Legionnaires’ disease can cause serious illness and, in some cases, even death if it is not managed correctly. It is contracted by breathing in droplets of air containing Legionella bacteria.
Legionella bacteria are present in natural waters and enter the building water systems through the mains water supply. Airborne water droplets are created by water systems such as showers, spa baths, hydrotherapy baths and hot and cold-water services such as spray taps.
Like other businesses and service providers, care home operators have a duty of care to protect residents, staff, visitors and anybody else who may be affected by their undertaking from foreseeable risks to their health, safety and wellbeing.
Why Care Homes are at Risk?
While anyone could become infected some groups are more susceptible, and these include the elderly and those with existing underlying health conditions.
The elderly are a high-risk demographic for legionella. According to a report “Legionnaires’ disease in residents of England and Wales” published by Public Health England in 2016, more than 84% of confirmed cases of Legionnaires disease were detected in people with an age group of more than 50 years.
In addition, plumbing fixtures in care homes tend to be breeding grounds for Legionella since these establishments have complex water systems. Their plumbing systems have been intricately designed to ensure that bedrooms, kitchens, bathrooms, laundry rooms and other areas will have access to water. These pipes also serve as the entryways of these pathogens.
Dead legs in pipework and infrequently used taps, outlets, and services all raise the risk factor.
Legal Requirements for Nursing Homes
Control and management of legionella in care homes (and any workplace) is a legal requirement.
Measures are required by law to manage the risk of Legionella exposure for workers as outlined in is The Safety, Health and Welfare at Work Act 2005 (S.I. No. 10 of 2005).
Failure to do so could invite legal action and could result in severe fines being imposed.
The primary document in this area is HPSC’s National Guidelines for Control of Legionellosis in Ireland, 2009. It should be read in conjunction with UK HSE’s ACOP L8 and other supporting documents such as HSG274 Parts 1,2 & 3.
The key to managing the risk is the implementation of the following five steps, as advocated under the HPSC National Guidelines of Control of Legionellosis in Ireland and ACOP L8:
We have looked at these requirements in previous blogs, please follow the links provided for more information.
Controlling Legionella Risk in Water Systems
As care homes are highly vulnerable to a Legionella outbreak, a written scheme of control must be prepared and implemented to manage and control the risks associated with legionella bacteria.
Temperature is the usual method of control with systems operated at the required temperatures to prevent legionella bacteria from growing. Hot water must be stored at 60°C and distributed at 50°C or higher to all outlets. Cold water must be stored and distributed at 20°C.
Regular checks need to be carried out in accordance with the risk assessment, some of these checks can be carried out by your trained site staff or you can choose an experienced water hygiene company to do these on your behalf.
Cold water storage tanks must be visually inspected at least every 6 months and cleaned as required. Showerheads and hoses must be cleaned and descaled quarterly. Calorifiers (hot water cylinders) need to be drained and internally cleaned and inspected annually.
It is also important to reduce the possibility of stagnating water in a system, so a risk assessment will identify dead-legs in the pipework which will need to be removed. Little used outlets which can include showers and taps must be flushed weekly or removed to prevent stagnation.
Where to Start?
Controlling legionella in nursing homes starts with a legionella risk assessment of the hot and cold water systems to ensure a scheme is put in place to control the risk.
It is the responsibility of the duty holder to ensure a risk assessment is in place and reviewed periodically but it must be undertaken by a competent person. In most cases, a risk assessment would already be in place, which can be reviewed.
The legionella risk assessment:
- Identifies and assesses likely sources of risk
- Recommends schemes to help control the risk
- Suggests a suitable routine monitoring program
- Clarifies lines of responsibility
- Identifies training deficiencies
- Provides recommendations
A legionella risk assessment will also include the review of your current records and a check of your previous assessments to ensure that all recommendations of remedial work or maintenance have been acted upon.
Risk assessments need to be undertaken regularly or as soon as any changes have been made to the water system. Evidence must be made available for inspections by the HSE or the local authority, so records must be kept of all activities.
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Care homes must be subject to regular risk assessments to identify the level of risk, potential hazards and a suitable maintenance and monitoring regime to ensure continued compliance.
Celtic Water Solutions provides legionella control services, water hygiene and treatment to a wide variety of institutions in the Republic of Ireland helping them stay compliant with health and safety laws.
Our risk assessors will always carry out an extensive risk assessment of all of the water services within the premises and provide easy to understand recommendations that will guide you to full compliance.
If you need more information on our water hygiene solutions, feel free to get in touch with our team of experts.
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