Providers of health and social care premises statutory obligations for water safety are enforced by the health and safety Executive (HSE). The HSE Legionnaires’ disease technical guidance has lots of useful information and HSE control of legionella bacteria audit checklists (1 and 3) are also helpful. For detailed technical guidance on management of water systems in healthcare premises, please refer to:
- HSE Legionnaires’ disease. The control of legionella bacteria in water systems
- HSE Control of Legionella in hot and cold water systems in care services / settings using temperature
- Health technical memorandum (HTM) 04-01) Safe water in healthcare premises
For primary care settings, the CQC GP myth buster on legionella outlines expectations on legionella risk assessments and control measures.
UKHSA responding to the detection of legionella in healthcare premises describes when a healthcare premises should contact the UK Health security agency (UKHSA) health protection team (HPT). National guidance on Legionnaires’ disease is also available Legionnaires’ disease: guidance, data and analysis.
Settings with augmented care areas must ensure that the water quality is of a higher microbiological standard, which is dependent on both the type of service user and the augmented care areas intended use, as outlined in HTM 04-01 addendum Pseudomonas aeruginosa – advice for augmented care units.
There is no fixed definition of “augmented care”, but the description encompasses caring for service users with severe immunosuppression because of disease or treatment, including heavily immunosuppressed service users during high-risk periods in their therapy.
Infection prevention and control best practice guidance in water safety would be to include the following assessments in the practices regular water safety audit schedule:
- Has the practice undertaken an assessment by an approved water engineer?
- Is the practice undertaking the actions listed by the water engineer?
- Is water sampling being performed?
- Are weekly water temperature checks being performed at sentinel taps?
- Are flushes of little used outlets being performed at least twice weekly?
- Is there evidence of managing limescale?
- Is there evidence of quarterly cleaning, disinfection and limescale removal of showerheads?
- Have “dead legs” (water outlet in an unused area) been removed, if identified by the water engineer?
Please see our infection prevention and control water safety audit tool for use for primary care and care homes.