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Focus: Legionella management in dental practices
9th May 2011
In 1985, 175 people were admitted to Stafford Hospital with symptoms similar to that of a severe chest infection. Of those admitted, 28 died.
The cause was found to be Legionnaire's disease and the infection was traced to an air conditioning cooling tower on the hospital roof. On close examination, it was discovered that the sufferers were almost exclusively outpatients, as the hospital workers themselves displayed evidence of having developed antibodies to the disease.
Legionnaire's disease is caused by Legionella Pneumophilia, a variant of the pathogenic gram-negative bacterium Legionella, which thrives in temperatures of 25-45º Centigrade. The bacterium is particularly common in warm, damp environments such as hot tubs and swimming pools, but is most frequently found in cooling towers and air conditioning systems.
Legionella has been found to be capable of travelling over 6km airborne, thus explaining the magnitude of some outbreaks (the largest recorded Legionella outbreak was in Spain in 2001 where more than 800 suspected cases were recorded).
Presenting as flu-like symptoms, which develop 2-10 days after exposure, Legionnaire's disease has a fatality rate of between 5% and 30%, although the incidence of death is considerably lowered by the prompt administration of the appropriate antibiotics.
Because of the fatality rates and potential magnitude of outbreaks, anybody who owns a business, particularly one with a large volume of transient visitors, is required by law to establish a series of protocols in order to protect against the disease, and then undergo a ‘Legionella risk assessment' to prove the instigation of said protocols.
In 2002, Barrow-in-Furness suffered an outbreak that resulted in seven deaths centred on the town's art centre, after which Barrow Borough Council was sued for corporate manslaughter. The council was cleared of the charges but the case served to highlight the fact that the onus of responsibility rests firmly on the shoulders of those in charge of building representing the epicentre of the outbreak.
Dentists are particularly at risk here, with a constant stream of patients through the practice and the daily use of air conditioning systems, dental unit waterlines, tap water and compressed air. Although, like the staff at Stafford hospital, your employees may possess the antibodies to fight off the infection, your patients certainly will not and so are at seriously increased risk of illness.
Because of this risk, HTM 01-05's section on Dental Unit Water Lines states: 'In view of the expertise required in this specialized field, practices (through the Registered Manager) should engage with an external specialist to assist in meeting the recommendations given in…this guidance. This may be a locally-based engineering consultant with specialist knowledge of Legionella and other water-borne organisms.'[1]
This is in line with the Health and Safety at Work Act 1974 as well as COSHH regulations 2002, under which the majority of businesses and public use buildings are legally required to undergo a Legionella risk assessment. As the owner of your business, you are legally responsible for the maintenance of health and safety standards with regards to Legionella risk assessment, even after the assessment has been carried out, and you could be vulnerable to prosecution in the event of an outbreak.
You should therefore endeavour to determine several key factors in your Legionella management plan. A management assessment will be necessary to ascertain whether your on site employees are sufficiently well versed in the risks and management of Legionella exposure and you should put in a place a management and communication structure to control Legionella exposure within the practice. You will also need to collate the following:
• A detailed schematic of the water system
• A detailed assessment of the system's associated assets (tanks, heaters, sinks etc)
• An assessment of system usage
• Fully documented photographic evidence of any potential risk areas.
After you have assessed your current system you will need to create a priority-based list of remedial actions along with a detailed plan of how you will maintain your established procedures in the future.
Ensuring competent Legionella management is a time consuming and complex undertaking and, like so many areas of regulatory compliance, can be significantly helped by the employment of an outside agency.
Consultancy firm CODE offers a comprehensive Legionella risk assessment in conjunction with Water Hygiene Solutions, which is a certified member of the Legionella Control Association.
With highly qualified staff, including a PhD qualified microbiologist, Water Hygiene Solutions and CODE offer to undertake a full risk assessment, including drawing up all necessary schematics. They will then provide your team with full guidelines on water safety procedures and all the necessary paperwork to help you maintain a complete log of your safety activities to prepare you for any inspections.
As business owners, it is vital that you maintain a high standard health and safety and be prepared for any eventuality. With the potential severity of Legionnaire's disease it is not only your legal responsibility but also your social responsibility, to ensure that every possible measure has been taken to guard against infection.
Please visit www.CODEuk.com, email info@CODEuk.com or call 01409 254 354 for more information.
Reference
1. HTM 01-05 guidelines page 39.
Author
Paul Mendlesohn
CODEPaul Mendlesohn is chief executive of CODE – The Association for Dental Practice. CODE provides practice managers and owners with advice and support on practice management and business development, which include the Clinical Governance Made Simple programme and CODE Assure for CQC compliance.
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