Managing Legionella Risk in Private Healthcare Premises
While much of the focus on healthcare in the UK centres around the NHS, a significant portion of healthcare services is delivered by private providers. These include private hospitals, clinics, care homes, and wellness facilities operated by organisations such as Bupa, Nuffield Health, HCA and Spire Healthcare. Regardless of ownership or funding model, all healthcare environments share a common responsibility: safeguarding patients, staff, and visitors from preventable health risks. One of the more serious, and often underestimated of these risks is Legionella bacteria, which can thrive in poorly managed water systems and cause the potentially fatal Legionnaires’ disease.
This article explores how private healthcare premises can effectively manage Legionella risks through a combination of regulatory compliance, system maintenance, and proactive measures. It covers the basics of Legionella and its health implications, highlights key legal and technical guidance documents, and outlines essential practices such as risk assessments, temperature control, water sampling, and staff training. Whether managing a small care home or a large private hospital, following these practices is important to ensuring a safe water environment for vulnerable populations.
A version of this story about the control of Legionella risk in private healthcare premises first appeared in Legionella Control International’s newsletter. To get it in your inbox, sign up here.
Legionella in private healthcare
In the UK, when we think of healthcare premises, we tend to think of NHS hospitals, buildings, clinics, and similar public facilities. However, there are plenty of healthcare facilities that are privately run, encompassing all areas of health and wellbeing.
Public and private healthcare services have much in common, even though the way they are funded and the people they cater for tend to be different. In both cases, though, those people in charge have a duty of care to make sure everyone using the private facilities can do so safely. As this article confirms, one aspect of this relates to Legionella and the safety of the hot and cold water systems used in each building or premises.
What is Legionella?
Legionella is a type of bacterium that thrives in water temperatures of between 20 and 45 degrees Celsius. While it is found in natural bodies of water, it doesn’t tend to cause any issues in these locations. It is also found in manmade water systems, and that’s where it can become hazardous to health if it is allowed to multiply and colonise parts of the water system or even spread through it.
Why is Legionella harmful to health?
Legionella bacteria cause the potentially fatal lung condition known as Legionnaires’ disease. Some people are at greater risk of falling ill if exposed to the bacteria. Those aged over 50, those with respiratory or chronic illnesses, and those with compromised immune systems are all at greater risk, for example. Many of these people are more likely to visit healthcare premises too – including private ones.
Legionella is spread through airborne water vapour or mist. As we’ve seen, it will thrive in water if given the right temperature range to do so. It will also thrive in stagnant water and areas of a water system where biofilms are present. These both protect, and act as a food source for bacteria, making it more likely that they will multiply.
Anywhere that water vapour or spray is generated will pose a risk to those in the vicinity. If the vapour is inhaled, the Legionella bacteria can get into the lungs, where it can cause Legionnaires’ disease, a serious type of pneumonia.
Sourcing support for Legionella risk management
Fortunately, there are many technical documents, memorandums, and Codes of Practice covering the healthcare sector and water safety management. These combine to provide those in control with plenty of insight into what they must do to ensure their facilities are safe to use.
Here are the main documents to be aware of:
- HTM04-01 – Health Technical Memorandum from the Department of Health in three parts, covering water safety
- ACoP L8 – the Approved Code of Practice L8 from the Health and Safety Executive, covering the management of Legionella risk
- HSG274 – Health and Safety Executive guidance in three parts, covering the management of Legionella risk in evaporative cooling, hot and cold water and other risk systems.
- BS8680:2020 – covering water quality, water safety plans, Code of Practice
While Legionella does pose a significant risk in any building with hot or cold water services or other assets that use water, it’s clear that the risk factors are more significant in healthcare premises. These are more likely to have many individuals who are older or who have certain health conditions that put them at greater risk. For example, privately run care homes for the elderly are included in this sector. With many aged residents, it’s vital that water safety is continually managed.
How to make sure Legionella risk is as low as possible
To avoid confusion, in every organisation, private healthcare or otherwise there should always be someone appointed to take responsibility for Legionella control and overall water safety. Obviously, there will be huge differences between small organisations with a single site and much larger ones, with multiple properties. The requirements of a care home catering for 15 people will be far different to those involving a private hospital, for example. In the latter case, a water safety group comprising several people with experience in different areas of the hospital would be far better placed to identify all risk factors and deal with them appropriately.
The importance of the Legionella risk assessment
The first step in managing the risk is to conduct a Legionella risk assessment that considers all risk factors throughout the building. This should be conducted by someone who is competent in completing healthcare risk assessments, someone who has had relevant training and is experienced in knowing what to look for. The focus is on removing risks where practicable and reducing risks where removal would not be as easy or impractical. All risk factors identified in the Legionella risk assessment should then be taken care of.
Everyone involved should be competent for their role
Everyone with a role to play in managing the risk of Legionella should receive relevant and regular training to ensure they fully understand their role and how to fulfil it. This covers any occasions where the lead person may be off for some reason, so there is a deputy who can step in.
Managing water temperatures and regular flushing
Hot water supplies should always be circulating and be between 55 – 60 degrees Celsius. Cold water should be stored and circulated at below 20 degrees Celsius. These temperatures ensure that Legionella bacteria do not have the ideal temperature range in which to multiply.
It is also necessary to make sure outlets are flushed through twice weekly if they are not used as often. In some cases, removal of certain outlets or pipework is best if they are never used. In other cases, infrequent use should be tackled by a programme of regular flushing.
Consider other measures to control Legionella
Other aspects that will help manage Legionella risks that should be considered include:
- The cleaning and disinfection of water filters and hot water generators
- An inspection of all parts of the water system to identify maintenance and repair issues
- Regular cleaning to ensure all parts of the water system are safe
- Chemical dosing of the system to ensure levels of Legionella and other waterborne bacteria are safe
Legionella water sampling
It is also prudent to take samples of water from various outlets in turn and having those samples tested in accredited laboratories. Such tests, which should form part of a targeted sampling plan will determine the composition of any bacteria present in the water. They can also confirm whether the controls, including the chemical dosing system is working as it should be.
Successfully managing Legionella in private healthcare premises
These are just a few of the tasks those in charge of water safety must consider and put in place. However, it’s important to remember that everything begins with the Legionella risk assessment, which should consider who is most at risk as well as assessing the various parts of the water system and where the risk factors are seen.
In short, while the risk assessment should identify any parts of the water system that may present greater risks, such as evaporative cooling towers and anything else that may generate water vapour, it is also important to consider other factors. Since many private healthcare providers will cater for those whose health is poor or who are elderly, there are significant factors here that must be considered. Legionella can be managed and kept at low levels, but only if the proper steps are taken. Following all relevant guidelines will help ensure this is the case.
Leading water safety specialists
Legionella Control International is a world leading water safety specialist, supporting those responsible for the control of Legionella and other waterborne pathogens in the workplace, including hospitals and other healthcare environments. Our water safety teams help keep water systems safe to use, protecting staff, visitors and others from harm.
We are experienced in the healthcare role of Authorising Engineer (Water) and can assist organisations in the development of water safety management teams, policies, and procedures to safeguard people across large scale and multi-site property portfolios, complex facilities and those considered to be higher risk. We also offer expert risk assessments, safety auditing, training and more.
If you are concerned by any of the issues raised or you would like to speak with one of our healthcare water specialists, please call us today on 0330 223 36 86.
