Environmental sampling for legionella proliferation risk in three long-term care facilities in Vancouver, British Columbia

Abstract


 Background: Legionella is a pathogen that causes Legionnaires’ disease in high risk populations. The pathogen is known to exist in plumbing systems that do not have preventative factors in place to prevent its growth and proliferation. Legionella grows between 25˚C and 42˚C and is killed at 60˚C, yet long-term care facilities (LTCFs) reduce accessible hot water temperatures from 60˚C at the hot water tank to less than 49˚C at the taps in order to prevent scalding of their residents. Currently, prevention against scalding takes precedence as temperature at accessible taps is regulated within the Residential Care Regulation (RCR) of the Community Care and Assisted Living Act. It is thought that Legionella proliferation risk can be balanced with scalding in-part through the appropriate installation location of thermostatic mixing valves (TMVs). Methods: Three LTCFs in Vancouver, British Columbia were selected for environmental sampling for Legionella proliferation risk. At each LTCF the author recorded the type of hot water tank, temperature of water within the hot water tank, the presence of a TMV and temperature of pipes before and after the TMV. As well, the author recorded hot water temperatures after one minute and free available chlorine concentration ([FAC]) at numerous resident-accessible taps throughout each LTCF. Results: The hot water tank temperatures were set at 60.6˚C, 73.0˚C and 62.0˚C for LTCF #1, LTCF #2 and LTCF #3, respectively. All three LTCFs had installed a TMV within the boiler room immediately after the hot water tank. It was found that LTCF #1’s plumbing system water temperature was reduced from 60.6˚C (at the tank) to 48.9˚C after the TMV. LTCF #2’s plumbing system water temperature was reduced from 73.0˚C (at the tank) to 43.3˚C after the TMV. LTCF #3 was an older plumbing system that did not have thermometers within the boiler room to check the drop in temperature after the TMV. Water temperatures at taps were compared to a standard of 49°C and [FAC] levels at taps to a standard of 0.2 mg/L. The mean hot water temperature and mean [FAC] residual for all three LTCFs were 40.2˚C and 0.27 mg/L, respectively. For all three LTCFs, it was statistically significant that mean water temperatures were less than the comparison value of 49˚C (LTCF #1 p = 0.00000, LTCF #2 p = 0.00022, LTCF #3 p = 0.00110). It was also statistically significant that the mean [FAC] of all three LTCFs were greater than the comparison vale of 0.20 mg/L (LTCF #1 p = 0.00042, LTCF #2 p = 0.00000, LTCF #3 p = 0.00107). Conclusion: It was found that all three LTCFs had set preventive measures in place to protect their residents. Water was heated to at least 60˚C to prevent Legionella and lowered to less than 49˚C to prevent scalding. [FAC] residual was also adequate to prevent growth of Legionella. However, the location of the TMV in the boiler room was suspected to be a possible contributing factor to Legionella growth, especially if cold water temperatures were to reach 20˚C or above, as they could in warm summer months. Further research is needed to determine the significance of the TMV location and the presence of Legionella.