Churchill Hospital Controlling Legionella Risk in a Oxford Hospital Building Using Copper and Silver Ionisation Churchill Hospital Case Study

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Churchill Hospital Controlling Legionella risk in a Oxford hospital building using copper and silver ionisation Churchill Hospital Case Study

Background with counts of 100 (2), 200, 300, 600 (2), 1300, 1400 and 5200 cfu/L. One outlet had flexible hoses and a large deadleg, which The Churchill Hospital (part of the John Radcliffe, Oxfordshire) caused Legionella to persist there for longer than in other outlets. is a teaching hospital in Oxford, England. The hospital was The number of outlets sampled was then reduced to 11 outlets, established in 1942 and is primarily a centre for the treatment of after ProEconomy was satisfied thatLegionella was being cancer patients, with research and teaching facilities. It has 180 controlled, and for the past year, six outlets are sampled monthly. in-patient and 100 day care beds. The Orca Copper and Silver Legionella at counts above 100 cfu/L persisted in some outlets Ionisation system (CSI) system was installed at the Churchill until April 2015 (Figure 1), due to flexible hoses and deadlegs. Hospital in November 2014. Since June 2015 (6 months after commissioning) Legionella has been controlled, with only three outlets showing low counts (100 Sampling cfu/L of mainly non-pneumophila). No Legionella has occurred in any of the tested outlets at Churchill Hospital after July 2016 Before the CSI system was activated, pre-commissioning samples (Figures 1 and 2). were taken from 16 outlets identified as being at risk ofLegionella contamination. After activation of the CSI system, samples were taken every month from 9 to 20 outlets that showed risk of Conclusion Legionella contamination and were analysed for Legionella by the culture method and for copper and silver by Inductively Coupled There was enough evidence to show Legionella posed a real Plasma-Optical Emission Spectroscopy/Mass Spectrometry threat to the hospital. Legionella control using a CSI system was (ICP-OES/MS), by UKAS accredited laboratories (ALcontrol and achieved from May 2015 and total Legionella eradication was ALS Laboratories, UK). The number of outlets sampled was achieved from August 2016 onwards. The system, like any other then reduced to 11 outlets, after ProEconomy was satisfied that Legionella control system, must be monitored regularly so that Legionella was being controlled, and it was reduced to six outlets any problem outlet is quickly detected and dealt with. Legionella sampled monthly in the past year. has been totally eradicated from the Churchill Hospital for about a year now and as a result, ProEconomy is now providing Legionella Results control to the whole of the John Radcliffe Hospital. The results of the pre-commissioning samples (November 2014) are shown in Figures 1 and 2. A total of nine of the 16 outlets tested showed the presence of Legionella pneumophilla SG2-14

5500

5000 Outlet 1 4500 Outlet 2 Outlet 3 4000 Outlet 4 3500 Outlet 5 Outlet 6 3000 Outlet 2500 Outlet 8 Outlet 9 2000 Outlet 10 Outlet 11 Legionella counts (cfu/L) counts Legionella 1500

1000

500

0 20/11/2014 20/12/2014 20/01/2015 20/02/2015 20/03/2015 20/04/2015 20/05/2015 20/06/2015 20/0/2015 20/08/2015 20/09/2015 20/10/2015 20/11/2015 20/12/2015 20/01/2016 20/02/2016 20/03/2016 20/04/2016 20/05/2016 20/06/2016 20/0/2016 20/08/2016 20/09/2016 20/10/2016 20/11/2016 Sample Date Figure 1 Legionella counts at eleven outlets Figure 1. Legionella counts at eleven outlets

25 100

20 80

15 60

10 40 Positives

Total Number of Samples of Samples Number Total 30

5 20

0 0 v - 16 - v eb - 16 - eb Jul - 15 Jul - Jul - 16 - Jul Oct - 16 - Oct Apr - 16 - Apr Apr - 15 - Apr Oct - 15 - Oct Apr - 16 - Apr Jan - 15 - Jan 15 - Feb Jan - 16 Jan - F Jan - 16 Jan 16 - Feb Jun - 16 Jun Jun - 15 - Jun Jun - 16 Jun Dec - 14 - Dec Dec - 16 Dec Dec - 15 - Dec Sep - 15 Sep Sep - 16 Sep Mar - 16 - Mar Mar - 15 - Mar Mar - 16 - Mar No Nov - 14 - Nov Nov - 15 - Nov Aug - 15 Aug Aug - 16 - Aug May - 16 May May - 15 - May May - 16 May

Total Number of Samples Total Positives Positive Figure 2 Total number of samples taken per month, number of positives and percentage of Legionella positives. the outlet concerned was infrequently.”used very while. The system allowed us to seethat and weevidenced that we were down tojust one positive. That one positive stayed fora sites sampled. In thefirst monthsampling,after theinstallation, the ProEconomy system went in, we had nine positives out of 16 John Radcliffe. The result was amazing. In the pre-sample, before be a showcaseof what we could introduce to thebiggersite at control issues. Depending on how the system worked, it would showers out of use andwhere calorifiers giving us temperature head and neckward at the Churchill Hospital,where we had the with the Orca system: “We with an installation at the started Foundation Trust, had the following to say about their experience Head of Operational Estates for Oxford University Hospitals NHS with Hospital Times magazine, ClaireIn an interview Hennessey, Testimonial Figure 1 Figure 2 positives.

positives. Figure 2. Total Number of Samples Legionella counts (cfu/L) 1000 1500 2000 2500 3000 3500 4000 4500 5000 5500 500 10 15 20 25 0 5 T Legionella counts at el 0 otal number of samples ta

Total numberofsamplestaken permonth,numberofpositives andpercentage ofLegionella Nov - 14 20/11/2014 Dec - 14 20/12/2014 Jan - 15 20/01/2015 Feb - 15 20/02/2015 Mar - 15 Total Number of Samples 20/03/2015 Apr - 15 20/04/2015 May - 15

Jun - 15 ev 20/05/2015

Jul - 15 en outlets 20/06/2015

k Aug - 15 20/0/2015 en per month, number of v positi Sep - 15 20/08/2015 Oct - 15 Sample Date 20/09/2015 Nov - 15 20/10/2015 Dec - 15 20/11/2015 Jan - 16 20/12/2015 Feb - 16 Total Positives 20/01/2016 Mar - 16 20/02/2016 Apr - 16 20/03/2016 May - 16 20/04/2016 Jun - 16 Jul - 16 20/05/2016 20/06/2016 es and percentage of Legionella Aug - 16

Sep - 16 Churchill HospitalCaseStudy 20/0/2016

Positive Oct - 16 20/08/2016 Nov - 16 20/09/2016 Dec - 16 20/10/2016 Jan - 16 20/11/2016 Feb - 16 Mar - 16 Apr - 16 May - 16 Outlet 1 Outlet 11 Outlet 10 Outlet 9 Outlet 8 Outlet Outlet 6 Outlet 5 Outlet 4 Outlet 3 Outlet 2 Jun - 16 0 10 20 30 40 50 60 0 80 90 100

Positives