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Legionella Risk Assessment: Special Considerations for Care Homes

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One of the biggest contributing factors to the manifestation of Legionnaire’s Disease in the human body – and one that can never be underestimated - is the presence of a compromised immune system. Advancing years also favours the likelihood of an individual contracting legionella, the former more often than not an inescapable by-product of the latter. So it goes without saying that, unfortunately, the older people are, the more increased their susceptibility to contracting legionella is. Therefore it’s imperative that residential nursing and care homes are not only fully aware of the potential risks, but subsequently do everything in their power to ensure that legionella doesn’t pose a threat to the elderly inhabitants within this otherwise safe and secure environment. Which is precisely where carrying out of a legionella risk assessment comes to the fore. Especially after numerous, well-publicised incidents where the HSE have been alerted to the significant failings of some negligent care home providers which ultimately led to residents contracting Legionnaire’s Disease; the findings of which later paved the way for prosecutions.

By their very nature – and often aided and abetted by their infrastructure – care homes could easily prove invaluable breeding grounds for the bacteria which is responsible for the advent of Legionnaire’s Disease. That’s because such establishments tend to comprise of complex water systems which are architecturally implemented within homes so as to infiltrate bedrooms, kitchens, bathrooms, laundry rooms, etc. To heighten the possible risk, it’s not unheard of for the inception of care homes to have arisen from repurposed buildings; which by default may well have instigated the revision of pipework at various junctures. And of course, neglected water tanks can play a pivotal role in the substantiation of legionella.

(Recommended reading: A guide to water safety in care homes)

Risk Assessment is Key to Protecting Care Home Residents, Employees and Visitors from Possibility of Contracting Legionnaire’s Disease

In terms of the starting point by which care homes can work towards eliminating the unseen menace posed by legionella, the performing of a risk assessment is by far the most important step to be taken from the outset. The undertaking of a legionella risk assessment at care homes will furnish owners and management with the undisputable facts of the matter; and moreover flag up perceived risks observed on the company premises and critically, how best to tackle the problem then and there. This will almost always result in the timely monitoring and routine analysis of the all-important stored water temperatures, while employee cognizance (and dedicated legionella risk awareness training) will also be key going forward. In addition to this, a risk assessment should be viewed and - subsequently treated - as a ‘living document’ (and one which necessitates routine reviews) thereafter, by both the duty holder and responsible individual(s) tasked by the care home with this vital role.

However all the above should be considered under the exacting auspices compliant with care and residential home operations. Which means the actioning of targeted and more specialist legionella risk assessments with such focused environments in mind. With regards to any special considerations merited in care homes contexts, water temperatures are again a hugely significant factor to prioritise. While under normal circumstances – and to actively discourage the formation and growth of legionella bacteria - hot and cold water systems should be within the HSE-acknowledged parameters (between 20-45°C), when it comes to care and residential nursing homes the minimum temperature of the hot water outlets should never be less than 55°C. Frequent water movement should also a primary objective for those charged with governance of systems so as to negate any potential legionella threat.

Download the care homes' Legionella risk assessment guide >

TMVs Offer a Viable Solution in Pro-actively Combating the Threat Posed by Legionella

That said, exacting temperature controls and management alone isn’t the sole consideration that those responsible for overseeing (and moreover, eliminating) legionella risks in care home surrounds need to be aware of. Indeed, along with hot temperatures being constantly measured and consistently 55°C at the outlets, the facilitation and proximity of thermostatic mixing valves (TMVs) is an equally important element to grasp, as we’ll discuss further now. One of the predominant risks faced by residents in care homes is scalding from hot water. Yet conversely – and as we’ve already pointed out above – it’s essential that hot water outlets adheres with the no-less-than-55°C compliance. Both of which stipulations have bearings on the other and seemingly stand at odds with one another; not least because the prevention of one directly affects the other. Or to put it another way, while hot water works to prevent Legionnaire’s Disease taking a foothold, perversely it might, inadvertently introduces a scalding risk in certain scenarios.

It’s a misconception that water has to be boiling to scald, as temperatures in excess of 45°C can result in serious injuries, while at 60°C it takes a mere 5 seconds for water to inflict a third-degree burn on an exposed individual. And of course, it’s not just showers and baths (and any other water-releasing tap assemblages) that are potentially dangerous, as central heating pipes and radiators are equally hazardous. Let’s not forget, elderly people’s skin is far more susceptible to burns and understandably their agility (to quickly distance themselves from the danger) is restricted by their age and physical wellbeing.

(Recommended reading: TMV legionella checklist)

TMVs Can Work in Tandem with Existing Legionella Preventing Practices and Protocols Within Care Homes

From a legal standpoint – and on a more positive note – (not to mention highlighted within the pages of the National Minimum Standards for Care Homes, Standard 25), the following is cited; ‘to prevent risks from scalding, pre-set valves of a type unaffected by changes in water pressure - and which have fail-safe devices - should also be fitted locally.’ Which (together with a number of alternative control methods such as ionisation, the use of UV light, chlorine dioxide, ozone treatment or regular thermal disinfection of the system), takes us back to TMVs. The former practices often require prohibitively expensive – or largely impractical - installations, maintenance and monitoring.

Pre-set thermostatic mixer valves (of a type uncompromised by changes in water pressure) have in-built fail-safe devices which are fitted close to water outlets, and can present as either single lever mixers or hot water-limiting, tamper-proof mechanically-controlled iterations. In a nutshell, TMVs minimise the discharge temperature of stored hot water to an appropriate/safe level, courtesy of fusing it with cold water before it reaches the tap; thereby ensuring a constant outlet temperature. The installation of such devices has proven to protect against both scalding injuries and Legionella, and therefore should be recognised as an integral component of the ongoing fight against the spectre of Legionnaire’s Disease in care home environments.

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