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Improving standards of legionella risk assessments in the healthcare sector

As difficult as it might be for some to imagine, there was a time – only a few generations ago – when health and safety law in the UK was much more haphazard and challenging to keep track of, than it is now.

While various health and safety laws began to be introduced from the early 19th century as society became more industrialised, there was often considerable inconsistency with regard to which rules applied in which sectors and areas of the country.

It is no wonder, then, that in 1970, the UK Government began to take steps to streamline the regulatory landscape in this regard, with the setting-up of a committee – led by Lord Robens – to consider the best way forward.

This set in motion a series of events that ultimately brought us the Health and Safety at Work etc Act 1974 (HSWA) and the creation of regulatory body the Health and Safety Executive (HSE).

These are both developments that remain extremely relevant to organisations assessing the risks that their premises may pose to the health and safety of building users and occupants – including in relation to potential legionella risk in healthcare settings.

What is the relevance of the HSWA to legionella risk assessments?

From the moment of the Health and Safety at Work etc Act’s introduction, there was a great emphasis on the importance of risk assessment.

Indeed, the first sentence of the original and current HSWA reads: “An Act to make further provision for securing the health, safety and welfare of persons at work, for protecting others against risks to health or safety in connection with the activities of persons at work.”

That very first sentence implies the need to have a risk assessment carried out at premises subject to the provisions of the Act – and sure enough, further information on this is provided in sections 2 and 3.

As a consequence, then, since the Act came into effect in 1974, it has been a legal requirement for employers to arrange for a risk assessment at any workplace under their control, to ensure the health and safety of their employees, “persons other than their employees”, and visitors.

What other legislation dictates the need for a legionella risk assessment in the healthcare sector?

Since the passing into law of the HSWA, other legislation has been put in place to further entrench the requirement for risk assessments to be carried out at premises such as healthcare environments.

Those have included the Control of Substances Hazardous to Health Regulations 2002 (COSHH), which set out a framework of actions for controlling the risk that can be posed by a range of hazardous substances – including biological agents such as legionella.

Included within COSHH is a stipulation of the requirement to identify and assess the risk, and to implement any measures that are necessary in order to control that risk.

Healthcare employers should also be aware of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – specifically Regulation 12, ‘Safe care and treatment’, and Regulation 15, ‘Premises and equipment’. Both of these regulations imply the requirement for a legionella risk assessment, otherwise known as an LRA, to be undertaken.

What steps can your healthcare organisation take to improve its own legionella risk assessment?

It won’t be news to too many people reading this, that healthcare settings are particularly high-risk ones as far as the management of legionella risk is concerned. Such premises have highly vulnerable patient populations, which heightens the importance of implementing responsible water management programmes to help reduce the infection risk for patients, staff and visitors alike.

Over the years, various guidance documents have been produced to help organisations fulfil their legal obligations with regard to legionella risk. Those have included the likes of Legionnaires’ disease: The control of legionella bacteria in water systems Approved Code of Practice and guidance on regulations, otherwise known as ACOP L8, and BS 8580-1:2019 Water Quality – Risk assessments for Legionella control.  

However, without going into too much detail here, being mindful of the below factors is likely to be helpful to your healthcare organisation’s efforts to improve the quality of its own legionella risk assessments:

  • The competence of the risk assessor. As BS 8580-1 sets out, there could scarcely be a more important factor in your organisation’s legionella risk assessment’s than the competence of the assessor. The assessor should have the appropriate capabilities for the complexity of the given system and the risk that is being assessed. The assessment is unlikely to be ‘suitable or sufficient’ if the assessor does not have the required level of competence.
  • The standard of record-keeping. Even if your organisation in the healthcare sector makes what it considers its best efforts to ensure the highest-quality legionella risk assessments, it cannot entirely rule out the possibility of something going wrong – and in the process, attracting the scrutiny of regulators. In this situation, the regulators will wish to see the records you have kept – including those documenting the competence of the risk assessor.
  • The temperature assessment of hazards. To cite one extract from BS 8580-1: “if the system contains water at a temperature greater than 20 degrees C, and less than 50 degrees C, and an aerosol can be generated under any foreseeable circumstance, then it is a system at risk of causing legionellosis.” Water conditions, then, are a crucial aspect to analyse at your healthcare premises, and temperature can be used to measure the risk. You should therefore be looking to temperature assess all hazards, including the likes of hot and cold water outlets, cisterns, and heaters that may be present at the property.
  • The conciseness and readability of the report. As part of the legionella risk assessment process, it will naturally be necessary to report your findings. But is the report concise and clear? This is another factor addressed by BS 8580-1, which stipulates that the report should avoid using jargon or abbreviations that have not been clearly explained, so that the target users can readily understand it. This should also mean being careful to avoid unnecessary repetition and/or superfluous content that isn’t specifically related to the risk presented by legionella.
  • The use of up-to-date templates. Using old and outdated templates will further hinder your efforts to achieve the optimal results from your legionella risk assessments. This is something that you might look to combat with the adoption of our own Vision legionella risk management platform, which delivers – as standard – an legionella risk assessment template fitting in well with the requirements set out in ACOP L8.

In conclusion, legionella risk assessments play a hugely important role in helping to protect vulnerable people and patients, which is a matter especially pertinent for healthcare organisations. You should therefore be taking every possible step within your own organisation to achieve the highest standards in how you manage and execute legionella risk assessments for your premises.

If we can assist, get in touch… CALL 0115 922 0600 or email

And/or if you’re looking for software to help you manage yours or your clients processes, we recommend you take a look at Vision Pro;