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Learning about Legionella
“There has been great public interest in the increasing incidence of Legionnaire’s Disease. Outbreaks have been reported in Europe, Australasia, the U.S.A., as well as the UK. The reported causes of this disease range from bacteria in showerheads to spray from cooling towers, air conditioning systems and even contaminated drinking water. There is uninformed theory and discussion which has not, at present, led to firm diagnosis of the cause or remedy.”
So said the December 1980 issue of ‘Waterline’, the newsletter of the Industrial Water Society (IWS), in a preamble on the major conference on Legionnaires’ disease that the then IWS was due to host in May 1981 in order “to put the facts as currently known before the public, industries associated with the problem and before the world press.”
First set up in 1976 as the Cooling Water Association, the IWS paved the way in encouraging companies to think about water consumption, to look at water use within buildings and ensure used water was cleaned up before being discharged to the drains. The society set up some of the first training courses and meetings on water management issues and ran definitive conferences, such as the one described above, on the emerging problem of Legionnaires’ disease.
What is Legionella?
The Health & Safety Executive defines Legionellosis as 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 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 water systems such as cooling towers, evaporative condensers, hot and cold water systems and spa pools.
If conditions are favourable, the bacteria may grow increasing the risks of Legionnaires’ disease and it is therefore important to control the risks by introducing appropriate measures outlined in Legionnaires’ disease – The Control of Legionella bacteria in water systems (L8).
The current picture
In present day, the ‘Water Management Society’ (WMSoc), as the IWS has been known since 1998, still aims to raise the bar as a leading source of expertise on Legionella awareness and training. It has a strong role in producing new guidance and was a collaborator alongside the Health and Safety Executive and other organisations in the recent review of the L8 Approved Code of Practice (ACOP) on [Legionella] (fourth edition) and this year’s accompanying technical guidance HSG274.
Today, WMSoc provides up-to-date instruction on how to prevent Legionnaires’ disease within various water systems, including cooling towers, and provides a forum for connecting members to other professionals and statutory bodies within the water management industry. The society also has a strong focus on prevention of other waterborne infections such as Pseudomonas aeruginosa and Stenotrophomonas maltophilia.
WMSoc’s most recent conference ‘Fifty Shades of Water Management’ covered a wide range of practical aspects of water engineering. On the health side it provided a focus for delegates to learn more about a variety of potential waterborne pathogens from Professor Kevin Kerr of the Harrogate and District NHS Foundation Trust and Hull York Medical School, while Dr Sam Collins from Public Health England looked at the advantages and limitations of rapid testing for Legionella bacteria in water samples.
This referenced DNA-based polymerase chain reaction (PCR) methods and immunomagnetic, MALDI ToF (matrix assisted laser desorption ionisation time of flight), looking at the relationship between results obtained using rapid techniques and classic culture methods. A fruitful discussion noted that PCR can be used to detect dormant but live (viable but not culturable [VBNC]) bacteria that cannot be detected by culture, and noted that results can be produced in hours rather than the days required by culture.
How cutting edge procedures can be compromised by poor hand washing, and how first risk assessments need to be carried out at the design stage rather than failing to consult infection control professionals at this stage, were just some of the topics covered during the conference’s workshops.
Another Water Management Society conference late last year focused on the new Pseudomonas aeruginosa guidance in the HTM 04-01 Addendum, ‘Pseudomonas aeruginosa – advice for augmented care units.’ Speakers discussed the contribution to the guidance of the most recent thinking, research and experience, including from leading plumbing product manufacturers, on minimising the risk of growth and spread of the organism in healthcare plumbing systems. The guidance’s publication in March 2013 followed the death, just over a year earlier, of three young infants in the neonatal intensive care unit (NICU) at Belfast’s Royal Jubilee Maternity Hospital (RJMH) from Pseudomonas aeruginosa-related infection. The source was subsequently identified as six hand washbasins.
WMSoc draws its membership from water treatment suppliers, scientists, engineers, manufacturers, consultants and facilities managers from both the UK and overseas.
As a not-for-profit organisation, the society offers its members a wide range of benefits including: City and Guilds accredited training courses, such as practical risk assessment including an extensive practical element and a detailed study of the HSE’s Approved Code of Practice; further practical and technical training on responsible management of water in both the public and private sectors; specialist on-site training; conferences and national and regional events and seminars; and publications at reduced rates.
The society produces a wide range of publications on managing Legionnaires’ disease in different systems and provides the latest industry news and guidelines in the quarterly ‘Waterline’ journal. This features technical papers and articles, current thinking in water management, products and systems, case histories and plant descriptions.
As WMSoc member, independent water consultant Paul Nolan, Water Hygiene Ltd, says: “WMSoc membership brings a broad approach to developing skills in the water hygiene world. For me, membership is continual learning and knowing I can obtain answers to challenges from the vast experience of other members and the Society ‘Waterline’ journal.”
The Water Management Society’s next event will be ‘Water Safety Plans: what do they mean to me?’, which will be held on 11 December in London. Water Safety Plans and Water Safety Groups and Teams are integral to the latest UK legislation and guidance on Legionella and Pseudomonas.
Speakers will include Dr Susanne Lee, former Director of the Health Protection Agency’s London Regional, Food Water and Environmental Microbiology Services Laboratory (LFWE) and co-director of the Legionella consultancy, Dr Mike Weinbren, Consultant Microbiologist at the Chesterfield Royal Hospital and George McCracken of the Belfast Health and Social Care Trust (BHSCT). Mr McCracken is the head of estates at the Belfast Trust and was responsible for delivering engineering solutions to address the immediate aftermath of the Pseudomonas aeruginosa incidents described above.