Prevention of Legionella outbreaks in nursing homes

Legionella - a serious waterborne risk
Legionella bacteria thrive in stagnant lukewarm water (20-50°C) and can cause severe pneumonia. Especially at risk are the elderly and people with weakened immune systems. Transmission occurs through inhalation of water mist from showers, taps, or ventilation systems.

Responsibility and organization

Property Manager
- Ensures that water systems are maintained according to regulations
- Monitors temperatures in hot water systems
- Responsible for technical measures and documentation

Operation Manager
- Implements routines for regular flushing
- Ensures that staff follow hygiene protocols

Care Staff
- Follow established flushing routines
- Inform about suspected cases of Legionella infection

Critical measures for prevention

Temperature control

Hot water systems
- At least 60°C in heaters
- At least 50°C at outlets
- Measurement and documentation twice a year

Regular flushing

Unused outlets
- Flushed for at least 5 minutes weekly
- Extra flushing after 3 days of non-use
- Documentation of completed flushing

Showers
- Change shower hose and nozzle annually
- Use shower heads that reduce aerosol formation
- Extra flushing after long periods of non-use

System maintenance

Cleaning and disinfection
- Clean and disinfect water tanks regularly
- Empty and clean water treatment equipment
- Taps that are never used can be plugged.

Specific routines for healthcare operations

Respiratory therapy
- Only use sterile water for nebulization
- Clean and disinfect equipment after each use

Water for patients
- Ice preparation in freezer bags, not ice machines
- Carbonated water should be consumed within 12 hours
- Personal drinking bottles should be washed daily

In case of suspected Legionella infection

Immediate actions
- Immediate notification to the infection control doctor
- Sampling of water systems
- Temporary shutdown of suspected outlets
- Inform affected residents and staff

Reflection questions

Care staff
- Which outlets in your residence are used the least often?
- How do you document completed flushing?

Manager, nurse, occupational therapist and physiotherapist
- Are there clear routines for temperature control?
- How do you ensure that all outlets are included in the flushing schedule?
- When was the last time the water heater was checked?

Residents and relatives
- Have you thought about regularly flushing the taps in the apartment?

Erland Olsson
Specialist nurse
Sofrosyne - Better care every day