Water Management Society – Conference 2013 on Preventing Pseudomonas

Hi All,

Just a quick blog about yet another excellent water management society conference this December!

Meet the experts and gain an understanding of Pseudomonas Management.

You can see the full conference details and book your place online by clicking the banner above or going to http://www.wmsoc.org.uk/conferences.php?id=70

All the best

Aqua Legion UK Ltd

Hospital trust that failed to ensure patients’ safety is fined £350k

Basildon hospital admitted failing to protect patients and visitors after two people died after contracting legionnaires’ disease

A hospital trust has been ordered to pay fines and costs of £350,000 for failing to ensure the safety of its patients.

Basildon hospital admitted failing to protect patients and visitors between 2006 and 2007 after James Compton, 74, and Raymond Cackett, 54, died after contracting legionnaires’ disease. Six others were also infected by chronic Legionella.

Bosses also pleaded guilty to a similar count after a patient, who was on the hospital’s elderly ward, was injured after falling five metres from an unrestricted window.

Sentencing at Chelmsford crown court, the judge David Turner said: “These are failures of very different kinds but each is in its own way serious.”

He ordered the Essex hospital – one of 14 named in a report into abnormally high death rates by the NHS medical director, Sir Bruce Keogh – to pay a fine of £100,000 for the legionnaires’ offence and £75,000 for the fall.

The trust must also pay the prosecution’s legal costs of £175,000.

The judge said: “The very phrase legionnaires’ disease is enough to strike a chord of concern for any of us staying in hospital anywhere in this country or who have elderly relatives staying in hospital.

“Managing and controlling these bacteria is a huge, costly and complicated challenge for hospitals everywhere.

“Their failure was not of ignorance, lack of concern or reckless disregard for safety.

“The extent of their shortcomings need to be seen against the complexity of the challenge they faced and the number of people through their doors.”

Compton, from Billericay, died in 2007 and Cackett, 54, from South Ockendon, died in 2010 after contracting the disease at the hospital.

Six other patients – Egbert Van Nuil, Lyn Kilshaw, Roy Leech, Joyce Limbert, Francis Nutt and Verona Hughes – were infected. The court heard some of them nearly died from the disease.

Opening the case, prosecutor Pascal Bates said the hospital had been battling the disease – a serious lung infection caused by Legionella bacteria that is common in water systems – for up to 15 years.

But despite a previous prosecution following the death in 2002 of George Bate, 77, from legionnaires’ disease, managers took insufficient steps to protect the public, the court heard.

Shower heads and thermostatic valves were not properly cleaned, the budget to chemically kill the bacteria was cut and attempts to tackle the disease by “super heating” hot pipes may have backfired by warming cold pipes, causing the bacteria to proliferate.

Bates said: “This wasn’t a situation where for a brief period of time the hospital followed advice from a particular consultant, which later turned out to be wrong.

“This was a lengthy period of time during which the hospital fell short of its responsibilities and failed its patients.”

Iain Daniels, mitigating, said the trust apologised for the deaths and for the injuries suffered by the elderly woman. He said lessons had been learned and steps taken to protect patients in future.

Speaking afterwards, Susan Matthews, a Health and Safety Executive inspector, said: “Healthcare providers, like all organisations, have a legal duty to control risks by properly maintaining hot and cold water systems.

“The trust received numerous warnings from regulators and consultants brought in to give the hospital advice and support, but these were not fully heeded.”

Andrea Gordon, director of operations (regions) of the Care Quality Commission, said Basildon and Thurrock University Hospitals NHS Foundation Trust’s failures were not acceptable but progress had been made.

“We will continue to monitor the trust, including further unannounced inspections, and will not hesitate to take action where we find standards have fallen short of what people should be able to expect,” she said.

Outside court, Basildon hospital’s chief executive, Clare Panniker, apologised to the relatives of those who suffered.

She said: “We need to ensure our patients are cared for in a safe environment where they do not come to any harm.

“Tackling and managing known risks to hospital environments such as Legionella is part of this and I am confident, as are our health partners and the Health and Safety Executive, that we are doing this.

“We continue to invest significantly in upgrading and managing our water systems to minimise the risks of any patients contracting legionnaires’ disease in the future.”

theguardian.com © 2013 Guardian News and Media Limited or its affiliated companies. All rights reserved. | Use of this content is subject to our Terms & Conditions | More Feeds

Third case of legionnaires’ disease hits Brisbane hospital

Wesley Hospital launches investigation into further case of deadly disease after death of patient last week

The Wesley Hospital in Brisbane is investigating a third case of legionnaires’ disease, after one patient died and another was put in intensive care last week.

The current case is being investigated after a patient returned a positive reading in a preliminary urine test.

“The patient is showing no symptoms of legionnaires’ disease, however we are starting treatment as a precaution,” the hospital’s medical services director, Dr Luis Prado, said in a statement.

“This preliminary test may remain positive for a year and therefore does not indicate when or where the patient contracted the disease.”

Prado said the man has been a patient at Wesley since March and was staying in a different building to the other two cases.

The original contamination was sourced to the hospital’s hot water system, which cancelled all admissions and elective surgeries while it dealt with the outbreak.

John Pearson, 66, died after contracting Legionnaires while being treated for cancer. A 46-year-old woman remains in a serious but stable condition.

Queensland Health has been notified and the hospital remains closed to admissions. All elective surgeries have also been cancelled.

theguardian.com © 2013 Guardian News and Media Limited or its affiliated companies. All rights reserved. | Use of this content is subject to our Terms & Conditions | More Feeds

Third case of legionnaires’ disease hits Brisbane hospital

Wesley Hospital launches investigation into further case of deadly disease after death of patient last week

The Wesley Hospital in Brisbane is investigating a third case of legionnaires’ disease, after one patient died and another was put in intensive care last week.

The current case is being investigated after a patient returned a positive reading in a preliminary urine test.

“The patient is showing no symptoms of legionnaires’ disease, however we are starting treatment as a precaution,” the hospital’s medical services director, Dr Luis Prado, said in a statement.

“This preliminary test may remain positive for a year and therefore does not indicate when or where the patient contracted the disease.”

Prado said the man has been a patient at Wesley since March and was staying in a different building to the other two cases.

The original contamination was sourced to the hospital’s hot water system, which cancelled all admissions and elective surgeries while it dealt with the outbreak.

John Pearson, 66, died after contracting Legionnaires while being treated for cancer. A 46-year-old woman remains in a serious but stable condition.

Queensland Health has been notified and the hospital remains closed to admissions. All elective surgeries have also been cancelled.

guardian.co.uk © 2013 Guardian News and Media Limited or its affiliated companies. All rights reserved. | Use of this content is subject to our Terms & Conditions | More Feeds

Legionnaires’ outbreak causes Brisbane hospital to stop admissions

One patient has died and another is in intensive care after outbreak of disease at the Wesley hospital in Auchenflower

Legionnaires’ outbreak causes Brisbane hospital to stop admissions

One patient has died and another is in intensive care after outbreak of disease at the Wesley hospital in Auchenflower

Water Management Society Conference – 4th June 2013

Water Management Society are pleased to present a one day conference in London on 4 June 2013.

 

Re-circulating Closed Heating and Chilled Water Systems in Buildings. Meet the Experts.

 

Topics include:-

• Legal implications.

• System problems and solutions.

• Minimising risks.

• Monitoring.

• Updates from BSRIA.

• Corrosion issues.

• Factors affecting sampling and testing.

• Maintaining serviceability of water and heating systems.

• Requirements from early stage management system to building occupation.

 

Interested?

 

Booking form, full programme details, prices and venue information at conferences

Risk Assessment for Legionella – Do they Require a List of Every Outlet

Risk Assessment for legionella – A debate about whether every outlet should be included or documented.

We have been part of a debate about whether a list of every outlet is required to be included in the legionella risk assessment. The debate has been so interesting that we felt we had to blog about it.

Firstly it was really interesting the way the discussion morphed from – do you need a list of every outlet in the risk assessment, to do you need to check every outlet? Then do you need to record the temperature at every outlet and then to Point of use filtration which seemed to be a real curve ball in the discussion.

As such we thought it best to submit this blog for clarity of our opinions for the wider community and prospective clients.

Risk Assessment of outlets Point 1

The main purpose of a risk assessment is to assess the likelihood or potential for legionella bacteria to colonise and proliferate in the system, the potential for legionella to be disseminated in aerosol form and the subsequent risk of exposure including the susceptibility of those exposed. It should also provide actions to take to reduce the foreseeable risks identified.

If we are honest about the nature of our work, “in the real world” it is not always possible to gain access to every outlet at the time of survey. As such, the importance of access needs to be clarified upfront as failure to gain access to all of the water services will mean it is not possible to identify or list every outlet.

However, in our opinion the intentions of any good risk assessor must always be to visibly check and flush test every accessible outlet if possible. This action means each outlet is assessed for its potential to cause colonisation, (dead leg, broken, isolated, temp gain or loss etc) it’s potential to disseminate a breathable aerosol and it’s potential for subsequent exposure.

Failing to have this fundamental intention from the offset of the legionella risk assessment means there is a compromise in quality and the risk assessment process.

In line with the Legionella Control Association (LCA) standards for risk assessment, this type of issue should be discussed upfront with the client and an agreement documented on what is to be included in the risk assessment to demonstrate that a sufficient assessment has been done.

The Legionella Control Association requires documented clarification and a detailed scope of works to be drafted prior to the commencement of the works. This acts as an agreement between the client and service provider and will define the detail to be included in the risk assessment and indeed whether a full list of every outlet is required etc.

In real terms it is not enough just to say in compliance with L8 or BS8580! and to be totally frank, a very simple assessment without a full asset register can and has been in the past considered compliant by Regulatory Authorities.

In our opinion, the devil is in the detail and the detail should be identified in the agreed scope of works. In our opinion, it is the difference in the scope of works offered between organisations that can partly explain the variable prices available in the market. As such we feel the industry would benefit from a standard but very simple minimum scope of works to be included as part of a risk assessment agreement. In doing this we would have a unified scope from the Regulators that define clearly whether every outlet must or should be listed in the risk assessment.

In our opinion, whilst failing to gain access and list every outlet does not mean a poor assessment was done, we believe failing to try and gain access to every outlet does mean there is a compromise in quality and the risk assessment process. Therefore the intention of the risk assessor must always be to at least try to list every accessible outlet inspected.

An asset register and schematic should be produced where required not only to provide a guide on the system but also to confirm the assets identified and assessed as part of the survey. In our opinion a sincere attempt to must be made to collect and record this data within the risk assessment.

Again, missing assets can mean the assessor failed to gain access at the time of survey for a justifiable reason. Nonetheless where access was denied, not possible, or additional services are suspected to be present this needs to be stated in the report with a recommendation to facilitate access to certain identified restricted areas for assessment going forward.

Risk Assessment of outlets Point 2

Taking temperatures from every outlet is by no means absolutely essential particularly if you have already confirmed there is a single source. However any good Assessor will know and be aware that temperature checking every accessible outlet will provide them with a great deal of information about the system as a whole and the individual asset they are inspecting. It will indicate suspect areas of a system, any anomalies to be investigated further, and help to build a picture for the provision of rational recommendations in direct context to the site being risk assessed.

In our view, temperature checking every accessible outlet is one of the assessors most valuable tools whilst onsite and holds more importance for the Assessor to formulate the risk rating and rational recommendations than it does for the client.

Whilst a list of assets and temperatures may mean little to the client. This information is essential to enable the development of a control regime, schematics and provision of rational explanations and recommendations for actions or remedial works etc going forward.

All our assessments are initially priced to risk assess and temp check every asset and outlet where access is provided. This is only compromised where there is an agreement between the client and ourselves to curtail the requirement to do this whilst ensuring the assessment itself will still be deemed adequate.

Nonetheless there is a big difference between an adequate or sufficient risk assessment and a comprehensive one and what type is required should be clarified before works are undertaken. Further to this, there is naturally a difference in price between what is considered an adequate risk assessment and a comprehensive risk assessment

As such defining the scope of works prior to commencement of the assessment or as part of the proposal phase provides an agreed level of service between client and service provider.

The price offered by an organisation big or small should be based on the level of service provided and or expected and the expertise of the individual providing that service. With risk assessments the price is normally based on time allocated and expertise required to complete the job competently. The assessment process itself is typically a low overhead process regardless of the organisations size.

In real terms price should be defined by how much time and material or resource is spent executing the work from start to finish alongside expertise of the individual executing the work, additionally the margin the organisation needs to continue offering a progressive and effective service to the client should be considered and that’s about it.

When other factors creep in like greed (as it does for some) then it distorts the focus and purpose of the service and this is a different ball game altogether. Nonetheless we all know there are rouge traders out there so who you choose to conduct your risk assessment is a very important decision. In our opinion it is vital that the organisation is both independent and registered with the legionella control association as a minimum.

If any Organisation is worth its weight and understands its own liability in providing the risk assessment, then the assessment should always be sufficient enough to demonstrate compliance.

Curtailing the scope or works so far as to render the assessment useless increases the assessors and or organisations liability greatly so any curtailing from the standard fully comprehensive approach needs to be discussed up front and agreed by both parties.

In some cases the assessor or organisation may decline such work if the curtailing of essential elements mean the assessment will be useless or non compliant and this does happen.

However, like I said earlier a sufficient or adequate assessment does not necessarily mean a comprehensive one.

If I didn’t make it clear, price does not reflect quality. However, the execution of certain tasks as part of the assessment and identification and provision of certain issues and information included in the assessment does and considering that all assessors should be “competent” the time spent onsite to identify the issues is the thing that often makes the difference in report quality.

In an honest and ideal world, the time and resources needed and allocated to the work should be the fundamental issue that reflects the price paid.

The scope of work in our opinion is what defines the time and detail to be provided and needed to complete the service competently and therefore the scope will enable the organisation to price the work appropriately. Consequently the scope of works will normally always define the price to be paid.

This is why we say an industry standard scope of work for risk assessment would be useful from the Regulators to support the Industry. This would support organisations and assessors in ensuring that there is not this debate on whether you need to check every outlet or not or whether a temperature check should be done from every outlet or not. It would standardise the items that must be included as a minimum and allow for a more standardised pricing structure for the industry would product a minimum level of risk assessment quality.

In reflection of the debate it is easy to understand that the time it takes to check and list every outlet in a large hotel for example against checking an obligatory 10% the outlets which tends to be the minimum acceptable level when using a more pragmatic approach will have a significant reflection on the time spent doing the survey and subsequently the price.

Halls of residents or social housing for example can be priced to inspect and list every outlet or priced for the more pragmatic approach of 10% of outlets, rooms or apartments for example. The cost will be clearly defined by the strategy taken as this defines the time allocation needed to complete the service.

The time allocation can vary from a day or even a few hours to a week or months work for the same site depending on the scope and strategy being used and this is the point being raised within the industry as some companies will initially price to take a pragmatic approach and some a comprehensive one.

As such we think it is important for the client to understand upfront what type of service or risk assessment they require. Is a basic risk assessment, sufficient or adequate assessment required or is a more pragmatic approach needed due to the size of the portfolio or does the assessment need to be fully comprehensive. Understanding what type of assessment is needed should dictate the price the client is prepared to pay.

However, it is important to confirm that the strategy implemented or type of assessment needed will depend on the expertise and competence of the client and risk assessor or organisations involved. It will depend on the size of the portfolio or property and whether the 10% approach for example can be justified as reasonably practical in the context of the site.

If the client only requires a basic or adequate risk assessment to tick the box then this will be reflected in the price they are prepared to pay and believe us there are purchasers who are prepared to pay no more than £100 for the complete job! Unfortunately it is unlikely to provide a risk assessment that would be deemed adequate or comprehensive and simply not enough time could be allocated to the service at this price.

We cannot emphasise enough that there are many sub standard risk assessments out there but the industry should ask itself why. Is it because the assessors are incompetent? Is it because the client curtailed the requirements of the assessment due to budget constraints? Or is it because the organisation covertly cut corners to create the margin?

If you look deep enough into the service there is normally a reason for the poor risk assessments out there and from our experience it is often a combination of the above that result in the substandard risk assessments we see out there.

However, whilst we can all mud sling at one another and believe me it’s very easy to do so, the truth is that if the scope of works is defined prior to commencement of work, then the reasons for sub standard risk assessments would be much more obvious to the industry.

Risk Assessment for Legionella Bacteria

 

Legionella Free Christmas

Season’s Greetings to all and every one!

From Aqua Legion UK Ltd.Seasons Greetings from the UK Leading Legionella Company

 

 

Legionella Management in Sheltered Accommodation

Sheltered Accommodation Providers

Hi All,

Have you heard the storey about the Legionella positive results obtained from a sheltered accommodation block in Lincoln?

No one was infected, but drastic steps have been taken to prevent any of the 51 elderly residents catching the disease.

Well done to the Council, we take our hats off to you for implementing what seems to be the most robust safety measure of all which is to provide an alternative water supply! This step is normally considered the ultimate precaution, and if at the time the team considered this measure proportionate to the risk then who are we to say it was the wrong or right one.

However, thousands of samples and sites water supplies test positive and in some situations high count positives for Legionella every year but they seem to manage the situation without any infections, change of water supply or public notoriety.

Whilst any response that prevents an infection should be seen as a positive one. The response should be measured, effective and in our opinion discreet if possible. If managed properly a high positive count doesn’t necessarily need to mean likely to cause infection. For example, once the result was identified, if residents were prevented from any significant exposure to aerosol, then the likelihood of infection would be significantly reduced or even practically eliminated.

It would also be interesting to know whether the positive counts were found in the hot water supply, the cold water supply, mains supply or all of them as the measures implemented could be different for each.

There are also many products on the market today that can be used to disinfect water systems safely without major disruption to building occupants or the water supply. Whilst the appropriate product to use depends on the situation, it is quite possible to disinfect a system without evacuation or restriction on general domestic water use or even drinking.

Pasteurising hot supplies for example is a quick way of treating a hot water system that has a Legionella positive count. Simply turning the boilers and water heater thermostats up to 70°C and then circulating this hot water throughout the system and holding the temperature in the entire system at 70° for a minimum of one hour can eradicate Legionella.

Cold water systems can be treated with chemical disinfection products that allow the water services to remain live and in use. Once the bacteria is killed, further control measures could be put in place to conduct more deeper cleaning if particular areas have raised concerns.

By implementing the above, the only restrictions on water use during the process would be exposure to aerosol, and the exposure to very hot water, as such supervised water use or careful instructions to residents could be sufficient to keep everybody safe.

Maybe a few bottles of drinking water for any inconvenience during the “water hygiene management and disinfection works” would be a nice compliment but providing a complete alternative water supply is a major undertaking.

Providing an alternative supply of water can be a logistical nightmare and can create a bit of hysteria as residents begin to speculate. This in itself often creates unnecessary attention that can escalate to unwanted or needed notoriety.

The Legionella bug can be dangerous one and we all need to understand that. However with careful planning, a clear understanding of the risks and an effective control and risk management regime, it is possible to manage the risk of Legionella in a way that protects you, your organisation and visitors and occupants of the buildings you manage.

http://www.bbc.co.uk/news/uk-england-lincolnshire-20565875