Young, fit, and healthy people are considered at low risk of succumbing to Legionnaires’ disease, but anyone over 60 and patients with weakened immune systems are exposed to water contaminated with Legionella through poorly maintained hot water systems, the risk becomes considerably higher. That’s why water checks in Care Homes are one strategy for controlling legionella risk.

Roughly 400,000 people over 60 years of age in the United Kingdom live in either nursing homes or residential homes. These facilities are subject to the guidelines set forth by the Health and Safety Executive with regards to the levels of Legionella found in water systems. The HSE document, HSG 274 sets out the levels which require immediate remedial action and intervention.

Legionella Risk Assessment

Specifically, the Health and Safety at Work etc. Act 1974 states that those who are tasked with managing these establishments have a duty to evaluate the risks of Legionella that can affect the Care Home residents.

The Control of Substances Hazardous to Health Regulations 2002 state that care homes should assess the risks posed by Legionella to both staff, residents and visitors.  This [legionella] risk assessment is a LEGAL requirement.  Once the risk assessment report has been completed, it will list the necessary recommendations required to reduced the liklihood of legionella bacteria becoming a hazard.

Legionella Written Scheme of Control

Information gathered during the risk assessment is used to prepare the “Written Scheme of Control”. This document must be specific to each site rather than generic. It is a fundemental part of legionella management and sets out necessary controls. It also details how these controls are maintained and monitored in order to remain effective.

The most common control are for water temperatures.  For most properties Hot water should be stored at a temperature 60°C minimum and distributed at a minimum temperature of 50°C. The distribution temperature of hot water in healthcare and care homes is different, it should be a minimum of 55°C

Another example would be, if the site has cold water storage tanks the control document would state:-

• How often the tanks are inspected (and by whom).
• A checklist of items included as part of the inspection.
• A definition of how to determine if the the item being checked is compliant.
• The actions necessary when an item is non-compliant.

All other “water” equipment would be addressed in a similar manner eg

• Calorifiers/Water Heaters
• Cooling Towers
• Showers
• Fountains/Water Features
• Fire Suppression Systems
• Humidifiers (Spray/Ultrasonic/Steam)
• Vehicle Wash Systems
• Rainwater/Greywater

Water Checks

The control scheme should set out what testing is necessary. This includes the number, frequency and location of the samples.  It may be that in addition to legionella test kits, your property needs potability tests if tanks supply drinking water.

Risk Review

The Written Scheme will determine how often reviews are required.

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When you take legionella samples, it’s normally a single location in a single bottle and that’s what our laboratories test.  But you can also undertake “indicative sampling” whereby you put up to 4 separate locations in a single bottle.

Is it allowed?

The bible document for this is HSG274 Legionnaires’ disease – Part 2: The control of legionella bacteria in hot and cold water systems. The first sentence of Microbiological Monitoring (page 40, para 2.119) says the following: ” Microbiological monitoring of domestic hot and cold water supplied from the mains is not usually required, unless the risk assessment or monitoring indicates there is a problem”.  So for many properties with simples systems and correct engineering, no sampling is necessary.  Whilst this is true, most property owners prefer to a belt & braces approach. So they do all the correct engineering and temperature monitoring – but still want to be reassured by a laboratory test. This is where indicative sampling come into play.

How do you choose which outlets to mix?

For most properties there are usually three areas where legionella are found in hot water supplies.

• Production/Storage – this is usually your calorifier\water heater. If the temperatures are too low then legionella can survive.
• Distribution – this is the pipework which extends from the production/storage all the way up to [but not including] the actual outlet.
• Outlets – these are the hot taps, showers etc

The table below explains where it is appropriate to use bulked locations for indicative sampling.

What if only 1 o f the 4 locations is positive?

It’s quite feasible that just one location out of the 4 is positive, so will the laboratory pick up this small amount of legionella.  For non-healthcare properties, concentrations of legionella below 100 cfu/litre are deemed low risk (or system under control). Consequently if only one location has this minimum level of legionella – it will be diluted down to 25cfu/litre by the other “clear” sample locations. That’s not a problem, our advanced screening methods can detect concentration below 25cfu/litre.

If there is a POSITIVE, will I have to resample again?

The results from the indicative sampling will highlight where the problem is, ie

1. Production/Storage
2. Distribution
3. Outlets

With that knowledge, you can investigate to establish which legionella measures are failing and rectify them, then re-sample. If the legionella count is high, more immediate steps will be required such as a disinfection.

Indicative Sampling – what’s the conclusion

In most cases individual sampling is required so that there is no ambiguity with the result. This is especially true if they may need to be used as evidence in a court of law.  But there are numerous instances where indicative sampling saves both time and money. If you would like to learn more, contact AquaCert on  FREEPHONE 0800 048 1737

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When the HSE investigate cases of legionnaires’ disease, the majority are traced back to either showers or spa/hot tubs.  That’s why, over 30 years ago,  the HSE published the document called HSG70 which first set out technical guidance on how to manage the risk from legionella bacteria.

This document has since been replaced by L8 and HSG274 but the recommendations remain the same, ie every 3 months “Dismantle, clean and descale removable parts, heads, inserts and hoses (where fitted)”.

What makes showers such a high risk?

Legionella bacteria thrive in water when the temperature is between 20°- 45°C, since our preferred temperature of showers is ~40°C this is ideal for their growth.

Legionella bacteria like to live in biofilm and scale, it is these environments which provide the nutrients needed for continued growth.

For humans to contract  legionnaires’ disease, we need to get the bacteria into our lungs. Showers emit a huge stream of water droplets, the smaller droplets (those that look like steam or fog) can be breathed in allowing legionella to enter our body.  Our lungs also provide a great place for them to live, the temperature is usually 37/38°C which is perfect for their needs and we also provide them with a feast of nutrients.

How do we reduce the risk?

Legionella bacteria prefer stagnant conditions so the first line of defence is to make sure the showers are used regularly so that they are frequently flushed out of the system whilst their numbers are small.  If you have an infrequently used shower, then either remove it or ensure it is flushed at least a couple of times each week.  If either of these proves impractical, fit a “point of use” legionella filter to prevent the bacteria reaching the aerosol.

The next task is to remove their habitat and nutrient supply, this is done by descaling and disinfecting the shower head and hose.  This task has to be repeated on a regular basis because both scale and biofilm formation are a continuous cycle. Specialist products are available which disinfect and descale in a single operation. For hand held showers you simply immerse the head and hose into a container of chemical or for fixed head showers (such as anti vandal, prisons etc) spray a slightly viscous chemical onto the showerhead.

For details and techniques  on how to clean a shower, see the document Legionella Shower Head Disinfection & Descaling Techniques.

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There are many types of water filters, some absorb chlorine to improve taste, others trap calcium to reduce scaling. The most common type are sediment filters which collect the larger dirt particles.

We all know that some types of bacteria can be hazardous to us especially for the very young, old or anyone with a depressed immune system.  Many of the worst pathogens are transmitted to humans via our water supply. Even the best supplies can still contain small numbers of dangerous bacteria.

A bacteria filter, often referred to as a legionella filter traps all bacteria in a membrane preventing it reaching the tap or shower outlet.

Filters are graded according to the smallest size of particle they can trap and this size is measured in microns (one thousandth of a millimetre) , examples of the size of small objects are:-

• Human hair                               70          microns
• Grain of table salt                    120         microns
• Length of a bacteria                5 – 10      microns

Safewater filters capture anything larger than 0.15 microns so no bacteria can get past them. It required the most advanced manufacturing process to produce hollow fibres with minute pore sizes which permit a high flow rate and minimal pressure drop.

Safewater filters are used extensively in hospitals to prevent water borne bacteria reaching susceptible patients. These Legionella, pseudomonas, E.coli and Nontuberculous mycobacteria.

How long do these legionella filters last?

The lifespan of the AquaCert Safewater Filter will depend on the quality of the incoming water, for example they will last much longer on a good clean supply that has no sediment compared to an untreated borehole feed. In Care Homes and Hospitals, they last up to 6 months.

As the filters collect more sediment and bacteria the pores slowly become blocked and the water flow rate reduces, when the flow rate becomes too little – simply replace the internal filter cartridge.

When & where do you use Legionella filters?

The most common use occurs when a routine legionella tests reveals that the water supply contains legionella bacteria.  Since closing a care home or hospital is not a viable option, legionella filters are fitted so that there is no risk to patients or service users. Once fitted, the maintenance teams can plan and implement the remedial actions necessary to eradicate\minimise the reoccurrence of the bacteria.

• When there is active legionella in the water, the filters should be fitted to all showers plus any other outlets which create an aerosol.
• To ensure 100% safety, hospitals use them continuously in specialist areas such as neonatal, wound washing and infection control.
• In buildings where there is intermittent usage such as schools, second homes, caravans, sport facilities, company first aid rooms.
• Ships and offshore facilities where production and storage of water can be problematic.

Why do AquaCert recommend Safewater filters?

Competitor products are intended to be used and then thrown away so they are manufactured accordingly. Safewater filters are engineered to the highest of standards so that they can be re-used for many years.  Safewater filter housings are designed to last for many years. They are built to be strong, sturdy and elegant so they look like any other quality shower head.

You’d be wrong to think that this makes them more expensive, it doesn’t!  Safewater filters incorporate a cartridge filter so instead of throwing the lovely showerhead away, you just replace the cartridge. This makes Safewater filters much cheaper in the long term plus you get a quality, good looking product.

AquaCert has also evaluated the technical attributes of legionella filters.

• The Legionella Filters tend to last longer and retain a higher flow rate due to the way the hollow fibres are manufactured.
• They tend to withstand higher water pressures than many of the other manufacturers due it their expected long lifespan.
• They are fully compliant with UK and International requirements concerning quality, efficacy and performance.

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	The Pool Water Treatment Advisory Group have two Technical Notes relating to Microbiological Testing: Microbiological Testing (TN27) Microbiological Testing (TN53)	IMPORTANT AquaCert is NOT a ‘postal’ service.
These documents explain: How to take the water samples What type of laboratory you should to choose to undertake the testing How the samples should GET to the laboratory

Why is this Important

The sterile sample bottles contain sodium thiosulphate which deactivates the chlorine in the water, if the chlorine is not neutralised it will continue to kill any bacteria in the water sample whilst in transit to the laboratory. This would obviously give false results.

However, by removing the chlorine – there is nothing to stop the bacteria proliferating so the sample needs to be tested as soon as possible.

Laboratories are overseen by a body called UKAS which set the rules/methods which the laboratories have to adhere to.

For pool / spa samples, these rules include how the sample get to the laboratory.

UKAS decrees the maximum period of time between taking the sample and its arrival at the laboratory, these are

• Within 4 hours (without temperature control)
• Within 24 hours (if temperature is maintained between 2-8°C)

It’s obvious that sending a sample by post would not meet these criteria.

You can trust AquaCert

• AquaCert only use same day couriers that have refrigeration facilities.
• We monitor our transit performance, during 2021 we averaged just over 6 hours from our clients to the laboratory and that’s with a temperature controlled environment throughout the journey.
• We easily exceed all the requirements of the PWTAG and UKAS bodies.

If you have any questions regarding our compliance, please call us on FREEFONE 0800 048 1737

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The bacteria becomes a real threat to the health and well-being of your family when the right conditions for their multiplication are present.  Examples are:

• The availability of food sources such as scale/corrosion.
• An optimal temperature range which is between 20-45°C. (At temperatures below 20°C, the bacteria can lie dormant while at a temperature of 60°C, the bacteria cannot survive).
• Whenever an aerosol is produced, the small water particles from showers are perfect.

Showerheads in particular create the optimal conditions for Legionella and other bacteria to thrive as the physical conditions on the showerheads change with every use. Scale is an ideal food source for legionella bacteria therefore it is imperative that showers are descaled regularly.

Biofilms will also form within the showerhead and hose over time and if not removed by regular cleaning.  Biofilms provide a perfect habitat for legionella and other bacteria as it provides an ever increasing food source.  Legionnaires Disease is contracted by inhaling infected water in the form of an aerosol. Therefore showering has the potential to become a risk  if the showerhead and hose are not kept clean and scale free.

How can you protect your family from the threat of Legionella bacteria?

Shower Head Disinfection

Showerheads, especially those that are used infrequently, should be flushed out at least once a week. These should also be cleaned and de-scaled every three months.

For Legionella shower head disinfection, you can use Showerhead Cleaner in liquid form.  We have a “gel” form for fixed heads which cannot be dismantled.

The post Shower head disinfection helps protect your family appeared first on Aquacert.

What is Legionella?

Any UK business, especially a care or nursing home, should be aware of the risks involved regarding legionella found in water-based systems running throughout a property. Those responsible need to be fully aware of the dangers involved. The are also responsible for complying with this important area of health and safety.

Legionella is present in natural locations, such as rivers and ponds.  It reaches the Care Home water system via the incoming mains supply.. The bacteria needs certain conditions in which to survive which, if present, means that it can proliferate throughout a water system. As the concentration of bacteria grows, so do the threat to the health and safety of the residents.

What are the Risks if not identified?

Simply carrying out a test every ‘now and then’ is not enough. Proper risk management plans should be put in place. The person(s) responsible for health and safety need to ensure that the care home business is fully compliant. The business should have an appropriate system in place to ensure that the risk, testing, management and prevention issues are dealt with in the correct manner. This needs to be done on a regular basis.

If residents breathe in the bacteria, (which is an aerosol from contaminated water), they can contract legionnaires disease or Pontiac disease. Symptoms of legionnaires are of a pneumonia-type nature.  Vulnerable residents can contract the disease quickly if levels of the bacteria are at a particularly high level. The symptoms of Pontiac disease are more mild and flu-like. And obviously, as the residents of care homes are normally elderly and/or have immune related issues, they are more susceptible to getting infected.

According to the Health and Social Care Act 2008 any provider of care is regulated in order to prevent risk and harm during any care or treatment and this regulation includes the spread of infection. The Care Quality Commission (CQC) will investigate incidents concerning unsafe or poor quality care which of course is detrimental to any business responsible for care homes and similar properties.

What are the Recommended Processes of Legionella Detection?

Controlling legionella in the UK is a legal requirement so, when planning a strategy for legionella testing in care homes, it’s important to have a solid process in place.

This ideally should start with a regular legionella risk assessment.  The findings within this report are the basis for the “Written Scheme of Control” which sets out how the risk will be controlled.

A second step will relate to competency when it comes to water testing. Legionella testing for care homes can actually be carried out by those responsible in a simple manner. Testing kits are an easy and inexpensive way of testing the water outlets and systems . Always return the test to a professional UKAS approved laboratory. Here it will be analysed for any present bacteria and the results returned to you.
The third step will be to record those results and keep them on record to show to the CQC. These external auditors will check to ensure that you are legally following processes required for a care home business.

And the fourth step is to take the advice provided should the results be positive and bacteria found. This is where the water system can be treated properly in order to remove the presence of any bacteria colonies and to prevent them over the short and long term. Should results be negative then a certificate is supplied to confirm that the water system has been tested and that no action is required at the present time.

AquaCert are able to provide specialist testing for legionella in care homes which are fully compliant with UK regulations.

We provide professional advice and can keep a record of the date the water had been tested. We also put a reminder in place when the next test should be carried out, therefore helping you with proper care and maintenance of your care home.

Our water testing process is simple and inexpensive yet legally compliant. Do contact us if you require further information on how many kits you may need for the property, or properties. We can advise fully on anything that you may need to know following the use of your water testing kits.

Simply testing water for legionella bacteria is not sufficient to comply with the complex legislation as a control measure. A risk Assessment will advise control measures required for an individual property.

Author: Duncan Hollis

The Importance Of Water Testing In Care Homes

The post Scheduled Legionella Testing in Care Homes appeared first on Aquacert.

Where to Check for Legionella

Since hotels receive numerous guests on a daily basis, such establishments have several water sources, systems and features. When a hotel gets a positive result, their first concern is whether the problem is local (to a single room or tap) or if the bacteria are endemic (everywhere). This is where a sampling plan is required, each hotel will be slightly different but the basic thought process is the same.

1. The main distribution system

Hot Water Source – Does your calorifier/water heater have legionella?

Test the stored hot water first, if there is a problem here – you will have a problem everywhere.

Sentinel Outlets

Next test is the furthest hot water outlets. This could be top & bottom floors for a multi storey hotel. Maybe it is the four corners of a large single storey hotel. In any event the locations should either be fed direct or taken just before any TMV valves.  If these results come back clear, you know that your main distribution system has no legionella.  If also means that any other samples which are found to contain legionella will probably be due to a local issue.

2. Other outlets

Showers

Legionella bacteria favour shower heads and hoses. This is because most shower systems sustain temperatures between 35° C and 45° C. Showerheads are also prone to scale, sludge and rust build-up, which provide nutrients to encourage proliferation.  Showers also produce vast aerosols which allow the legionella to enter our lungs as we breathe in.  Testing a couple of showers on a rotational basis will determine if your cleaning/disinfection regime is satisfactory.

Rarely used rooms or outlets

Very few hotels maintain 100% occupancy levels so some rooms will not be filled. Are there are some rooms which are typically the last to be let? Maybe the reason is due the view, noise or they are awaiting refurbishment. In any event you should be flushing all these outlets at least weekly. Why? Because legionella bacteria favour static water so pipes that are stagnating are ideal places for them to thrive. Checking one or more “not in use” rooms will determine if the flushing regime is satisfactory.

Taps

It is good practice to fit thermostatic mixer valves (TMVs) just prior to the hot water outlets in guests’ rooms. This reduces the risk of scalding but increases the likelihood of legionella bacteria being present.  TMVs lower the water temperature to a pleasant ~41°C which is pretty much the most perfect temperature for legionella to thrive. It only takes a small slip in the hot water temperatures to enable legionella to survive/pass through the hot water storage vessel.  Once the legionella get into a TMV they can remain there for years.  Even when the hot water distribution temperatures are 65°C, the TMV protects them by keeping the water at around 40°C. So if you find a [TMV fed] tap positive it is either a local problem or indicative or a past issue with the distribution temperatures. It requires a chemical disinfection to kill them.

Water storage tanks

Virtually every single hotel has one or more water storage tanks. They are crucial for ensuring all areas and rooms in the hotel have water for all workers and guests to use. If the water temperature in a cold water storage tank rises above 20°C, legionella can grow.   If you regularly monitor the temperature and it’s always below 20°C, then the location is a low risk and has no great need to be tested regularly.

3. Other Water Systems

Water features

Fountains and other types of water features are popular, everybody has an affinity to water. Unfortunately they are linked with a high risk of Legionella because of their design. Since they spray water, the aerosol they produce is a key way in which Legionella is transmitted.  Indoor water features have ambient temperatures which is higher allowing the bacteria to grow.  These systems must be treated with a UV or biocide to prevent bacteria growth, then checked with a legionella test kit to prove the preventative measures are satisfactory. A positive legionella result means anyone walking past the feature could become infected.

Lawn/plant irrigation

If your hotel has a front/back yard or gardens, chances are you have an irrigation system. Just like fountains, they spray out contaminated water droplets which people can accidentally inhale. In general, there is a higher risk of Legionella being present in these droplets since the sprinkler system is outside where temperatures are high enough for the bacteria to grow.

Author: Duncan Hollis

The post Where do Hotels use Legionella Test Kits? appeared first on Aquacert.

What people should be aware of, however, is that hot tubs are probably the greatest source of legionnaires’ disease cases. Legionnaires’ disease is a type of pneumonia that afflicts as many as 18,000 patients every year in the USA alone. Legionnaires’ disease is caused by Legionella, a type of bacteria that naturally thrives in hot or warm water.  So, hot tubs a are an ideal breeding ground for these bacteria. Infection occurs when a person breathes in droplets of water from the mist given off by a contaminated hot tub. The bacteria will happily live and grow in the lungs.

Legionnaires’ disease is potentially fatal, but it can be treated with antibiotics if proper and timely management of the infection is followed. It can pose serious risks to certain types of patients, including older adults, smokers, people with diabetes, cancer or kidney failure. In fact anyone with a weakened immune system is much more vulnerable to a fatal infection.  Luckily, Legionnaires’ disease does not spread from one person to another.

Protection tips

One way to protect yourself and your family from Legionella is to be discriminating when choosing which hot tubs to use.   Also, make it a habit to observe the quality of water first before going in.

• A properly maintained hot tub has no or little odour, those with a strong chemical/chlorine smell indicates incorrect maintenance systems.
• The water should be clear, never cloudy.
• You should be able to hear the noise of pumps, filters and hot tub equipment that indicate that they are turned on and running.
• Lastly, check the side and tiles: they should feel squeaky-clean and not slippery or sticky.

Advanced protection

Both commercial and home owners must carry out regular microbiological testing. Should the test results come back positive, AquaCert will guide you on the fast and complete elimination of bacteria as well as long-term control and monitoring.

+Duncan Hollis

The post Legionella Risk in Hot Tubs and Spas appeared first on Aquacert.

The answer is bacteria, lots of bacteria, luckily you can fight these bacteria with shower head cleaner. One pathogen is Non-tuberculosis myctobacteria (NTM) are small, rod-shaped bacilli found in the natural environment, and like its name implies, it does not cause tuberculosis. However, it is the cause of other health woes such as lymphadenitis, pulmonary disease resembling tuberculosis, skin disease, etc. 

The most common exposure people have to these bacteria is through water distribution systems. Almost every water system has biofilms and protozoa that have been established to assist the proliferation of mycobacteria. Studies reveal that NTM is somewhat resistant to chlorine so even if these water distribution systems and water itself are treated with chlorine, the bacteria will continue to thrive and infect people.

People acquire NTM through ingestion, aspiration, or inoculation of bacteria through the water. So basically, all the usual “water activities” can expose you to the bacteria.

• Washing your face
• Brushing your teeth
• Taking a shower

You do these tasks to cleanse your body, but they can increase the risk of developing any of the diseases mentioned earlier. Medical experts point out that those who are at higher risk of infection and developing even more complicated health conditions are young children, old people, and those who have pre-existing conditions such as asthma and HIV. 

But there’s an even bigger concern than NTM — Legionella bacteria. This is the pathogen which causes the potentially fatal Legionnaire’s disease. Legionella bacteria may also be present in the water and distribution systems. While it’s not as resistant to chlorine as NTM, it can still thrive in chlorine-treated water because it lives in the biofilm.

NTM infection and Legionnaire’s disease are both treatable (though Legionnaire’s is more complicated and aggressive), but why subject anyone through the intense discomfort of these bacteria if prevention is possible? 

Disinfections Work

Since it’s established that water distribution systems are where these bacteria thrive, disinfecting them is the obvious solution. But before disinfection commences, it’s important to determine the actual infected areas first; our water quality testing kits will do the trick. These kits come with sterile bottles and free courier service to get the samples to the lab and deliver the results of the test. If results turn out positive of these bacteria, then disinfection can begin. 

For NTM, dosing disinfectants into the water such as higher levels of chlorine or chlorine dioxide are effective enough. UV irradiation are also effective but have no residual effect downstream.

For cleaning and disinfecting shower heads and hoses, use a product such as  AquaCert Shower Head Cleaner. Tests show it is one of the most effective solutions in getting rid of L. pneumophila. In fact it kills the bacteria in less than a minute. But it is also strong enough for NTM. So it’s not just preventing the occurrence of Legionella disease but NTM-related illnesses as well.

How to test

Visit our store for details on testing for Mycobacteria and legionella.

www.aquacert.co.uk/knowledgehub/how-does-it-get-into-our-water-systems/shower-head-disinfection-descaling-techniques/

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