Legionella is a genus of gram-negative bacteria
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May 08, 2025
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About This Presentation
Legionella is a genus of gram-negative bacteria that can be seen using a silver stain or grown in a special media that contains cysteine, an amino acid.
Slide Content
Legionella
Raising awareness about a deadly disease in the UK care
system
Raising awareness about a deadly disease in the UK care
system
What you’ll
learn today:
➢What is Legionella
➢The importance of Legionella in the UK
care system
➢Places where Legionella spreads
rapidly
➢Which populations have a bigger
chance of getting infected
➢Signs and symptoms of infection
➢What to do in case of outbreak
➢Short quiz at the end
learn today:
➢What is Legionella
➢The importance of Legionella in the UK
care system
➢Places where Legionella spreads
rapidly
➢Which populations have a bigger
chance of getting infected
➢Signs and symptoms of infection
➢What to do in case of outbreak
➢Short quiz at the end
Introduction
A brief overview of
Legionella
Legionella is a rare type of bacteria that causes life-
threatening illnesses, known as legionellosis.
It took its name from an outbreak in 1976, when
221 U.S. Army Veterans got infected in a Legion
convention and 34 of them died from a “mystery
disease” as it was then called. The jug on the
picture is filled with contaminated water from the
hotel where the convention took place.
As for the disease itself, there are two main types of
legionellosis:
•Legionnaire’s disease, the most common, which is
a deadly lung infection and
•Pontiac Fever, a milder, self-limiting illness, almost
like the flu.
Legionella
Legionella is a rare type of bacteria that causes life-
threatening illnesses, known as legionellosis.
It took its name from an outbreak in 1976, when
221 U.S. Army Veterans got infected in a Legion
convention and 34 of them died from a “mystery
disease” as it was then called. The jug on the
picture is filled with contaminated water from the
hotel where the convention took place.
As for the disease itself, there are two main types of
legionellosis:
•Legionnaire’s disease, the most common, which is
a deadly lung infection and
•Pontiac Fever, a milder, self-limiting illness, almost
like the flu.
Epidemiology of Legionella
Now, we might not see Legionella every day, but that doesn’t mean that
we ought to ignore it, especially when the stats show that it’s getting
more and more common.
In fact, a study from 2017 showed that up to 48% of domestic showers in
the UK are positive for Legionella. That’s really bad news, because if one
of our residents were to catch it, they’d most likely not make it due to
being extra vulnerable.
Keep in mind that the actual numbers could be significantly higher, as
only 10% of Legionella cases are confirmed by lab tests. Plus, some
types of Legionella are super tricky to identify, so the disease might not
even get noticed sometimes.
Now, we might not see Legionella every day, but that doesn’t mean that
we ought to ignore it, especially when the stats show that it’s getting
more and more common.
In fact, a study from 2017 showed that up to 48% of domestic showers in
the UK are positive for Legionella. That’s really bad news, because if one
of our residents were to catch it, they’d most likely not make it due to
being extra vulnerable.
Keep in mind that the actual numbers could be significantly higher, as
only 10% of Legionella cases are confirmed by lab tests. Plus, some
types of Legionella are super tricky to identify, so the disease might not
even get noticed sometimes.
Relevance in the UK care sector
Cases of Legionella in care homes are reported almost every year. Just
to name a few:
•In 2018, a Staffordshire elder care village was put in lockdown due to a
Legionella scare.
•In 2020, 39 residents had to be relocated from a care home in
Londonderry after high amounts Legionella were found in the home’s
water systems.
•A few months later, the same thing happened in Essex where an
elderly resident mysteriously passed away after a battle with
pneumonia. It was later discovered that he had Legionella.
Cases of Legionella in care homes are reported almost every year. Just
to name a few:
•In 2018, a Staffordshire elder care village was put in lockdown due to a
Legionella scare.
•In 2020, 39 residents had to be relocated from a care home in
Londonderry after high amounts Legionella were found in the home’s
water systems.
•A few months later, the same thing happened in Essex where an
elderly resident mysteriously passed away after a battle with
pneumonia. It was later discovered that he had Legionella.
Importance of Legionella awareness for care
workers
First of all, residents have a significantly higher risk of infection than the rest
of the population due to underlying conditions they may have. Those include
old age, chronic illnesses, immunosuppression, disabilities etc, which all put
them at a disadvantage when fighting bacteria. We've got to keep them safe
from infections, and knowing about Legionella is a big part of that.
What’s more, care workers must be informed on how Legionella is
transmitted to prevent spread to residents or staff in case of an outbreak.
Care homes are also obliged by law to keep up with the latest guidelines on
Legionella prevention and control, so being unaware might also lead to legal
trouble.
And finally, you should be able to recognize early signs and symptoms of
infection as this plays a major role in the diagnosis and treatment of
Legionella. Remember: Every second counts, and a slip-up could cost
someone their life.
workers
First of all, residents have a significantly higher risk of infection than the rest
of the population due to underlying conditions they may have. Those include
old age, chronic illnesses, immunosuppression, disabilities etc, which all put
them at a disadvantage when fighting bacteria. We've got to keep them safe
from infections, and knowing about Legionella is a big part of that.
What’s more, care workers must be informed on how Legionella is
transmitted to prevent spread to residents or staff in case of an outbreak.
Care homes are also obliged by law to keep up with the latest guidelines on
Legionella prevention and control, so being unaware might also lead to legal
trouble.
And finally, you should be able to recognize early signs and symptoms of
infection as this plays a major role in the diagnosis and treatment of
Legionella. Remember: Every second counts, and a slip-up could cost
someone their life.
Understanding
Legionella
Legionella
What is Legionella and what does it
do?
Legionella is a family of rare bacteria that infect
humans and animals, and cause disease. There are
more than 50 species, with the most common being
Legionella pneumophila (literally meaning “lung-
loving” in Greek). And, yes, it got its name from the
illness it causes, which is Legionnaire’s Disease, a
fatal inflammation of the lungs.
Under a microscope, they look like small, red rods,
kind of like tiny pieces of spaghetti, but once they
form organized communities, biofilms as they’re
called, you can actually see them with your own eyes.
Here’s an interesting fact: Legionella needs cells to
replicate itself and this is done by invading cells in our
lungs called macrophages, which are a part of our
immune system. And that’s the reason why the
infection targets the lungs.
Legionella under an electron microscope
do?
Legionella is a family of rare bacteria that infect
humans and animals, and cause disease. There are
more than 50 species, with the most common being
Legionella pneumophila (literally meaning “lung-
loving” in Greek). And, yes, it got its name from the
illness it causes, which is Legionnaire’s Disease, a
fatal inflammation of the lungs.
Under a microscope, they look like small, red rods,
kind of like tiny pieces of spaghetti, but once they
form organized communities, biofilms as they’re
called, you can actually see them with your own eyes.
Here’s an interesting fact: Legionella needs cells to
replicate itself and this is done by invading cells in our
lungs called macrophages, which are a part of our
immune system. And that’s the reason why the
infection targets the lungs.
Legionella under an electron microscope
Where is it found?
Legionella is typically found in natural or man-made
water systems like tanks, pumps and reservoirs, and
prefer warm temperatures ranging from 20 to 45 °C. In a
nutshell, wherever there’s moisture and it’s warm, that’s
the perfect place for Legionella to grow in.
If they find a place with lots of rust or sludge, those serve
as food and allow Legionella colonies to grow rapidly.
They’re also very resilient types of bacteria which can live
without human contact for months due to seeking refuge
inside other small microbes called amoebas.
Lastly, they thrive especially in stagnant water, due to
forming slimy biofilms in plumbing systems with no flow.
This is where it multiplies like crazy.
Biofilm inside pipe
Legionella is typically found in natural or man-made
water systems like tanks, pumps and reservoirs, and
prefer warm temperatures ranging from 20 to 45 °C. In a
nutshell, wherever there’s moisture and it’s warm, that’s
the perfect place for Legionella to grow in.
If they find a place with lots of rust or sludge, those serve
as food and allow Legionella colonies to grow rapidly.
They’re also very resilient types of bacteria which can live
without human contact for months due to seeking refuge
inside other small microbes called amoebas.
Lastly, they thrive especially in stagnant water, due to
forming slimy biofilms in plumbing systems with no flow.
This is where it multiplies like crazy.
Biofilm inside pipe
How does Legionella spread in a care
setting?
First of all, the good news is Legionella can’t spread from person to person.
There has been only one documented case where that happened, so it’s
safe to say there’s no danger of getting it if one of the residents gets
infected.
Instead, you mainly get it from breathing in water droplets, like when you're
showering or washing your hands. So, if you're around any type of poorly
maintained water or cooling systems, you might be at risk. Those include:
•Air conditioners
•Cooling towers
•Pools and spas
•Humidifiers
•Respiratory therapy equipment like nebulizers
setting?
First of all, the good news is Legionella can’t spread from person to person.
There has been only one documented case where that happened, so it’s
safe to say there’s no danger of getting it if one of the residents gets
infected.
Instead, you mainly get it from breathing in water droplets, like when you're
showering or washing your hands. So, if you're around any type of poorly
maintained water or cooling systems, you might be at risk. Those include:
•Air conditioners
•Cooling towers
•Pools and spas
•Humidifiers
•Respiratory therapy equipment like nebulizers
Which populations are considered
high-risk and why? (1/2)
When bacteria enter our body, they face the
defensive cells of our immune system, which target
little proteins on the intruders, called antigens, and
after that starts the killing process, until the
infection is resolved.
However, residents in care homes are at a greater
risk, due to having significantly weaker immune
systems, and thus being unable to fight off
infections like Legionella. In other words, there is
almost an 80% chance that a resident dies if they
catch it. That’s because with old age the organs that
monitor our immune system, like the spleen, reduce
in size and make less and less immune cells.
Old age isn’t the only reason for that, as residents
might have other underlying conditions that destroy
the immune system, like being chronic drinkers or
smokers, or having autoimmune diseases like
rheumatoid arthritis, lupus, diabetes etc.
Rheumatoid arthritis
high-risk and why? (1/2)
When bacteria enter our body, they face the
defensive cells of our immune system, which target
little proteins on the intruders, called antigens, and
after that starts the killing process, until the
infection is resolved.
However, residents in care homes are at a greater
risk, due to having significantly weaker immune
systems, and thus being unable to fight off
infections like Legionella. In other words, there is
almost an 80% chance that a resident dies if they
catch it. That’s because with old age the organs that
monitor our immune system, like the spleen, reduce
in size and make less and less immune cells.
Old age isn’t the only reason for that, as residents
might have other underlying conditions that destroy
the immune system, like being chronic drinkers or
smokers, or having autoimmune diseases like
rheumatoid arthritis, lupus, diabetes etc.
Rheumatoid arthritis
Which populations are considered high-risk and why?
(2/2)
Another thing is that respiratory illnesses, such as COPD or bronchitis,
are very frequent in this age group and since Legionnaire’s Disease is a
pulmonary infection, this puts them at an even higher risk as their lungs
are already very weak.
Also, due to having limited mobility, residents might be exposed to
contaminated droplets for longer periods of time without realizing. The
close living quarters and tight spaces in some homes don’t help either,
as they make it easier to get Legionella.
Last but not least, keep in mind that residents might have dementia or
other neurological syndromes that make it difficult to identify and
explain their symptoms in case of infection and as a result they might
die when the infection gets worse.
(2/2)
Another thing is that respiratory illnesses, such as COPD or bronchitis,
are very frequent in this age group and since Legionnaire’s Disease is a
pulmonary infection, this puts them at an even higher risk as their lungs
are already very weak.
Also, due to having limited mobility, residents might be exposed to
contaminated droplets for longer periods of time without realizing. The
close living quarters and tight spaces in some homes don’t help either,
as they make it easier to get Legionella.
Last but not least, keep in mind that residents might have dementia or
other neurological syndromes that make it difficult to identify and
explain their symptoms in case of infection and as a result they might
die when the infection gets worse.
Risk Areas and
Prevention
Prevention
Identifying high-risk areas in care
settings
Legionella can be found wherever there’s
water and:
•The temperature is between 20 and 45
°C
•There is buildup of sludge or rust
•Droplets are produced
In a care setting, areas you should look
out for are: residents’ rooms, kitchens,
dining rooms, bathrooms, laundry
rooms and common areas.
settings
Legionella can be found wherever there’s
water and:
•The temperature is between 20 and 45
°C
•There is buildup of sludge or rust
•Droplets are produced
In a care setting, areas you should look
out for are: residents’ rooms, kitchens,
dining rooms, bathrooms, laundry
rooms and common areas.
Routine Check Example
Resident’s room: check for calorifiers, humidifiers, air conditioners, any
nebulizers they might use and even flower vases as they contain stagnant
water that helps Legionella grow.
Kitchen: have a look at the sink and the dishwasher for Legionella biofilms.
Bathroom: check the showerheads and the taps, especially in less
frequently used bathrooms and don’t forget about any spas and Jacuzzis.
Laundry rooms: Legionella can grow in washing machines that might
malfunction and either operate at low temperatures or have issues with
water stagnation.
Common areas and gardens: water hoses, pools and fountains are where
Legionella colonies usually grow.
Utility rooms: large amounts of bacteria are found in cold water tanks.
Resident’s room: check for calorifiers, humidifiers, air conditioners, any
nebulizers they might use and even flower vases as they contain stagnant
water that helps Legionella grow.
Kitchen: have a look at the sink and the dishwasher for Legionella biofilms.
Bathroom: check the showerheads and the taps, especially in less
frequently used bathrooms and don’t forget about any spas and Jacuzzis.
Laundry rooms: Legionella can grow in washing machines that might
malfunction and either operate at low temperatures or have issues with
water stagnation.
Common areas and gardens: water hoses, pools and fountains are where
Legionella colonies usually grow.
Utility rooms: large amounts of bacteria are found in cold water tanks.
A few words about testing for
Legionella
In the UK, it’s the law for every care home to
do risk assessments for Legionella, especially
when they’re making changes or renovations
in the water systems. In fact, lots of care
homes play it safe and decide to have their
place checked out every year.
But that’s not enough and it’s necessary to
keep an eye on things regularly. We must
check for changes in water temperature inside
storage tanks, showers etc, and also take
water samples and send them to UKAS-
certified labs to identify potential bacteria.
Of course, maintaining records of all the tests
and assessments and keeping them up-to-
date is equally important as inspections can
happen at any time.
Legionella
In the UK, it’s the law for every care home to
do risk assessments for Legionella, especially
when they’re making changes or renovations
in the water systems. In fact, lots of care
homes play it safe and decide to have their
place checked out every year.
But that’s not enough and it’s necessary to
keep an eye on things regularly. We must
check for changes in water temperature inside
storage tanks, showers etc, and also take
water samples and send them to UKAS-
certified labs to identify potential bacteria.
Of course, maintaining records of all the tests
and assessments and keeping them up-to-
date is equally important as inspections can
happen at any time.
Who does the testing and how?
Testing is usually done by a water testing company, but
anyone from the staff or even the manager can do it with
sample kits and send the test to the lab for analysis. The
whole procedure is very simple and takes a few minutes. But,
if you’re in a hurry and can’t wait for the labs, there are also
rapid tests available that show results on the spot.
In more advanced facilities, however, there are remote
monitoring systems, which test the water 24/7 and provide
instant feedback in case they find Legionella.
Testing is usually done by a water testing company, but
anyone from the staff or even the manager can do it with
sample kits and send the test to the lab for analysis. The
whole procedure is very simple and takes a few minutes. But,
if you’re in a hurry and can’t wait for the labs, there are also
rapid tests available that show results on the spot.
In more advanced facilities, however, there are remote
monitoring systems, which test the water 24/7 and provide
instant feedback in case they find Legionella.
How to use the testing kits yourself
This is what the average testing kit has: a
sampling cup, three syringes and the
testing device. Although you should
read the full instructions in the little
paper that comes with the kit, the main
steps are:
•Fill the sample cup with the water you
want to test
•Use the big syringe and move some of
it to the other syringe which has a filter
in it
•Flush through many times to catch
bacteria and then draw some using the
red syringe
•Finally, drop the sample onto the
testing device. If it shows two lines, it’s
positive for Legionella.
This is what the average testing kit has: a
sampling cup, three syringes and the
testing device. Although you should
read the full instructions in the little
paper that comes with the kit, the main
steps are:
•Fill the sample cup with the water you
want to test
•Use the big syringe and move some of
it to the other syringe which has a filter
in it
•Flush through many times to catch
bacteria and then draw some using the
red syringe
•Finally, drop the sample onto the
testing device. If it shows two lines, it’s
positive for Legionella.
What you can do to help
You don’t have to wait for the folks from the company to come up – you
can start taking measures against Legionella right away by following a
few steps:
•Cleaning hot and cold water systems
•Doing temperature control
•Getting rid of stagnant water
•Checking sentinel points of plumbing systems
•Keeping up with HSE guidelines
Before you start, make sure you bring a Legionella testing kit and a
working, certified thermometer with you. Also, speak with your
supervisor before you do any testing to stay clear of any trouble.
You don’t have to wait for the folks from the company to come up – you
can start taking measures against Legionella right away by following a
few steps:
•Cleaning hot and cold water systems
•Doing temperature control
•Getting rid of stagnant water
•Checking sentinel points of plumbing systems
•Keeping up with HSE guidelines
Before you start, make sure you bring a Legionella testing kit and a
working, certified thermometer with you. Also, speak with your
supervisor before you do any testing to stay clear of any trouble.
Hot water systems
Calorifiers and boilers are the main hot water systems to test for
Legionella. Start by draining the water and see if there’s any
biofilm buildup, like green sludge. If so, use the sampling kit on it.
Also, in case there isn’t an inspection hatch on the machine, just
flush and collect a water sample to send it for testing later.
Make sure that flow and return temperatures are at least 50 and
60 °C respectively, which is where Legionella can’t survive.
Run the system for a minute and then test the water temperature
at the sentinel outlets, which are the furthest and closest ones to
each tank. It must be at least 50 °C to consider it safe.
All this must be done once a month, apart from opening the
system completely and checking inside, which is done annually.
Calorifiers and boilers are the main hot water systems to test for
Legionella. Start by draining the water and see if there’s any
biofilm buildup, like green sludge. If so, use the sampling kit on it.
Also, in case there isn’t an inspection hatch on the machine, just
flush and collect a water sample to send it for testing later.
Make sure that flow and return temperatures are at least 50 and
60 °C respectively, which is where Legionella can’t survive.
Run the system for a minute and then test the water temperature
at the sentinel outlets, which are the furthest and closest ones to
each tank. It must be at least 50 °C to consider it safe.
All this must be done once a month, apart from opening the
system completely and checking inside, which is done annually.
Cold water systems
In cold water tanks, which are very high-risk areas, find the ball valve,
usually on the main pipe, open it and let it flow for 2 minutes. After that,
place the thermometer under running water and check if the temp’s
below 20°C. Also, open the tanks once a year and check for any
Legionella biofilms.
As for stagnant waters, start by flushing out toilets and showerheads
that aren’t used frequently and clean them too once a week. Do the
same for water hoses and finally remove any dead ends in pipework:
look for the feeding “T” in redundant places far from the main supply
and remove it or flush the pipes frequently.
Last, dismantle and check all taps with removable parts, especially if
they’re not used, and take samples from inside their heads.
In cold water tanks, which are very high-risk areas, find the ball valve,
usually on the main pipe, open it and let it flow for 2 minutes. After that,
place the thermometer under running water and check if the temp’s
below 20°C. Also, open the tanks once a year and check for any
Legionella biofilms.
As for stagnant waters, start by flushing out toilets and showerheads
that aren’t used frequently and clean them too once a week. Do the
same for water hoses and finally remove any dead ends in pipework:
look for the feeding “T” in redundant places far from the main supply
and remove it or flush the pipes frequently.
Last, dismantle and check all taps with removable parts, especially if
they’re not used, and take samples from inside their heads.
Cooling systems
Air conditioners and cooling towers are some of the
main sources of Legionella and must be fully checked
at least twice a year. However, make sure they’re
working properly every day by turning them on and
seeing if there’s any corrosion, dust or any other thing
that might make them malfunction.
Open the air conditioner unit and have a look inside.
Is it free of nasty odor and dust? Have you cleaned the
filters in the last two months? Did a professional do a
full maintenance check recently? If not, do these first
before checking for Legionella.
Go outside at the air intake valves or the cooling
towers and get rid of stagnant waters or fix any sort
of damage to the units. An expert might be needed
here as they’re complex systems with lots of hidden
parts. And, as always, if there’s any sort of sludge,
take a sample.
Air conditioners and cooling towers are some of the
main sources of Legionella and must be fully checked
at least twice a year. However, make sure they’re
working properly every day by turning them on and
seeing if there’s any corrosion, dust or any other thing
that might make them malfunction.
Open the air conditioner unit and have a look inside.
Is it free of nasty odor and dust? Have you cleaned the
filters in the last two months? Did a professional do a
full maintenance check recently? If not, do these first
before checking for Legionella.
Go outside at the air intake valves or the cooling
towers and get rid of stagnant waters or fix any sort
of damage to the units. An expert might be needed
here as they’re complex systems with lots of hidden
parts. And, as always, if there’s any sort of sludge,
take a sample.
Cleaning protocols (1/2)
Before you start, there are some hazards you should look out for, like chemicals,
working at height, electricity etc, which might pose risks to your health, so be
careful when cleaning anything.
Hot water systems: turn it on for at least an hour and let the water flow through
the whole system. Ensure the temperature doesn’t fall below 50 °C.
Cold water systems: before you start, fully drain tanks and flush pipes and taps.
Clean the inside of tanks in a way that doesn’t damage the coating, such as using
mild soap and water just to get rid of any sludge and dry them with a vacuum
cleaner. Refill the tank first with fresh water and add high concentration chlorine
(~50ppm). Don’t forget to put a warning label outside the unit, as long as there’s
disinfectant inside. Also, test if the mix is potent enough using the quantitative test
kit, and if it’s good, run it through the whole system. Let it sit for an hour and then
add a neutralizing agent. Check if there’s any disinfectant left in the system,
remove the label and flush many times with water to be sure.
Before you start, there are some hazards you should look out for, like chemicals,
working at height, electricity etc, which might pose risks to your health, so be
careful when cleaning anything.
Hot water systems: turn it on for at least an hour and let the water flow through
the whole system. Ensure the temperature doesn’t fall below 50 °C.
Cold water systems: before you start, fully drain tanks and flush pipes and taps.
Clean the inside of tanks in a way that doesn’t damage the coating, such as using
mild soap and water just to get rid of any sludge and dry them with a vacuum
cleaner. Refill the tank first with fresh water and add high concentration chlorine
(~50ppm). Don’t forget to put a warning label outside the unit, as long as there’s
disinfectant inside. Also, test if the mix is potent enough using the quantitative test
kit, and if it’s good, run it through the whole system. Let it sit for an hour and then
add a neutralizing agent. Check if there’s any disinfectant left in the system,
remove the label and flush many times with water to be sure.
Cleaning protocols (2/2)
Cooling systems:
•Air conditioners: turn off the power, take off
the covers and give the filter pads a good
clean with a hose. Replace them if they’ve
been damaged. After that, give all the
waterways a good scrub with a chlorine-
soaked piece of cloth and then flush with
clean water. Let all the components fully dry
before you put them back inside.
•Cooling towers: speak with a water treatment
expert before doing anything, but the usual
procedure starts with shutting the system
down and flushing with a disinfectant/ water
solution through the whole unit. Then, you
scrub wherever there’s sludge buildup and
make sure the pH levels remain where we
want them for at least a day. Think of pH as a
measure of how acidic or basic a surface is.
Cooling systems:
•Air conditioners: turn off the power, take off
the covers and give the filter pads a good
clean with a hose. Replace them if they’ve
been damaged. After that, give all the
waterways a good scrub with a chlorine-
soaked piece of cloth and then flush with
clean water. Let all the components fully dry
before you put them back inside.
•Cooling towers: speak with a water treatment
expert before doing anything, but the usual
procedure starts with shutting the system
down and flushing with a disinfectant/ water
solution through the whole unit. Then, you
scrub wherever there’s sludge buildup and
make sure the pH levels remain where we
want them for at least a day. Think of pH as a
measure of how acidic or basic a surface is.
Recognising and responding to
outbreaks
outbreaks
Signs and symptoms
of legionellosis
Let’s break down the two main types of Legionella
infections:
•Legionnaire’s Disease: it’s the most common and
can take up to 10 days or more for symptoms to
show up after infection, which are mainly high fever,
coughing, shortness of breath and muscle pain.
Also, residents might cough up green mucus or even
blood if the infection’s really bad. In any case, send
the resident to a hospital immediately to start
treatment. However, the diagnosis can also be done
right then and there with a urine rapid test.
•Pontiac Fever: this is a rare type of legionellosis that
kicks in 1-3 days after infection. It usually goes away
by itself in a few days and causes mild fever and
muscle pain. Since it’s an even rarer disease, not
much is known about it, and it often goes
undiagnosed. The big difference here is that it
doesn’t cause pneumonia, coughing and the rest.
of legionellosis
Let’s break down the two main types of Legionella
infections:
•Legionnaire’s Disease: it’s the most common and
can take up to 10 days or more for symptoms to
show up after infection, which are mainly high fever,
coughing, shortness of breath and muscle pain.
Also, residents might cough up green mucus or even
blood if the infection’s really bad. In any case, send
the resident to a hospital immediately to start
treatment. However, the diagnosis can also be done
right then and there with a urine rapid test.
•Pontiac Fever: this is a rare type of legionellosis that
kicks in 1-3 days after infection. It usually goes away
by itself in a few days and causes mild fever and
muscle pain. Since it’s an even rarer disease, not
much is known about it, and it often goes
undiagnosed. The big difference here is that it
doesn’t cause pneumonia, coughing and the rest.
Steps in case of outbreak
When there are 2 or more cases within a short time period (usually weeks
apart), and on top of that there’s suspicion of a common source of infection,
that is considered an outbreak, even without lab tests. So, what now?
In no particular order:
Step 1: give management the heads up and lay out all the details about the
incident.
Step 2: call local HSE authorities. They’ll send over the Proper Officer to start
an investigation and officially declare an outbreak.
Step 3: ensure that residents, staff and whoever’s affected get the necessary
treatment, whether it’s getting them to a hospital or calling in a doctor.
Step 4: identify the source. This will be the key for the investigation moving
forward.
When there are 2 or more cases within a short time period (usually weeks
apart), and on top of that there’s suspicion of a common source of infection,
that is considered an outbreak, even without lab tests. So, what now?
In no particular order:
Step 1: give management the heads up and lay out all the details about the
incident.
Step 2: call local HSE authorities. They’ll send over the Proper Officer to start
an investigation and officially declare an outbreak.
Step 3: ensure that residents, staff and whoever’s affected get the necessary
treatment, whether it’s getting them to a hospital or calling in a doctor.
Step 4: identify the source. This will be the key for the investigation moving
forward.
The legal stuff
One more thing – don’t forget to look at the legislation in the UK around
Legionella:
•Health and Safety at Work Act (HSWA - 1974): employers are required ‘so
far as reasonably practicable’ to ensure the health and safety of all
employees at work and everyone else connected to their business, aka
residents, visitors, volunteers etc. In turn, employees must cooperate with
employers and take care of their own health and others’.
•Control of Substances Hazardous to Health Regulation (1994):
employers have to be aware of Legionella and also assess the risks around
it, prevent it, control it and finally provide the necessary training to all
employees.
•HSE ACoP L8 (The Control of Legionella Bacteria in Water Systems): it
contains lots of info on how to do risk assessments, it sets the duties of
those responsible for water systems and many more.
One more thing – don’t forget to look at the legislation in the UK around
Legionella:
•Health and Safety at Work Act (HSWA - 1974): employers are required ‘so
far as reasonably practicable’ to ensure the health and safety of all
employees at work and everyone else connected to their business, aka
residents, visitors, volunteers etc. In turn, employees must cooperate with
employers and take care of their own health and others’.
•Control of Substances Hazardous to Health Regulation (1994):
employers have to be aware of Legionella and also assess the risks around
it, prevent it, control it and finally provide the necessary training to all
employees.
•HSE ACoP L8 (The Control of Legionella Bacteria in Water Systems): it
contains lots of info on how to do risk assessments, it sets the duties of
those responsible for water systems and many more.
Knowledge Check
Question 1
Legionella is a _______
•Fungus
•Bacterium (correct)
•Virus
•Parasite
Legionella is a _______
•Fungus
•Bacterium (correct)
•Virus
•Parasite
Question 2
Legionella is more commonly found in _____
•Soil
•Food
•Water (correct)
•Furniture
Legionella is more commonly found in _____
•Soil
•Food
•Water (correct)
•Furniture
Question 3
The most common legionellosis affects the ______
•Spleen
•Lungs (correct)
•Kidneys
•Liver
The most common legionellosis affects the ______
•Spleen
•Lungs (correct)
•Kidneys
•Liver
Question 4
Which of the following populations are at a low risk for
Legionella?
•College students (correct)
•Diabetics
•Arthritis patients
•The elderly
Which of the following populations are at a low risk for
Legionella?
•College students (correct)
•Diabetics
•Arthritis patients
•The elderly
Question 5
Legionella sources in care homes are:
•Showerhead (correct)
•Drawers
•Pillow
•Garden hose (correct)
•Kitchen sink (correct)
•Dust
•Toilet (correct)
Legionella sources in care homes are:
•Showerhead (correct)
•Drawers
•Pillow
•Garden hose (correct)
•Kitchen sink (correct)
•Dust
•Toilet (correct)
Question 6
Which symptoms aren’t typical for Legionnaire’s Disease?
•Coughing
•Hearing loss (correct)
•Light sensitivity (correct)
•Muscle pain and fatigue
•Toothache (correct)
•Fever
•Numbness (correct)
Which symptoms aren’t typical for Legionnaire’s Disease?
•Coughing
•Hearing loss (correct)
•Light sensitivity (correct)
•Muscle pain and fatigue
•Toothache (correct)
•Fever
•Numbness (correct)
Question 7
Which is the ideal temperature for Legionella?
•10-35 °C
•50-60 °C
•30-40 °C
•20-45 °C (correct)
Which is the ideal temperature for Legionella?
•10-35 °C
•50-60 °C
•30-40 °C
•20-45 °C (correct)
Question 8
Which are correct about cleaning and testing water systems?
•Chlorine solution must be at ~50ppm (correct)
•Scrubbing the insides of water tanks is preferred
•Odor from an AC unit doesn’t mean Legionella
•Cooling towers are usually cleaned by professionals (correct)
•Legionella rapid test kits don’t exist
•Risk assessments are optional in the UK
Which are correct about cleaning and testing water systems?
•Chlorine solution must be at ~50ppm (correct)
•Scrubbing the insides of water tanks is preferred
•Odor from an AC unit doesn’t mean Legionella
•Cooling towers are usually cleaned by professionals (correct)
•Legionella rapid test kits don’t exist
•Risk assessments are optional in the UK
Question 9
Which cooling tower has been cleaned properly?
(Correct)
Which cooling tower has been cleaned properly?
(Correct)
Question 10
In how many places can Legionella be found in this
bathroom?
•1
•2
•3
•4 (correct – sink, toilet, flush,
vase)
In how many places can Legionella be found in this
bathroom?
•1
•2
•3
•4 (correct – sink, toilet, flush,
vase)
Supplementary material
Make sure you check out these sources before you take any
measures against Legionella:
•https://www.gov.uk/government/collections/legionnaires-dis
ease-guidance-data-and-analysis
(PHE)
•https://www.hse.gov.uk/legionnaires/ (HSE guidelines)
•https://www.cqc.org.uk/guidance-providers/regulations-
enforcement/legislation#:~:text=The%20Health%20and
%20Social%20Care,of%20health%20and%20social%20care
(CQC)
Make sure you check out these sources before you take any
measures against Legionella:
•https://www.gov.uk/government/collections/legionnaires-dis
ease-guidance-data-and-analysis
(PHE)
•https://www.hse.gov.uk/legionnaires/ (HSE guidelines)
•https://www.cqc.org.uk/guidance-providers/regulations-
enforcement/legislation#:~:text=The%20Health%20and
%20Social%20Care,of%20health%20and%20social%20care
(CQC)
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