WATER SYSTEM HYGIENE AND SAFETY
Take the time for extra care in Legionella control
It is widely acknowledged that the healthcare sector – where patients by nature are at more risk of infection, is more susceptible than most to the dangers presented by Legionella bacteria. What may be less well known is that this risk is rising, as the number of healthcare-acquired cases of Legionnaires’ disease worldwide continues to increase. Greg Rankin, CEO at Legionella testing specialist, Hydrosense, explains how healthcare establishments can ‘go beyond compliance’ to better help protect the patients, residents, staff, and visitors, they serve.
In recent years, the importance of prioritising Legionella control as part of a robust water management plan in hospitals and other healthcare settings has been regularly highlighted by announcements on, and press coverage of, outbreaks. Earlier this year, for example, the discovery of Legionella bacteria led to a delayed opening of a new £41 m healthcare facility, Worthing Integrated Health Centre, in West Sussex.1
This follows myriad similar stories
in recent years, with several hospitals and healthcare facilities across the country – including Lister Hospital, Stevenage, Western General Hospital, Edinburgh, and Victoria Hospital, Kirkcaldy, to name but a few – having reported Legionella bacteria detections, prompting urgent precautionary measures to protect patients and staff. Worldwide, cases of hospital-acquired Legionnaires’ disease have been on the rise, with research showing that the potentially fatal bacterium is present in 12-85% of all hospital water systems too.2
Another high-profile study
found that 19% of cases are associated with long-term care facilities, and 15% with hospitals.3
No sign of abating The consensus is that this worrying upward trend shows no sign of abating anytime soon, with a range of complex factors – such as our changing weather, ageing infrastructure, and evolving water usage patterns, combining to promote favourable conditions for Legionella.
Not surprisingly then, hospitals and all other healthcare facilities are coming under increased pressure, both from the government and the public, to reduce infection count. To understand how this might be achieved, it’s important to first explore what Legionella is, and the full breadth of risks involved. As many healthcare providers will already know, Legionella is the bacterium that causes Legionnaires’ disease. It can colonise and grow in a range of man- made water systems found in healthcare settings, such as taps, showers, air-conditioning units, cooling towers, and even birthing pools. Although there are different species of Legionella, Legionella pneumophila is the most common pathogenic species, and responsible for most cases of Legionnaires’ disease. Generally speaking, most healthy people exposed
to Legionella will not fall ill. However, for those that do, Legionnaires’ disease is life-threatening unless treated quickly. This is especially true in healthcare facilities, where mortality rates are much higher due to the vulnerability of residents. Individuals with weakened immune systems, who have undergone recent surgery, and who are using respiratory equipment, are at a much
September 2025 Health Estate Journal 73
higher risk of being infected with the disease. Smokers, the elderly, and newborn babies, are also more susceptible to infection.
survivors of Legionnaires’ disease suffer with long-term impacts.4
Importantly too, it’s estimated that seven out of eight These include fatigue, memory loss, insomnia,
and PTSD; the upshot of which, for the already vulnerable healthcare patient, doesn’t bear thinking about. As a result it’s critical that healthcare establishments have the most robust measures possible in place to protect the people in their care from exposure to Legionella.
Complexities and challenges Simultaneously, the reality is that there are a number of practical challenges which put healthcare establishments at greater risk of Legionella contamination. Foremost, hospitals and other healthcare buildings often have bigger and more intricate water systems than other premises, due to the number of residents and the components and services needed. Key contributing factors include the size and complexity of the estate and buildings on it, along with the scope for multiple washroom facilities, birthing pools, commercial grade catering facilities, and high rates of hot water consumption during periods of peak demand. These factors not only increase the potential for Legionella bacteria colonisation and spread, but equally make control more challenging. Adding further complexity is the common use of
aerosol-generating equipment such as humidifiers, respiratory therapy machines, nebulisers, and cooling
Safety first: hospitals must implement stringent infection control procedures to manage Legionella risks in birthing pools, especially pre-filled, heated pools.
AdobeStock / Rafael Ben-Ari
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