Who are ‘at risk’ ?
Not only the elderly are at risk of contracting Legionnaires’ Disease. Anyone who has a weakened immune system, due to health problems or deliberate suppression, following organ transplantation, for example, is at high risk. Also, people suffering from heart or lung problems, such as asthma, are very vulnerable.
What is the reported incidence of legionella infection from visiting a dental practice?
It is true to say that the numbers of reported cases is very few. However, despite the fact that there seem to be few cases of infection reported from dental surgeries, there is significant evidence to cause concern with regards to the potential growth of legionella within dental practices, in particular, the presence of legionella within dental unit water lines (DUWLs).
Scientific studies have shown that samples taken from over 50 dental surgeries in the south-west of England contained a wide range of bacteria including legionella; up to 25 per cent of DUWLs have been shown to be contaminated with legionella.
How could the bacteria be transmitted to staff and patients?
The main route of transmission of the legionella bacteria for dental staff and the patient is by inhalation of contaminated water droplets or aerosol, generated by dental instruments such as the high speed hand piece or ultrasonic scaler.
The use of masks can provide limited protection from aerosol for members of staff, but the aerosol generated can easily be inhaled by the patient who has no barrier protection. Therefore, it is essential to ensure that the water used during dental procedures is of a quality that does not pose any threat or risk to health to either staff or the patient.
How can I control the growth of legionella in dental lines?
Currently, there is no single method or device that will completely eliminate bacterial growth in DUWLs or exclude the risk of cross-infection. In view of this, several simple procedures need to be implemented to control the risk of bacterial proliferation within DUWLs.
The purging of DUWLs is one such procedure. This procedure is simple but effective, as long as it is performed diligently. However, it is very important to evidence that this has been carried out. Therefore, a checklist should be devised to record purging activity and a record kept in a Logbook (an exercise book should be sufficient for the purpose).
What about the water system(s) at the practice?
Hot and cold water systems must also undergo specific checks, which are laid down in the HSE’s Approved Code of Practice (ACOP) on the control of legionella in water systems, usually referred to by its number (L8). Particularly important are the tasks relating to flushing infrequently used outlets and monitoring the water temperatures.
What are the legal requirements regarding legionella control?
You are required to comply with the above ACOP. The Code gives practical advice on how to comply with the law but is not in itself primary law.
However, unusually, the Code has a ‘special legal status’, due to the dangerous nature of Legionnaires’ Disease, and can be brought into reference, if you are prosecuted for breach of health and safety law.
Failure to fully comply with the provisions of the Code of Practice, which can be a time consuming and awkward task, is regarded as a serious matter by a Court. The expectation is that the ‘responsible’ person at the practice (usually the practice manager) should be tasked with ensuring compliance.
Apart from the ACOP, you are also required to comply with the requirements of the Health and Safety at Work (HSWA) and the Control of Substances Hazardous to Health (COSHH) Acts.
Is there anything available to assist with ACOP compliance?
Fortunately, you are permitted to use ‘alternative methods’ to ensure your compliance with the ACOP (L8) Code of Practice. Testing on a regular basis, using an accredited laboratory, for the presence of the legionella bacteria in the water system(s) is generally regarded as an acceptable ‘alternative method’. This process is currently used by many dental practices around the country, ensuring protection and peace of mind.
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