Not even healthcare organisations are exempt from Legionella outbreaks. Andy Smith, National Business Development Manager, Clearwater Technology, explains how they can be best avoided

For hospitals and healthcare organisations, preventing patients, staff and visitors from contracting Legionnaire’s disease is an everyday battle. The potentially fatal disease is at its most deadly in healthcare facilities, with new-born and elderly patients the most susceptible due to immunosuppression.

Legionnaire’s is caused by bacteria that can lurk in water systems and managing the risk should be of major importance in healthcare facilities. In order to safeguard patients, staff and all other visitors, facilities must implement effective Legionella control schemes that include regular monitoring. Only then can the risk be effectively controlled.

Implement a temperature control regime

Legionella bacteria naturally breed in fresh water; and therefore may be impossible to completely eradicate from any influent water source. Legionella become active when water is between 20C and 60C in temperature, therefore a temperature control regime is commonly used as a control measure for Legionella bacteria. In these instances, monitoring and record keeping is a major element of managing the risk, and providing evidence of risk management. Diligent record keeping is also critical to monitor the effectiveness of the control regime.

Introduce secondary disinfection measures

A further step in controlling the risk is introducing secondary disinfection measures. Secondary disinfection is the process of preventing the growth of pathogens throughout the entire water system by maintaining a consistent quality in the microbiological makeup of the water. Continuous secondary disinfection solutions can include Chlorine Dioxide (ClO2) dosing, Ultra-Violet (UV) disinfection and other chemical dosing systems. They can help reduce the cost of operation by minimising the requirement for hyper-chlorination procedures.

Secondary disinfection systems can be installed and maintained by some water treatment providers but these solutions can be applied to various different systems in different ways, therefore hospitals and healthcare organisations should enlist providers with extensive expertise in the healthcare sector. A solution that includes inline monitoring, remote control systems and alarms will go further in helping to manage the risk and strengthen the water safety plan.

Monitor cooling towers, water tanks, boilers, pipework closely    

The presence of rust, sludge, scale and organic matter in water systems provides an ideal environment for Legionella bacteria that can breed freely. Cooling towers and boilers, commonly used in hospitals and healthcare sites, can be a breeding ground for these if not managed effectively. Effective management should include risk assessment, an effective chemical treatment regime, regular inspection and optimisation. The same goes for water tanks, pipework, and domestic systems where scale and other matter can build up as a result of ineffective management of plant and equipment such as cooling towers and boilers.

Make limited budgets go further with expert water treatment providers

With limited budgets and resources, it’s a challenge for hospitals and healthcare organisations to effectively keep track of their water temperatures while maintaining a consistent log that can prove the Legionella risk is being well managed. This is not simply a case of providing proof that temperature control measures are in place – it must also be proven that a full control scheme is in place with regular risk assessments being conducted.

Hospitals and healthcare organisations must therefore look to their water treatment providers to assist with the creation and implementation of control schemes that include the monitoring and regular logging of water temperatures on-site. The water treatment provider may also carry out all necessary risk assessments and provide transparent, easy-to-access reporting including GPS and time stamps with a fully documented trail, ensuring that, should the HSE investigate the site, those responsible for the site’s health and safety will have the peace of mind that all the required evidence of risk management can be provided.


It is paramount that hospitals and healthcare organisations enlist the expertise of water treatment providers that have experience and expertise in this sector, with a clear awareness of the challenges, and legislation specific to hospitals and healthcare facilities. The chosen water treatment provider must be able to tailor its services to individual hospital or healthcare businesses to ensure that the water treatment solutions are both economical and effective for the size and scale of water systems on each individual site.

With these services and measures in place, hospitals and healthcare organisations can continue their roles in serving the public with the peace of mind that legionella risk is being managed effectively.