Legionaries Assessment and Recommendations for Risk Factors

Executive summary

In light of the extensive reports and deductions of the World of Fitness, a potential strain of Legionaries was suspected. The Royal Bairnsdown Hospital has admitted six people, four showing signs of the strain. The World of Fitness was perhaps the most frequented destination shared by the four. The state health agency has requested reports from the spa, cooling tower, and pool to help them understand the problem better, as well as alternative solutions and analyses of the issue's severity. According to the findings and risk analyses, various locations such as the spa were investigated to determine the primary cause of the patient's illness, necessitating various intervention strategies.

Introduction

Legionnaires' disease is a severe instance of lung inflammation often brought on by an infection. Specifically, the legionella bacterium brings it on through inhaling water-borne organisms. Additionally, many natural and artificial water systems risk being infected with Legionella if various regulations and guidelines are not met. In one case, a putative strain of Legionaries was offered in light of the comprehensive reports and inferences of the World of Fitness. Four out of six who were inducted to the Royal Bairnsdown Hospital have symptoms of the strain. Additionally, the four had several places in common, the most likely being the World of Fitness. Reports from the swimming pool, cooling tower, and spa have been submitted to determine better the area of cause, measures, and possible analysis of the severity of the issue to the state health department. Therefore, this evaluation will focus on the occurrence of Legionnaires' infection in people and the presence of Legionella in water structures, encompassing spas, public pools, and cooling towers, to identify the cause of the patient's illness and the potential suggestions for the state health department.

Methods

In light of the current risk posed by the places shared by the patients, a clear chemical, microbiological and risk assessment test was required to give a definitive study on the issue at hand. Therefore, a microbiological water test was done for the spa, cooling tower, and pool, where various levels of Legionella and Heterotrophic plate count were considered to advance the investigation. Ultimately, assessing the risk management plans for the cooling towers, the chemical agents used on the spa and pool, and the risk factors associated with the design were required to help generate a recommendation.

Testing results

Water samples were taken from different sections during inspection to determine the risk factors associated. The swimming pool and cooling tower all had 0 Legionella presence which was a good sign. However, the spa had elevated levels of Legionella pneumophilia s 1-14. Additionally, the cooling tower had the most Heterotrophic plate count (7938), followed by the spa (3710) and the swimming pool, which had a plate count of 750. None of the places showed any instance of Legionella other than pneumophilia. As a result, the findings from the microbiological water testing necessitated further investigation of pool records, cooling tower risk management plans, and spa inspection records (Weiss et al., 2017). This was a means to help follow the guidelines set where if there is a risk factor in either of the systems, clear requirements for owners and operators of high-risk water systems will be erected (Whiley, 2016). Therefore, the microbiological testing results have shown the need for further investigation of the systems.

Cooling Tower Results and recommendations

Cooling towers have a significant role to play in bacterial outbreaks. This is because of the way they operate. Consequently, a risk management plan that tackles numerous risk variables must be provided for investigating the cooling tower (Hamilton et al., 2018). This is a result of the cooling tower's high levels of Heterotrophic plate count, which shows a likelihood of bacterial regrowth (Health, 2021). The most probable cause of this regrowth is poor water quality, but the results are not an indicator of deteriorated water safety (Fitzhenry et al., 2017). However, the first thing to consider is whether the system has any standing water and whether a lack of water circulation would likely cause sediments to settle out as sludge and promote microbial development (Whiley, 2016). The system does not idle for more than a month, but a recirculating timer is lacking if such an occurrence does happen (Cebrián et al., 2018). As a result, this requires a control strategy to be implemented where an installation of a timer connected to a recirculating pump set to operate at least once a day is required to circulate water efficiently (Whiley, 2016). Additionally, dead legs are in the system, necessitating their removal for safety (Ângelo and Barata, 2021). Thus, the cooling tower has a high likelihood of bacterial growth requiring the implementation of a control strategy within the system such as a timer connected to a recirculating pump.

Additionally, a nutrient growth risk and poor water quality risk control strategy are needed to address the elevated Heterotrophic plate count. As per the nutrient growth report, the cooling tower does not pose any factors in and around the site that may lead to environmental contamination (Ângelo and Barata, 2021). However, there is a lack of the use of a bio-dispersant compatible with the chemicals used, such as chlorine. As a result, a comprehensive water treatment program that includes a bio-dispersant is needed. Moreover, the wetted surfaces exposed to sunlight need to be protected to minimize the regrowth of viable bacteria and a possible means to reduce the water temperature (Papadakis et al., 2018). This will further minimize the growth of bacteria in the system. For water quality, a comprehensive water treatment program is required since some system rotations lack two or more biocides (Bones, 2018). This will allow for installing an automated biocide dosing device encompassing all agents. Given all the present results, various deficiencies are present in the system, and a review of the whole system is required to see whether it meets the required safety standards (Weiss et al., 2017). If not, the system may be temporarily shut down to allow for the implementation of the prescribed systems (Orkis et al., 2018). Therefore, the need for a nutrient growth and water quality risk control strategy is needed to come up with a comprehensive water treatment program which will prevent the regrowth of bacteria within the system.

Spa and Pool Results and recommendations

A well-known source of illnesses brought on by bacterial infections, such as the Legionella bacteria that causes Legionnaires' disease, are spa systems and public swimming pools. However, the swimming pool has shown moderate levels of Heterotrophic plate count and no instance of Legionella. As such, the main focus of the area where the patients might have contracted the bacteria is the spa (Dabrera et al., 2020). Numerous outbreaks have been connected to spa pools in recreation areas. Risk hazards are present in this type of recreational water due to certain operational parameters that promote the generation of aerosols, such as the high water temperature and the existence of hydromassage systems (Leoni, Catalani, Marini and Dallolio, 2018). From the inspection record, the water temperature is maintained at 28 degrees Celsius to 30 (Gleason and Cohn, 2022). This is the ideal temperature required for the Legionella to grow. Therefore, the swimming pool has been shown to not be a probable cause of the spread of the disease but the spa possesses a risk hazard.

Additionally, the chemical agents used have a minimal effect on disease prevention. As a result, given the data presented, the spa will have to be shut down, and the water features need to be cleaned and disinfected to get rid of Legionella as per the SA Public Health Legionella Regulations 2013. This will include suitable design, sufficient residual decontamination, quality infrastructure inspection and maintenance, and proper ventilation (Sciuto et al., 2021). Given how common the use of a spa is, it is highly recommended that the structure be closed indefinitely to manage the disease outbreak—enhancing operator expertise, raising risk awareness, and encouraging adherence to countermeasures to appear critical to strengthening the collaboration among the many professions involved (public health specialists, policymakers, property managers, technical personnel, and device manufacturers) (Orkis et al., 2018). Therefore, the spa was the main cause of concern as the results required additional management techniques to be implemented. Therefore, the spa needs more attention given its elevated levels of both Heterotrophic plate counts and Legionnaire which will ultimately lead to its closure as a means of enhancing public safety.

Conclusion and Recommendation

The evaluation will focus on the occurrence of Legionnaires' infection in people and the presence of Legionella in water structures, encompassing spas, public pools, and cooling towers, to identify the cause of the patient's illness and the potential suggestions for the state health department. From the results and risk assessments, the spa system is the main agent for the patients' ailment necessitating various management techniques. As such, the facility will have to be shut down, and the water features are cleaned and disinfected to eliminate Legionella as per the SA Public Health Legionella Regulations 2013. In addition, the cooling tower must also follow certain guidelines despite its bacteria levels. Thus, the assessment helped develop various recommendations to reduce the occurrence of the bacteria outbreak.

Reference List

Bones, A., 2018. Effectiveness of Biocide Substitution and Management Plan Implementation for the Control of <i>Legionella pneumophila</i> in Cooling Tower Waters - ProQuest. [online] Proquest.com. Available at: https://www.proquest.com/openview/d93804a514dcab2cab4ef5fca86fc7ce/1?pq-origsite=gscholar&cbl=18750 .

Cebrián, F., Montero, J. and Fernández, P., 2018. New approach to environmental investigation of an explosive legionnaires´ disease outbreak in Spain: early identification of potential risk sources by rapid Legionella spp immunosensing technique. BMC Infectious Diseases, 18(1).

Dabrera, G., Naik, F. and Phin, N., 2020. Legionellosis incidents associated with spa pools, England, 2002–2018. Public Health, 185, pp.232-234.

Fitzhenry, R., Weiss, D., Cimini, D., Balter, S., Boyd, C., Alleyne, L., Stewart, R., McIntosh, N., Econome, A., Lin, Y., Rubinstein, I., Passaretti, T., Kidney, A., Lapierre, P., Kass, D. and Varma, J., 2017. Legionnaires’ Disease Outbreaks and Cooling Towers, New York City, New York, USA. Emerging Infectious Diseases, 23(11).