Legionella Testing For Hospitals and Care Homes

Legionella Testing For Hospitals and Care Homes

Worldwide, cases of hospital acquired Legionnaires’ disease have been on the rise, with research showing that the potentially fatal bug is present in 12-85% of all hospital water systems.1 A study carried out by CDC found that 19% of cases are associated with long-term care facilities and 15% with hospitals. The majority of cases have been linked to Legionella pneumophila Serogroup 1. 2

Legionnaires’ disease is life-threatening unless treated quickly. This is especially true in healthcare and care facilities where mortality rates are as high as 40% due to the vulnerability of residents. 3 Because of this, such facilities should be highly aware of the risks and where they come from and should aim to reduce risk factors to 0.

 

Factors Affecting Increased Risk of Legionella in Domestic Water Systems

  • Vulnerable persons– Healthcare facilities are high-risk areas for Legionella and Legionnaires’ disease due to the high number of vulnerable persons present. Individuals who have a weakened immune system, have undergone recent surgery or who need to use respiratory equipment are at a much higher risk of being infected with the disease. 4 Smokers, the elderly and new-born babies are also more susceptible to infection.
  • Generation of Aerosols-While Legionnaires’ disease can be caught from any water source that produces spray or aerosols, some common sources of infection in a healthcare setting are showers, humidifiers, birthing pools and respiratory devices.
  • Design– Complicated, old pipework with dead legs and water systems where water is kept below 50 degrees Celsius also pose a threat, as they provide ideal conditions for rapid Legionella growth and spread. This is a serious problem in ageing facilities or newly renovated facilities where schematics of old and new pipework may not be up to date or complete. Failure to keep an up to date schematic can compromise the facilities risk assessment and leave high-risk areas in the system unmonitored.
  • Water Management –Regular cleaning and disinfection of water systems is crucial when vulnerable persons are present. However, water safety plans are often designed to meet bottom line regulations rather than to minimise Legionella risks to 0, and in some cases may not be comprehensive enough to completely avoid growth and spread of Legionella bacteria.
  • Traditional Testing Methods – Duty holders in hospitals and care homes are often advised to send samples of water to a laboratory. This a well-known, traditional method for Legionella testing, however, researchers have recently found some disturbing limitations of this technique. 

Click Here to Find Out More About Limitations of the Lab Culture Test

Remember that it is simply not enough to rely solely on the culture test. Doing so can lead to false negative results, underestimated counts of Legionella bacteria, slow decision making and delayed action – resulting in fines, reputational damage, illness and even fatalities.

 

How to manage the risk of Legionella in Hospitals and Care Homes? 

Remember that Legionnaires’ disease is now killing ~1 in every 10 people who are infected. 8 However, this number is much larger in high-risk scenarios such as healthcare facilities. CDC states that 1 in 4 people who get the infection from facilities such as hospitals or care homes will likely die. 9

Due to the high-risk nature of the hospital and care home sector, duty managers should take extra precautions against Legionella. Writing up a Legionella management plan is a good place to start.

HSE also suggests removing any dead legs or areas of stagnation. It may also be necessary to implement temperature controls and ensure that the hot water is kept above 60 degrees Celsius and cold water below 20 degrees Celsius 5.  At these low temperatures, Legionella enters a low metabolic state thus minimising and discouraging growth and spread.6If temperature control is not possible in the system, duty managers should ensure the regular use of biocides.

It is important these controls are tested regularly. The risk of acquiring Legionnaires’ disease can increase by 64% for every hour spent near the source of an outbreak7  and this number is likely to be higher for patients who are immunosuppressed. Thus, it is crucial that duty managers in the healthcare and nursing home sector can implement remedial action quickly.

The Innovative technology from Hydrosense helps to protect the lives of the most vulnerable individuals, quickly and accurately. The world’s only on-site Legionella test offers an immediate picture of Legionella contamination risk and facilitates quicker, better- informed decision making. In only 25 minutes the duty holders receive a clear Yes/No answer which empowers them to make faster and more responsible decisions about water safety in the hospital or care home. Moreover, the Hydrosense test requires no training or experience and can be carried out by anyone, anywhere. The test results can be stored and managed via the Hydrosense Pro.  The certificate of conducting the test can also be printed from the secure Hydrosense Pro Portal.

Legionella- Don’t Risk It. Test It.

Find Out More About The Role Of Continous Monitoring In Hospitals and Health Care Facilities

Recommended Kit

Our Single Syringe Test Kit is both flexible and sensitive – it allows for sample collection from any water source and has an excellent Limit of Detection of 100 CFU/L.

Legionella Test Kit

Single Syringe Test Kit

References

  1. Stout, J. and Yu, V. (2003). Hospital-acquired Legionnaires’ disease: new developments. [online] Pdfs.semanticscholar.org. Available at: https://pdfs.semanticscholar.org/0444/e0a719263ff7a0f5be17c371be4fe25fd0ac.pdf[Accessed 3 Oct. 2018].
  2. Stout, J. and Yu, V. (2003). Hospital-acquired Legionnaires’ disease: new developments. [online] Pdfs.semanticscholar.org. Available at: https://pdfs.semanticscholar.org/0444/e0a719263ff7a0f5be17c371be4fe25fd0ac.pdf[Accessed 3 Oct. 2018].
  3. Health.gov.au. (2015). Guidelines for LEGIONELLA CONTROL in the Operation and Maintenance of Water Distribution in Healthcare and Aged Care Facilities. [online] Available at: https://www.health.gov.au/internet/main/publishing.nsf/content/A12B57E41EC9F326CA257BF0001F9E7D/$File/Guidelines-Legionella-control.pdf  [Accessed 11 Oct. 2018].
  4. World Health Organization. (2018). Legionellosis. [online] Available at: http://www.who.int/news-room/fact-sheets/detail/legionellosis[Accessed 3 Oct. 2018].
  5. http://www.hse.gov.uk/healthservices/legionella.htm
  6. Rogers, J., Dowsett, A., Dennis, P., Lee, J. and Keevil, C. (n.d.). Influence of temperature and plumbing material selection on biofilm formation and growth of Legionella pneumophila in a model potable water system containing complex microbial flora.. [online] Applied and Environmental Microbiology. Available at: http://aem.asm.org/content/60/5/1585.full.pdf+html[Accessed 12 Oct. 2018].
  7.  D.B. Jernigan MD, J. Hofmann MD, M.S. Cetron MD, J.P. Nuorti MD, B.S. Fields PhD, R.F. Benson MS, R.F. Breiman MD, H.B. Lipman PhD, R.J. Carter PhD, C.A. Genese MBA, S.M. Paul MD, P.H. Edelstein MD, I.C. Guerrero MD. (1996) Outbreak of Legionnaires’ disease among cruise ship passengers exposed to a contaminated whirlpool spa. The Lancet Volume 347, Issue 9000, 24 February 1996, Pages 494-499 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(96)91137-X/abstract
  8.  Cdc.gov. (2018). Legionnaires Disease and Pontiac Fever | Legionella | CDC. [online] Available at: https://www. cdc.gov/legionella/ [Accessed 30 May 2018].
  9. Henderson, R. (2017). Legionnaires’ Disease. Information about Legionnaires’ Disease. [online] Patient.info. Available at: https://patient.info/health/legionnaires-disease-leaflet[Accessed 7 May 2018].

Other Resources

Guideline on the management of Legionella cases, incidents, outbreaks and clusters in the community (NHS): https://www.hps.scot.nhs.uk/resourcedocument.aspx?id=2430