Legionella related risk management in care facilities
There is risk associated with Legionella in any drinking water distribution system. Of greatest concern are systems that automatically deliver warm water for washing and bathing at approximately 45°C to prevent scalding, as they have the most potential to become colonised with Legionella bacteria. These systems are typically used in care facilities such as:
- supported residential facilities (SRFs)
- retirement villages
- residential aged-care facilities
- respite facilities
Guidelines for Legionella Control in the operation and maintenance of water distribution systems in health and aged care facilities
The enHealth "Guidelines for Legionella Control in the Operation and Maintenance of Water Distribution Systems in Health and Aged Care Facilities" (PDF 2MB) and associated risk management template (DOC 167KB) were endorsed by the Australian Health Protection Principal Committee in December 2015 and are now approved for release.
This publication is a national guidance document for health and aged care facilities to support them to understand and control Legionella through the proper operation and maintenance of their facility’s drinking water distribution systems.
The Guidelines describe a process for hospitals and aged care facilities to develop and implement their own Legionella risk management plans by providing information on:
- Establishing a Legionella risk management system
- Analysing their risk
- Managing their risk
- Responding to detections or cases
- Reviewing their Legionella risk management plan
- Risk Management Plan Template
Copies of the Guideline are being printed by the Australian Government and are anticipated to be available for distribution in early 2016. In the meantime, electronic copies of the Guidelines for Legionella Control (PDF 2MB) are available for download here.
Managing risk and responding to Legionella detection
The Managing Legionella risk and responding to Legionella detection in care facilities fact sheet (PDF 66KB) has been developed to inform facility operators on Legionella related risk management and the recommended responses to Legionella detection in water samples. Information includes:
- Legionella related risk and risk management in care facilities
- what to do when Legionella is detected
- verifying the efficacy of decontamination and the preventative maintenance regime
- responding to ongoing detections of Legionella
- Legionella colonisation of cold water pipes
Managing the risks associated with chilled water and ice machines in care facilities
Legionella has been detected in high concentrations in water and ice dispensed from these machines. Cases of Legionnaires’ disease in individuals with severely compromised immune systems have been linked to consumption of ice or water from these machines. Heat generated by the chiller compressor is thought to be responsible for providing temperatures suitable for growth of the bacteria in the incoming cold water lines of these machines.
Chilled water dispensing machines may have a chilled water outlet or a combined tap that dispenses chilled and boiling water. The boiling water from combined devices does not present a Legionella risk.
It is recommended that operators of care facilities that use ice machines and chilled water devices implement protocols to protect high risk patients.
See Managing the risks associated with chilled water and ice machines in care facilities fact sheet (PDF 58KB) to inform operators of care facilities of recommended protocols for managing Legionella risks associated with these machines.
Recommended risk management protocols
Ice and water given to patients should be subject to similar controls applied to other environmental conditions (for example air and food quality). Patients provided with increased protection from infection (for example HEPA filtered air and low bacteria food) should not be provided with ice or chilled water from these machines.
Ice and chilled water from machines should not be provided to patients with high risk of micro-aspiration and susceptibility to Legionella. Instead, pre-boiled tap water should be chilled or frozen in conventional style fridges or freezers for these patients. Ice and chilled water can be provided to other patients from these machines. However, carbon filters should not be used on the inlets of these machines in care facilities.
All internal wetted surfaces of ice and chilled water machines (pipes, tanks and hoses) should be cleaned and disinfected at least once a year (ideally every 3 to 6 months) to remove any Legionella, and other organisms, that may be present. This may require the use of heat and or chemicals. In any case, the machine manufacturer’s advice should be sought to determine appropriate cleaning and Legionella decontamination methods.