LEGIONELLA

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LEGIONELLA

• MANAGEMENT CONTROL

Nemco
U T I L I T I E S
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LEGIONELLOSIS

• Legionella water-borne bacteria
• Naturally widespread in the environment
• Over 50 different species identified
• 20 known to cause disease in man
• Legionella pneumophila
• Legionnaires Disease
• Pontiac Fever / Lochgoilhead Fever

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LEGIONELLA

• Temperature range 20 - 50C
• Proliferates at 37 C
• Requires nutrients
• Slow moving / stagnant water
• Poorly managed water system
• perfect environment

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LEGIONNAIRES DISEASE

• American Legion Convention, July 1976
• 182 cases - 29 died
• 38 cases in passers by (5 died)
• 200-300 cases/year - England Wales
• 10-12 mortality rate
• Respiratory disease

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SYMPTOMS

• Head muscle ache
• Tightness in chest
• Dry cough
• Sickness diarrhoea
• Confusion / delirium
• Coma
• Death

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AT RISK GROUPS
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CHAIN OF EVENTS

• Bacteria present in water system
• Slow moving / stagnant water
• Adequate food source
• Temperature range 20-50C
• Aerosol formed
• People present

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RISK AREAS

• Hot cold water systems
• Cooling Towers Air Conditioning
• Storage Cisterns
• Calorifiers
• Deadlegs
• Showers
• Spa pools

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SHOWERS
Operate at desired temps Poor hygiene Infrequently
used Prone to scaling Create aerosol
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DEAD LEGS
Stagnant water Ambient temps Breeding ground
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STORAGE TANKS
Over capacity Stagnation Out of sight Poor
flow Ambient temps
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CALORIFIERS
Can run at critical temps Thermal
stratification Sludge build up
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COOLING TOWERS
Run at ideal temps Open to elements Contamination
via water supply Intermittent use Drift affects
wide area
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RISK MANAGEMENT

• Risk assessment
• Regular monitoring
• Temperature control
• Water Treatment
• Maintenance Cleaning
• Annual review
• Awareness

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CASE HISTORY

• Hospital outbreak - Glasgow 1992
• 1 patient died
• Source fire hose
• Deadleg
• Need for awareness

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CASE HISTORY

• Flower Show - The Netherlands 1999
• 242 Cases - 28 died
• Source - Whirlpool Spa exhibit
• Fed from hose
• Where could it strike next?

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THE LAW

• Health Safety at Work Act (1974)
• COSHH Regulations (1999)
• Notification of Cooling Towers Regulations (1992)
• Approved Code of Practice (1992)
• Revised ACOP January 2001

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RESPONSIBILITY - ACOP

• Identify assess sources of risk
• Prepare scheme to prevent/control the risk
• Implement manage control programme
• Keep Records
• Appoint a responsible person

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Responsible Person

• Managerially responsible for implementation
  supervision
• Ensure all those involved are trained and
  competent
• Manage contractors and suppliers
• Maintain records
• Ensure regular reviews are carried out

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PROSECUTIONS

• 1988 - BBC London
• 70 reported cases
• 2 people died
• Source of bacteria cooling tower
• Fined 3,600 / Costs 3,200
• 26,400 in compensation to taxi driver

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CORPORATE MANSLAUGHTER

• Local Authorities Individuals
• Barrow-in-Furness Manager charged
• 7 counts of manslaughter could have got life
  for gross negligence (actually fined 15,000)
• Council could have received unlimited fine
  (actually fined 125,000 with costs of 90,000
• Service contract lapse cooling tower
• 172 cases, 7 people died (Aug 2002)

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THE CASE SUMMARY

• May 01 Streamline contract cancelled
• Jun 01 council H S mgr asked to do checks but
  refuses
• Jul 01 GB appoints Interserve but contract
  omits dosing and dipslides
• Jan-Jun 02 Engineer warns of danger
• Aug 02 Outbreak declared

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KEY FACTORS

• Poor communication (internally)
• Responsibilities not defined
• Lack of training
• Failure to record meetings / conversations
• Insufficient contract documentation
• Poor advice / management
• Risk assessment not carried out

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COST TO BUSINESS

• Sick pay
• Loss of production / skills
• Cost of an investigation
• Prosecution Civil Action
• Bad publicity - loss of business
• Employee de-motivation

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LEGIONELLA MONITORING

• Programme for continual risk assessment
• Identification of problem areas
• Demonstrate effective temperature control
• Visual inspection - cleanliness
• Compliance with current guidance

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SCHEME FOR CONTROL

• DOMESTIC WATER SYSTEMS
• Weekly flushing - infrequent use services
• Monthly temperature monitoring - sentinel taps
  calorifiers
• Quarterly shower head de-scaling
• 6 monthly storage inspections
• Annual review of risk assessment
• Cleaning and disinfection as required

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LOGBOOK RECORDS

• Lines of communication responsibility
• Original risk assessment
• Asset list - uniquely identified water services
• Schematic drawings of water system
• Scheme for control
• Monitoring flushing records
• Records of remedial or maintenance work
• Emergency procedures

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CONTRACT MANAGEMENT

• Use registered suppliers - Code of Conduct
• Check training records / CVs
• Ask for references
• Agree document levels of service
• Agree document areas of responsibility
• Review contract at agreed intervals
• Check log book records regularly

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FUTURE TRENDS

• Rise in susceptible individuals
• Increased installation of TMVs
• (new building regs required on all baths /
  showers)
• MRSA increased use of alcohol gel
• Office water coolers / boilers
• IR no touch taps (low flow areas)
• Increase in solar heating installations
• Global warming
• Rapid detection techniques are improving

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HELP ADVICE

• For any help or advice
• HELPLINE 0800 0741237