Drink it or Sniff it? IHEEM Technical Platform May 2014 Seminar - PDF document

15/05/2014 Drink it or Sniff it? IHEEM Technical Platform May 2014 Seminar Legionellosis Risk Assessment Dr Nick Hill, Research & Development Director, Water Hygiene Centre (Chair of the IHEEM Water Technical Platform) Content • Some of the regulations don’t work; • Beware of the Public Relations Officer; • Get risk into perspective; • Understand inherent and actual risk; • Rainwater recovery is a fashion; • Stones always have beetles under them; • If you use a contractor as a consultant, it serves you right; • PFI Change Control Notices are great for door handles. Water Hygiene Centre 1

15/05/2014 Drink it or Sniff it? • TVC count of 10 cfu/mL is 10,000 cfu/L. • This TVC 10,000 cfu/L count is relatively boring, but.. • A Legionella count of 10,000 cfu/L is “quite interesting”. Small Bag of Acid Tennis Court Water Hygiene Centre 2

15/05/2014 HSG 274, Part 2 – Draft for Comment • Water components that may increase risk of colonisation:- – TMVs – Proximity operated taps – Flexible hoses Water Hygiene Centre 3

15/05/2014 What is ALARP? • It will depend on the risk • There will be an ALARP for design, monitoring, maintenance, etc • It’s a balance of risk, cost and difficulty • It’s not as low as possible Which is higher risk? Water Hygiene Centre 4

15/05/2014 Now which one is riskier? High active risk Low active risk Which is higher risk? Low inherent risk High inherent risk Water Hygiene Centre 5

15/05/2014 Now which one is riskier? High actual risk Low actual risk Which is higher risk? Cold water storage Cooling tower Water Hygiene Centre 6

15/05/2014 Now which is riskier? Cold water tank internals Cooling tower internals Now which is riskier? Leukaemia ward Office block Water Hygiene Centre 7

15/05/2014 Now which is riskier? Office block Leukaemia ward Water Hygiene Centre 8

15/05/2014 Abstractions – England and Wales Water Hygiene Centre 9

15/05/2014 Legionella Testing as Part of Routine Risk Assessment? Water Hygiene Centre 10

15/05/2014 Actions Taken • Local cleaning and disinfection • Tanks cleaned and disinfected • Flushing • Resampling • Wider sampling Water Hygiene Centre 11

15/05/2014 Tank 1 (linked to tank 2) Tank 2 (linked to tank 1) 19 o C 15 o C Water Hygiene Centre 12

15/05/2014 Showers Summary • Failed to identify that one of two shower heads was not being used, ie stagnant • Failed to identify multi-function shower head, with potential stagnation • Failed to recognise that one of the supply tanks to the shower was stagnant • Incorrect recommendations – repeated sampling and disinfections not the answer! Water Hygiene Centre 13

15/05/2014 �������� Recommendations for Calorifier 1 �������� Water Hygiene Centre 14

15/05/2014 Recommendations for Calorifier 1 �������� Recommendations for Calorifier 1 �������� Water Hygiene Centre 15

15/05/2014 Recommendations for Calorifier 1 �������� Failed to notice 2 out 3 shunt pumps upside down Water Hygiene Centre 16

15/05/2014 Their picture… My picture…. ? Water Hygiene Centre 17

15/05/2014 Are we sure what calorifier temperature should be? Calorifiers Summary • Inappropriate recommendations for DHW testing for Legionella • Did not spot shunt pumps upside down • Did not spot DHW flow restriction • 2 different recommendations for calorifier temperature – both wrong! • Failed to take any DHW return temperatures (presumably don’t have a contact temperature probe?) Water Hygiene Centre 18

15/05/2014 PFIs and the Change Control Notice • Can be too slow when there is imminent danger; • MHSWR – cooperate and coordinate? • Acute hospital with the tank support defect; • Alert issued November 2013, not resolved by April 2014. Content • Some of the regulations don’t work; • Beware of the Public Relations Officer; • Get risk into perspective; • Understand inherent and actual risk; • Rainwater recovery is a fashion; • Stones always have beetles under them; • If you use a contractor as a consultant, it serves you right; • PFI Change Control Notices are great for door handles. Water Hygiene Centre 19

15/05/2014 Drink it or Sniff it? IHEEM Technical Platform May 2014 Seminar Legionellosis Risk Assessment Dr Nick Hill, Research & Development Director, Water Hygiene Centre (Chair of the IHEEM Water Technical Platform) Water Hygiene Centre 20