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Legionella: Another sad reminder of the need for effective management

08 July 2014

Following a single confirmed case of Legionnaires’ disease in a baby born in a birthing pool at home, Public Health England (PHE) and NHS England recently issued a Patient Safety Alert, temporarily advising against the use in the home of birthing pools

The advise extended to those birthing pools using built-in heaters, recirculation pumps, and those pools that may be filled for a period of time in advance of the birth. At the time of writing, the baby was still receiving intensive care treatment in hospital.

While legonellosis, the disease caused by Legionella, is well documented from many other water systems, this is not only the first case in England relating to a birthing pool (there have been two similar cases reported in Italy and Japan some years ago however), says Greg Davies, head of service development at Assurity Consulting. "It is also very rare in this age group: HPA/PHE published figures show that there was only one recorded case of Legionnaires’ disease in children under 9 between 1990 and 2011."

Professor Nick Phin, head of Legionnaires' disease control, at HPE said, "This is an extremely unusual situation, which we are taking very seriously… As a precaution, we advise that heated birthing pools, filled in advance of labour and where the temperature is then maintained by use of a heater and pump, are not used in the home setting, while we investigate further and until definitive advice on disinfection and safety is available."

Advice from PHE is “This alert is to highlight the importance of women not labouring or giving birth in a birthing pool which has been filled prior to the onset of labour and where the temperature has been maintained by use of a heater and pump. It is essential to note that this alert does NOT refer to birthing pools:

• of any type which are filled from domestic hot water systems at the time of labour.
• Pumps of any type should be used solely for pool emptying and not for recirculation.”

In December 2008, a large outbreak of Legionella infection occurred with babies in Cyprus provided some further information on the epidemiological and clinical features of Legionellosis in this age group. These babies were infected in the nursery at the private hospital by aerosol produced by a recently installed cold-mist humidifier filled with contaminated water.

What these cases again highlight is the need for appropriate risk assessments and where required clear and effective management to control Legionella. As the outbreaks at Edinburgh (cooling tower) and Stoke on Trent (spa pool), both in 2012, confirm, even when risk is well understood, without management led, evidence based processes things can still go badly wrong.

For those who can demonstrate proactive management it is a reminder that all water systems under your control need assessing and as we introduce new water technologies these too must be included.

As recently with L8, advise and practise can also change as we get more information and greater understanding of particular risk, that is why successful Legionella management will always be about today’s realities and not historic perceptions. 

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