Numerous Areas for Improvement Details in Review of the Prevention and Control of Legionella Pneumophila Infection in Queensland

By Petrina Smith
Thursday, 17 October, 2013

Chief Health Officer Dr Jeannette Young’s Review of the prevention and control of Legionella pneumophila infection in Queensland was tabled in Parliament today and detailed numerous areas for improvement.
The review fully investigated circumstances surrounding two cases of Legionnaires disease at The Wesley Hospital in May/June this year and makes recommendations regarding the future management of Legionella pneumophila in Queensland.
Dr Young said while the review showed the Wesley Hospital did not specifically breach any legislation or regulation, administrative issues did affect its management of and response to the Legionnaires outbreak.
“Deficiencies were also detected in the laboratory information system and supporting procedure documents at Sullivan Nicolaides Pathology,” Dr Young said.  “These deficiencies resulted in their failure to notify Queensland Health of the first positive Legionella test result from the Wesley. “Fortunately, in this case, this failure had no impact on future risks to other patients given the prompt and comprehensive actions undertaken by The Wesley Hospital.
“Both the Wesley and Sullivan Nicolaides took steps to address these administrative issues immediately once they were identified by Queensland Health.”
The scope of the review also included sampling, testing and treatment of water supplies in all of Queensland’s public, private and day hospitals.
Health Minister Lawrence Springborg said this was a massive logistical exercise requiring the cooperation of more than 260 facilities statewide.
“These facilities reported more than 5,000 test results and of these, 83 public and 76 private facilities were free of Legionella,” Mr Springborg said.
“Positive samples were however returned at 106 facilities across the state.
“This bacterium has proven highly persistent in some areas, particularly at Charleville and Waroona, which have undergone nine separate rounds of testing and treatment to date.
“On top of the logistical issues posed by this task, there has also been a large financial impost on some Hospital and Health Services.
“Costs received to date from hospital and health services have ranged from $20,000 to around $100,000 depending on the scope of testing undertaken, the treatment required or the size of the health service.”
The review identified numerous areas for improvement to ensure a more robust approach to preventing and controlling Legionella and Legionnaires Disease in Queensland including:
• regulation
• water supply to health and residential aged care facilities
• water infrastructure and water quality management, including periodic testing
• electronic data management, notification and follow-up of cases of legionellosis
• national collaboration and consistency
• information for the community.
Recommendations in full (to be implemented in conjunction with other agencies)
1. In the short-term, public and private hospitals and all public residential aged care facilities be required, and private residential aged care facilities be requested, to develop water quality risk management plans which will include periodic testing of their water supplies for Legionella and heterotrophic plate count, based on risk. This can be achieved through:
· a directive applicable to all public hospitals and residential aged care facilities
· modification to the Physical Environment Standard within the Private Health Facilities Act 1999 Standards
· a letter issued by the Chief Health Officer to all private residential aged care facilities strongly encouraging the adoption of such plans.
2. In the medium-term, legislation be strengthened relating to the design, commissioning, installation, operation and maintenance of cooling water and water delivery systems in hospitals and residential aged care facilities, through inclusion of requirements under the Public Health Act 2005. This would include as a minimum the requirement for facilities to have a water quality risk management plan which include requirements for periodic testing for Legionella and heterotrophic plate count, based on risk.
3. A memorandum of understanding be developed by relevant regulatory agencies—Department of Housing and Public Works, Department of Justice and Attorney General, Department of Energy and Water Supply and Department of Health—to clearly articulate the roles of each agency and coordination arrangements with respect to Legionella risks in hospitals and residential aged care facilities.
4. National collaboration be sought with regard to the following:
· finalising as a priority the Australian Technical Standard for warm water systems and subsequently, the updating of AS 3500.4 to include standards for warm water systems
· strengthening AS 3666.2 in relation to the operation and maintenance of heated water systems
· specific requirements for the design, installation, replacement and commissioning of drinking water systems in hospital and residential aged care facilities
· guidelines for the operation and maintenance of drinking water systems for hospital and residential aged care facilities
· reviewing the national guideline for the public health response to legionellosis
· reviewing accreditation processes for both hospital and residential aged care facilities to determine if aspects relating to the physical environment should be strengthened
5. An immediate upgrade of the Notifiable Conditions System (NoCS) be progressed to provide enhanced prevention and control capabilities including:
· a reliable and efficient system for the electronic notification of notifiable conditions
· electronic clinical information management capacity in public health units, that supports public health action in responding to notifiable diseases and enhances statewide reporting of outcomes, quality and activity
· enhanced disease surveillance, outbreak detection, enhanced surveillance and early warning of disease risks, including emerging infections and pandemics.
6. A review of information for the community be undertaken in collaboration with other agencies to ensure opportunities are maximised to increase awareness of the generally low, but potential risks of Legionella and how to minimise them.

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