It is crucial for employers and those otherwise in control of premises such as nursing and residential homes to be aware of the risks posed by the growth of legionella bacteria, which is especially likely to occur in man-made water systems.

Unfortunately, for a number of reasons – including the age and vulnerability of the residents of care homes – this setting can pose a particular risk to the health of those using such buildings, unless measures are adopted to help control this.

So, what steps can you take as a care home manager – and as someone therefore responsible for on-site health and safety – to comply with your legal and moral duty in this regard?

legionella risk in nursing homes

What is legionella?

Legionella bacteria are frequently found in both natural and artificial water systems. They thrive at temperatures between around 20 degrees C and 45 degrees C, and can survive at low temperatures. However, they are killed at higher temperatures, which is the main means by which legionella bacteria are controlled in domestic water systems.

Unfortunately, when someone breathes in small droplets of legionella-contaminated water, from sources such as air conditioning systems or taps and showers that aren’t used often, this can lead to the development of Legionnaires’ disease or other conditions in the wider Legionellosis group of pneumonia-like illnesses.

Why should managers be aware of the legionella risk in nursing homes?

Legionnaires’ disease is a particularly serious illness in people who are well-represented in nursing and residential homes, including people over 45 years of age, those suffering from chronic respiratory or kidney disease, and anyone with an impaired immune system.

This makes it especially crucial for the managers of care homes to put in place robust arrangements for the control of legionella, to help protect anyone in their care or using their buildings who may be at risk from the disease.

Is legionella testing a legal requirement?

There can sometimes be confusion among the managers of nursing and residential care homes, as to whether there is a legal obligation for them to have legionella testing carried out.

In accordance with the Health and Safety at Work etc Act 1974, care home managers have a duty to consider the risks from legionella that could potentially affect people in their care. The Control of Substances Hazardous to Health Regulations 2002 (as amended) state that you are required to assess the risks bacteria like legionella pose to all staff and patients, and take suitable precautions.

As an employer, you have a broad legal responsibility to ensure the premises are safe and free from health hazards. With regard to legionella specifically, the Health and Safety Executive (HSE) has made clear that employers must take reasonable steps to ensure the proper use and application of any control measures.

In a nutshell, the two simple rules to remember are the following: (a) all employers have a duty to understand and manage legionella risks, and (b) regular legionella testing is required for all places of work, including nursing and residential care homes.

How can care homes be legionella compliant?

There are various steps that care home managers can take to ensure their compliance with the relevant legislation for controlling legionella risks.

These should include arranging for a competent person, who understands the premises’ water systems and any associated equipment, to assess the risks presented by the hot and cold water systems. This person should be able to advise on whether adequate measures are in place to control the risk of anyone using the buildings being exposed to legionella bacteria.

The traditional means by which the risk legionella poses is reduced and controlled, is water temperature control. You can help increase safety and achieve compliance by ensuring water services are operated at temperatures that prevent the growth of legionella bacteria.

This means that hot water storage cylinders (calorifiers) should store water at temperatures no lower than 60 degrees C, and hot water should be distributed at 50 degrees C or higher – although thermostatic mixing valves may be needed where there is an identified risk of scalding. As for cold water, this should be maintained – wherever possible – at temperatures of less than 20 degrees C.

Your care home premises’ hot and cold water systems should also be designed in order to guard against conditions that would promote the growth of legionella bacteria. A good design in this respect will include pipework that is kept as short and direct as possible, as well as the adequate insulation of pipes and tanks.

Hot and cold water systems in care homes should also not consist of materials that would favour the growth of legionella, and other measures should be put in place to protect against contamination – for example, storage tanks being fitted with lids.

What is the cost of a legionella risk assessment – and can you undertake it yourself?

If you are interested in having a qualified legionella risk assessor undertake a legionella risk assessment at your care home, the price you can expect to pay will likely depend greatly on the size and sophistication of the water system.

If, for instance, you have the kind of larger water system typically seen in care homes, you will probably be looking at an asking price of £500 upwards, largely dictated by the number of tanks, cylinders and other assets in the system that will require assessment.

The care home manager – in their capacity as the duty holder – is responsible for ensuring the risk assessment is carried out. It is by no means impossible, however, for the duty holder to undertake the risk assessment themselves, as long as they are competent to do so.

Whether the duty holder is considered competent to undertake the risk assessment themselves in the eyes of the law will depend on their level of experience and their understanding of the water systems under their control. The HSE provides more detailed advice and guidance on this subject in its Approved Code of Practice (ACOP), L8 document.

Unfortunately, nursing and residential care homes tend to have somewhat larger and more complex systems than the simple domestic water systems in the typical private house. This increases the likelihood that as a care home manager, you will need to arrange for an expert with a background in these systems to conduct the risk assessment for you and advise you on the next steps.

Having considered the above, you should also ask yourself if a risk assessment is enough!  Regular risk assessments at frequent intervals or following any changes to systems or personnel will certainly help you with compliance and allow you to ‘tick the mandatory requirement box’.  If, however, you want to competently manage your legionella risk, then you should consider including the management of all the water assets, regular temperature checks, awareness of location, condition, servicing and replacement(s).

How can software help you manage your legionella risk?

If you decide that you want to be able to manage the risk and thereby ensure the safety and wellbeing of your residents and colleagues, the good news is that, with the right software package, you can… and you won’t have to reinvent the wheel when transitioning from your current process.

Our Vision Pro software offers an industry standard, fully compliant legionella risk management audit template that not only gives you a complete breakdown of your current legionella risk, maintenance and compliance within your care home premises, but does so in such a way that allows your responsible person/assessor to follow the requirements easily and effectively.

With its many features including the ability to upload documents, drawings, images and video footage, and NFC tag technology for the recording, monitoring and maintenance of water equipment and assets, all in one place and all of which can be embedded into your risk assessment template, Vision Pro can help take the stress out of ensuring you maintain your duty of care in this area.

Call one of our specialist advisors today and we will be pleased to introduce you to more of the elements that make Vision Pro a complete, sophisticated and easy-to-use solution.