If you provide residential accommodation it is your responsibility to ensure that the risk from exposure to legionella are controlled Assess the risk to staff, residents and others using your premises and introduce appropriate control measures. Legionella does occur in smaller domestic systems

5. Why do have to comply? Legionella multiply on hot or cold water systems / storage tanks Can be spread from taps and showerheads ↑throughput and ↓volume of water reduces likelihood of dangerous levels of bacteria Must carry out risk assessment then introduce a course of action to prevent/control those risks identified.

6. Assessing the risk Do it yourself or seek advice from a consultant Conditions right for bacteria to multiply i.e. water between 20-45ºC? Any deadlegs/areas of stagnant water? Infrequently used outlets e.g. taps/showers Is there debris in the system – rust, sludge, scale Are there thermostatic mixing valves? Are any employees, residents, visitors vulnerable to infection? Answering yes means there is an increased risk of residents being exposed to legionella & falling ill.

7. Introduce proper controls Refer to ACOP Design, maintenance and operation of the system are important in controlling growth of legionella. Remove redundant pipework, run taps & showers that are infrequently used Keep water cisterns covered, insulated, clean & free from debris. Insulate pipework. Correct temperature at hot water cistern Advise maintenance staff working on the system of the risks

8. Word of caution Raising temp of water is one way of controlling legionella but may lead to increased risk of burns/scalds – consider what control measures to use

9. Further information Legionnaires’ disease: The control of legionella bacteria in water systems. Approved code of practice and guidance. HSE Books Controlling legionella in nursing and residential care homes. Leaflet INDG253 from HSE Local HSE office – see local directory Environmental Health Dept at local authority

10. QUESTIONS?