Infection control Many older care homes also have


outdated plumbing systems with dead legs or incomplete schematics, complicating risk assessment and management.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. Temperature control can add to the


complexity too. While Legionella can survive at temperatures up to 60°C, the bacterium flourishes between 20-45°C. With this, best practice dictates that to manage the risk of Legionella hot water should be stored above 60°C and distributed above 50°C, while cold water storage and distribution should be below 20°C. However, this entails another very prolific safety consideration in itself – hot water temperature control. Each year, a significant number of people in the UK are seriously injured from scalds caused from hot water – with the elderly particularly susceptible. Though several strategies can be employed to manage this delicate balance, most providers will rely on temperature control and monitoring and the use of Thermostatic Mixing Valves (TMVs). However, while TMVs are essential for minimising the risk of scalding, they can inadvertently increase the risk of Legionella growth. This is because the blended water downstream of a TMV can create an environment conducive to the bacteria’s multiplication. Ensuring safe TMV use depends on implementing a robust maintenance programme, including regular flushing to prevent water stagnation – a known factor for promoting Legionella. Despite this, the consensus is that TMV maintenance, inspections, and servicing are not necessarily always as thorough as they need to be.


Rising risk


Against this backdrop, statistics show that the scale and severity of Legionella cases happening in the USA, the UK, and Europe are all increasing at alarming levels. The EU recently observed its highest annual notification rate of Legionnaires’ disease to date5


and in the USA there has been a 1000 per cent increase since 2000.6 The consensus is that these increases can be attributed to several factors, including aging infrastructure, warming temperature, more frequent weather extremes, and increasingly complex water systems. It is also understood that this trend shows no sign of abating anytime


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There is scope to do more to limit exposure and reduce the risk of infection


soon, and thus there is even greater onus on the need to combat Legionella risk through more robust water management, more regular system maintenance, improved regulation, and increased public awareness of prevention strategies.


Rules and regulation


The good news in all this is that the UK is home to one of the first and most comprehensive regulations to manage and control Legionella bacteria. In fact, as an early adopter, the UK has continued to influence global standards for Legionella control all around the world. As part of this, current regulation under the HSE mandates that care homes must adhere to the Approved Code of Practice (ACOP) L8 – Legionnaires’ disease: The control of Legionella bacteria in water systems. These regulations require care homes to: n Conduct risk assessments: Identify and evaluate the risk of Legionella contamination within the water system.


n Implement a water safety plan: Develop and maintain a comprehensive plan to control identified risks.


n Regularly monitor and check water temperatures, inspecting tanks and pipes, and cleaning systems to prevent bacterial growth.


From our experience, however, there is scope to raise the bar on safety through a more robust and routine Legionella testing regime.


Better detection, better protection Most care home duty holders will already be well acquainted with the standard lab- culture method, whereby water samples are collected from water systems on-site and sent to a UKAS accredited laboratory for testing, which will identify the presence or absence of Legionella. However, this approach is timely, cumbersome, and has limitations.


Foremost, most lab 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 installers and the premises 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 Legionella (VBNC) – which, though dormant, can still be incredibly dangerous due to their ability to resuscitate and reinfect a water system – while 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 even when repeated subsequent tests confirm non- conformance. Arguably, as Legionella risk evolves, there is a clear case for care home duty holders to consider including rapid testing as part of the Legionella testing process.


www.thecarehomeenvironment.com May 2025


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