Managing legionella in hot and cold water systems
Please note if you are a provider registered with CQC, and with premises located in England, CQC is the relevant regulatory body for patient safety matters
What is legionella?
Legionella bacteria is commonly found in water. The bacteria multiply where temperatures are between 20-45°C and nutrients are available. The bacteria are dormant below 20°C and do not survive above 60°C.
Legionnaires' disease is a potentially fatal type of pneumonia, contracted by inhaling airborne water droplets containing viable Legionella bacteria. Such droplets can be created, for example, by: hot and cold water outlets; atomisers; wet air conditioning plant; and whirlpool or hydrotherapy baths.
Anyone can develop Legionnaires' disease, but the elderly, smokers, alcoholics and those with cancer, diabetes or chronic respiratory or kidney disease are at more risk.
HSE's Legionnaires' disease page provides information on managing the risks
What you need to do
Health and social care providers should carry out a full risk assessment of their hot and cold water systems and ensure adequate measures are in place to control the risks.
Using temperature control
The primary method used to control the risk from Legionella is water temperature control.
Water services should be operated at temperatures that prevent Legionella growth:
- Hot water storage cylinders (calorifiers) should store water at 60°C or higher
- Hot water should be distributed at 50°C or higher (thermostatic mixer valves need to be fitted as close as possible to outlets, where a scald risk is identified).
- Cold water should be stored and distributed below 20°C.
A competent person should routinely check, inspect and clean the system, in accordance with the risk assessment.
You must identify 'sentinel' outlets (furthest and closest to each tank or cylinder) for monthly checking of the distribution temperatures. You should also check the hot water storage cylinder temperatures every month and cold water tank temperatures at least every six months.
Stagnant water favours Legionella growth. To reduce the risk you should remove dead legs/dead ends in pipe-work, flush out infrequently used outlets (including showerheads and taps) at least weekly and clean and de-scale shower heads and hoses at least quarterly. Cold-water storage tanks should be cleaned periodically and water should be drained from hot water cylinders to check for debris or signs of corrosion.
Design systems to minimise Legionella growth, by:
- keeping pipe work as short and direct as possible;
- adequately insulating pipes and tanks;
- using materials that do not encourage the growth of Legionella;
- preventing contamination, eg by fitting tanks with lids and insect screens.
Water samples should be analysed for Legionella periodically to demonstrate that bacteria counts are acceptable. The frequency should be determined by level of risk, in accordance with the risk assessment.
Other control methods
Other methods to control Legionella include copper and silver ionisation and biocide treatments (eg chlorine dioxide). To ensure that they remain effective their application will need suitable assessment as part of the overall water treatment programme including proper installation, maintenance and monitoring.