Legionella in care homes and healthcare premises

The people most likely to be harmed by Legionnaires’ disease are the people these buildings exist to look after. That changes both the temperatures and the scrutiny.

Why the risk is higher here

Legionnaires’ disease does not affect everyone equally. HSE lists the elderly, smokers and heavy drinkers among those at higher risk, alongside people with cancer, diabetes, or chronic respiratory or kidney disease. A care home is, by definition, a building full of people in at least one of those categories.

The exposure route is unchanged: breathing in water droplets from a shower, a tap or a fine spray. What changes is the consequence, and with it the standard you are held to.

The temperatures for care and healthcare premises

The figures are tighter than in a commercial building, and HSE publishes them directly.

60°C in the cylinder – Hot water storage calorifiers should store water at 60°C or higher.

50°C distributed – Hot water should be distributed through the system at 50°C or higher.

55°C at the outlet – In healthcare premises the outlet should reach 55°C within one minute of running, against 50°C elsewhere.

Below 20°C cold – Cold water should be stored and distributed below 20°C.

How often to check

Monitoring frequency is where most care home regimes drift. These are the minimums.

Monthly at sentinel outlets – The outlets nearest to and furthest from the storage, hot and cold.

Monthly at the cylinder – Calorifier temperatures checked every month.

Six-monthly cold water tanks – Cold water tank temperatures checked at least twice a year.

Scalding is the other half of the problem

Water hot enough to control Legionella is hot enough to scald, and the people at highest risk from one are often at highest risk from the other. The resolution is not to lower the temperature. It is to fit thermostatic mixing valves close to the outlets where there is a scald risk, so the system stays hot while the water reaching the user does not.

That creates its own maintenance duty. A mixing valve is a serviceable item sitting in the part of the pipework where water is coolest, and an unserviced one is both a scald risk and a Legionella risk.

Who regulates you

Health and safety duties sit with HSE. For providers registered in England, the Care Quality Commission is the relevant regulator for patient safety matters, and water safety routinely appears in inspection findings. HSE also publishes Health and safety in care homes (HSG220), which covers this alongside the other risks specific to the setting.

Water safety where getting it wrong is not survivable.

We carry out Legionella risk assessments and monitoring for care homes and healthcare premises.

For any enquiries or questions please call: 01707 527 069