Legionella Risk Assessment

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Requirement to have a risk assessment

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Carrying out a legionella risk assessment and ensuring it remains up to date is required under the health and safety legislation and is a key duty when managing the risk of exposure to legionella bacteria. The requirement to have a risk assessment covers the person in control of the premises or responsible for the water systems in their premises. They have a legal duty to ensure that the risk of exposure to legionella bacteria is properly assessed and controlled. This duty extends to residents, guests, tenants and customers. It also covers those who have, to any extent, control of premises for work-related activities or the water systems in the building have a responsibility to those who are not their employees, but who use those premises.

Where a property has a number of occupiers the management contract should clearly specify who has responsibility for maintenance and safety checks, including managing the risk from legionella. Where there is no contract or agreement in place or it does not specify who has responsibility, the duty is placed on whoever has control of the premises and the water system in it, and in most cases, this will be the landlord themselves.

In estate management, it is increasingly common for there to be several duty holders in one building. In such cases, duties may arise where persons or organisations have clear responsibility through an explicit agreement, such as a contract or tenancy agreement.

The extent of the duty will depend on the nature of that agreement. For example, in a building occupied by one leaseholder, the agreement may be for the owner or leaseholder to take on the full duty for the whole building or to share the duty. In a multi-occupancy building, the agreement may be that the owner takes on the full duty for the whole building. Alternatively, it might be that the duty is shared where, e.g. the owner takes responsibility for the common parts while the leaseholders take responsibility for the parts they occupy. In other cases, there may be an agreement to pass the responsibilities to a managing agent. Where a managing agent is used, the management contract should clearly specify who has responsibility for maintenance and safety checks, including managing the risk from legionella. Where there is no contract or tenancy agreement in place or it does not specify who has responsibility, the duty is placed on whoever has control of the premises, or part of the premises.

All systems require a risk assessment, however not all systems will require elaborate control measures. A simple risk assessment may show that the risks are low and being properly managed to comply with the law (e.g. small domestic-type water systems). In such cases, further action may not be needed but it is important to review regularly in case of any changes and specifically if there is reason to suspect it is no longer valid. (para 25)

The ACOP states that a suitable and sufficient assessment must be carried out to identify and assess the risk of exposure to legionella bacteria from work activities and water systems on the premises and any precautionary measures needed. The duty holder is responsible for ensuring the risk assessment is carried out. The duty holder is either:
• the employer, where the risk from their undertaking is to their employees or others; or
• a self-employed person, where there is a risk from their undertaking to themselves or others; or
• the person who is in control of premises or systems in connection with work, where there is a risk from systems in the building, e.g. where a building is let to tenants, but the landlord keeps responsibility for its maintenance. (Para 28)

The duty holder must ensure that the person who carries out the risk assessment and provides advice on prevention and control of exposure is competent to do so. (Para 29).

The risk assessment must be regularly reviewed and specifically when there is reason to believe that the original assessment is no longer valid. The management and communication procedures should also be updated as appropriate. (Para 32)

The ACOP also states that before any formal health and safety management system for the water systems is implemented, the duty holder should carry out a risk assessment to identify the possible risks. (Para 33) The assessment also enables the duty holder to show they have considered all the relevant factors and the steps needed to prevent or control the risk. (Para 34)

Although the revised ACOP no longer states a review date, best practice would seem to be that the 2 year previously noted is being used as “regular”. However, if anything significant changes then the assessment should be reviewed sooner – this includes changes to the water systems and the persons in control.

Carrying out a the risk assessment
The risk assessment should consider all aspects of the operation of the hot and cold water systems and while there will be common factors; the individual characteristics of each system should be taken into account. Site personnel who manage the systems to determine current operational practice should be consulted. The commissioning, decommissioning, periods of operation, maintenance, treatment and subsequent management of each individual aspect of operation will require review and validation to ensure site procedures are effective.n control.
Failure to comply
The ACOP has been approved by the Health and Safety Executive, with the consent of the Secretary of State. It gives practical advice on how to comply with the law. If the advice it gives is followed then you will be doing enough to comply with the law in respect of those specific matters on which the Code gives advice. Alternative methods to those set out in the Code may be used in order to comply with the law. However, the Code has a special legal status. If you are prosecuted for breach of health and safety law, and it is proved that you did not follow the relevant provisions of the Code, you will need to show that you have complied with the law in some other way or a Court will find you at fault.
What next?
We would advise that a water hygiene risk assessment is carried out if there is not a current one in place for the site (within 2 years). If there is a document in place, review the contents to ensure that the written scheme and control measures are being maintained and monitoring is within the recommended guidelines. Review the current water hygiene programme if required. Confirm that the management structure and communication pathways are current and up-to-date. Confirm that there is a current schematic plan. Ensure that documents relating to the checks being carried out are stored and kept for 5 years.
Further reading

Legionnaires’ disease: The control of legionella bacteria in water systems. Approved Code of Practice L8 (Fourth edition) HSE Books 2013 www.hse.gov.uk/pubns/books/l8.htm

Legionnaires’ disease
Legionellosis is a collective term for diseases caused by Legionella bacteria including the most serious Legionnaires’ disease, as well as the similar but less serious conditions of Pontiac fever and Lochgoilhead fever. Legionnaires’ disease is a potentially fatal form of pneumonia and everyone is susceptible to infection. The risk increases with age, but some people are at higher risk, including the very young, people over 45, people already suffering from an illness (e.g. especially cancer, chronic respiratory or kidney disease, lung and heart disease or diabetes), people with an impaired immune system, smokers and heavy drinkers. Men also appear to be more susceptible than women but today women are not far behind.

The bacterium Legionella Pneumophila and related bacteria are common in natural water sources such as rivers, lakes and reservoirs, but usually in low numbers. They may also be found in purpose-built systems, such as cooling towers, hot and cold water systems and spa pools etc. If conditions are favourable, the bacteria may multiply, increasing the risk of Legionnaires’ disease, and it is therefore important to control the risk by introducing appropriate measures. Outbreaks of the illness occur from exposure to Legionella growing in purpose-built systems where water is maintained at a temperature high enough to encourage growth.

Legionnaires’ disease is normally contracted by inhaling small droplets of water (aerosols), suspended in the air, containing the bacteria. It is important to control the risk by introducing measures which do not allow proliferation of the organisms in the water system and reduce, so far as is reasonably practicable, exposure to water droplets and aerosol. There is an incubation period of 2-10 days before symptoms ranging from a mild influenza-like infection to full-blown pneumonia. In the cases of Pontiac fever and Lochgoilhead fever, the symptoms are a short fever without signs of pneumonia. In approximately 12% of reported cases, infection with Legionella bacteria is fatal. The level of fatalities is significantly higher among risk groups.

Proliferation of Legionella

Legionella bacteria occur naturally (in low numbers) in most natural sources of water and can survive at temperatures ranging from 6°C to 60°C. They can remain dormant at low temperatures and multiply readily at temperatures between 20°C and 45°C, (which is suitable for growth), providing they have a suitable supply of nutrients. Legionella bacteria are at their most virulent at 37°C. Legionella bacteria can obtain the nutrients that they need to multiply from a wide variety of sources, including algae, amoebae, sediment, sludge, scale, corrosion by-products, biofilms and other bacteria.
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