WATER SYSTEM HYGIENE AND SAFETY
The ‘need for speed’: rapid testing technology allows healthcare providers to ‘elevate standards’ in Legionella control, Hydrosense says.
towers, which can all produce tiny water droplets that, if contaminated, can carry Legionella directly into patients’ lungs. Many older healthcare establishments also have outdated plumbing systems, with deadlegs or incomplete schematics, complicating risk assessment and management. The scope for unoccupied rooms or infrequently used outlets brings further risk due to water stagnation, creating ideal conditions and breeding grounds for Legionella growth.
Below: From hot water safety and hygiene through to Legionella control, there are many washroom safety considerations for the modern healthcare setting.
Below right: ‘Lurking’ Legionella can multiply in hot and cold water systems – including cooling towers, HVAC systems, showers, and even taps.
Temperature control Temperature control can add to the complexity too. Most healthcare providers will use TMVs to enable water to be stored at 60 °C+, which is hot enough to kill Legionella, while being safely delivered at cooler temperatures to outlets. However, this can come as a double-edged sword – since while TMVs are essential for minimising the risk of scalding, they can inadvertently increase the risk of Legionella growth due to the scope for stagnant water and biofilm formation. In this way, TMVs require careful management and maintenance to avoid them becoming part of the Legionella problem. Couple all this with the challenges of constant and variable use, resource constraints, and extensive guidelines, and the result is a clearly arduous task for most healthcare providers. So, what is to be done? Undoubtedly, more regular monitoring, testing, and disinfection of water systems offers healthcare providers the best possible chance of better detection and protection. However, in our experience most Water Safety Plans are often designed to meet bottom line regulations, rather than to reduce Legionella risks to the absolute minimum, and in some cases may not be comprehensive enough to completely avoid growth and spread of Legionella bacteria. For example, most healthcare providers still rely solely
on the standard lab-culture method – whereby water samples are collected from water systems on site and sent to a UKAS-accredited laboratory which will identify the presence or absence of Legionella – for Legionella testing. However, this approach is timely, cumbersome, and has limitations. Foremost, most laboratory culture tests take 7-10 days to return results. Yet Legionella can double in a day. This large time lag means increased exposure and risk for healthcare providers and the people they serve. Water samples can also get damaged in the transportation process, potentially killing the Legionella inside, and increasing the risk of a false negative result. Lab culture testing is also unable to detect Viable but Non-Culturable (VBNC) Legionella – which, though a dormant form, can still be incredibly dangerous due to their ability to resuscitate and reinfect a water system – also being able to directly infect human cells, even in their dormant state. The result can be a false sense of security, with the potential for lab results to state a negative outcome when repeated subsequent tests confirm non-conformance. Arguably then, as Legionella risk evolves, there is a clear case for healthcare establishments to consider including rapid testing as part of the Legionella testing process.
Latest generation of rapid testing kits Designed to overcome the limitations of traditional Legionella detection, the latest generation of rapid testing kits enable detection in just 25 minutes, and are incredibly accurate at quickly detecting the most common and potentially fatal species of Legionella bacterium – Legionella pneumophila. To confirm its accuracy, we recently invested in an extensive third party study, conducted by California-based CDC ELITE laboratory Chemicals Incorporated (CHEM Inc.) The study, which
74 Health Estate Journal September 2025
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