1. Session 7: Problems with Hotels
Facilitator notes:
Legionnaires’ disease: Risk assessment, outbreak investigation and control
Session 7: Problems with Hotels
ECDC, 2012

2. Problems with Hotels - Overview
20% of detected Legionella cases considered as travel related
1999 figures for Europe: travel association in 21% of cases
90% of these, associated with hotels or apartment
rest with camp sites, private homes, cruise ships and other sources
Approximately 60% of hotel-associated cases are sporadic !

3. Problems with Hotels When did it all start?
Bellevue Stratford Hotel, Philadelphia, 1976
First hotel implicated (or confirmed) as implicated in cases.
Over 200 implicated cases – many of whom stayed at the hotel
A large hotel with over 1000 rooms

4. Problems with Hotels What’s in a Hotel?
Complex water systems – including potable water and showers etc
Leisure facilities on site – used by residents/visitors (in various states of health)
Cooling towers – on the building (or in fact on neighbouring buildings)
Water features – within the building
Other water on site – laundries,

5. Problems with Hotels Water Systems
Poor design of the systems on site
Over-capacity of stored water
Poor temperature control of hot- and cold water systems

6. Problems with hotels Water Systems
Poor management of the water system
Poor circulation
Calorifiers not maintained
Anti stratification pumps ineffective
TMVs not maintained

7. Problems with Hotels; Recreational Water
Poor management of recreational etc water
Poor cleaning regimes in pools and associated facilities such as changing rooms
Poor management and maintenance of pool water treatment
Poor training of staff

8. Problems with Hotels; Cooling Towers
Poor management of the cooling/air conditioning systems
Difficulties in identifying sources in outbreak situations
Towers – not always registered
Many cooling towers in city areas

9. Problems with Hotels - solved !
Good system design
Effective management
Effective maintenance
Robust risk assessments
Robust water safety plans
Review of water safety plan
Don’t forget water features

10. Facilitator notes:
Acknowledgements The creation of this training material was commissioned in 2010 by ECDC to Health Protection Agency (UK) and the University of Chester (UK) with the direct involvement of Louise Brown, Janice Gidman, Emma Gilgunn-Jones, Ian Hall (on behalf of the ECDC Legionnaires Disease Outbreak Toolbox Development Group), Tim Harrison, Rob Johnston, Carol Joseph, Sandra Lai, John Lee, Falguni Naik, Nick Phin, Michelle Rivett, and Susanne Surman-Lee. The revision and update of this training material was commissioned in 2017 by ECDC to Transmissible (NL) with the direct involvement of Arnold Bosman and Kassiani Mellou.