Guidelines on minimising Legionnaires' risk are failing to safeguard ageing population, research finds

June 19, 2017 by Sarah Cox, Brunel University London
Credit: Brunel University

Global guidelines aimed at minimising the risk of contracting Legionnaires' disease are inadequate for safeguarding the health of our ageing population, new research from Brunel University London concludes.

Dr Edwin Routledge and colleagues say that people living in standard blocks of flats (as opposed to hospitals or care homes for the elderly which house residents most at risk from Legionella pneumophila) are neglected when it comes to monitoring and protecting against the water-borne bacteria, even though one in five residents are in high-risk categories.

Writing in Environmental Technology Reviews, the research team have critically assessed the codes of practice on Legionnaires' risk issued by the World Health Organisation, UK Health and Safety Executive (HSE) and the European Centre for Disease Prevention and Control.

Guidelines should cover standard residencies as well as care homes

Major contributing factors in susceptibility are a weakened immune system, being male, over the age of 45, and suffering from an existing illness such as respiratory problems, kidney disease, diabetes or cancer. Around 10-15% of all reported cases of Legionnaires' disease result in a fatality.

Approximately 400,000 people in the UK over the age of 65 live in nursing homes or residential homes for older residents, but millions live in standard, mixed, non-healthcare blocks of flats with shared hot and cold water pipes which are just as likely to house dangerous bacteria.

Brunel's researchers surveyed the residents of twenty standard building complexes in a variety of London boroughs, varying in size from 65 flats to 645. Some 18%, or almost 1 in 5, residents were over the age of 65 and most suffered from at least one condition that is associated with greater susceptibility to Legionnaires' Disease.

Unlike healthcare residencies, mixed residential buildings are not subject to WHO or HSE guidelines on what levels of Legionella present in the water system should result in further remedial action or intervention. European guidelines, however, do recommend remedial action at a certain level, regardless of the type of property.

"Our ageing population tend to prefer shared dwellings over detached or semi-detached houses due to increased security and a variety of communal facilities that they can enjoy without the responsibility for maintenance. They may choose to downsize from a family home, and of course, in a city like London, the cost of renting or buying a house is also increasingly prohibitive," says Dr Routledge.

"The burden of age-related diseases in society is increasing. By 2035 we can expect more than six million people in the UK aged 65 and above, with long standing serious illness, living in . But your typical block of flats is currently not considered to be 'high risk'. Based on the percentage of elderly and vulnerable residents living in them, we believe they should be."

Testing methods are not reliable enough

Disparities in current sampling technique and detection methods for Legionella have also raised concerns about the reliability of measures to safeguard public health, the authors also say.

Research in 2014 by Whiley and Taylor saw almost 4,000 environmental samples analysed for Legionella, with 34% of samples testing positive when 'culture methods' were used but 72% testing positive when using a quantitative (qPCR) method.

Neither technique is perfect, say the Brunel research team - the former method is likely to underestimate the presence of Legionella, while the latter can overestimate the concentration of live bacteria present.

Figures quoted in the Brunel report also suggest a possible link to global warming - an increase in Legionnaires' cases has been recorded during exceptionally warm or wet weather as conditions become more favourable for the survival and replication of Legionella.

The report recommends:

  • Measures to protect the susceptible population of residents in non-healthcare premises should be re-examined
  • There should be greater harmonisation of Legionella standards in both health and non-healthcare premises
  • The proportion of residents over 65 occupying a building should be included as a risk factor in routine risk management strategies
  • New rapid test methods for Legionella should be developed
  • The potential impact of global warming on the risk of exposure to Legionella and its consequences should be investigated.

Explore further: Legionnaires' hiding in hospital, nursing home plumbing systems: CDC

More information: 'Barriers to Effective Legionella Control in a Changing World – A Practitioners View' by Mr Aji Peter, Professor Clive Thompson and Dr Edwin Routledge was published online in Environmental Technology Reviews on 12th June 2017, dx.doi.org/10.1080/21622515.2017.1335352

Related Stories

Legionnaires' hiding in hospital, nursing home plumbing systems: CDC

June 6, 2017
(HealthDay)—Deadly Legionnaires' disease is lurking in the water systems of hospitals, nursing homes and long-term care facilities, putting the most vulnerable patients at risk, U.S. health officials said Tuesday.

Cases of legionnaires' disease reported in NYC, las vegas

June 14, 2017
(HealthDay)—Cases of Legionnaires' disease in New York City and Las Vegas are being investigated by health officials.

Newborns sickened with Legionnaire's disease via home water birth: CDC

June 8, 2017
(HealthDay)—Two cases in Arizona and one in Texas highlight a little-known danger of "water births" at home—infant infections with Legionnaire's disease.

Legionnaires' kills 2 Illinois veterans' home residents

August 29, 2015
Two residents of an Illinois veterans' home have died of Legionnaires' Disease, the Illinois Department of Public Health said Friday.

Study finds lack of testing for Legionella

September 27, 2011
A new study from Rhode Island Hospital shows that guidelines concerning testing patients for possible community-acquired pneumonia due to Legionella may underestimate the number of cases being seen by clinicians. The study ...

Recommended for you

'Man flu' may be real

December 11, 2017
The much-debated phenomenon of "man flu" may have some basis in fact, suggests an article published in the Christmas issue of The BMJ.

Full moon linked to increased risk of fatal motorcycle crashes

December 11, 2017
The full moon is associated with an increased risk of fatal motorcycle crashes in the United States, the United Kingdom, Canada and Australia, finds a study in the Christmas issue of The BMJ.

Social media trends can predict tipping points in vaccine scares

December 11, 2017
Analyzing trends on Twitter and Google can help predict vaccine scares that can lead to disease outbreaks, according to a study from the University of Waterloo.

Study suggests being proud may protect against falls in older people

December 11, 2017
Contrary to the old saying "pride comes before a fall", the opposite appears to be true, according to a study published in the Christmas issue of The BMJ.

Peppa Pig may encourage inappropriate use of primary care services

December 11, 2017
Exposure to the children's television series Peppa Pig may be contributing to unrealistic expectations of primary care and encouraging inappropriate use of services, suggests a doctor in the Christmas issue of The BMJ.

Women's sexual orientation linked to (un)happiness about birth

December 11, 2017
Unhappiness about a pregnancy or birth has been associated with negative health outcomes for mothers and babies. Yet, unhappiness about a pregnancy or birth has been understudied, particularly among sexual minority (non-heterosexual) ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.