iosh essex branch event event subject: legionella awareness date: 8 december 2010

IOSH Essex Branch Event

Event Subject: Legionella Awareness

Date: 8 December 2010

• Welcome• Essex Branch Executive Committee

• Events • Legionella Awareness• Timing


Legionella Awareness

HOW2 Training Services

(division of H2O Chemicals Limited)


Background

• American Legion Convention 1976

• Philadelphia, Bell Vue Stratford hotel

• 182 cases with 29 deaths

• Discovered by Dr Joseph McDade

• Bacteria common in water and soil


How legionella multiplies

• Favourable pH & temperature 20 – 45C• Ideal is 37C (human body)

• Stagnation provides time for multiplication

• Key nutrients are free iron & L cysteine

• Biofilm protection


Single Bacteria


Facts About Legionnaires’ Disease

• Between 320-375 cases per year

• Under reporting is believed to occur

• Legionella Pneumophila accounts for most cases

• At least 50 other species are known


Legionnaires’ disease in residents of England and Wales by category of exposure 1980-2004

0

50

100

150

200

250

300

350

400

450

'80 '82 '84 '86 '88 '90 '92 '94 '96 '98 '00 '02 '04

Cas

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epo

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Travel Abroad

Travel UK

Community acquired

Nosocomial

Data from CDSC


Infection and symptoms• Inhalation of Bacteria, size is important• Incubation Period 2-10 Days• Can be diagnosed but difficult to

– severe pneumonia: dry cough, diarrhoea, vomiting, breathing difficulty, high fever, chills,

– headache, some become confused or delirious

• Fatality rate is about 12%• Can be treated effectively with antibiotics


Legionella colonising Amoeba


Susceptibility of Individuals• Increasing age, especially over 45

• Gender; men

• Smokers, alcoholics

• Chronic respiratory or kidney disease

• Diabetics, cancer sufferers


Types of System• Cooling systems (if applicable)

• Domestic water services– Hot water systems– Cold water systems

• Spa Baths

• Other systems


Hot and cold water systems

Cause the most cases


Cold Water Storage Tanks


Types of water heaters


Showers


Legionella Control

Regulation & Legislation


Legislation• Health & Safety at Work etc Act 1974 (HSAWA)• Management of Health & Safety at Work Regulations

1999 (MHSWR)• Control of Substances Hazardous to Health

Regulations 2002 (COSHH)• The Notification of Cooling Towers and Evaporative

Condensers 1992• The Control of Legionella Bacteria in Water Systems

Approved Code of Practice & Guidance 2001 ACoP L8• Reporting of Injuries, Diseases and Dangerous

Occurrences Regulations 1995 (RIDDOR)


Approved Code of Practice• Identification and assessment of risk• Prepare a scheme for preventing or

controlling the risk• Implement, manage and monitor

precautions• Keep records• Appoint a person to be managerially

responsible


Legionella Control Association

• Code of Conduct for Service Providers – Allocation of Responsibilities– Training & Competence of Personnel– Control Measures– Communication & Management– Record Keeping– Review Meetings– Internal Auditing– Subcontractors– Distribution of the code


Risk assessment & control measures

Why does it matter ?

The HSE views Legionnaires’ Disease as preventable

• To satisfy regulation and legislation

• To show due diligence

• To protect employees and public


Schematics example

T I T L E R E F : H O C H E M I C A L S L T D2

k c

K E Y : -f l o w o f m a i n s w a t e r

f l o w o f h o t w a t e r

f l o w o f c o l d w a t e r

M A I N S W A T E R

D A T E : O C T 2 0 0 3

C W S T 1 C W S T 2 C W S T 3

C A L 7C A L 8

L A D I E ST O I L E T

M A I NK I T C H E N

K I T C H E N S T A F F G E N T S

K I T C H E N S T A F F L A D I E S O U T S I D E

D I S A B L E D T O I L E T

G R O U N DF L O O R

R O O M 2 2 R O O M 2 3 R O O M 2 4

C W S T 6 C W S T 5

O L D S I D E

R O O M 5 R O O M 6 R O O M 7R O O M 8 R O O M 9 R O O M 1 0 R O O M 1 1 R O O M 1 2R O O M 1F I R S TF L O O R

S E C O N D F L O O R

R O O M 2 R O O M 3 R O O M 4 R O O M 1 8 R O O M 2 1R O O M 2 0R O O M 1 4 T O S T A F FB A T H R O O MR O O M 1 7

E X A M P L E H O T E L W A T E R S C H E M A T I C , A S S E E N A B C H O T E L


When should it be repeated?

• At least every 2 years or when NO longer valid e.g.– Changes to the use of the building.– Availability of new information.– Control measures are no longer

effective.– Case of LD associated with system.– Changes to the system or its use.


Typical written scheme: H & C Water Systems checks

• Weekly - flushing little used outlets

• Monthly – temperature checks

• Quarterly - shower cleaning

• Six monthly - CWS Tank temperatures

• Annually - CWS Tank inspections, calorifier checks

• Other systems as required


Dirty Tanks = clean & disinfection


Management & Training• Inadequate management, lack of training and

poor communication have all been identified as contributory factors in outbreaks of Legionnaires Disease.

• Those who are appointed to carry out control measures and strategies should be suitably informed, instructed, properly trained and their competency assessed.


Appropriate Records• Responsible persons

• Significant findings of the risk assessment

• Written scheme of actions and control measures

• Results of any monitoring, inspection, test or check carried out


Typical log book records• Training records

• Lines of communication

• Current state of operation

• Signature of person that did the work

• Plans or schematic drawings

• Visit log for contractors, council staff annual check


Why keep records?• To demonstrate compliance with the law• Show what control measures are being taken• Monitor water temperatures, system

cleanliness, bacteria levels (if appropriate)• Show trend analysis learn more about the

systems• Review performance• Provide evidence of reducing the risk


Any questions?

Questions

iosh essex branch event event subject: legionella awareness date: 8 december 2010

Documents

cold water systemscause

control of legionella

legionella awarenessdate

work regulations

health regulations

hse views legionnaires

kidney disease diabetics

symptomsinhalation of