WATER QUALITY AND SAFETY


Improving standards in Legionella risk assessments


IHEEM Registered AE (Water), Steve Mount, BSc (Hons), CBiol, MRSB, FIHEEM, MWMSoc, discusses, on behalf of the IHEEM Water Technical Platform, the current standard of Legionella risk assessments seen in the healthcare community, and the improvements required to provide clients with the information they need to mitigate the risks from Legionella.


From the early 19th century on, the UK produced numerous health and safety laws applicable to individual industries within different regions. The legislation focused on a variety of workplaces – including factories, offices, and railway premises, and there were often considerable inconsistencies between which laws applied where. The UK government recognised that such a broad spectrum of legislation for different sectors was both confusing and complex, and so in 1970 a committee was set up, led by Lord Robens, to propose a way forward. The resulting Robens Report made recommendations which led to introduction of the Health and Safety at Work etc Act 1974 (HSWA), and the creation of the Health and Safety Executive (HSE) as the regulatory authority for UK industrial occupational health and safety.


Risk assessment provisions Risk assessment was a primary purpose


of the Act. The first sentence of the original and current Act states: ‘An Act to make further provision for securing the health, safety and welfare of persons at work, for protecting others against risks to health or safety in connection with the activities of persons at work.’ This implies the requirement for a risk assessment to be conducted, as detailed in sections 2 and 3. So, since 31 July 1974 it has been a legal requirement for employers to carry out a risk assessment of any workplace under their control to ensure the health and safety of the employees, ‘persons other than their employees’, and visitors. Subsequently, other legislation has been produced requiring risk assessments to be undertaken. The Control of Substances Hazardous


to Health Regulations 2002 (COSHH) provide a framework of actions to control the risk from a range of hazardous substances, including biological agents (e.g. Legionella), to identify and assess the risk, and implement any necessary


Enforcement cases by failing (n=401)


Risk Assessment Scheme of Control Responsible Person Cleaning & Disinfection Training & Competence


1% 4% 5%


measures to control it. COSHH requires an assessment of the risk of exposure under Regulation 6, ‘Assessment of the risk to health created by work involving substances hazardous to health’, where it is stated: “An employer shall not carry out work which is liable to expose any employees to any substance hazardous to health unless he has: ‘made a suitable and sufficient assessment of the risk created by that work to the health of those employees and of the steps that need to be taken to meet the requirements of these Regulations’.” The Health and Social Care Act 2008


(Regulated Activities) Regulations 2014, Regulation 12: ‘Safe care and treatment’, and Regulation 15: ‘Premises and equipment’, both imply the requirement for a Legionella risk assessment (LRA) to be conducted.


Working in a high-risk environment In healthcare we are working in a high-risk environment, and water management programmes are especially important to reduce infection risk among vulnerable patient populations, staff, and visitors. Issues with poor risk assessments are not new, and at one point the Health and Safety Laboratory (HSL), an agency of the HSE, was tasked with gathering data on outbreaks of Legionnaires’ disease in Great Britain for the 10-year period to August 2011. This revealed that 31% of the enforcement cases over that period were attributable to issues with failing risk assessments (see Figure 1).


59% 31%


Figure 1. Enforcement cases by failing (taken from Legionella outbreaks and HSE investigations; an analysis of contributory factors HEX/12/07. Health and Safety Laboratory 2012).


Risk assessment guidance Various guidance documents have been written, revised, and updated, to help organisations comply with their legal duties. The Legionnaires’ disease: The control of legionella bacteria in water systems Approved Code of Practice and guidance on regulations L8 (Fourth edition), published in 2013 (ACOP), Legionnaires’ disease: Technical guidance HSG274, published in 2014 (HSG274), and the Department of Health’s Health Technical Memorandum, HTM 04-01:


February 2022 Health Estate Journal 37


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