Transcript LEGIONELLA - Institution of Occupational Safety and Health

LEGIONELLA
MANAGEMENT & CONTROL
Nemco
U T I L I T I E S
IS IT WORTH WORRYING
ABOUT?
Nemco
U T I L I T I E S
Nemco
U T I L I T I E S
LEGIONELLOSIS





Legionella = water-borne bacteria
Naturally widespread in the environment
Over 50 different species identified
20 known to cause disease in man
Legionella pneumophila
– Legionnaire’s Disease

Pontiac Fever / Lochgoilhead Fever
Nemco
U T I L I T I E S
LEGIONELLA





Temperature range 20 - 50°C
Proliferates at 37 °C
Requires nutrients
Slow moving / stagnant water
Poorly managed water system
= perfect environment
Nemco
U T I L I T I E S
INCIDENCE RATES






300+ cases/year - England & Wales
Steady rise in cases since 2002
Studies show LP could be responsible for 23% of community acquired pneumonia
(approx 83,000 cases of CAP) so 2,500?
Treatment is cheaper than testing
10-12% mortality rate
Respiratory disease
NUQPR024 V3.0 040313
Nemco Utilities Limited ©
Nemco
U T I L I T I E S
19
8
19 1
8
19 2
8
19 3
8
19 4
8
19 5
8
19 6
8
19 7
8
19 8
8
19 9
9
19 0
9
19 1
9
19 2
9
19 3
9
19 4
9
19 5
9
19 6
9
19 7
9
19 8
9
20 9
0
20 0
0
20 1
0
20 2
0
20 3
0
20 4
0
20 5
0
20 6
0
20 7
0
20 8
0
20 9
1
20 0
11
Number of Cases of LD
CASES BY YEAR
Total Number of Cases in UK
600
500
400
Barrow
Outbreak
300
200
100
0
Year
Nemco
U T I L I T I E S
‘AT RISK’ GROUPS
England & Wales Cases
250
200
150
Cases
Male
Female
100
50
0
0-9 10-19 20-29 30-39 40-49 50-59 60-69 70+
Age in Years
Nemco
U T I L I T I E S
EU SURVEILLANCE
Nemco
U T I L I T I E S
ENVIRONMENTAL FACTORS
Nemco
U T I L I T I E S
WHERE IS IT ACQUIRED?
Distribution of Where Legionnaires' Disease was Acquired
1980-2006
Nosocomial
Travel Outside UK
Travel Within UK
Community Aquired
Nemco
U T I L I T I E S
CHAIN OF EVENTS
Bacteria present in water system
Slow moving / stagnant water
Adequate food source
Temperature range 20-50°C
Aerosol formed
People present
Nemco
U T I L I T I E S
OUTBREAKS
Nemco
U T I L I T I E S
SHOWERS
Operate at ideal temps
Poor hygiene
Infrequently used
Prone to scaling
Create aerosol
Nemco
U T I L I T I E S
DEAD LEGS
Stagnant water
Ambient temps
Breeding ground
Nemco
U T I L I T I E S
STORAGE TANKS
Over capacity
Stagnation
Out of sight
Poor flow
Ambient temps
Nemco
U T I L I T I E S
Nemco
U T I L I T I E S
Nemco
U T I L I T I E S
CALORIFIERS
Can run at
critical temps
Thermal
stratification
Sludge build up
Nemco
U T I L I T I E S
COOLING TOWERS
Run at ideal temps
Open to elements
Contamination via
water supply
Intermittent use
Drift affects wide
area
Nemco
U T I L I T I E S
CASE HISTORY





Hospital outbreak - Glasgow 1992
1 patient died
Source = fire hose
‘Deadleg’
Need for awareness
Nemco
U T I L I T I E S
THE LAW





Health & Safety at Work Act (1974)
COSHH Regulations (2002)
Notification of Cooling Towers
Regulations (1992)
Approved Code of Practice (1992)
Revised ACOP January 2001
Nemco
U T I L I T I E S
RESPONSIBILITY - ACOP





Identify & assess sources of risk
Prepare scheme to prevent/control the risk
Implement & manage control programme
Keep Records
Appoint a responsible person
Nemco
U T I L I T I E S
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
Nemco
U T I L I T I E S
CAUSES OF OUTBREAKS
Nemco
U T I L I T I E S
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
Nemco
U T I L I T I E S
2012 OUTBREAKS

Edinburgh – 101 cases, 3 deaths
– North British Distillery Company – HSE Improvement Notice (failure to
devise & implement a sustained & effective biocide control programme in
one cooling tower)
– Macfarlan Smith – HSE Improvement Notices require thorough cleaning of
one cooling tower & provision of access for inspection & maintenance.
– All three notices have been complied with, and the HSE has stressed that
the notices do not mean that the cooling towers have been identified as the
source of the outbreak

Stoke on Trent – 21 cases, 2 deaths
– JTF discount warehouse in King Street, Fenton, where a hot tub on display
was singled out as the probable source of the bug
Nemco
U T I L I T I E S
COST TO BUSINESS






Sick pay
Loss of production / skills
Cost of an investigation (FFI)
Prosecution & Civil Action
Bad publicity - loss of business
Employee de-motivation
Nemco
U T I L I T I E S
RISK MANAGEMENT







Risk assessment
Regular monitoring
Temperature control
Water Treatment
Maintenance & Cleaning
Annual review
Awareness
Nemco
U T I L I T I E S
RISK ASSESSMENT


‘Suitable & Sufficient’ - all water systems
Reviewed regularly (bi-annually) and where:
–
–
–
–

change to plant / water system or its use
change to the use of the building
new information about risks / control measures
tests indicate control measure are ineffective
Carried out by competent person
Nemco
U T I L I T I E S
BS8580




Establish a standard approach to working
Encourage risk assessment rather than ‘surveys’
Meet standards expected by the HSE / EHOs
More emphasis on
–
–
–
–
Appraisal of records and control measures
Incidents of persistent non-compliance
Training and competence of site personnel
Timely completion of recommended remedial work
Nemco
U T I L I T I E S
SCHEME FOR CONTROL

Weekly flushing - infrequent use services

Monthly temperature monitoring - sentinel taps &
calorifiers

Quarterly shower head disinfection / de-scaling

6 monthly storage inspections

Annual review of scheme and risk level

Bi-annual review of the risk assessment document

Cleaning and disinfection as required
Nemco
U T I L I T I E S
LEGIONELLA MONITORING





Programme for continual risk assessment
Early identification of problem areas
Demonstrate effective control
Visual inspection – cleanliness / operation
Compliance with current guidance
Nemco
U T I L I T I E S
CONTRACT MANAGEMENT








Use registered suppliers – LCA
BS 8580 / BS 8558
Check training records / CVs
Ask for references
Agree levels of service
Agree areas of responsibility
Review contract at quarterly intervals
Check log book records regularly
Nemco
U T I L I T I E S
FUTURE TRENDS


Rise in susceptible individuals
Increased installation of TMVs
– (new building regs – required on all baths / showers)





MRSA / Swine flu – increased use of alcohol
gel
Office water coolers / boilers
IR no touch taps (low flow areas)
Increase in solar heating installations
Global warming
Nemco
U T I L I T I E S
IS IT WORTH WORRYING
ABOUT?
Nemco
U T I L I T I E S