Legionnaires’ Disease (Scotland) Policy

Policy Statement

This policy shows the measures this care provider takes to prevent occurrences or outbreaks of Legionnaires, which are requirements under health and safety laws for all business premises including care homes and offices.

Care providers must also take these measures to comply with the national care standards, My Support, My Life, which require service providers to ensure that their care users experience high quality care and that they have confidence in their care providers in all matters concerning their health, safety and wellbeing.

All reasonable steps will be taken to identify potential legionellosis hazards in the workplace and to prevent or minimise the risk of exposure for service users, staff, visitors and the general public.

If employees are concerned about the risk of an outbreak, they should report concerns to a responsible person so the organisation can take appropriate measures to eliminate or reduce the risks that might occur as a result of the normal operation of the water system in the premises.

The policy will have the full co-operation of management and employees at all levels.

Introduction to Legionnaires’ Disease

Legionnaires’ disease is a form of pneumonia caused by victims ingesting or breathing in legionella bacteria. Victims often feel confused and run high temperatures, many developing acute septicaemia. For older people and those with immune system weakness, legionella infection can be fatal or can result in severe complications such as renal failure.

Legionella bacteria are very commonly found in natural sources of water including rivers, streams and ponds and may even be found in soil. Here they do little harm but unfortunately they can also grow in recirculating hot and cold water systems in buildings and, in certain conditions, they can cause infections, particularly when released as a spray, in a shower for instance.

Since legionella bacteria are so common in our environment they cannot be prevented from entering water systems, but the risk of an outbreak developing can be reduced by taking simple precautions. In {{org_field_name}} the following will apply.

Procedures

Control of Exposure

Where potential exposure to infection cannot be prevented, there is a written control scheme to minimise exposure. ____________ holds managerial responsibility for implementing and supervising the scheme.

Health Surveillance

People exposed to significant occupational risk of infection will receive instruction about the nature of the risks and the means of controlling exposure. Staff should report any relevant symptoms that may indicate a possible infection.

Action in the Event of an Outbreak

There is a contingency plan in case of an outbreak of legionellosis. This will include the:

identification of people who may have been exposed
involvement of public health authorities
dissemination of information to employees and other interested parties as to the nature of the risks.

Selection, Training and Competence of Staff

Persons carrying out control measures associated with the management of legionellosis will receive appropriate in-depth training so they are able to perform their duties competently.

Safe System of Work

A comprehensive programme of hazard control should reduce the risk of occupationally acquired legionellosis to a very low level in most workplaces.

Avoidance of Conditions Favouring Growth of Organisms
As far as practicable, water systems should be operated at temperatures that do not favour the growth of legionella. The recommended temperature for storing hot water is at least 60°C with its distribution such that it reaches a temperature of 50°C within one minute at the outlets. Cold water systems should be maintained, where possible, at a temperature below 20°C.
The use of materials that may provide nutrients for microbial growth should be avoided. Corrosion, scale deposition and build up of bio films and sediments should be controlled and tanks should have tight-fitting covers or lids to prevent contamination.
Avoidance of Stagnation
Dead legs, which occur when water services leading from the main circulation water system to taps or appliances, are used only intermittently and other parts of systems which may provide a stagnant reservoir for infection should be eliminated.
Minimisation of Water Sprays
The dissemination of organisms should be reduced by careful design of equipment and the use of drift eliminators to stop excessive circulation of potentially contaminated air or enclosure.
System Maintenance
Water systems should be disinfected by an effective means before being taken into service and after shut downs of five or more days. Plant must be regularly and effectively inspected and maintained (eg by monthly visits from a water treatment specialist). Plant should be disinfected periodically (normally twice yearly) by chlorination or by temporarily raising water temperatures. Biocides may be used to control microbial growth. Maintenance personnel must wear appropriate protective clothing.
Sampling
Sampling for legionella should not normally be necessary, unless in the case of an outbreak or to monitor the effectiveness of precautionary measures. Weekly monitoring of chemical and microbiological water quality may give a useful indication of the state of the system.
Maintenance Procedures
Staff involved in plant maintenance or who might otherwise be at significant risk will require safe systems of work. The following should be their priorities.
a. Design procedures to minimise exposure, eg by prior disinfection.
b. Avoid creation of water sprays, eg by high pressure jetting.
c. Avoid exposure of others in the building to water sprays, eg by carrying out maintenance out of normal working hours.
d. Wear respiratory protection approved by the Health and Safety Executive (HSE). This will normally be high efficiency, positive pressure respirators with either a full face piece or hood and blouse.
e. Take necessary precautions when entering confined spaces, eg permits to work.
f. Handle biocides and water treatment chemicals with care.
g. Report relevant symptoms of illness to supervisors immediately.

Safe Water Systems

The organisation is committed to providing a safe and healthy workplace environment for its employees, service users and visitors, and this extends to the design, management and maintenance of safe water systems.

The water system within the premises is formally assigned to a named individual manager (such as premises or facilities manager) who shall ensure compliance with this policy and best current practice. The system shall be assessed and evaluated to ensure that there is a low risk to staff, visitors and others coming into contact with very hot water.
Residents will be assessed for the risk of scalding and wherever a risk is identified this should be controlled by fitting appropriate thermostatic mixer valves to limit the water discharge from any outlet to a maximum of 43°C. This allows hot water to be stored at 60°C and circulated at 50°C (temperatures which prohibit the growth of legionella) but discharged at a temperature which does not expose residents to scalding risks.
To further reduce legionella risks, temperature control valves should be located as close as possible to the outlet.
Pipework runs shall be inspected and wherever practicable hot water pipes at temperatures above 60°C shall be either secured in inaccessible positions such that there is little risk of coming into contact with the pipework inadvertently, or else the pipework shall be boxed in or otherwise made safe.
Water systems shall be assessed, maintained and checked to ensure that the system is microbiologically clean and action taken to implement guidelines for microbiological safety.
Drinking water supplies shall be maintained in a good, clean and reliable condition, and, as appropriate, labelled.
Records shall be kept of the actions taken to ensure and maintain safety in water systems.
Only water system fittings and materials which comply with water authority by-laws will be used in the home (certain materials, eg leather, some rubbers and plastics, support the growth of bacteria and should not be used).

Reporting

Any cases of legionellosis in an employee who has worked on cooling towers or hot and cold water systems that are likely to be contaminated with legionella must be reported to the HSE under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR).

Legionnaires’ disease is a notifiable disease in England and Wales. Local public health protection teams should be informed of any suspected cases. Public Health England publishes annual surveillance data. The data helps healthcare professionals identify clusters and prevent outbreaks.

Summary Policy Statement

Legionellosis is a serious and potentially fatal disease in susceptible persons. The organisation will ensure:

all systems in the workplace that could be a potential source of infection are identified and assessed for risk
a control scheme is implemented to ensure the risk of exposure is minimised
special instructions are issued to plant maintenance staff.

Personnel

_______________ is the infection control lead for the home.
Other infection control personnel in the home are:
- _______________ who is responsible for infection control risk assessment and staff training
- _______________ who is responsible for the cleaning and hygiene of the home.

Training

All new staff should read this policy along with the policy on Infection Control as part of their induction.

Existing staff should be offered training about infection control which is relevant to their role and responsibilities.

In-house training sessions should be conducted at least annually and all relevant staff should attend.

________________ is responsible for organising and co-ordinating training.

Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next review date: this policy is reviewed annually (every 12 months). When needed, this policy is also updated in response to changes in legislation, regulation, best practices, or organisational changes.

SCH140. Legionnaires’ Disease