Précis of HTM 04 - Legionella Control for Healthcare Environments

HTM 04 or to give it its full title “Health Technical Memorandum 04-01: The control of Legionella, hygiene, “safe” hot water, cold water and drinking water systems” was first published by the Department of Health in 2006 replacing HTM 2027 and HTM2040.

HTM 04 builds on the Health & Safety Executive’s primary legionella control Approved Code of Practice (ACOP) document “L8” but provides additional guidance to those involved with the control of legionella in hospital and healthcare environments.

Brief extracts from our précis are included below.

"Our precis of the Department of Health's HTM 04 provides a useful tool for anyone with responsibility for the control of legionella in a healthcare environment ..."

To coincide with the release of our new healthcare focused training courses Legionella Control International have recently published a précis of the Department of Health’s HTM 04.

The précis offers an excellent summary of HTM 04 and forms a useful tool for anyone with responsibility for the control of legionella in a healthcare environment, including senior executives, health professionals, estates and facilities managers; and contractors.


In the UK Legionella pneumophila serogroup 1 is the commonest cause of Legionnaires’ disease and is also the cause of Pontiac fever.

To date over 45 species of legionella have been identified.

The risk of healthcare associated Legionellosis depends on a number of factors including:

  • The presence of legionella bacteria in sufficient numbers.
  • Conditions for suitable multiplication including temperatures between 20°C and 45°C.
  • A source of nutrients.
  • A means of creating and disseminating respirable droplets.
  • The presence of vulnerable persons exposed to an infected aerosol.

Many if not all of these conditions are to be expected in healthcare premises.

Susceptibility of Individuals

Previously healthy individuals may develop Legionnaires’ disease but the following factors can increase susceptibility:

  • Increasing age, especially in those above 50 years, children are rarely infected.
  • Men are three times more likely to be infected.
  • Those with existing respiratory ailments are more at risk.
  • Illnesses that weaken the bodies natural defences such as diabetes, cancer, kidney disease and alcoholism.
  • Immunosuppressant drugs, these inhibit the body’s natural defences.

Systems at Risk

Building services and other systems that pose a Legionella risk include any equipment containing water likely to exceed 20°C and which release an aerosol or spray, hot and cold water systems, laundry systems, sterile services departments, hydrotherapy pools, spa pools and birthing pools.

Management Responsibilities

An organisations management team has overall responsibility to ensure the implementation of safe operational procedures.

A written scheme must be in place in respect of the control of legionella in water systems as defined in the HSE’s Approved Code of Practice, L8.

The statutory duty holder must appreciate the requirements and delegate to suitable persons to ensure compliance with this guidance.

A risk assessment of the water services will be necessary.

Risk assessments should be carried out by competent persons, if sub-contracted it is recommended that such contractors should be a member of the Legionella Control Association or able to... more

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For further information and expert assistance regarding legionella risk management and compliance issues in healthcare environments please call +44 (0) 161 877 0586 to speak to one of our specialist advisors or email your questions to This email address is being protected from spambots. You need JavaScript enabled to view it..

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