How to Conduct a Legionella Risk Assessment

Legionella is a serious health risk that affects all kinds of people, particularly sick patients. It falls to employers to ensure their GP surgeries and pharmacies don’t encourage the pathogen to grow in their water supplies.

Without proper supervision, you could end up inflicting life-threatening illnesses on anyone who encounters the legionella virus. Employers could then end up facing unlimited fines, business closure, and imprisonment.

Peninsula offers expert advice on how to manage the risks of legionella. We also offer 24-hour H&S advice – helping you eliminate dangerous pathogens found in your GP practice. Call us on 0800 028 2420 to book a free consultation with our Health and Safety consultants today.

Now, let’s take a look at what legionella is, where it’s found, and what the laws are around protecting vulnerable people from such dangerous pathogens.

What is Legionella?

Legionella is a type of bacteria that causes fatal forms of pneumonia. The pathogen is linked to all kinds of respiratory illnesses; the biggest one, Legionnaires’ Disease.

Legionella bacteria is originally found in natural environments like ponds, rivers, lakes, and reservoirs. However, the conditions are rarely aligned enough for people to contract it. Instead, it’s found in poorly managed water supplies like:

• Water systems.
• Cooling towers.
• Evaporative condensers and humidifiers.
• Hot and cold-water systems.
• Spa pools, hot tubes, and saunas.
• Indoor ornament fountains.

If your GP surgery or pharmacy owns water sources like these, you must ensure they’re safe to use. Without proper GP health and safety procedures, you could end up putting your patients’ lives at risk of contracting this deadly pathogen.

How is legionella contracted?

When people encounter legionella disease, it’s usually done through inhalation. They’ll breathe in small droplets of water that contain the lethal pathogen.

Whilst the risk of contracting legionella through natural habitats is low, the case is quite the opposite for man-made water sources. There are many reasons for what causes legionella. For example:

• The temperature in some or all parts of a water system is between 20-45°C (which encourages bacteria growth).
• Breathable water droplets are made and dispersed through devices, like cooling towers or water outlets.
• Devices have storage areas where water is saved and re-circulated.
• Bacterial cultures grow certain types of nutrients (like in rust, sludge, or organic matter).

What is Legionnaires disease?

Legionnaires disease is a severe form of pneumonia, which can be contracted after inhaling tiny droplets of contaminated water containing Legionella. Whilst uncommon, it is highly serious and can be potentially fatal.

It can cause a variety of physical symptoms, such as a long-term cough. There is treatment available for the condition. For example, affected individuals might receive antibiotics, or even a machine to aid breathing. Other symptoms include:

• Shortness of breath.
• Chest pain or discomfort.
• A high temperature.
• Flu-like symptoms.

Regardless of the severity of the condition - or the treatment options available, you must remove or reduce the risk of Legionnaires disease occurring in your workplace.

Who does legionella affect?

Symptoms of legionella can affect anyone; however, there are certain patients who are more susceptible to dangerous viruses, like Legionnaires’ disease. For example, patients who:

• Are over 45 years old.
• Smoke and drink alcohol heavily.
• Receive certain medical treatment (like chemotherapy or organ transplants).
• Have heart conditions or respiratory issues.
• Have a weak or suppressed immune system.

Signs of legionella include coughs, shortness of breath, chest pains, and feverish temperatures. Despite flu-like symptoms, legionella is not contagious. Vulnerable people, particularly those with respiratory problems, can suffer from long-term health issues or even fatalities.

What is the law on managing legionella?

In the UK, employers are legally obliged to minimise any health and safety risks that could potentially harm people within their premises – including legionella prevention.

GP practices and pharmacies must comply with all relevant legislation, including regulations outlined by the Care Quality Commission (CQC) and the Health and Safety Executive (HSE). Let’s look at all forms of legionella regulation:

The Health and Safety at Work Act 1974 (HSWA)

Under the Health and Safety at Work Act 1974 (HSWA), employers must ensure the health, safety, and welfare of all their staff through reasonable measures and safe working practices within your GP premises.

The Control of Substances Hazardous to Health Regulations 2002 (COSHH)

Under the Control of Substances Hazardous to Health Regulations 2002 (COSHH), employers must ensure any harmful materials found on their premises are managed properly. This includes toxic pathogens, like legionella, which has the potential to cause serious to fatal infection.

The Health and Safety Executive’s Approved Code of Practice (ACOP)

Under the Approved Code of Practice and Technical Guidance (L8), employers are expected to follow advice on legionella testing kits to help ensure all water systems within their GP practices are safe to use.

The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR)

Under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR), employers must report any legionella illness connected to their GP surgery or pharmacy. This includes anyone who’s worked on water systems that have been contaminated by legionella bacterium.

How to prevent legionella in water systems

From risk assessments to replacing equipment, there are numerous ways to help prevent deadly legionella pathogens. The main methods include temperature control, cleaning maintenance, and proper plumbing.

Water systems within GP surgeries or pharmacies should meet the following standards:

• Cold water must be stored below 20°C.
• Cold water must be distributed below 20°C.
• Hot-water storage cylinders should store water at 60°C or higher.
• Hot water must be distributed at 50°C or higher.

 Water systems must be reviewed regularly, and only by a competent person with the right training and qualifications. They’ll inspect, clean, and maintain them in accordance with legionella risk assessments.

 Legionella is often found in areas with stagnant water, like unused outlets (showers, taps, and toilets). These should be cleaned weekly and descaled quarterly. Water storage tanks should also be checked for signs of debris and corrosion.

Plumbing is another area where legionella is often found. Employers must ensure their water pipes:

•   Are as short and direct as possible.
•  Are protected from contamination (like with tank lids or insect screens).
• Have adequate insulation.
• Use material that doesn’t encourage legionella growth.

Employers must check distribution temperatures on sentinel outlets regularly. This includes those closest and furthest away from water tanks or cylinders. Hot-water cylinders are checked monthly; and cold-water cylinders are checked every six months.

What occupations are most at risk of spreading Legionella?

Several occupations are more at risk of spreading Legionella than others, for example, hair salon owners. Essentially, Legionella can occur in any workplace where water systems are present. This includes:

• Dental and orthodontic surgeries.
• Leisure centres with water systems, such as a spa or pools.
• Hospitality settings, such as a restaurant or cafe.

Any workplace that operates water systems has a risk of Legionella bacteria growth. Which is why - if you own a business such as the above - you must perform a Legionella risk assessment.

What is a Legionella risk assessment?

A Legionella risk assessment is an evaluation of the risks posed by water systems - specifically used in domestic premises, buildings and commercial properties.

As part of Legionella control, property managers and employers conduct Legionella risk assessments. These assessments determine whether Legionella is present in your workplace. But, they can also advise on what control measures you must implement to reduce or remove the risk of harm.

How much does a Legionella risk assessment cost?

The cost of a Legionella risk assessment varies depending on the size and scale of your business. For example, if you own a small dental practice - the cost will be approximately £200.

Medium-to-larger sized enterprises will have an increased cost, beginning at £500. But, these are just estimates - for more information, request a quote from a water treatment company.

Is a Legionella assessment mandatory?

Yes, a Legionella risk assessment is mandatory in any premises that operate a water system. As advised by the UK Health and Safety at Work Act (1974), employers are responsible for the Health & Safety of their staff, and any visitors to their company.

Meaning, business owners must conduct a sufficient assessment of their work to identify any health hazards or substances hazardous to health. If your workplace operates water systems, then your risk assessment must check the risk of Legionella - as well as the likelihood of harm occurring.

Either way, when properly undertaken, a Legionella risk assessment will help you implement suitable precautions to mitigate the danger. Remember, if your workplace has five or more employees, it's a legal requirement for you to record your findings.

However, all businesses must be able to demonstrate how they manage Legionella risk - recording your risk assessment is simply the easiest way to do this.

Who can carry out a Legionella risk assessment?

Health & Safety law says you must appoint a 'Legionella responsible person' to carry out your Legionella risk assessment. This person will be in control of:

• Ensuring your legal compliance.
• Identifying Legionella hazards.
• Assessing the risk of harm.
• Implementing control measures to prevent harm.

The person you decide to appoint doesn't have to be a part of your key personnel. But they do have to be equipped to assess the risks of Legionella in a technically competent manner. For example, they might have had Legionella awareness training, or be familiar with conducting risk assessments.

Ultimately, these health regulations help to create a work environment where all staff are safe from harm.

What happens if you don't perform a Legionella risk assessment?

You could face severe consequences if you don't perform a Legionella risk assessment and your workplace has water systems.

First and foremost, you'll likely increase the risk of Legionella bacteria spreading. Which, if left untreated could cause adverse health effects, such as Legionnaires disease.

Additionally, you might have your legal non-compliance investigated by the Health and Safety Executive (HSE). As a result, you may face fines, legal proceedings, and even reputational damage.

How often should a Legionella risk assessment be reviewed?

The HSE's approved code of practice advises that employers perform risk assessments annually. But, depending on the situation, a Legionella risk assessment might need to be conducted more often.

For instance, the HSE also asks employers to conduct routine testing for Legionella quarterly. If your test reveals that the amount of Legionella in your water has changed, you should review your Legionella risk assessment.

This assessment should also be reviewed regularly if your workplace experiences significant changes. For example, if you hire more employees, or open another water facility.

How to do a Legionella risk assessment

There are several steps involved in a Legionella risk assessment. It's slightly different from a general risk assessment, as there's just one hazard you need to evaluate. But, you still must do everything you reasonably can to assess this risk properly, and comply with the relevant legislation.

Let's explore the steps in further detail:

Evaluate who is affected

The first step you should take in your Legionella risk assessment is to evaluate who is at risk of being affected by Legionella. For example, if these are younger members of staff, they'll have a low risk of contracting a severe type of Legionnaires disease.

However, if you employ older staff members, they'll have a higher risk level of being severely impacted by Legionella growth. Ensure your assessment also includes those with disabilities or any pregnant workers.

Assess both water systems

Next, you need to assess both the hot and cold water system. Depending on what system you use will affect the chance of Legionella risks. You need to confirm whether these are:

• Mains fed, or;
• From a water storage, or;
• A combination of both.

If any part of your system collects water from storage, you'll have a higher risk of Legionella spreading throughout. This is because stagnant water is ideal for Legionella bacteria growth. If your water comes from storage, you'll need to work out what measures to implement to prevent Legionella from spreading.

Record water temperature

Now you've assessed the above, you need to record the temperature of your water systems. This is so you can ensure that their temperature won't enable the growth of Legionella bacteria.

Your hot water cylinder and systems need to be above 50°C, and your cold water systems need to be under 20°C. The only exception is if you already have secondary disinfection systems in place.

Identify and assess potential risks

After recording the temperature of your water systems, you can begin identifying the risks within. For example, you might need to assess the risk that redundant pipework in your cold water tank poses.

Or you might need to work out how to properly maintain certain equipment, such as any thermostatic mixing valves. Either way, it's important to evaluate every aspect of your water system. Otherwise, you might fail to identify risk - which could cause harm to staff or visitors.

Implement control measures

Once you've identified the risks within your water systems, you must prevent the risk from occurring, or remove it completely. If you can't eradicate the risk, then you must control it instead.

For example, if your workplace has evaporative cooling systems, you'll have a higher risk of Legionella growth. This is because the water used for cooling becomes stagnant in the process. So, to control the risk, you should appoint someone to regularly monitor and maintain the system.

Download our free risk assessment template today, which is ready to use when required.

Review your risk assessment regularly

Now you've finished your risk assessment, you should record the results. This is one of your legal obligations if your workplace employs five or more people. But it's also useful as a point of reference for future assessments.

If you operate more complex systems, it's worth contacting the Legionella Control Association. They can offer further advice on assessing your workplace for Legionella, as well as what control measures you should implement.

Get expert advice on managing legionella with Peninsula

Poor temperature controls, dead-leg pipes, and unused water fixtures – any of these can host traces of legionella. That’s why it’s important for employers to eliminate the deadly bacteria within their GP surgeries and pharmacies.

Peninsula provides expert advice on managing legionella. We offer 24-hour H&S advice – ensuring your business premises are free from lethal pathogens and viruses.

Want to find out more? Contact us on 0800 028 2420 and book a free consultation with one of our Health and Safety consultants today.