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All water systems are possible sources of harmful pathogens, including Legionella bacteria. The ones found in care homes are no exceptions.
Man-made hot and cold water systems such as storage tanks, calorifiers, cooling towers, showers and air conditioning systems are often present and used in such establishments. These are the usual areas where Legionella bacteria can be found, and as such may harbour these deadly microbes.

In addition, plumbing fixtures in care homes tend to be breeding grounds for Legionella since these establishments have complex water systems. Their plumbing systems have been intricately designed to ensure that bedrooms, kitchens, bathrooms, laundry rooms and other areas will have access to water. These pipes also serve as the entryways of these pathogens.
The frail and the elderly, especially those with weak immune systems, are more susceptible to developing a Legionella infection. Since they live in care homes, all owners and managers of such establishments need to ensure there are key measures in place to minimise the risk of Legionella.

Risk Assessment in Care Homes

Legionella risk assessment is crucial to protecting care home residents from the possibility of contracting Legionnaires’ disease. It is the starting point by which nursing homes can work towards eradicating the danger posed by Legionella.

Having a comprehensive Legionella risk assessment protocol at care homes will allow owners and managers to:

• Regularly test the quality of water without fail
• Timely monitor and conduct routine analysis of the temperature of stored water temperatures
• Flag up perceived risks observed on the company premises and know how best to tackle the problem as it happens

At the very least, all care homes must have:

• An appointed duty holder
• A compliant and up-to-date Legionella risk assessment
• A clear executive summary stating all risks associated with your premises
• A written scheme for the management of Legionella and Legionnaires’ disease
• A well-designed preventative maintenance regime
The duty holder will be responsible for:
• Evaluating and identifying sources of risk
• Taking all necessary measures to comply with the law
• Creating a written scheme for preventing or controlling risk
• Preparing an outline for the management of Legionnaires’ disease
• Implementing, managing and checking precautions
• Keeping and updating records

Most often, the care home manager or owner can also be the duty holder. However, care homes can also employ a third-party specialist to take on this role to regularly undertake risk assessments and help put in place any preventative measures.
It is also important to note that a risk assessment must be viewed frequently and reviewed routinely by both the duty holder and other individuals tasked by the care home with this critical role.

Areas of Concern

Although the infrastructures, plumbing systems and fixtures of nursing homes differ, the duty holder or anyone given the task of helping with risk assessment should regularly check the following:

1. Dead legs – These are pipes that lead to an outlet which has already been removed, rarely used, or unused completely. Since they prevent water from circulating and flowing, they can pose contamination risks since the water standing in these pipes is already stale. Water that is allowed to stand or stagnate creates the ideal conditions for Legionella growth.

2. Water tanks – Water tanks have to be checked regularly to ensure they are clean and well-maintained. Care homes should ensure water in tanks does not sit or stay unused for long.

3. Shower heads – Legionnaires’ disease can be contracted when a person inhales Legionella-contaminated aerosols or small droplets of liquid in the air. These aerosols often come from shower heads.

4. Infrequently used outlets – Unused taps and toilets in unoccupied rooms and other areas have to be inspected and flushed frequently because they contain standing water which can pose a risk.

5. Temperatures in pipes – It is crucial to check if pipes are insulated against temperature fluctuations that could boost Legionella growth.

6. Temperature control – Care homes should have the right temperature control system so that hot water is always stored at a high enough temperature to kill Legionella (60°C minimum). With the installation of Thermostatic Mixer Valves (TMV’s) or Thermostatic Taps, the water can still be delivered at the point of use at a temperature that does not pose a scalding risk.

Water from these sources has to be tested regularly. The duty holder can easily do this with a good-quality Legionella water testing kit.
In such cases where the water tested has proven positive for Legionella (or other harmful microbes), the laboratory will provide the duty holder a detailed list of recommendations. They can also help the care home to put these into practice.

At the bare minimum, regular cleaning and disinfecting of cold water tanks and showerheads must be done. If dead legs are the leading culprits, changing or updating the plumbing system will have to be recommended.

The failure to control Legionella bacteria — or worse, being responsible for an outbreak of Legionnaires’ disease — can be disastrous for any care home. If you are the owner or manager of a nursing home, don’t take any unnecessary costly risks. Make sure you have a good Legionella risk assessment in place and do not forget to update it whenever new regulations are introduced.

Author: Duncan Hollis