Legionella (associated) risk management. Andrew Vickers Health Protection Programs Public Health Services SA Health
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1 Legionella (associated) risk management Andrew Vickers Health Protection Programs Public Health Services SA Health
2 Overview > Legionella associated risks in hospitals and aged care facilities > Legionella associated risk management planning > Responding to Legionella detection
3 Potable water delivery systems > Focus on potable water distribution systems and attached equipment and installations in high risk facilities > Legionella associated risk management starts at the incoming water meter > Cooling towers: comply with the regulations and increase monitoring during periods of high temperature.
4 Hazard and risk > A hazard can cause harm or adverse effects (to individuals as health effects or to organisations as other adverse effects). > Risk is the chance or probability that a person or organisation will experience an adverse effect if exposed to a hazard. > Legionella is a complex hazard in hospital and aged care facility water systems.
5 LP1 notification statistics SA > LP1 cases: 5 year average ( ) = 13.4 cases per year (67 total) > 47 confirmed cases, 20 probable > 59 hospitalised, 7 not hospitalised, 1 unknown > 45 males, 22 females > Highest number of notifications in the 60 to 64 age group (17.9%) 8 > 60% of notifications for 7 6 persons aged > 60 years 5 > Legionellosis fatality rate has been reported as ranging from 5 to 30 per cent, depending on the underlying risk factors of the patients (Source: CDI Vol 26, No 3, 2002) No. of Notifications per (Totals Only) Period 01 Jan 2009 to 17 Mar 2014 (Calculated Onset Date) - Legionella pneumophila Serogroup /1 2009/4 2009/7 2009/ /1 2010/4 2010/7 2010/ /1 2011/4 2011/7 CalculatedOnsetDate Totals Only 2011/ /1 2012/4 2012/7 2012/ /1 2013/4 2013/7 2013/ /1
6 Comparison to other health risks > Road crashes on South Australian roads (source: SAPOL) kill a person every 2 to 3 days injure 24 people each day admit 4 people to hospital every day > Pedal cycle crashes constituted 17.4% of all traffic crashes resulting in hospital admission in 2010 (Source: Centre for Automotive Safety Research, Adelaide University) > Five year SA notification averages (source: CDCB) HIV 52 cases per year Hepatitis B 42.6 cases per year > SA notifiable workplace fatalities (Source: Safework Australia) > 14 people drowned in SA in FY (Source: RLSS Australia) > In the 12-months to 1 December 2013, South Australian players scored 35 division one prizes across all lotto products from SA Lotteries, equating to more than $37 million in division one prize money (Source: SA Lotteries)
7 Legionella related risks Routine water sampling Routine public health inspection Legionnaires disease investigation Risk event Legionella detection in water infrastructure Non-compliance identified by regulator Case or outbreak of Legionnaires disease Breach of duty of care identified Public health enforcement Media attention Union involvement Safework involvement Funding compliance audits Coronial investigation Possible adverse effects Legal action (civil / criminal) Operational impacts Reputational damage Financial implications Political response Public health risk Organisational risk
8 High risk facilities v high risk systems > The Legionella Regulations focus on high risk manufactured water systems (warm water systems) > All types of potable water system (residential and commercial) can (and do) become colonised with Legionella bacteria > Healthcare and residential aged care facilities are high (health) risk regardless of the types of systems > Managing the risk requires a deliberate and coordinated effort
9 Water system risks vs infection risks Water system risks Infection risks Factors that increase risk of contamination of water, microbial colonisation of facility water infrastructure and subsequent proliferation of Legionellabacteria within the facility water systems Factors that increase the risk of a person contracting Legionnaires disease from a facility water system
10 Some Legionella headlines
11 The Wesley Hospital >
12 Legal action
13 SA Public Health Act 2011
14 Be proactive, prepare and implement a plan > Just complying with the minimum requirements of the SA Public Health Legionella regulations is not sufficient to manage the risks.
15 Establish a risk management system
16 Analyse your risk
17 Manage your risk
18 Potable/drinking water in high risk facilities > Water safety guidance designing and implementing water safety risk management plans
19 Responding to Legionella detection > Warm water system: immediately shut down and prescribed decontamination procedure (sch 3 pt 2). > Cooling water system: <1000 cfu/ml follow AS (table 3.1), 1000 cfu/ml immediately shut down and prescribed decontamination procedure (sch 3 pt 1). This requires a double drain of the entire system. This can not be done online an extended shut down is required. Can t shut down??? - consider a Ministerial Approval alternative decontamination application. > Unregulated system: refer to your Legionella (associated) risk management plan / water safety plan.
20 > enhealth guidelines Future directions > Investigation guidelines > Review of regulations
21 Health Protection Programs SA Health Ph Protecting public health > water quality > Legionella regulations and guidelines QUESTIONS?
22
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