WATER SYSTEM HYGIENE AND SAFETY


facts [Internet]. ECDC. https://tinyurl. com/yuahcw4r


6 Scanlon MM, Gordon JL, McCoy WF, Cain MF. Water Management for Construction: Evidence for Risk Characterization in Community and Healthcare Settings: A Systematic Review. International Journal of Environmental Research and Public Health 2020; Mar 24;17(6):2168.


7 World Health Organization. Legionellosis factsheet [Internet], 2018. https://tinyurl. com/232frjwm


8 Hammami N, Laisnez V, Wybo I, Uvijn D, Broucke C, Van Damme A et al. A cluster of Legionnaires’ disease in Belgium linked to a cooling tower, August-September 2016: practical approach and challenges. Epidemiology and Infection [Internet]. [cited 2023 Mar 14];147:e326.


TMVs can provide an environment for the proliferation of Legionella bacteria if they are not correctly installed, maintained, or cleaned.


Health and Social Care’s HTM 04-01: Safe water in healthcare premises document.14 This process can be lengthy, must be carried out by an accredited laboratory, takes around 10 days to receive results, and involves the transportation of samples, which can kill Legionella. Lab culture will test for all culturable Legionella species, including non-pneumophila, but will not detect VBNC Legionella.


The rapid testing option Another option, which does not replace lab culture, but may help give a more immediate view of the Legionella health of a water system, and also checks the efficacy of remedial works, is rapid testing. PCR is classed as a rapid test, and will detect all species plus VBNC Legionella, but takes between 2-4 hours for the results, is a relatively complex process, and requires a high level of skill to conduct. Finally, there are rapid antigen tests like Hydrosense, which focuses on Legionella pneumophila, can be carried out by anyone with minimal training, and gives accurate results in 25 minutes. Relying solely on lab culture is likely


to not be effective enough, since by the time results are returned, the levels of Legionella in the system, if positive, will be dramatically increased. Adding another layer of detection will undoubtedly help to positively monitor and control Legionella risk. The health risk to patients and staff must be more important than simply ‘ticking the box’ when it comes to Legionella testing. Complete eradication of Legionella


is very unlikely – due to the scale and complexity of the water systems in healthcare buildings, both old and new, and the survival instinct of the bacterium itself. However, by maintaining a robust water management programme, following


the preventative measures outlined by the HSE, and regularly testing for and treating potential Legionella growth, healthcare facilities of all types can reduce the risk of their staff and visitors becoming ill from Legionnaires’ disease.


References 1 Horwitz MA, Silverstein SC. Legionnaires’ Disease Bacterium (Legionella pneumophila) Multiplies Intracellularly in Human Monocytes. Journal of Clinical Investigation 1980 Sep 1; 66 (3):441-50.


2 Hospital Admitted Patient Care Activity, 2021-22 [Internet]. NDRS.


3 Patient safety put ‘at risk’ by crumbling NHS hospitals in desperate need of repair [Internet]. ITV News, 22 February, 2023. https://tinyurl.com/2p8dhdmd


4 Zhang Q, Zhou H, Chen R, Qin T, Ren H, Liu B et al. Legionnaires’ Disease Caused by Legionella pneumophila Serogroups 5 and 10, China. Emerging Infectious Diseases [Internet]. 2014 Jul; 20(7).


5 Legionnaires’ disease Annual Epidemiological Report for 2020. Key


9 Kusnetsov JM, Ottoila E, Martikainen PJ. Growth, respiration and survival of Legionella pneumophila at high temperatures. Journal of Applied Bacteriology 1996 Oct; 81(4):341–7.


10 What Owners and Managers of Buildings and Healthcare Facilities Need to Know about the Growth and Spread of Legionella. Centers for Disease Control and Prevention, 30 April, 2018. https:// tinyurl.com/2xjnmb2e


11 Falkinham J, Pruden A, Edwards M. Opportunistic Premise Plumbing Pathogens: Increasingly Important Pathogens in Drinking Water. Pathogens 2015 Jun 9; 4 (2):373–86.


12 Li L, Mendis N, Trigui H, Oliver JD, 6 Faucher SP. The importance of the viable but non-culturable state in human bacterial pathogens. Frontiers in Microbiology 2014 Jun 2; 5.


13 Dietersdorfer E, Kirschner A, Schrammel B, Ohradanova-Repic A, Stockinger H, Sommer R et al. Starved viable but non-culturable (VBNC) Legionella strains can infect and replicate in amoebae and human macrophages. Water Research 2018; Sep; 141:428–38.


14 HTM 04-01: Safe water in healthcare premises. www.england.nhs.uk. NHS England, 21 May 2021. https://tinyurl.com/ mrxumuht


Greg Rankin


Greg Rankin, CEO at Hydrosense, is a ‘technology product veteran’, marketeer, and business developer. His 30+ year career has been ‘underpinned by innovation’. He has been responsible for product inception, product development, marketing, and sales, within the IT and SaaS industries, and has secured significant global deals, launched turnaround products, and – Hydrosense says – ‘delivered world-leading solutions’. Today, he is an ambassador for protecting lives against


Legionnaires’ disease, and for finding Legionella quickly to help keep businesses operational and protected from potential reputational damage. He has spent the past six years leading the team at Hydrosense, and driving the technological and digital advances to realise those beliefs – ‘delivering solutions that work quickly and accurately to detect the Legionella pneumophila species’, ultimately delivering what Hydrosense claims is ‘the world’s fastest Legionella testing kit’.


May 2023 Health Estate Journal 49


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