Health Care 

It’s a fact that care homes and health centres have the highest potential for Legionella outbreaks due mainly to the inherent problems associated with old and frailer residents. 
Legionnaires’ disease is a potentially fatal form of pneumonia. It is normally contracted by inhaling tiny, airborne droplets containing viable legionella bacteria. Although everyone is susceptible to infection, the risk increases with age and some people are at a higher risk, such as people over 45, smokers, heavy drinkers, people suffering from chronic respiratory or kidney disease, diabetes, lung and heart disease and anyone with an impaired immune system. 
Water systems in care premises, with residents likely to be particularly vulnerable, need particular consideration. Although legionella bacteria are widespread in natural water sources, outbreaks of the illness occur from exposure to legionella growing in purpose-built systems where water is maintained at a temperature high enough to encourage growth (between 20–45 °C) and where there are nutrients that support bacterial growth such as rust, sludge, scale, organic matter, and biofilms. 
The bacteria are dormant below 20 °C and do not survive above 60 °C. Airborne water droplets are created by water systems such as hot and cold water services, atomisers, wet air conditioning plant, spa baths and hydrotherapy baths. When managing water temperatures to control legionella in care homes, you should consider potential scald risks 

Key points to consider 

Have you assessed the risks and put suitable and sufficient controls in place? 
Do you have access to a competent person who can manage the risk from legionella? 
Do you ensure that the system remains clean, at the correct temperatures and there is no stagnation of water? 
Are the frequency of temperature checks and controls in line with HSE guidance? 

Other Main Issues 

Infrequently used hot and cold water outlets. Homes tend to be excessively warm for the wellbeing of the residents so cold water pipework can easily become too hot (greater than 20 degrees C) and develop an ideal environment for legionella growth. Also, many homes have bedrooms with ensuites which are not used enough. Therefore temperature monitoring and flushing become a key control parameter to minimise legionella growth. 
The scalding potential of hot water outlets. Need for TCV’s (Mixing taps) 
Security is a major issue with some residents vulnerable should doors be left unsecured or outsources labour is used monitoring and maintenance that are not trained or vetted. 
Due to high workloads, in-house maintenance staff do not have time to carry out consistent legionella control tasks 

Main Reference and Guidance Documents for the Control of Legionella 

Legionnaires' disease - A brief guide for duty holders 
The control of legionella bacteria in water systems L8. Approved Code of Practice and guidance on regulations 
Health and safety in care homes HSG 220 2nd edition 
Health and safety guidance HSG274 Part 2 Hot and Cold water service 

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