Legionnaires’ disease outbreak in Brisbane June 2013

The news about a man dying and another patient affected with Legionnaires’ disease associated with Wesley Hospital Brisbane sheets home the fact that it is not only cooling towers which are a source of legionella which in susceptible people may be fatal.

It is understood that this is the first case of someone dying in Australia from exposure to legionella through the warm water system. It is also understood that in Queensland there has been no requirement for warm water system routine testing or for risk control management measures to be in place at the hospital in Brisbane. Each Australian state and territory has their own response to this potential or now in Queensland actual public health problem.

It is thought that the hospital was running the water heating at too low a temperature to effectively kill off legionella as an energy saving measure.

Subsequent testing of warm water systems in hospitals in Queensland have generated positives to legionella at a number of different hospital sites.    Routine testing will now implemented in hospital warm water systems in Queensland.

In Victoria there has been a requirement for risk management including monitoring of legionella in potable water system.

At the URL http://www.health.vic.gov.au/legionella/waterdelivery.htm

“On 1 January 2010 the Public Health and Wellbeing Act 2008 and the Public Health and Wellbeing Regulations 2009 (the regulations) commenced. Regulation 62 requires that the responsible person must take reasonable steps to manage the risks of Legionella in water delivery systems in certain premises.

The ‘certain premises’ which the regulations apply to are:

Aged care
Health services
Health service establishments
Registered funded agencies
Correctional services
Commercial vehicle washes

The responsible person is any person who owns, manages, or controls the water delivery system.”

Warm water systems

Legionella has been detected in warm water systems associated with showers both in hospitals and in aged care facilities in Victoria. However, much of the evidence linking Legionella in warm water systems to cases or outbreaks of Legionnaires’ disease is from overseas. In Victoria we have seen persuasive evidence that a small number of sporadic cases of Legionnaires’ disease have been linked to warm water systems in health care and aged care facilities.. The only outbreak of Legionnaires’ disease associated with a warm water system was related to a water delivery system that stored warm water in a Victorian car wash facility.

The Department of Health recommends that the premises listed above should prepare a Legionella risk management plan for their warm water systems. More information relating to warm water systems is available by contacting the Legionella Team on 1800 248 898 or by emailing Legionella@health.vic.gov.au

Car washes

Because a car wash facility was linked to 7 cases of Legionnaires’ disease in 2008, these car wash facilities have been included in the list of certain premises that must control the risk of Legionella.

What are the risks for a car wash facility?

Legionella is a ubiquitous organism in the environment and can be found in very low concentrations in the potable water supply. The Legionella bacteria are able to multiply when they find a suitable environment. Risk factors for Legionella growth in car washes are:

Warm water stored at temperatures between 30°C and 60°C
Rubber hosing
Absence of a biocide
People may contract Legionnaires’ disease if they are exposed to small droplets containing the bacteria, like those produced by high pressure hoses.

The department recommends that all car wash facilities assess the risks associated with there systems and prepare a Legionella risk management plan.

To manage the risks associated with Legionella, the following should be considered:

Not using warm water at temperatures between 30°C and 60°C
Replacing warm water storage with instantaneous units
Replacing rubber hosing with poly tubing, metal tubing or clean copper tubing
Regularly disinfecting the system with a chlorine based disinfectant.”

In practice this has meant hospitals for example have routinely testing warm water systems for legionella and have ensured where wards have been out of service for some time that the plumbing system is flushed prior to use as part of recommissioning the ward.

(MB 5th July 2013)

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