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    Care Home Legionella Testing Kits

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    Care Home Legionella Testing Kits

    This Legionella test kit is specifically for Care Homes to analyse the hot water for the presence of legionella bacteria. It will be tested at one of our UKAS accredited laboratories.

    The pack we send out to you will contain 1 or more sterile bottle and full instructions on how to take the sample(s).

    What does this cost include?

    How often should we test for legionella in our hot water?

    The number of samples and the frequency of testing depend on the age/health of your service users and the control regime you use to minimise the risk of legionella bacteria growing.

    If, like most Care Homes, you use temperature to control the legionella risk then the next questions to ask are:-

    1. Do we consistently store our hot water above 60°C for every hour of every day?
    2. Does our hot water reach the furthest parts of the building above 50°C within one minute of running the tap (55°C in healthcare premises).

    If it’s a YES to both questions, then a six monthly legionella test will act as a check that the engineering controls are working.

    If it’s a NO to both questions, then the HSE recommend WEEKLY legionella tests until the systems consistently attain the correct temperatures.

    If your Care Home mainly achieves the correct temperatures, most of the time – then you are really saying NO to the questions.  Get the temperatures compliant as soon as possible and carry out frequent testing in the meantime.

    How often should we test for legionella in our cold water?

    Legionella bacteria are less widespread in cold water systems but they have the ability to grow whenever the temperatures reach 20°C.

    Check your monthly temperature records, if these show cold water temperatures above 20°C, then check for legionella.

    For most properties, cold water is generally below 20°C for most of the year. However, it is common to find cold water above 20°C in the summer months so that is the time to test.

    Where should we test for legionella bacteria?

    There are numerous different sampling regimes to determine where to take water samples for legionella testing.  Care Homes will generally choose one or two of these regimes and maintain the regimes unless adverse results are obtained.

    Checking the main system is not colonised with legionella

    If you wish to assess if the main distribution pipework is free from legionella, then choose direct fed outlets which do not have a thermostatic mixer valve (TMV) installed. Outlets such as the Kitchen, Sluice, Laundry and Staff Only rooms are normally the best.

    Choose outlets which cover all areas of the building ie nearest and furthest points – we call these Sentinel Outlets (see later for more details). These same locations are often tested again and again.

    If there are several separate hot water systems, repeat the process for each one.

    If these samples come back clear from legionella, you can be confident that the bacteria is not endemic within the system – but that doesn’t mean there are no legionella in some parts of the building/system.

    At this point, continue onto the second regime!

    Checking likely places where legionella bacteria tend to flourish

    Legionella bacteria grow when water temperatures are between 20°C – 45°C and even more so if the pipework is rarely used or has deadlegs.

    Outlets which fall into this category include:-

    • Showers
    • Taps fed from TMVs
    • Rarely used outlets or rooms

    The results of water samples from these outlets will identify if the current engineering controls are working such as the shower cleaning, weekly flushing, TMV servicing etc.

    Getting a positive result from one of these locations is quite common but if you already know the main system is legionella free, then it’s just a local problem so you don’t have to disinfect the whole property.

    Different outlets are chosen on rotation so that over a period of time, most of the outlets within the Care Home get tested.

    What do I do if I get a legionella positive result?

    It’s not uncommon for Care Homes to find legionella bacteria, particularly in the hot water supplies.  The level of risk and what measures are required depends on which particular strain of legionella is found and how high the count is. We will advise you on what steps to take to reduce the risk immediately and the follow-up works necessary to eradicate the bacteria.

    Should I report a positive result?

    You do not need to report a legionella positive result to the Environmental Health or your Local Authority.

    You do need to inform CQC of positive results, in 2014 they fined a North Yorkshire Care Home £2,500 following the provider’s failure to inform the commission about a positive legionella test result.

    If a member of staff or service user contracts Legionnaires Disease, then this is notifiable under the Health Protection (Notification) Regulations 2010 and in Scotland under the Public Health (Notification of Infectious Diseases) (Scotland) Regulations 1988.

    Do we have to have a legionella risk assessment?

    100% YES.  It is a legal requirement to have a risk assessment.

    Our last legionella risk assessment is 5 years old, do we need another?

    Not necessarily, however the existing one should be reviewed. Like all risk assessments, they should be reviewed to check that they remain valid. 

    When does our legionella risk assessment become invalid?

    The risk assessment should be reviewed If there are significant changes to the Care Home, these changes include:-

    • A change to the water system, such as installing ensuites or showers.
    • An extension to the building, adding extra bedrooms.
    • If the water no longer attains the correct temperatures.
    • Staff or service users contract legionnaires’ disease from your Care Home.

    What water records do we need to keep?

    Each Care Home should keep the following records:                                                 

    • A management structure which shows who is responsible for conducting the risk assessment, managing, and implementing the written scheme.
    • All significant findings of the risk assessment.
    • A written control scheme.
      • Details on how the water services operate.
      • Results of microbial analysis of the water.
      • Inspections and checks on the water treatment equipment such as cold water storage tanks & hot water cylinders.
      • Temperature records of the stored hot water and hot/cold water outlets.
      • Maintenance records for the water system components, equipment and water treatment system.
      • Any cleaning and disinfection certificates.
      • Water treatment chemical usage if a biocide is dosed into the water system.

                    The records should be kept for 5 years.

    What is a Written Control Scheme?

    This document is just as important as the initial risk assessment. It sets out how your Care Home intends to manage the risks arising from water.  All new risk assessments should now include a Written Control Scheme which should include the following information:-

    • Management and communication structure.
    • A simple schematic of the water services within the Care Home.
    • The temperature at which the Care Home is going to store its hot/cold water, also the temperatures that should be attained at the outlets.
    • The frequency that temperature monitoring will be undertaken and what actions to take if the water is too hot or too cold.
    • Details on the inspection routines for tanks and hot water storage, what details will be checked, what is deemed compliant and what to do if something is found to be non-compliant.
    • Details on which person or company is responsible for the checks, tests and inspections.
    • Training records for the people undertaking the various checks, tests and inspections.
    • The procedures to be implemented should there be failure of the boilers, high levels of legionella or continued repeat positives for legionella bacteria.

    Each Care Home is different in terms of age, size, type of service users, installed equipment etc.  For these reasons the Written Scheme of Control will not be the same for every property.

    Do we have to clean & disinfect tanks every year?

    If the tank does not supply drinking water then there is no set frequency for Care Homes to clean and disinfect their cold water storage tanks.  The operation of draining, cleaning and disinfecting causes a great deal of disruption so only undertake it when it is required.

    When should Cares Homes clean & disinfect their cold water storage tanks?

    There are several instances when this task becomes necessary, such as:-

    • When there have been significant plumbing changes within the property, so much that it is easier to disinfect the whole system than try to disinfect just a few rooms.
    • When a visual inspection shows that there is significant level of sediment within the tank.
    • When you have had a poor microbiological result.

    We check the tap temperatures each month for CQC – surely that’s enough?

    Sorry, probably not!

    Many Care Homes monitor their taps every month but this is for different reasons. These checks are to ensure that the final water temperature is not a scald risk, in other words to confirm that the TMVs (thermostatic mixer valves) are working correctly.

    For legionella control, Care Homes need to check the stored water temperatures and Sentinel Outlets every month to make sure that the correct temperatures reach the TMVs (thermostatic mixer valves).

    What’s a Sentinel outlet?

    Hot Water

    • If your hot water recirculates, then the first and last hot water tap are ‘Sentinel Outlets’
    • If your hot water doesn’t recirculate, then the nearest and furthest taps are ‘Sentinel Outlets’

    Cold Water

    • The nearest and furthest taps from the storage tank are ‘Sentinel Outlets’

    If you have more than one cold water storage tank or hot water cylinder, then you will have additional ‘Sentinel Outlets’ – each hot and cold water system has its own sentinels and these all need to have the temperatures taken each month.

    If the furthest tap has a TMV (thermostatic mixer valve) fitted, then you take the temperature of the pipework just before the TMV using a thermometer with a surface probe.

    What temperature should my Sentinel Outlets be?

    Hot Water

    The calorifier\water heater\hot water cylinder should have a storage temperature of at least 60°C.

    The nearest and further taps should attain at least 50°C within 1 minute of running the tap. (55°C for healthcare premises).


    Cold Water

    The nearest and further taps should be below 20°C within 2 minutes of running the tap.

    In the summer months, the incoming mains temperature may exceed 20°C in some parts of the UK.

    One of my Sentinel Outlets has a TMV fitted – how do we check the temperature?

    If the furthest tap has TMV (thermostatic mixer valve) fitted, then you take the temperature of the pipework just before the TMV using a thermometer with a surface probe.

    Care Home Legionella Testing Kits

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