Why Legionella is a Big Risk in Care Homes

Over the past decade, the risk of legionella in residential nursing and care homes has increased. As recently as January 2016, Reading Borough Council was made to pay £120,000 after a fatal incidence of Legionnaires ’ disease at a council-run care facility; many other homes have been fined by the HSE and CQC simply for failing to carry out compliant legionella risk assessments.

But are the risks of legionella significantly higher in care homes than in other sectors? Or should facilities managers apply no greater precautions than they would elsewhere?

Here’s what we think are the risk factors care homes ought to consider when it comes to legionella control.

The elderly are a high-risk demographic

The likelihood of contracting Legionnaires’ disease is related to:

  • Level of contamination in the water source.
  • The ability of the water source to generate aerosols.
  • Susceptibility of the person exposed to the contaminated water.

Not everyone exposed to legionella bacteria becomes sick. You’re more likely to develop the infection if you:

  • Smoke. Smoking damages the lungs, making you more susceptible to all types of lung infections.
  • Have a weakened immune system. This can be a result of HIV/AIDS or certain medications, especially corticosteroids and drugs taken to prevent organ rejection after a transplant.
  • Have a chronic lung disease or other serious condition. This includes emphysema, diabetes, kidney disease or cancer.
  • Are 50 years of age or older.

Legionnaires’ disease can be a problem in hospitals and nursing homes, where germs can spread easily and people are vulnerable to infection.

The elderly are a high-risk demographic for legionella. According to a report “Legionnaires’ disease in residents of England and Wales” published by Public Health England in 2016, more than 84% of confirmed cases of Legionnaires disease were detected in people with an age group of more than 50 years.


The report further shows the proportion of cases with one or more reported underlying medical conditions/risk factors in 2016 was 74.6%.


Other Risk Factors in Care Homes

Care homes often require bigger and more complex water systems than typical households due to the number of residents and the components and services needed, size and complexity of the building, multiple en-suite facilities, assisted bathrooms, and commercial-grade catering facilities.

These facilities will have many hot and cold water taps, showers, sinks, and other sources of water available.

Some of these water outlets will be in regular use, whereas others may hardly see any use at all.

This alone poses a problem because a lack of use significantly raises the risk of water stagnation and colonisation by Legionella bacteria.

The bacteria like warm surroundings between 20-45 degrees Celsius, especially when water does not flow (or at least not often).

Dead legs and dead ends in pipework and infrequently used taps, outlets, and services all raise the risk factor.

These are also common in older buildings used as care homes, hospitals, or similar venues, where water system design and usage may change over the years.

Larger and more complex water systems can be more difficult to keep under control and represent a greater potential for problems.

How to Prevent & Control Legionella in Care Homes?

As with all businesses, care homes and nursing homes have a duty of care concerning the health and safety of their residents, staff and visitors. Every care home establishment should enlist a duty holder who must take suitable precautions to prevent or control the risk of exposure to legionella.

The first step in controlling the risks from Legionnaires’ is to understand or assess the nature of the water system – its complexity, the demands placed upon it, who uses it, and where the specific risks are.

This type of in-depth assessment makes it easier to understand how to manage, maintain, and treat the system.

Regardless of the level of care or the standards to be applied, the key to managing the risk is the implementation of the following five steps, as advocated under the HPSC National Guidelines of Control of Legionellosis in Ireland and ACOP L8:

  • Appoint a manager to be responsible for others;
  • Identify and assess sources of risk (i.e. carry out risk assessments);
  • Prepare a scheme to prevent or control risk (water safety plan);
  • Implement, manage and monitor the scheme of precautions;
  • Keep records of the precautions.

The written scheme of control (WSOC) details who does what, and how; it needs to specify measures to take to ensure that risk assessment remains effective and should be laid out clearly in an easily accessible manner.

Are You Doing Everything to Prevent a Legionella Outbreak in Your Care Home?

As care homes are highly vulnerable to a Legionella outbreak, strict management systems must be in place to eliminate or manage and control the risks associated with legionella bacteria.

It may never be possible to eradicate these risks completely, but following the guidance provided above and that issued by the HSE will help duty holders and responsible persons perform their roles efficiently.

Water Treatment Ireland Ltd provides water hygiene and treatment services to numerous care homes and hospitals across the Republic of Ireland. We understand the pressure that institutions are under to provide good quality care to patients.

Our risk assessors will always carry out an extensive risk assessment of all of the water services within the premises and provide easy to understand recommendations that will guide you to full compliance.

Once you have a strong legionella prevention plan in place, the risk is kept to a minimum and it’s easy to keep on top of your responsibilities.

Talk to our team to know how we can help you ensure the safety of your residents and stay compliant with legislation.