Minimising the risk of Legionnaires’ disease T4113: 2002Minimising the risk of Legionnaires’ disease CIBSE TM13: 2002 CIBSE The Chartered Institution of Building Services Eng 222 Balham High Road, London SW12 9BS‘The rights of publication or translation are reserved. No part of this publication may be reproduced, stored ina retrieval system or transmitted in any form or by any means without the prior permission of the Institution. © April 2002 The Chartered Institution of Building Services Engineers London. Registered charity number 278104 ISBN 1 903287 235 This documentis based on the best knowledge avaliable atthe ‘time of publication. However no responsibility of any kind for any injury, death, loss, damage or delay however caused resulting from the use of these recommendations can be accepted by the Chartered Institution of Building Services Engineers, the authors or others involved in its publication. In ‘ adopting these recommendations for use each adopter by doing so agrees to accept full responsibilty for any personal injury, death, oss, damage or delay arising out of or in connection with their use by or on behalf of such adopter irrespective of the cause or reason therefore and agrees to defend, indemnify and hold harmless the Chartered institution of Building Services Engineers, the authors and others involved in their publication from any and al liability arising ‘out of or in connection with such use as aforesaid and irrespective of any negligence on the part of those indemnified. Typeset by Sandhurst Editorial Consultants/CI8SE Publications Department Printed in Great Britain by Page Brothers Ltd, Norwich, NorfolkForeword These Technical Memoranda offer the best collective advice obtainable on how to minimise the risk of Legionnaires’ disease from engineering services in buildings. This publication is an update of the one last revised in October 2000°. ‘There are several significant changes in the light of Government initiatives in combating the problem: — The Control of Substances Hazardous to Health Regulations 1994 (COSHH)®), updated in 1999, provide the framework to control the risk from a range of hazardous substances, including Legionella. — The Management of Health and Safety at Work Regulations 19920) provide a broad framework for health and safety at work. — The Construction (Design and Management) Regulations 1994 place specific duties upon the client, the designer, the planning supervisor and the contractors, to ensure safe practices in the construction, maintenance, and cleaning of a building and its services. — The Health and Safety Commission (HSC) brought out an Approved Code of, Practice, ACOP L8 Prevention and control of legionellosis (including Legionnaires’ disease), in 1991, and complemented this with a Guidance Note, HS(G)70 The control of legionellosis including Legionnaires’ disease, also in 1991. The ACOP was updated in 1995. These were replaced on 8 January 2001 by a combined HSC Approved Code of Practice (ACoP) and Health and Safety Executive guidance publication: Legionnaires’ disease — The control of Legionella bacteria in water -gstems®), commonly referred t0 a8 ‘L8". — The Notification of Cooling Towers and Evaporative Condensers Regulations 1992 require the local authority to be notified of the location of all such equipment. This helps to identify potential sources of Legionella quickly in the event of an outbreak. — The Health and Safety Executive supplement Control of legionellosis in hot and cold ‘water systems MISC 150 (1998) described novel techniques of biocide control. This was replaced on 8 January 2001 by HSC Approved Code of Practice (ACoP) L8: Legionnaires’ disease — The control of Legionella bacteria in water systems”). — The Health and Safety Executive is particularly concerned about the risk of Legionnaires’ disease, and is prepared to prosecute where procedures in design, installation, commissioning, operation or maintenance are found to be inadequate. — The National Health Service Estates publication ‘Safe’ hot water and surface temperatures (1998) provides guidance for National Health Service health care premises on those subjects. ‘The authors are also aware of an increasing number of guidelines aimed at different ‘groups, and thank the authors of these guides for maintaining contact and debating items freely, These publications differ slightly as they are aimed at different users. This document is intended for engineers who design, install, commission, operate and maintain building services. Some general checklist items have been included co draw attention to aspects of particular importance. Please note also that there are several codes of practice and application guides to help those who lack experience to learn the correct techniques, particularly for commissioning procedures. M13 Task Group Editors GW Brundrett (Chairman) K Ashley (Health and Safety Executive) G Green (Winton Environmental Management Ltd) IV Lee (Public Health Laboratory Service) R J Oughton (Consultant) CIBS! i M Shouler (BRE Ltd) Bea aan L Browne (Sandhurst Editorial Consultants) K J Butcher (CIBSE) AC WatsonNote from the publisher This publication is primarily intended to provide guidance to those responsible for the design, installation, commissioning, operation and maintenance of building services. It is not intended to be exhaustive or definitive, and it will be necessary for users of the guidance given to exercise their own professional judgement when deciding whether to abide by or depart from it.Contents Introduction 1.1 Background to the legislation and statutory guidance 12 Aim of this publication Legionnaires’ disease: background 21 Introduction 22 Risk of infection 23 Multiplication factors 24 Aerosol generation 25 Number of bacteria inhaled 26 — Susceptibility of individuals 27 Determining the risks Risk management 3.1 Background 3.2 Design and specification 33 Commissioning 34 Operation and maintenance 3.5 Quality management 3.6 Microbiological testing 3.7 Record keeping Evaporative cooling applications 4.1 Introduction 42 Design 43. Location 44 Operation 45° Monitoring 46 Maintenance 47° Control Hot and cold water services 5.1 General 5.2 Cold water services 53. Hot water services (Hws) 5.4 Small scale, non-recirculating nws systems Spa pools, whirlpool spas and whirlpool baths Other possible risk areas 7.1 Industrial uses of water 7.2 Humidifiers 73 Ice-making machines 74 Safety showers 75 Decorative fountains 7.6 Misting devices ww ers ae 10 10 4 1s 0 19 20 21 al a B 6 7 28 28 29 29 29 29 297.7 Fire/sprinkler systems 78 Vehicle washes 8 Conclusions References liography Appendix A1: Glossary Appendix A2: Emergency cleaning procedure for cooling towers and hot and cold water services systems Appendix A3: System checklists Appendix Ad: Action plan for suspected outbreaks of Legionnaires’ disease : Some considerations for inviting tenders for water treatment 29 29 30 30 30 32 36 39 42 43 45Minimising the risk of Legionnaires’ disease 1 Introduction 14 Background to the legislation and statutory guidance ‘The Health and Safety at Work etc. Act 1974 regulates all work except domestic service. Employers have a general duty to ensure, so far as is reasonably practicable, the health, safety and welfare at work of employees, and to conduct their undertakings in such a way as to ensure, again so far as is practicable, that other persons who may be affected by the work are not exposed to risks to their health and safety. General guidance on this for building services engineers is outlined in CIBSE TM20”. The Management of Health and Safety at Work Regulations 1992 provide a framework for controlling health and safety at work. As well as calling for risk assessments they also require employers to have access to competent help in applying the provisions of health and safety law, to establish procedures to be followed by any worker if situations presenting serious and imminent danger were to arise, and for co-operation and co- ordination in the workplace. The Control of Substances Hazardous to Health Regulations 1994, updated 1999, (COSHH) provide a framework to control the risk from a range of hazardous substances including microbiological contamination. The essential elements include risk assessment, selection of control measures, the preparation of written procedures, maintenance and checking of the control measures, and the provision of information, instruction and training for employees, and where appropriate the provision of health surveillance. The Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) define legionellosis as a reportable occupational disease. All cases are to be reported to the enforcing body. For the manufacturing industry this is the Health and Safety Executive (HSE); for commercial premises or buildings where the public have access, it is the local authority Environmental Health Department. ‘The Notification of Cooling Towers and Evaporative Condensers Regulations 1992 require the local authority to be formally notified of all such equipment when installed and again on removal. 144 ‘The prevention or control of legionellosis/Legionnaires’ disease HSE Approved Code of Practice (ACoP) L8: Legionnaires’ disease — the control of Legionella bacteria in water systems” applies to plant and water systems containing water that is likely to exceed 20 °C and which may present a particular risk potential by releasing a spray or aerosol during operation or when being maintained. More specifically, it identifies cooling towers, evaporative condensers, hot, water services, humidifiers and air washers that create a water spray above 20 °C and spa pools containing water that is deliberately agitated and recirculated. This code proposes five simple steps to minimise or eliminate the risk of Legionnaires’ disease: (@) identification and assessment of risk (6) devising measures to preventiminimise risk (©) management ofthese measures (4) record keeping (© formal allocation of responsibilities. 11.2 ‘The control of legionellosis including Legionnaires’ disease HSE ACoP L8®, gives detailed technical guidance on risk minimisation. The general techniques are avoidance of ‘operational water temperatures between 20 °C and 50 °C, prevention of stagnation of the water, use of construction, materials that are neither toxic nor provide nutrient for micro-organisms, cleanliness, and the biocidal treatment. ‘of that water which remains between 20 °C and 50 °C for several hours, HSE ACoP L8® also outlines some new techniques of biocide control that may be used provided that there is evidence of the success of the control. Such methods can be particularly useful wherever the temperature control, regime cannot be applied effectively. Treatments such as metallic ionisation, using silver and copper ions, and dosage by chlorine dioxide are referred to in detail in this, HSE publication. (See also National Health Service Estates Health Technical Memorandum HTM 2040: The control of legionellae in healthcare premises: a code of practice”) and HTM: 2027 Hot and cold water supply, storage and mains services), and BSRIA TN6/96: Lonisation twater treatment for hot and cold water services.) 1.2 Aim of this publication These Technical Memoranda set out to give guidance on the appropriate design, installation, commissioning, oper- ation and maintenance procedures necessary to minimise the risk of infection from Legionella bacteria from water systems within a building. Principles are highlighted, and practitioners in these fields are encouraged to apply them, to their own particular building services applications. A glossary of terms is given in Appendix Al. Health care premises may contain a high proportion of susceptible persons, and HTM 2040) provides much more detailed advice for these patient areas and ancillary buildings. The premises include in-patient and out-Minimising the risk of Legionnaires’ disease patient accommodation such as hospitals, clinics, health centres, private hospitals, blood transfusion service premises, and nursing and mental homes as defined in the Registered Homes Act 1974", However, where ancillary buildings such as offices, staff residences, workshops, laundries and ambulance stations have self-contained water services systems that do not serve patient areas then this CIBSE publication is equally appropriate. Cooling towers and evaporative condensers require a water treatment regime usually based on chemical conditioning. ‘While the emphasis in these Technical Memoranda is on engineering it is important to recognise that the best engineering solutions can fail and have failed if their operation and implementation are not managed effectively. Some indications of how to ensure effective management are included. 2 Legionnaires’ disease: background 24 Introduction Legionnaires’ disease was first recognised in July 1976, when an outbreak occurred among delegates attending an American Legion convention in Philadelphia. The cause of the outbreak eluded scientists for several months, but, in January 1977 the Center for Disease Control and Prevention, Atlanta, reported the isolation of the causative agent, a bacterium that they named Legionella pneumophila. Diagnostic tests were developed, and reviews of stored specimens in laboratories revealed earlier outbreaks of the disease and sporadic cases dating back to the 1940s. This showed that the infection was not new, but had escaped recognition because the causative organism does not grow on the conventional media used to culture bacteria in diagnostic laboratories. Legionnaires’ disease is an uncommon infection: between 100 and 275 cases each year in England and Wales are reported to the Communicable Disease Surveillance Centre. Reporting is not notifiable under the Public Health Act in England and Wales but is compulsory in Scotland. An occurrence in the workplace, however, must be reported under RIDDOR), One-half of the cases identified in the UK are associated with travel abroad. It is probable that some cases of Legionnaires’ disease are not detected or reported: the best estimate of incidence is 25 cases per year per million population. However, a multi-centre study by the British Thoracic Society and the Public Health Laboratory Service showed that only about 2% of the 450 community-acquired primary pneumonias that were studied were diagnosed as, Legionnaires’ disease. Legionnaires’ disease is an illness characterised mainly by pneumonia. It begins quite abruptly with high fever, chills, headache and muscle pain. A dry cough soon develops, and many patients suffer difficulty with breathing. About one-third of patients also develop diarrhoca or vomiting, and about half become confused or delirious. The case fatality rate is about 12%, which is similar to that of most other types of pneumonia. L. pneumophila also causes a self-limiting influenza-like illness without pneumonia called Pontiac fever; L. micdadei causes an illness called Lochgoithead fever, which is similar but not identical to Pontiac fever. Neither of these infections results in fatalities, and those infected recover with no residual illeffects. Any illness caused by Legionella is known under the generic term ‘legionellosis’. Although previously healthy people may develop Legionnaires’ disease, individuals who are particularly at risk include smokers, alcoholics, and patients with cancer, diabetes and chronic respiratory or kidney disease. There is a distinctive age distribution, with those over 50 years of age being most commonly affected; children are affected only rarely. Men are at greater risk than women. Legionnaires’ disease may be treated effectively with appropriate antibiotics. The diagnosis of Legionnaires’ disease can be fully established only by laboratory tests: the organism can be cultured from sputum, blood, bronchial washings or lung tissue; antigens derived from Legionella may be detected in urine; and blood tests that measure the presence in serum of specific antibodies produced by the body to combat infection may be used. The enzyme-linked immunosorbent assay for the detection of Legionella antigens in urine is well validated, available commercially and now the most common method of diagnosis. It is very specific and can provide a rapid reliable diagnosis during the acute phase of the illness often much earlier than can be achieved by serological analysis of the blood which was previously the most common method of diagnosis ‘Two tests for antibodies in serum can be used: the rapid microagglutination test (RMAT), which serves as a screening test, and the indirect immunofluorescent, antibody test (IFA); both of these have been validated as diagnostic tests in the UK. The results are presented as titres, which give the greatest dilution of the patient’s serum at which a specific antibody can be detected: the higher the titre, the greater the amount of antibody in the blood, and therefore the stronger the evidence of infection. In some instances, however, several weeks may elapse before measurable levels of antibodies appear, so that these serological tests may not be helpful in identifying Legionnaires’ disease in the early stages of the illness. Other tests may be used to demonstrate the presence of the bacterium in tissues, but these tests either lack sensitivity or are unsuitable for use in the routine diagnostic laboratory. L. pneumophila is one member of a large family of bacteria, the Legionellaceae. At least 47 other species of Legionella have been reported, and at least 16 serogroups of L. pneumophila have been described. L. pneumophila serogroup 1 is the organism most commonly responsible for Legionnaires? disease in the UK, but all other serogroups of this and at least 16 other species have been found to cause disease in man. L. pneumophila serogroup 1 can be further divided into various groups (see Figure 1) including monoclonal antibody subgroups, one of which, has been implicated in most cases of legionellosis.Legionnaires’ disease: background Species (48) L. pneumophila . micdadei, , longbeachoe, Serogroups (16 for L pneumophila) 234567 8 9101112131415 16 Subgroups (eg, monocional antibody subgroups) Figure 1 The genus Legionella The genus Legionella, including L. pneumophila serogroup 1, is found in aquatic environments, both natural and artificial. The organism is found most commonly in hot water services systems, particularly in HWS storage calorifiers and evaporative cooling water systems that serve air conditioning plants. Systems that are corroded or contain debris or have evidence of organic fouling are more likely to harbour the organism. Other factors that favour growth are stagnation of the system water content, and an appropriate temperature: multiplication occurs between 20°C and 46°C. ‘Monoclonal antibody subgrouping has been developed for LL. pneumophila serogroup 1, and studies have shown that cone particular monoclonal antibody distinguishes those strains most commonly associated with Legionnaires’ disease. More discriminating molecular subtyping methods have been developed. One method, amplified fragment length polymorphism, has been shown in a European-wide trial to be the most suitable for inter- laboratory investigation of the common source of outbreaks. Such subtyping schemes provide means of linking strains isolated from patients with strains found in suspected environmental sources of infection ‘The incubation period—the time between exposure to the organism and development of first symptoms—is usually 2-10 days, but can occasionally be up to 21 days Person-to-person spread of the infection has not been documented. ‘The investigation of outbreaks of Legionnaires’ disease hhas led to the identification of various sources of infection and routes of transmission. Sources of infection include: — cooling towers serving air conditioning and process cooling systems — hot water and exceptionally and more rarely cold water services systems in large buildings such as hospitals and hotels (aerosols containing Legionella ‘may be generated by running taps or showers where the water is contaminated) — spa pools (sometimes called whitlpoo! spas) — fountains with a particularly fine spray in an enclosed space — machine tool cutting coolant — misting devices used for humidifying vegetables and meat — untreated natural hot spring spa water used for inhalation, bathing or showering — non-disposable nebulisers used for respiratory therapy — potting composts. Legionellosis is caused by inhalation of an aerosol of bacteria generated from water droplets (compost is a possible exception). Rarely, it may also be caused by aspiration of Legionella-contaminated water (i.e. by contaminated water ‘going down the wrong way’). Survival of the bacteria in an aerosol will depend on a number of factors including ambient temperature, relative humidity, sunlight and transportation by wind. 2.2 Risk of infection ‘The risk of infection from a water system is dependent upon a number of factors including: — the presence of one or more multiplication factors that allow legionellae to grow from low to high numbers; such factors include the water temper- atures within the system, stagnation, and the presence of certain materials such as natural rubbers, some sealants and wood, which may serve as a nutritional source within the system — the ability of the water system to generate aerosols — the concentration of Legionella in the aerosol and the size of the aerosol particles; the risk increases the higher the concentration of bacteria and the smaller the size of particle (smaller particles are more dangerous because they can penetrate more deeply into the lung) — the susceptibility to Legionella infection of the people exposed to the aerosol, ‘The duration of exposure may also have some influence. Ic is worth considering these factors in a little more detai because they provide the clues to the prevention or control of the risk of infection. 2.3 Multiplication factors The optimum temperature for multiplication of L. pneumophila in the laboratory is around 37 °C. At higher temperatures the rate of multiplication of the organisms in. the laboratory decreases, and at 46 °C multiplication ceases. The bacteria can survive at higher temperatures, but the survival time decreases from a few hours at 50 °C to a few minutes at 60 °C; at 70 °C the organism is killed virtually instantaneously. Below 37 °C the multiplication rate decreases, and it can be considered insignificant below 20 °C. The organisms can survive in a dormant state at much lower temperatures, and will return to active multiplication whenever more favourable temperatures occur. Legionella has been found in water systems having a wide range of pH values. Typical design temperatures for water in building services are illustrated in Figure 2. Cooling towers and spas are designed to operate at temperatures that happen to be favourable for the growth of Legionella, and therefore such systems require regular biocidal treatment. Similarly, hot4 Minimising the risk of Legionnaires’ disease 100 op Stn bumiifeation a 25 Number of bacteria inhaled poset The actual dose of organisms required to infect a human is 80 Jp LTHW heating system aa “Legionella will not g Ws tap outlets —__, 2299 | Gieintime 3 =o Ro * Jescrammertees Sieg | may 20: = ~ = © Spray humidifier Legionella will Increasing rsk of multiplication of Legionella Figure 2 Design temperatures and associated risks water services may contain deadlegs and other stagnant zones that could hold water for long periods at the temperatures at which Legionella multiply. Cold water services may also reach temperatures likely to encourage multiplication ofthe bacteria. 24 Aerosol generation Contaminated water presents a risk of actual infection only when it is dispersed into the air as an aerosol. Small particles will remain airborne for long periods, and small droplets of 5 um diameter or less penetrate deeply into the lung and cannot be expelled easily. However, larger droplets can evaporate and become smaller ones, which still contain the initial number of organisms. The main mechanisms of producing an aerosol are by water streams breaking up or striking a surface, or by a bubble bursting on the water surface. In both a cooling tower and an evaporative condenser, water is distributed over lange areas of wetted surfaces to create intimate contact between air and water. This water continuously drains and collects into the pond at the base of the tower or condenser. Both the water distribution action and the draining flow create aerosols. The fan, which aids cooling, disseminates this aerosol over very large areas (drift) and, even when water is circulating with the fan switched off, the wind or convection draughts may force a significant amount of aerosol from the tower outlet. The exposure of building occupants to aerosols from cooling towers and evaporative condensers can be greatly increased if they are drawn into ventilation systems. ‘Water services are also capable of generating aerosols from the impact of tap water hitting wash basins, sinks or baths, and from spray taps and showers. In whirlpools and spas the agitation of the water is achieved by the combination of air jets and pulsating water flow. Splashing of the water and bursting of the air bubbles as they break through the water surface creates an aerosol immediately above the water surface. not clearly understood. In susceptible individuals it must be quite small—probably no more than a few tens of organisms, However, in healthy individuals it must be considerably greater, as the organisms are so common that the general population must all be regularly exposed to them. The risk increases with the number of bacteria inhaled and the susceptibility of the people exposed. Two factors determine the number of bacteria inhaled by an individual: the concentration of bacteria in the air, and the duration of exposure to the contaminated air. 25.1 Concentration of bacteria in the air This is dictated by both the concentration of bacteria in the water and the amount of contaminated water aerosols dispersed into a given air volume. The concentration in the air of aerosols containing live bacteria falls rapidly with an increase in distance from the water source. Where a cooling tower and the fresh air inlet to the building are both at roof level, then it may be possible for contam- ination from the tower to reach the air inlet and hence be distributed through the building by means of the ventilation system. The contamination may also reach street level, and people have been infected up to 500 m away from a contaminated tower''®. Risk of infection generally diminishes with distance from the cooling tower as the aerosol droplets become dispersed; however, the degree of dispersion is dependent on local climatic conditions and other variables. The quantity of aerosols from an evaporative cooling system entering a ventilation system will depend primarily on the distance between the tower and the fresh air inlet. Increasing this distance of separation, and location of the air inlet upwind of the tower, help to reduce the likelihood of aerosols entering the building. Running a tap vigorously or using a shower will also create an aerosol. Bubbles rising through water and bursting, as in a spa pool, and cutting fluids striking and ejecting from spinning objects also cause aerosols, 25.2 The duration of exposure to the contaminated air The risk increases with the number of legionellae in the air, the respiratory rate of the individual, and the length of time for which the person is exposed, Exposure in a shower or bathroom is normally limited to a few minutes, while exposure in a spa is usually longer. Ics, probable that an infectious dose is not inhaled in a single breath but is accumulated over a few minutes, Exposure to airborne legionellae distributed within or outside a building from an evaporative cooling water system may take place whenever the tower is operating, which may be most of the day during the summer.Legionnaires’ disease: background 2.6 Susceptibility of individuals Many people have been exposed to legionellae, and their body defence system has responded to prevent an illness. Although previously healthy people may develop Legionnaires’ disease there are several factors that have ‘been shown to increase susceptibility): — increasing age, particularly above 50 years: children are rarely infected — sex: males are three times more likely to be infected than females — smoking, particularly heavy cigarette smoking — existing respiratory disease, which makes the lungs more vulnerable to infection — illness, such as cancer, diabetes, kidney disease or alcoholism, which weakens the natural defences — treatment using renal dialysis or immuno- suppressant drugs that inhibit the body's natural defences against infection. 27 Determining the risks ‘The assessment of the risk of legionellosis needs to take into account the above factors and to apply some measure to each, 50 as to produce a basis on which to judge whether there is a significant risk. A risk assessor who possesses an understanding of the particular water systems and of the ecology of Legionella should be selected. The name and title of the risk assessor should always be on the assessment, together with some indication of competence. The assessment will sometimes indicate that the risk associated with certain sources is negligible, and will frequently identify conditions or practices that could be improved (perhaps reducing the risk to a negligible level), In many cases some risk will remain, necessitating @ scheme of precautions or control measures. 274 Identifying all sources of risk In order to ensure that all sources of risk have been included, a register of equipment needs to be composed. This could be taken from an asset register, but is more likely to be based on drawings and inspection. 272 Negligible risk sources Some sources will immediately appear to constitute a minimal risk, but they require confirmation that risk conditions do not prevail. Typical sources in this group (@) direct mains cold water supplies where there is reasonable water throughput (®) cold water storage cisterns in which the temperature is consistently below 20 °C (this requires checking several times to establish seasonal variations in temperature) (©) cold water distribution systems where there is reasonable water throughput and the temperature at all draw-offs reaches 20 °C within 2 minutes of use (@) hot water service systems where the temperature remains above 60 °C throughout the stored volume and the temperature at all draw-offs reaches 50 °C within 1 minute of use (©) steam systems (f) primary hot water heating systems (@) chilled water systems. Note that the systems in (¢) to (g) are closed systems, and therefore present no risk under normal operation; also, they are not listed in HSE ACoP L8© as vulnerable systems. Some consideration should be given to the risks associated with all parts of the system under all reasonably foreseeable operating conditions. For example, a heating system may operate above the temperature range at which Legionella can survive and is fully enclosed. However: (@ the feed and expansion cistern could easily contain ‘warm water, as could any parts of the system where there is no recirculation, in each case providing conditions suitable for Legionella to multiply (6) maintenance work such as draining water for chemical testing or dosing, or even air venting radiators, could create contaminated aerosols. Only once considerations such as these have been given, should a source be deemed to be of negligible risk. 2.73 Sources constituting a risk Other water systems may also constitute a negligible risk, ‘but most will have some risk associated with them. The degree of risk can be assessed by considering: — the potential for Legionella to be introduced into the system — the factors that affect the multiplication, such as temperature, stagnation and sources of nutrient — _theability of the source to generate an aerosol — the exposure to that aerosol (eg. in the confines of a shower cubicle, outside in the street within 500 m of a cooling tower, via an open window or a ventilation system, working over a water spray, sitting in a spa bath) and the susceptibility of those exposed — the extent of the exposure (the number of people affected and the duration of their exposure) — the precautions in place to control the risk. 2.74 Recording and reviewing the risk assessment ‘The assessment of the risk of legionellosis must be recorded, whether it concludes that there is no significant risk, the risk is controlled by virtue of existing design or operational techniques, or whether further precautions are required The assessment needs to be reviewed whenever there are changes to the system, its mode of operation or the environment in which the system operates that may affect the risk, and also at regular intervals to confirm that it remains valid. The review interval depends on the level ofrisk, and could range from a few months for an open evaporative cooling system in a dirty environment to more than one year for a simple hot and cold water services system. 275 Compatibility of recommended control measures In most instances, the measures required for the control of Legionella bacteria in water systems, so far as is reasonably practicable, reflect good practice and are, generally, of modest cost. In some cases, however, interpretations of the requirements of HSE ACoP L8© lead consultants, facilities management contractors and water treatment specialists to make recommendations which may go ‘beyond what is necessary for compliance. Building operators should be aware of this possibility and check any recommendations offered against the requirements of ACoP L8 itself. General advice for building operators in this respect is given in HSE publication Legionnaires’ disease: a guide for employers), For nursing and residential homes, more specialised guidance is given in another HSE publication Controlling legionella in nursing and residential homes\'?. Both of these publications are available free of charge from the Health and Safety Executive. ‘The review of proposed control measures to minimise the risk of Legionnaires’ disease is made simpler where the organisation preparing the recommendations is required to state specifically: (@) those aspects of the installation which: @® meet the requirements of ACoP L8 Gi) meet the requirements subject to defined modifications Gi) (®) _incach instance, the paragraph or table in ACoP L8 relevant to the particular requirements. fail to meet ACoP L8 requirements 3 Risk management 31 Background Good management is needed at all stages in the provision of building services. Such management requires clear guidelines on how the services are designed to work, written operation and maintenance manuals, appropriate staff training, authenticated recording of cr operational factors, and regular management checks, details of which should be recorded formally. The occupier and user of the building must understand that, they have a statutory duty to ensure that the documented procedures are followed. Under health and safety legislation the occupier of the building is also deemed responsible for what occurs in operation. A named managerial person (referred to in these Memoranda as the operations manager) should be appointed to be responsible for water hygiene. Five aspects are reviewed below: design and specification, commissioning, operation and maintenance, quality management, and microbio- logical checks for Legionella Minimising the risk of Legionnaires’ disease Where possible designers, contractors, commissioning specialists and maintenance companies should be registered with a recognised quality assurance scheme: this helps to ensure training standards for company personnel and the use of consistent working procedures throughout the workforce. 3.2 Design and specification Building services engineers should guide the client in the preparation of an adequate and definitive brief for a new building or major refurbishment. Clear understanding of what will be provided is essential, particularly in the form of design operating conditions, commissioning records, and operation and maintenance manuals. The National Engineering Specification®) aims to produce clear guidelines for each requirement. The design engineer ‘must ensure that all of the documentation, including the operating manual and the maintenance instructions, is clearly written in a style that can be easily understood by non-technical readers. It must also represent the design intent correctly and include description of how the design is intended to operate, together with the concept, for the control and regulation of its operation. Documentation should follow the guidelines given in BS 48840 and BS 49402, and should be kept readily available in a convenient location for access by operation and maintenance staff. A master copy of the doc- umentation should be kept by the operations manager. The operating manual should be available to the commissioning team so that it can be used to check that all is correct before handover. It is helpful to invite the commissioning engineer to join the design team at an, carly stage In addition to ensuring that the design will provide suitable conditions forthe health, safety and welfare of the building occupants, the designer also has a duty to carry out a risk assessment of the installation and maintenance of the design, highlighting any risks to personnel and detailing measures to minimise these (see the Construction (Design and Management) Regulations 19944. The responsibility for preparing the operating and maintenance manuals should be allocated at the briefing stage of the design, and arrangements should be made to ensure that the completed documents are delivered to the client at handover of the building. If possible the client should identify the person who will ultimately be operating and maintaining the building so that early contact between the author and user of the manuals can be made. Comprehensive advice in detail on manuals and on the allocation of responsibility during commissioning is, available in BSRIA Applications Guide AG1/87: Operating and maintenance manuals for building services installations, and BSRIA TM1/88: Commissioning HVAC systems: division of responsibilities?) ‘The specifier should pay particular attention to detailing requirements for the provision of adequate commissioning and the preparation of satisfactory operation and main- tenance instruction manuals. These features are sometimes not given full attention by the design team during tendering. To concentrate attention on these two critical tasks at the tender stage it could be helpful to identify appropriate sums of money within the contract toRisk management be set aside for these purposes. A checklist for the contents of the manuals is given below. Further guidance is provided in BSRIA Applications Guide AGI/872, and BSRIA Technical Memorandum TM1/88™®, Check that the operation and maintenance manual contains the following: — overview of the system — intended mode of operation — record drawings of the installation — schematic diagram of the total system — schematic wiring diagram — automatic control diagram — pertinent manufacturer's information (ie. not the ‘manufacturer's catalogue) — relevant statutory requirements, — location of access points — commissioning records — operating instructions, including water treatment and monitoring procedures — maintenance instructions — maintenance schedules, including tasks and related frequencies — safety information and procedures (e.g. hidden features that may be hazardous, emergency isolation provisions) — record sheet of changes to the original system. 3.3 Commissioning ‘A number of outbreaks have been associated with the start-up of evaporative cooling systems from new or following a period out of use. It is essential that, precautions be taken to control the risk during commissioning and start-up as well as during normal operation of the system. Commissioning and start-up procedures should include detailed precautions, particularly in respect of systems that have been left charged/filled with water for any length of time prior to the work being carried out Correct commissioning is vitally important for the satisfactory operation of the plant, and it should include the integrated operation of all parts of the system, including the controls, for a suitable ‘proving’ period. ‘This stage of the work is often allocated insufficient time and resources. It is the designer's responsibility to specify fully and clearly the extent of the commissioning and the objectives that must be achieved, including details of any particular requirements and the permissible tolerances on performance parameters. Recommissioning after a major design change or modification is equally important. ‘The project manager must ensure that the responsibility for commissioning is clearly attributed, and that adequate time is allocated. Pressure to compress this time-scale must be resisted if quality could be compromised as a result. Commissioning should be carried out in a logical manner and in accordance with a method statement prepared by the commissioning specialist, utilising written procedures to ensure a consistent approach. Each particular installation will require its own plan but this should be based on the CIBSE Commissioning Codes), taking account of the particular design risk. I is essential that a full report of all commissioning activities, including anecdotal comment by the commissioning technicians on plant performance etc. is, compiled for retention by the customer. The final details should form an integral part of the operation and maintenance manual for that installation, which in turn should constitute part of the health and safety file. The availability of such records enables the operations manager to make periodic checks that the installation continues to operate as intended, Formal arrangements should be made to check that commissioning has been completed to the standard specified. This may require an independent authority to witness selected aspects of commissioning, and to countersign the relevant record sheets. 34 Operation and maintenance Operating staff should be provided with a manual containing clearly written operating procedures and instructions. Before they operate the equipment they should be trained to understand and implement these procedures. The instructions should include: — a clear description of the system and its mode of operation — accurate installation record drawings — a schematic diagram of the total system together with the wiring diagrams and automatic control schematics — manufacturers’ instructions and data for the proprietary components — details of any relevant statutory requirements. Details should also include the location of access points and means of reaching them. Commissioning records should be readily available so that current operating conditions may be compared with those originally established. Operating instructions should define those duties in which local judgement may be exercised and those that are mandatory. Modifications to the operating instructions should be recorded in the manual, together with a brief summary of the reasoning that led to the changes. HSE ACoP L8°) requires that the owner appoint an oper- ations manager who should ensure that all responsibilities are clearly defined and formally allocated, that all demarcations are identified, and that lines of communica- tion are recognised not only within the services section bur by all the other building occupants. The operations manager would normally be expected to be spokesperson for all aspects of plant operation, although formally nominated deputies are necessary to cater for occasional absences.Minit ing the risk of Legionnaires’ disease Operating staff must be given adequate training on the particular plant, typically provided during the handover procedures, before they take over their responsibilities. ‘The responsibilities and liabilities of each operative must also be defined in writing. The operations manager should be responsible for making all necessary arrangements for providing this training, for maintaining records of the training given to each individual, and for ensuring that all operatives are fully capable of carrying out their duties competently and effectively. The operations manager should also brief the operatives on how to communicate with the building occupants and others. As part of their duties under the Management of Health and Safety at Work Regulations, the building owner must carry out a risk assessment of the operation of the premises. This should include the work done by the operation and maintenance staff, and should also include appropriate control measures to minimise any risk entailed ‘As operation and maintenance staff become more familiar with the installation, and as their knowledge of its, performance characteristics improves, they will be able to identify scope for improvement by fine-tuning of the plant. This may be carried out by the commissioning specialist or by the operation and maintenance staff themselves, but in either case, whenever this is done, the actions must be faithfully recorded in the operation and ‘maintenance manual. Regular, signed recording by the operative of the critical factors in plant operation is important. A log book and proformas should be provided for this purpose, and the records should be monitored on a regular basis by the operations manager. Regular planned maintenance is essential, and the records should be monitored on a regular basis by the operations manager. Details should be specified in a comprehensive manual readily available to the maintenance staff on site. In addition, provision should be made for prompt maintenance attention to faults reported by the ‘operational staff. The operations manager should ensure that a formal procedure exists for occupants to register their complaints about the building services, and that a proper response is provided within an appropriate time. ‘The whole organisational management structure, from the highest level, must be aware of the serious responsibility they hold in implementing procedures to ensure the health, safety and well-being of the complete workforce and the neighbouring public. This applies particularly to the person responsible for the undertaking (typically the employer or, in some cases, the building landlord) and to the person appointed to take managerial responsibility for controlling the risk (referred to here as the operations manager). This responsibility must be shared with the operating and maintenance staff. Operations managers must also understand the infection route for Legionella and appreciate the function of the water treatment programme. They also need to understand and countersign some of the more crucial, items in the log book record sheet after each visit by the water treatment specialist. Both the laboratory test results and the routine inspection findings should be scrutinised by the operations manager as soon as they are available, and appropriate action taken where necessary. ‘These requirements apply equally whether the site is large of small, maintained by a directly employed labour force or by a contractor, and by a resident operative or by a mobile operative making regular visits. Good communic- ations are especially difficult for a site with no resident engineering operative. A well-formatted system of records and manuals is even more important in these circumstances because site-specific knowledge of the ‘mobile operatives may sometimes be limited. 35 Quality management Quality management should include regular checks to demonstrate that the operation and maintenance procedures are achieving the desired aim. Preparation of operational record sheets in graphical form (to indicate operational trends clearly) or with builtin warning notes (showing clearly the actions to be taken in the event of. deviations beyond defined limits from ‘normal’ conditions) should be encouraged. The name or other means of identification of the person undertaking the measurement of record should be provided. Such records help to make supervision by the operations manager easier and more effective (see Figure 3). In hot and cold water services systems the checks simply record the physical conditions of storage, storage time, temperature and its stability over the day, and the draw- off temperature reached after a period of time at the taps. Tn cooling towers the composition of the make-up water and of the cooling water should be monitored routinely to ensure the continued effectiveness of the chemical treatment programme. The frequency and extent of the checks will depend upon the operating characteristics of the system, but the minimum is once a week to ensure that dosage and bleed rates are correct. Details of such procedures are provided in section 4, 3.6 Microbiological testing Routine monitoring of total bacterial numbers (colony- forming units per millilitre, cfu/ml) is appropriate as a general indication of microbiological control. This is usually undertaken for cooling towers rather than for hot and cold water systems. Routine testing for aerobic bacteria can be done using low-cost dip slides, and these provide a reliable, rough estimation of bacterial colonisation. However, such techniques do not record the presence or otherwise of Legionella, which requires a skilled microbiological laboratory for assessment and interpretation. Periodic sampling for Legionella in cooling towers is recommended to demonstrate that the biocidal control is effective for the organism. Such sampling may also be valuable in cases of unproven techniques or in all, systems in which control is proving difficult. 37 Record keeping ‘The operations manager should ensure that appropriate plans of systems are recorded and retained. These should form permanent records. Records should include details of the person responsible for conducting the risk assessment, the written scheme of risk assessment, the action plan to control the risk, and details of the implementation of theRisk management 9 Organisation Site address Cooling tower no. Building Location System capacity Tives Corrosion inhibitor ype Biocide type Other dosages Water treatment company Week no 1 [esteem 3 a 5 Date of sample Time of sample Hours of operation Initials of operative ‘Manager check (opt) 705 emer 52500 (CAUTIONYE conductivity 2000-2500 measure)" 1500-2000 =1500 ‘Note: if oad is constant and TOS is controlled by a bleed valve, the setting of the bleed valve should be noted and any changes to the setting should be recorded Dip slide (cfurm) |= 10" Actiont (ie, colony-forming |< 10° Review units) "10" Under control Caution if cfurml shows sudden increase (incubate dip slides for 48h at 30 °C)t Makeup water | Meter reading (itres)*___ | Used in week Corrosion inhibitor [_In stock itees)® ‘Used in week Per 1000 1 make-up Pump setting (Uh) Caution if usage rate falls (assumes continuous dosing) Biocide (hires)™ Reservoir content ‘Used in week Purp setting (A) Caution if usage rate falls (assumes continuous dosing) Pond temperature |_>25 (CAUTONT co 20-225 15-20 15 Commentarecommendations ‘Target or typical values appropriate to each particular system to be entered against which monitored levels may be compared +t Operative must advise operations manager of readings that require action or indicate need for caution (shaded boxes) + Note that incubation time and temperature difer from those commonly used inthe water supply industry Figure 3 Example of an operational record for a cooling tower (Note: for e particular ste, to ensure effective control of water quality, the water teatment specialist may consider it necessary to measure and record properties additional to those given in this example)10 Minimising the risk of Legionnaires’ disease action plan, which should be retained for a period of five years. The record should also include: — the results of any monitoring — inspection and tests carried out, together with the dates undertaken — chemical analysis of the water — certification of cleaning and disinfection work and logs of visits by contractors, consultants and other personnel. Staff details showing responsibilities for implementing the scheme and the training undertaken by staff are also required, as are details of other hazards, such as information on the chemicals used in water treatment. 4 Evaporative cooling applications 44 Introduction Evaporative cooling applications are defined in the Notification of Cooling Towers and Evaporative Condensers Regulations 1992, which state that: — ‘cooling tower’ means a device whose main purpose is to cool water by direct contact between that water and a stream of air — ‘evaporative condenser’ means a device whose main purpose is to cool a fluid by passing that fluid through a heat exchanger which is itself cooled by contact with water passing through a stream of air. (This definition includes evaporative coolers.) ‘The Regulations require any person who has control of premises (referred to in these Technical Memoranda as the operations manager) where there is an evaporative condenser or cooling tower to notify the local authority of: — the address of the premises where the cooling tower(s) is/are situated — the name, address and telephone number of a person who has, to any extent, control of the premises — the number of cooling towers — the location of the cooling towers on the premises. The local authority must be advised of changes in these details, for example removal of a cooling tower, within one month of such changes taking place. All air conditioning systems provide cool air. This is generally obtained by passing air through a heat exchanger, which is chilled by a reftigerant or by refrigerated water. All refrigerant circuits need a means of rejecting the heat collected. For small duties it is often both economically expedient and practical to use air-cooled condensers. Larger air-cooled condensers are now readily available, although in general as the plant size increases it becomes more convenient in cost and size to consider evaporative cooling. Although there are many different plant types and configurations they all have one common feature: water is, sprayed or distributed over an extensive area of wetted surface through which air is drawn. The presence of this water, and its operating temperature, can lead to conditions in the condenser cooling water system that are suitable for the multiplication of Legionella. However, evaporative condensers or cooling towers that are well designed, properly sited and thoroughly maintained present little risk. Adiabatic cooling systems, in which the airstream is pre- cooled by water sprays, are becoming more commonly used but, if operated intermittently, may pose problems associated with water stagnation. This may result in microbiological proliferation, Each case must be considered on its individual merits. With the current drive to limit global warming, it is important to note that air cooling results in inferior refrigerating performance and hence significantly greater power consumption than evaporative cooling processes, at both the compressor and the fans, and consequently in increased CO, generation. 42 Design There are three kinds of evaporative water cooling system used in air conditioning: cooling towers, evaporative condensers/coolers, and adiabatic cooling systems. Cooling towers are the most commonly used. In such a system water collects heat from the refrigerant condenser and is then recirculated through a separate cooling tower, where the heat is rejected. The evaporative condenser/cooler uses the same principle, but the condenser is sited within the evaporative cooling unit, and a much smaller volume of water is necessary. Water treatment costs are higher for the larger-volume cooling tower circuit, but control is easier. Conditions can change much more rapidly in the much smaller water volume in the evaporative condenser, and even heavy rain can significantly dilute non-oxidising biocides and inhibitors. Control of water quality is more difficult in these circumstances, and may require additional checks and adjustments, The guidelines for cooling towers apply equally co evaporative condensers/coolers. ‘The components of a cooling tower are illustrated in Figure 4, and some notes on good practice are given in Table 1. Some different fan arrangements are shown in Figure 5 Water is drawn from the pond at the base of the tower and pumped through the refrigerant condenser. Having gained heat, the water is pumped to the top of the tower, where it is distributed over the fill pack. Distribution is achieved by a system of self-draining troughs and gutters, or spray nozzles (see Figure 6). The water then flows through the fill pack and drains into the pond. Air passing through the fill pack cools the water by evaporation. Under full load conditions approximately 1% of the recirculating water is, evaporated on each pass for a typical 6 °C temperature difference across the tower. The water circuit should be as simple as possible, should avoid deadlegs, and should minimise awkward loops, which may be difficult to drain.Evaporative cooling applications " 4) Air our ® te Water distribution @ or ® rift eliminator a, ® owertow ete tum fine and Nee Y ok protection WG X iX}-—$ Electrical fo conc | scons Sie ® | ow : ve ' | sretesing pump Greetion oe colrated Panes chemical tanks ‘Temperature —* Sample ® @ point Strainer ethgerant Refrigerant Tundish or Figure 4 Example condenser cooling water system floor gulley (see Table I for notes on good practice) Trap wate With the spray nozzle arrangement more droplets may be created, whereas the low water velocities associated with the trough and gutter arrangement can lead to the accumulation of sediment in troughs and gutters. The airflow through the unit will tend to entrain the finer droplets and carry them through the tower. Drift climinators are essential to minimise the discharge of droplets to atmosphere; these work by taking air through a complex system of baffles so that the water droplets impinge upon the walls while the air flows smoothly through. The normal drift from a cooling tower without an eliminator would be excessive, and no tower should be operated without one. Modern eliminators, available for both new and existing towers, should be selected to reduce drift to below 0.01% of the water recirculation rate, although they tend to remove proportionally more of the larger droplet sizes. It is important to select drift liminators that are effective at the air velocity prevailing when the cooling tower is in operational use; when they are fitted and maintained they must be well seated and butt closely against one another with no gaps where the airstream can bypass the baffles. Damaged drift climinators can lose their efficiency, and should be replaced as soon as practicable. Construction materials should be non-porous, with a smooth, easy to clean surface. All non-metallic components, such as jointings and sealants, should be of a type known not to support microbiological growth. The Water fittings and materials directory provides identi- fication of such materials. The overall construction of the tower should avoid static water zones and provide easy access for inspection, sampling, draining, cleaning and component removal. Large, robust access doors will permit easy accessibility ‘The amount of piping above the water level in the pond should be designed to minimise overflow from the pond when the tower is shut down. Piping layouts should be as simple as possible, with standby pumps isolated or arranged so that cross-connections between them can be flushed out when the system is cleaned. Standby pumps and associated pipework should be put into use regularly to minimise the build-up of fouling, or be out of the water12 Table 1 Cooling tower good practice Minimising the risk of Legionnaires’ disease TT Gonsider tower location carefully in relation vo fresh air intakes and Due ouiets Water distribution to minimise aerosol generation Housing to offer full and casy access (eg. quick-release fitings) ‘erred areas and pond to be shielded from direct sunlight Sump drain to be of adequate size 10 Air breaks and traps to be provided forall drsins Design drift eliminator to minimise cary-over under all operating conditions Frill pack to be readily accesible and easy 10 clean (consider use of spare pack to facilitate maintenance) Overflow outlet must be well below water mke-up inlet level to protect the supply against the risk of back-siphonage Sump design to have radiused corners and promote accumulation of sludge and facilitate its removal 11 Pipework system design, fuings and components to be appropriate 1o the actual volume flow rates required to meet design standards; arrangements for Nushing and drainage to be adequate (50 mm dia. minimum); washers, jointing materials et. to be selected from approved lise 12 Mark system water volume on tower or other agreed location. Know and record water make-up rates, Water treatment programme to be integrated in all respects, and water quality 0 be monitored regularly. Testing forthe presence of Legionela is included as part of the ‘monitoring, but care must be taken to ensure that it does not: (@) become a substitute for control of water condition (@) delay corrective action if the water condition is suspect (© divert resources from maintaining water quality 13 Standby equipment such as towers and recirculating pumps 0 operate on a rota basis, e@. daily onjoff, or otherwi isolated and held dry 14 Automatic control operation to accord with design intent and be checked regularly 15. Swainers and screens to be provided and cleaned regularly 16 Condenser to be easily cleanable 17 All components tobe provided with manufierurers’ instructions for operation and maintenance, including cleaning; instructions to be implemented 18 Sample point circuit ready to be connected in the event of failure. Strainers should be positioned so that they can be properly cleaned during maintenance. Specialist coatings on fan and pond components will assist cleaning. Radiused corners on the pond also ease cleaning. The screen around the outlet from the pond and any anti- vortex plates must be easy to demount and to clean, Balance pipes between adjoining duty towers and between, duty and standby towers may not have any water flow during normal operation and could become dead legs where water may stagnate. Therefore they should be as short and straight as practicable, and easy to clean; such balance pipes must be capable of being fully drained and flushed. Control valves in the piping must be properly sized to ensure that stable and satisfactory control is achieved; it is essential that the controls provided can match the requirements of the cooling tower throughout its operational mode. The control criteria need to be thoroughly understood by designers, contractors and ‘operational staff. Balancing valves must be properly sized and correctly set, with the setting clearly identified on the valve and noted in the commissioning records included in the operation manual. Overflows and bleed (blow-down) pipes both require air breaks. Drains require traps. The total water volume of the cooling system including the pond, the condenser and its associated piping system should be measured and verified using independent techniques and clearly marked on the cooling tower as a basis for water treatment. The system total volume should also be recorded in the operation manual and the log- book. Techniques for measuring cooling system water volumes include the followin, (a) metered filling from completely empty (6) metered draining (©) addition of a known quantity of a tracer agent (such as a potassium salt), thoroughly mixed, measurement of the resultant concentration, and calculation of the volume from the dilution (the bleed should be closed for this exercise) (@ measurement of the internal dimensions of the components of the system, including the pond, to waterline, pipework, distribution system, heat exchangers, water’ jackets, pumps, cross- connections, bypasses, sidestream, filter or other particle separation units (©) estimation of the internal dimensions of the components of the system from a scale drawing. Exact agreement between measurements made using wo techniques is unlikely; however, the match should be within 15%. Where a water make-up rate is quoted by the designer, this should be based on the aggregate of evaporation, windage and drift for the particular equipment used. A water meter on the feed supply to the tower is useful because it canEvaporative cooling applications 1B 2222222223.” dinar | oes Water distribution rit RVVVVVVVVVJ| stat }——? water distribution ; sacectesaectaneiete Susess retagerant BSA RES | si pack SERRE fondarser | LS Rocco 4 0 KC arn 20°C ‘Does the cistern hold more than 24 hours’ use? ‘Yes No Is the cistern or inspection hatch covered? Yes No Is the inside of the cistern clean? ‘Yes: No Is ita single cistern? Yes No ‘Do the overflow, warning and vent pipes Yes have insect guards? No Examine where aerosols are likely because of high- pressure operation or close proximity of basin to tap. If likely, take action to minimise aerosol production No action Action: No action ‘Modify to ensure compliance No action ‘Take action to lower temperature Reduce to 24 hours maximum No action No action Fit cover to protect cistern from dirt No action Clear loose debris and, where internal surface is marked, paint with approved paint Ifthe building is in continuous use, such as a hotel or hospital, consider the addition of a small break-tank to facilitate cleaning Caution: ensure that flow through multiple cisterns is equal and simultaneous, for example by connecting them in series No action Fit thema2 Minimising the risk of Legionnaires’ disease Appendix A4: Action plan for suspected outbreaks of Legionnaires’ disease Aat Background If an outbreak of the disease is suspected then the local consultant in communicable disease control and, where appropriate, the control of infection team will normally work in association with the Public Health Laboratory Service and the local medical or environmental health officers (EHOs) to search for the source of the bacteria. In industrial premises the HSE inspector would usually be involved in conjunction with an EHO. This is a specialist task involving epidemiological studies, taking water samples and analysing them. The engineer's role is an important one in guiding these specialists to the various water systems within the building and, in particular, to the points from which they can take samples. Easy access to these sampling points is essential, and the correct means of opening valves must be readily available. The engineers must not drain or disinfect the systems before these samples have been taken, and the team will need to follow the HSE inspector's instructions or those of the local authority EHO. A4.2 Services Aa24 Hot and cold water services ‘The investigators will require a plan of the hot and cold water services systems throughout the building from the mains supply inlet to the final end uses. The location of any water storage vessels and calorifiers should be clearly marked and suitable sampling points identified. The end. uses should be identified in terms of taps or showers and. the nearest and furthermost outlets indicated. 4.2.2 Recreational facilities The location of any therapy pool, recreational whirlpool or spa should be shown. Manufacturers’ details of access to components such as filtration plant should be available. A423 Air conditioning Plans of the building will be needed to show the location and types of cooling tower or other evaporative cooling device fresh air inlets to the building and nearest openable windows. The cooling tower water circuit circulation diagram should be available. The protective air inlet screen of the cooling tower should be removable so that easy access can be achieved to inspect the pond water and the tower. Records of the tower use and operating temperatures, and details of the biocide treatments, would. be useful to the investigation team, The location and type of any humidification system must be identified. The location of air cooling coils will need to be identified and ready access provided to the condensate drains from them. A424 Decorative fountains ‘The location of any decorative or functional water sprays should be identified. AAS Excavation work Any local sites where recent excavation and earth moving hhas occurred should be noted. A426 Medical equipment Water supplies to any medical equipment should be identified. This includes haemodialysis units, respiratory therapy and dental care. AA27 Other wet systems ‘Any special equipment that may aerosolise water should be identified. Aa3 Weather station ‘The address and telephone number of the nearest weather station will be required. This will often be a local airport or a university or college department, A44 Disinfection If written disinfection procedures for the installations at risk are not already available, consideration should be given to how the different water systems could be disinfected if this became necessary. This would be by chlorination or some other means. Disinfection procedures should not start until the investigation team has had the opportunity to survey and sample all the water systems and given their agreement for this to proceed‘Appendix AS: Some considerations for inviting tenders Appendix A5: Some considerations for inviting tenders for water treatment The Institution gratefully acknowledges the Wright Biocide Committee for permission to adapt the following from the Report of the Expert Advisory Committee on Biocides™), AS. Open evaporative cooling systems (incorporating cooling towers or evaporative condensers) The report indicates the importance of physical cleanliness for effective biocide action. The treatment of ‘open evaporative cooling systems will thus involve: — Start-up procedures to ensure that the system is clean and the water is hygienic — wice-yearly (e.g. in spring and autumn) disinfec- tion (with a biodispersant), cleaning (with dismantling as necessary to gain access to all parts), followed by disinfection — the use of softening or other scale-preventive measures as necessary to control scale and sediment accumulation — the use of corrosion-preventive measures to control corrosion — the use of controlled bleed (blow-down) to prevent ‘over-concentration of total dissolved solids — _ theuse of one or more biocides (preferably incorpo- rating a dispersant) with due regard to the effective concentration, contact time and water condition requirements (e.g. pH, compatibility with system components and other additives to the water). ‘These and the following points are designed to aid the ‘owner in improving further the efficacy of the biocide in the general treatment package when negotiating with ‘water treatment companies and in obtaining this service at a reasonable cost, and they should be incorporated in tender invitation documentation. AS.2 Technical data to be supplied by the building owner or occupier (@) Name of installation () Type and number of tower(s) including: — type of heat load (process, chillers, cooling jackets, etc.) — configuration of towers and heat load (series, parallel, principal circuit with local connections across the flow and return, ete.) — details of any parts that are not in use (local connections, bypasses, standby pumps, heat reclaim plant, standby chillers, chillers set to lag in lead/lag operation, cooling towers bypassed when the heat rejection load is low, etc.) 43 (©) recirculation rate (@) system water capacity (© maximum bleed-off () make-up rate © cooling system construction materials (®) temperatures (cooling water flow and return and ‘maximum waterside and process temperatures) (@ operating period for system including any periods off-line @ frequency of use of system (®) system half-life or holding time index, where known @® cleaning and maintenance schedules for system (m) source of make-up water and composition, where known (n) likely sources of contamination—airborne or waterborne—where known, AS. Extent and limits of responsibilities and lines of communication ‘The delegation of water treatment services to third parties does not remove the responsibility of the owner, occupier or operator of systems {0 ensure that they are run safely To avoid misunderstanding over the extent and limits of responsibilities of each party, these must be set out clearly in writing and circulated to all those involved. ‘Grey” areas ‘must be avoided. Lines of communication including reporting obligations and instruction authority must also be set out clearly in ‘writing and circulated to all those involved AS.4 Details to be supplied by the tenderer ‘The companies selected to tender for the treatment should operate a management system that complies with the requirements of the following: = BSISO 900109 — _ BSISO 90026 — BS QAS/23/253 (and will carry out the work in accordance with the requirements of the Code of Conduct Association” — Code of Conduct Association® (see AS.4.1 (g) and @) below). Laboratories carrying out legionella tests need to be accredited by UKAS (United Kingdom Arbitration Service); they need to participate in an external quality scheme, such as that operated by the Public Health Laboratory Service, and to apply a minimum theoretical ‘mathematical detection limit of less than or equal to 100 legionella bacteria per litre. ‘The companies tendering would be expected to maintain the system in good microbiological condition. It is44 Minimising the risk of Legionnaires’ disease accepted that a universal microbiological standard cannot be applied to all cooling towers, but a general microbiological limit should be proposed for the system by the tenderer and agreed with the owner. Limits for specific troublesome organisms (e.g. sulphate-reducing bacteria) are also desirable. The microbiological methods for determining and maintaining compliance with these limits must also be agreed between the tenderer and the owner. The latter will need to consult a microbiologist about this, aspect of hygiene as standardised methods for the microbiological examination of water systems have yet t0 be universally agreed. It is understood that suitable methods are being considered by the Standing Committee for Analysts. A541 General information @ Name of company ©) Address (© Copy of company health and safety policy @ Exemplar method statememts and procedures for treatment and monitoring of similar systems © What chemical and microbiological laboratory facilities does the company have available? If a contract service is used details should be provided. Are the contract services accredited? (D) Names of the company site personnel who will be primarily responsible for the efficacy of the treatment regime ©) How are the site personnel qualified and/or trained to discharge their obligations? Have they detailed knowledge of the properties of the biocide(s) that will be used? (®) What arrangements are made to train the staf? (@® Is the company certified under the Quality Systems Scheme BS EN ISO 9000? Does the company comply with the BACS Code of Practice? () Is the company registered as a service provider (which encompasses all aspects of legionella control, including water treatment) under the voluntary scheme operated by the Code of Conduct Association (formerly operated by the ‘Water Management Society/British Association of Chemical Specialists (BACS))? () Is the laboratory carrying out analysis NAMAS accredited by UKAS for the tests being undertaken? AS.4.2 Treatment schedules (@) Proposed biocide-dosing frequency (®) Target biocide concentration; how Jong is this concentration to be maintained in the system? (© Details of the dosing methods and equipment (@ What method will be used to ensure that the biocide has been added and a satisfactory concentration maintained? A543 Site visits (@ A report on a preliminary site visit and recommendations should be made in writing. (@) How frequently will the site be visited for visual reports and detailed reports? 5.4.4 (@) The company should outline its sampling and analysis procedures and the microbiological methods to be used for total counts, with a detectability of 100 cfu/litre or lower for Legionella () How will they identify and quantify organisms such as fungi, algae, legionellae, iron bacteria and sulphate-reducing and slime-forming bacteria? Microbiological testing AS.45 @ = Trade used, (6) Chemical name(s) of the active ingredient(s) Technical information e(s) of the biocide preparations to be (©) Details of their anti-microbial activity @ Evidence for the activity of the biocide(s) at different pH values, temperatures and in the presence of organic matter (© What is the effect of dilution (concentration exponent) on the activity of the biocide to be used? () What evidence does the company provide that their preparations are effective in the laboratory and in the field against fouling organisms and legionellae? (©) What, if anything, is known of the development of resistance of micro-organisms to the biocide(s)? (h) Is there evidence of the chemical stability of the biocides at pH values and temperatures likely to be encountered in use? @ Are the biocides compatible with other water treatment chemicals the company proposes to use and the materials used in construction of the water system? @) Is the foaming potential low? () Are the active agents biodegradable? © Areany of the breakdown products toxic? (m) The company should provide any information available on environmental and mammalian toxicity. (m) Has the company consulted the local water or P i sewage undertaker on the suitability of the active agents for discharge to water courses or foul drains? (0) Details on recommended methods of handling, storage and emergency procedures (refer to COSHH Regulations) () Whats the shelf-life of the biocide preparation(s) when stored as recommended?Adiabatic coolers 10, 32 Acrobic bacteria, sampling 8,17Index 45 Cooting towers 1,254, 8,8, 10-20, 38, Lochgoiead fever 2M Index 36-37, 39-40, 42,43 Log-books — see Documentation Conrsion 3,16 19,20, 38 Aerosols 34,5,1620,27,28-29, COSHH Reauations 119,20 Machine ool cating coolants 428-29 33,3642 Cutting Suds 4:28-29Msimtenance—see Operation rd maintenance =e alto Drift and drift liminators Make-up water 812 14 16,34 Air condoning 29,32,39,42 Dental avipment, 28,42 Management of Health and Safety at “ace alo Colin towers Dip sides 8.17.33 Work Regulations 192 he Ais ow, around buildings Mets Disinfstion 19-20,21,22,27,28, Metical equipment ‘e Airinles sigan 29,35, 36-38,42 Mental homes ~ see Health cae premises Air washers 28.32 —sceaao Cleaning Microbiologia tetingand conte) Alene 14,32 Docomenttion 56-10 115,19, 16,4 see aso Organi fouling 21,23,24,42 Misting devices 3 Ani-vorte plates 12,32 Dosing 14, 16,19,20,21,38 Monitoring 15,1719,21,23, Drainage 10-14 131415, 24,26,27 Bacteria 2-3,4,8,17-18,32 19,20,38 Mulan factors Bn Balance pipes 12 Drifeand di etiminsore 1,148, Biocies 1510, 16,17,1520, 33,6 National Enginering Specification 6 21,2%,29,38,48 Drinking water 2 Nebulites 3 see ato Bromine; Chlorine; Chlorine Noise attenuators “ dioxide Blectrotsis 1,16,17,21,22 Notifation of Cooling Towers nd Evaportive Bleed 12,14,16,19,32 Emergency asks 36-38 42 Condensers Regulations 1992 110 Bod transision service premises —se Environmental considerations 10,36 Nutsng homes — se Health cae premises Heath care premises Bauipment register 5) Nutrients se Organic fating Blow-down se Bleed Evaporative condensers 2.4.10, Break anks ne 13,3443 Operation and maimenance 710,114 Bromine 16,17,20,33,36.37 Evaporative cooling — see Cooling 19-20,21, 22-23, 1s ase Excavation work 2 24,26, 27-28, 29 BS 4540 6 Exhwont oie ateneators 14 amano 6781219 ss6700 2,38 Exposure 35 —see alo Cleaning; Disinfcion BS 6920; Pat 21 see also Aerosols Operations manager 67,8 10,15, [BSRIA Applications Guide AG 147 ye wash says 2% 21,27,34 Onering ond maineance mane Operatives 18,15, 38 orbuiing vcr ntlaion 6.7 tation 14, 16,28,29 tecalao Health and safety "BSRIA TM 1/88: Commision 4c Fire sprinkler systems 28,29 Organi fouling 41,21 ‘antes dion of rapa 6.7 Fouling 31,21 —secalea Algae BSRIA-TN 696: nation ater eaten see also Algse Outpatient socommodstion — se Heath eae fort and od water sees a7 Founine 28,29,42 premises Building teria 1,3,11.21—Froseprotecon 1615,20 Ozone —seeBiocdes Caoriters 323-2633 Hardness conta 15,28 Patin-DPD method » Cac washes 28.29 Heakthandsafery 1,6,7,8,20,36 pHi values 20,35 Chericals — see Disinfeton; Water Health and Soeryat Work Act 1976 1 Pipesand pipework 11-12,21-26,2729 treatment Heath care premises 1-2,6,23,24 see also Water distribution Chilled water systems 5) Heat wentment processes 2% Ponds 10, 11-12, 14,29 Chlorination 20,21,22,33,38 Heating systems 3 Pons ever 229,35 see also Disinfetion Hospitals se Healthcare premises Pools 4,27-28,42 Chlorine 16517,20,27,28,33, Hotspring pa water 3 Postehlorination 34353637 Hotwaterservces 34,5,8,21,23-26,36, Potable water2 Chlorine donde 116, 20,21,22,36-37 37-38, 40-41,42 Potting composts CIBSE Commissioning Codes 7 HTM 2027; Hot and cold wate upp, Prechlorination CIBSE Technical Memorandum TM2Q: Hes, storage and mans vce 1 Private water supplies {a and efi inhe bt noronment HTM 2040% The cor of eine in Public water supply CGisterns—see Water storage Ikon pense acodeofpracie 1,23 Pumps Gieaning 12,14, 19-20,22,24,27, Humisifers 3,28, 29,42 28,28,36-38 Hin for spa pole pide for Quality management : — see ato Disinfection ‘he operon a nies — se Healthcare premises Record-Keeping — see Documentation Cold water services 45,6 21-25 36, Ieecubes 29° —_Registerofequipmemt s 37-38,4,42_ Toomaking machines 29 Registered Homer Act 1974 2 Commissioning 67518 Infesion 36,36. Reporting of Injures, Diseases nd Compost 3 steals Disinfection; Emergency Dangerous Occurrences Regulations 1995. 1,2 Condensers 2,4,10,13,34,48 cake; Health and sey Resdenl homes — se Health care premises Conductvey 14,16, 18,19 38,34 Toisaton 1,16,17,21,22 —Ribkasssment and management 1 Construction (Design and Management Irradiation 16. 510,36 Regulations 1994 6 OUT! 18136 Construction materials L3tn2t Sampling BS 17 Cont leon recommended Level bacteria 2-51-1834 Sealdingempersares code of conduct for tec provides 15 Legionlosis 423 Serene Contec of Substances Huardous to Heath esto Legonosices dese Sentinel ape Regulation 198 and 1999 119,20 __Lachpolea fever; Ponti fever Shot dosing Conlin loan marin and Legionnaires disease 1.26,34,42 Showers 34,26, 26, 28,29 residential homer 6 Leplownae dice a gidefr emplers"6— Shutdown 15,20 Coolants 4,28-29 Lepiomeir dae: Hecnrel of Leginlla,_Silvercopperelecysis — se Electoysis Cooling 23,4 10-20,32, 34,43 botnet emt 168,67, 21,22 Slog dosing 1646 Minimising the risk of Legionnaires’ disease Spa pools 4,77-28,42 Tesining 7-815 Watermeters 4 Spa water 3 Water quality — see Water treatment Sprinkler systems 28,29 Ultraviolet irradiation 16,29 Water softeners — see Hardness contol Stageation 13,46 Water storage 5, 21-22, 23-24, 33,41 Standby pumps 1151225 Valves 12,1419, 23,24 Water supply 21,22 Start-ups 7,19-20 Vehicle washes 28,29 Water Supply (Water Fittings) Regulations Steam systems 5 Ventilation —see Air inlets a Storage — see Water storage ty) Regulations Surainers| 12,14,16, 23,35 Water disposal — see Drainage 2 Susceptibility 2,3,4,5,35 Water distribution 10,14,23,24 Water temperature 1,3-4,21,22,23-26, — see also Cold water services; Hot water 27,28, 38. ‘Taps 3,424, 26 services Pipes and pipework Water treatment 2,10,14,15-19,21, — see also Sentinel tps ‘Water features — see Fountains 27,28, 43-44 “Temperature — see Water temperature Wate filtration 14,16,28,29 Water volume 10, 12,14 ‘Thermal disinfection —see Water ‘Water fitings and materials directory "11, Weather stations 2 temperature 21 Whinlpo! baths and spas —see Spa pools ‘Total dissolved solids 16,18,19,35 Water jetting 20 Wind flow “4The Chartered Institution of Building Services Engineers 222 Balham High Road, London SW12 9BS +44 20 8675 5211 www.cibse.org