Legionella in Healthcare

in line with the HSE Approved Code of Practice ACOP L8

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If you manage any healthcare related premises then you have a legal obligation to have a Legionella Risk Assessment carried out and regularly reviewed as well as other control & prevention measures.


There are many myths and rumours about Legionella in the health care environment, most are due to a misunderstanding of the requirements around Legionella, some of the confusion is even caused by the regulators themselves such as the CQC.


Forest Gate GP surgery faces closure following ‘inadequate’ rating from CQC including Legionella failings – May 2018


Legionella is potentially fatal, and the most susceptible groups of people are those that you would generally find in the healthcare environment.  As a practice manager, owner or employer you have a legal obligation to your patients, employees and anyone else effected by your undertaking which includes visitors.


The Health & Safety Executive have issued an Approved Code of Practice for the Control of Legionella Bacteria commonly called ACOP L8, this is in effect a legal document.  The ACOP L8 gives guidance on how to comply with the law in relation to Legionella, it states increased performance criteria for healthcare properties such as care homes.  The increased performance criteria are designed to minimise the risk presented to the more susceptible groups of people found in the care environment.


Ashby Doctors Surgery put in special measures by the CQC for Legionella failures including staff training - Aug 2017


Failures to meet the requirements of the ACOP L8 can lead to substantial fines, prosecution and even imprisonment.


So what do I need to do?  The first step is simple, you need a Legionella Risk Assessment carried out by someone who is competent.  Given the increased risk found in the healthcare environment we would advise that whoever carries out the risk assessment needs formal qualifications.


Why Formal Qualifications?  You have a legal obligation under Health & Safety law to ensure that whoever carries out the work on your behalf is competent.  By using someone with formal qualifications you can prove you have done everything possible to have the work carried out competently and if the worst happens you have given yourself some protection.

Bromley GP Surgery rated “Inadequate” and placed in special measures are Legionella related failures - May 2017

What Happens Next?  Once the risk assessment is complete you will have a list of recommendations ranging from weekly flushing to annual water testing.  Based on the recommendations you need to implement a written control scheme.  The control scheme is nothing more than who does what, when, how often and their competency to do the task.


Competency? The ACOP L8 explains in some detail that those involved in the Control & Prevention of Legionella need to be "Technically Competent".  From the very start of the risk assessment right through to the regular control & prevention tasks, if there is a failing in competency then the potential for a worst case scenario is increased, and someone could find themselves being prosecuted for a breach of health & safety.


Control & Prevention?  Control & Prevention refers to carrying out & recording tasks to minimise (Prevent) legionella bacterial growth and control any levels of bacteria you may already have.  In the healthcare environment, the minimum level of regular control & prevention tasks you would expect to see if the risk was being managed correctly are;


Flushing Infrequently Used Outlets.

Monthly Temperature Monitoring.

Quarterly Cleaning & Descale of "Spray" Outlets.

Annual Maintenance of TMV Valves.

Annual Legionella Testing.


Other "elaborate" control & prevention tasks maybe advised based on the risk assessment, these tasks may involve more regular reviews of the risk assessment.

Cleaning & Disinfection of Water Storage Tanks

An increased frequency of Legionella Testing.

Removing "Dead Legs" from the system.

Hereford Medical Centre order to improve patient safety by the CQC after Legionella failures were found – May 2017


How do the CQC cause confusion?  Under "Safe" the CQC are to inspect a service to ensure it is safe for users.  The "Safe" part of the inspection should include the Legionella Risk Assessment.  The guidance that the CQC gives to its inspectors and providers is misleading as it gives the impression providers may not need to carry out any control and prevention measures.


For example, in section 27 of "Nigel's Surgery" the CQC gives general advice taken from the ACOP L8 but the information that they give is taken out of context for healthcare providers.  Nigel's surgery states "A simple risk assessment may show that the risks are low and being properly managed.  In many cases the risk assessment will lead the practice to conclude that the risks are insignificant and are being properly managed to comply with the law.  In these instances, the assessment is complete, and no further action is required."  This has led many healthcare related premises to believe they can conduct the risk assessment themselves and not carry out any further control and prevention tasks.


However, further reading of the ACOP L8 2.152 to 2.168 is entitled "Special Consideration for Health Care and Care Homes".  This special consideration explains that you need to consider the people using the service and implement most if not all the guidance given in the ACOP L8.  A vastly different recommendation in comparison to the advice given by the CQC in "Nigel's Surgery".


What this effectively means is that regardless how low risk your systems are you cannot be low risk as a property because of the service users.  So, in the healthcare environment "A simple risk assessment" is not suitable and even if the risks are "insignificant" or "being properly managed" you will always need to carry out at least the minimum control & prevention measures listed in the ACOP L8 if not all of them.


Ultimately you need to remember if there is a health & safety breach it is not the CQC that will find themselves in trouble, it's you.  Even if the CQC guidance is misleading health & safety is your responsibility.


South Reading Surgery rated as “Inadequate” by the CQC after they failed to put a Legionella Risk Assessment in place - Mar 2017

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