Water Safety and Legionella Compliance

1. Water Safety and Legionella Compliance London Health and Safety Group Meeting 15th October 2012

2. Water Safety and Legionella ComplianceAgenda • Health, safety, water and buildings • Water regulation - The UK picture • Legionella a lesson in health and safety strategy? • Ten years on from Barrow what have we learnt

3. Health, safety, water and buildingsQuestion 1 • How much water does the average person use each day in the UK? • 350 litres • 550 litres • 150 litres • 250 litres • 450 litres

4. Health, safety, water and buildingsQuestion 1 • How much water does the average person use each day in the UK? • 350 litres • 550 litres • 150 litres • 250 litres • 450 litres

5. Health, safety, water and buildingsQuestion 2 • Collectively how many Olympic sized swimming pools would be filled with the water British businesses use each year? • 600,000 • 1,000,000 • 1,600,000 • 2,000,000 • 2,600,000

6. Health, safety, water and buildingsQuestion 2 • Collectively how many Olympic sized swimming pools would be filled with the water British businesses use each year? • 600,000 • 1,000,000 • 1,600,000 • 2,000,000 • 2,600,000

7. Health, safety, water and buildingsQuestion 3 • How much pipework supplies mains water and removes waste water within the UK? • 350,000 miles • 450,000 miles • 550,000 miles • 650,000 miles • 750,000 miles

8. Health, safety, water and buildingsQuestion 3 • How much pipework supplies mains water and removes waste water within the UK? • 350,000 miles • 450,000 miles • 550,000 miles • 650,000 miles • 750,000 miles

9. Health, safety, water and buildingsQuestion 4 • The DWI classify “domestic water” as for which of the following purposes? • Drinking • Hygiene • Sanitation • Food preparation • Laundry

10. Health, safety, water and buildingsQuestion 4 • The DWI classify “domestic water” as for which of the following purposes? • Drinking • Hygiene • Sanitation • Food preparation • Laundry

11. Health, safety, water and buildingsQuestion 5 • What percentage of mains supply water samples failed (either microbiological or chemical) in 2011? • 8.40% • 0.40% • 4.40% • 0.04% • 6.40%

12. Health, safety, water and buildingsQuestion 5 • What percentage of mains supply water samples failed (either microbiological or chemical) in 2011? • 8.40% • 0.40% • 4.40% • 0.04% • 6.40%

13. Water regulationThe UK picture

14. Water regulationThe UK picture • Regulators of water finance and economics • England and Wales - Water Services Regulatory Authority (Ofwat) • Scotland - Water Industry Commission • Northern Ireland - Utility Regulator Responsibility • Regulating the water companies finance and charging

15. Water regulationThe UK picture Regulators of drinking water quality • Drinking Water Inspectorates (Northern Ireland, England and Wales) • Drinking Water Quality Regulator in Scotland Responsibility • Maintaining EU and UK standards • Water Supply (Water Quality) Regulations 2010

16. Water regulationThe UK picture Regulators of the water environment • England and Wales - Environment Agency (EA) • Scotland - (SEPA) / Northern Ireland - NIPA Responsibility • Abstraction, use and pollution control/enforcement • The Water Act 2003, The Water Resources Regulations 2003 and 2006 • The Private Water Supply Regulations 2009 • Environmental Damage (Prevention and Remediation) • Regulations 2009

17. Water regulationThe UK picture Regulators of water health and safety • Health and Safety Executive (HSE) • Local authorities Responsibility • The Health and Safety at Work etc Act 1974 • The Water Supply (Water Quality) Regulations 2000 as amended • The Workplace (Health, Safety and Welfare) Regulations 1992 • Legionnaires’ disease The control of legionella bacteria in • water systems (ACoP and guidance) 2000 • Planning and Building Regulations

18. Water related diseases and waterbornepathogens • Water-related diseases include: • those due to micro-organisms and chemicals in water people drink; • diseases which have part of their lifecycle in water; • diseases with water-related vectors; • other diseases • Four main groups of organisms to consider: • protozoa (e.g. Cryptosoridium) • parasitic (e.g. Ascaris, Enterobius) • bacterial (e.g. E,coli, Salmonella, Leptospira, Legionella) • viral (e.g. Hepatitis A)

19. Water related diseases, waterborne pathogens and buildings • Where is water used? • Drinking • Sanitation • Washing • Cleaning • Catering • Heating/cooling • Humidifying • Aesthetics (water features/atria) • Landscaping/gardening • Fire protection • Laundry

20. Water related diseases, waterborne pathogens and buildings • Sources of contamination: • Mains • Harvested water • Systemic (commissioning and in use) • Other • “Filthy water cannot be washed!”

21. Water related diseases, waterborne pathogens and buildings • Sources of contamination: • Mains samples • Coliforms – 0.9% • TT E.coli – 0.03% • Vending machines and other dispensed drinking water • Coliforms – 4.4% • TT E.coli – 0.13%

22. Legionella a lesson in health and safety strategy

23. Legionnaires’ disease - background historyThe facts

24. Legionnaires’ disease - background historyThe outbreaks

25. Legionnaires’ disease - background historyStafford District General Hospital Outbreak • The investigation outcomes: • Inadequate cooling tower installation and commissioning led to cooling tower water achieving temperatures about 30oC when in use. • Lack of Operations & Maintenance manuals • System volume had been miscalculated by a factor of 2 resulting in the inadequate dosing of biocide into the systems • Change of water treatment company who continued to use inaccurate system volume data • The consultant microbiologist failed to take a lead role in the process of infection control

26. Legionnaires’ disease - background historyStafford District General Hospital Outbreak • The investigation outcomes (cont’d): • 6. The infection control technician role which provide the key link between the wards, clinicians and labs had been phased out the month before the outbreak • 7. Operating theatre staff who wished to maximise use of theatres prevented maintenance staff the time needed to turn off, clean and chlorinate towers • 8. The clinicians had not been told that legionella had been isolated from the cooling tower • 9. The hospital engineers had never been alerted to the health implications of the building services

27. Legionnaires’ disease - background historyStafford District General Hospital Outbreak • The investigation outcomes (cont’d): • 10. Nobody appeared to carry out regular checks on the efficiency of the water treatment • 11.The identification of two cases of influenza B virus in the suspect group delayed the ultimate identification that the problem was Legionnaires’ disease

28. Legionnaires’ disease - background historyStafford District General Hospital Outbreak Catastrophe Theory - Applied to Stafford District General Hospital by Brundrett (1992). • The formation of an error chain • Identification of a responsibility gap • Information difficulties • Poor control • Rigid and limited perception

29. Legionnaires’ disease - regulatory backgroundThe framework

30. Legionnaires’ disease - regulatory backgroundThe Approved Code of Practice

31. Legionnaires’ disease - regulatory backgroundOther considerations • Risk “ There is no need to prove that people are exposed to L. pneumophila, just that there is a risk that the organism may emerge” R v The board of trustees of the Science Museum (Court of Appeal 1993) • Enforcement - HSE “ the thrust of any... enforcement action is likely to be on proving:” • Water temperature in the appropriate range • Supply of nutrients available • Presence of aerosols • Potential for exposure • Not the presence of legionella

32. The Barrow in Furness outbreak of Legionnaires’ disease at Forum 28 - July and August 2002 The incident led to: • 5 deaths (previously 7) • 179 confirmed cases • Many more ill (flu like symptoms) • Investigation involving CPS, HSE, Cumbrian Police • Barrow Borough Council and Gillian Beckingham jointly charged with 7 counts of manslaughter • Council also charged under section 3 HASW 1974 • Gillian Beckingham also charged under section 7 HASW 1974

33. The Barrow in Furness outbreak of Legionnaires’ disease at Forum 28 - July and August 2002 Ten years on: • Trial - March / April 2005 • Trial - June / August 2006 • Public meetings following trial verdict (December 2006) • Report released following public meeting (April 2007) • Coroners inquest (June 2007) • Those affected by the outbreak

34. Legionella, a lesson in health and safety strategy? Policy Your statement of intent. It should; • Identify the requirements you want to comply with • Have clear objectives • Be authorised and signed by senior management • Be regularly reviewed • Be implemented “By definition, a government has no conscience. Sometimes it has a policy, but nothing more.” Albert Camus

35. Legionella, a lesson in health and safety strategy?Policy

36. Legionella, a lesson in health and safety strategy? Approved Code of Practise L8 • Comprises 5 main elements: • Identification and assessment of the risk • Managing the risk: management responsibilities, training and competence • Preventing or controlling the risk from exposure to legionella • Record keeping • Responsibilities of manufacturers, importers, suppliers and installers

37. Legionella, a lesson in health and safety strategy? Risk Assessment Your foundation document • Must cover all water systems present • Identify where exposure can be prevented or needs to be managed • It’s the beginning, not the end of the process • A living document • Should be reviewed at least every two years “There are risks and costs to a program of action. But they are far less than the longer range risks & costs of comfortable inaction” John F Kennedy

38. Legionella, a lesson in health and safety strategy? Responsibilities • “ the person on whom the statutory duty falls should appoint a person or persons to take managerial responsibility and to provide supervision for the implementation of precautions” L8 para 39 “You cannot escape the responsibility of tomorrow by evading it today” Abraham Lincoln

39. Legionella, a lesson in health and safety strategy? Responsibilities

40. Legionella, a lesson in health and safety strategy? Responsibilities

41. Legionella, a lesson in health and safety strategy? Responsibilities

42. Legionella, a lesson in health and safety strategy? Responsibilities Also extends to suppliers: • Covers competence, limitations of service and/or expertise and provision of information as well as… “ to ensure that any deficiencies or limitations identified in the system or written scheme are made known to the statutory duty holder or responsible person” L8 para 71(d)

43. Legionella, a lesson in health and safety strategy? Responsibilities Figure 6 - Report of the Public meetings into the legionella outbreak in Barrow-in-Furness, Aug 2022

44. Legionella, a lesson in health and safety strategy? Prevent or control - Written scheme You written scheme should include: • An up to date plan of all systems • A description of their safe operation • The precautions to be taken • The checks to be carried out • Remedial actions if the scheme is shown not to be effective “Underlying the whole scheme of civilization is the confidence men have in each other, confidence in their integrity, confidence in their honesty, confidence in their future.” Bourke Cockran

45. Legionella, a lesson in health and safety strategy?Prevent or control - Training Training requirements • All people involved in the management should be trained in the general requirements • The responsible person should have additional training to fully understand their role in the process • Those undertaking day to day activities should have additional training in these areas. This should be system/site specific • Levels of competency should be assessed for 3rd parties (UKAS/LCA/other/experience)

46. Legionella, a lesson in health and safety strategy? Record keeping Should include: • The persons responsible for the risk assessment, as well as those managing and implementing the written scheme • The significant findings of the risk assessment • The written scheme itself • The results of all works undertaken on the systems “History is a confused heap of facts.” Lord Chesterfield “History is a vast early warning system.” Norman Cousins

47. Legionella, a lesson in health and safety strategy? Record keeping • 34.2oC

48. Legionella, a lesson in health and safety strategy? Record keeping - Data Cooling tower dip slide results

49. Legionella, a lesson in health and safety strategy? Record keeping - Information Cooling tower dip slide results

50. Legionella, a lesson in health and safety strategy? Record keeping - Knowledge Cooling tower dip slide results