Back in June 2013, the human cost associated with legionella was on full display when 60-year-old cancer patient John Pearson died after contracting the disease at the Wesley Hospital in Brisbane.

The disease is an infection of the lungs caused by legionella bacteria which are found most commonly in water and soil and can be present in water cooling systems in cooling towers as well as water in other settings such as whirlpool spas, plumbing and shower heads.

Unfortunately, that outbreak was not the only time the disease has raised its head. In Brisbane, for example, a patient tested positive in the Mater Private Hospital in January 2016. In Sydney, 15 people contracted the pneumonia-like condition after visiting the CBD during two separate outbreaks in March and May. One man in his 80s died from the infection.

In response, authorities in New South Wales are reviewing regulation in this area. A discussion paper published in December proposed that building occupiers be required to maintain risk management plans in respect of cooling towers, conduct annual audits of water cooling systems and send evidence of compliance with risk management plans in to local government. The paper also recommended building occupiers notify the local council about legionella bacteria readings of 1000 cfu/mL or above or readings of HPC levels of 5,000,000 cfu/mL or above. The paper proposes that testing of water cooling systems for legionella and heterotrophic plate count (HPC) would be required monthly.

In light of this, it is timely to look at some of the key misconceptions regarding legionella as well as some of the important things about which building managers and facilities managers need to be aware along with some of the critical strategies needed to manage legionella risk.

According to Ryan Milne, owner and director at Perth-based water and environmental management consultancy Ecosafe International, one common area of misconception revolves around a belief that the disease is no longer in existence. In addition, Milne said, another myth was that the disease occurs only in cooling towers.

In reality, he said, legionella is naturally occurring and is in fact present in most water systems, though not everybody is susceptible to the bacteria and the bacteria does not necessarily proliferate in all systems. However, he said the risk is in fact present in buildings both old and new or in those undergoing commissioning.

Milne said proactive management is key. Too often, he says, legionella risk management is done as an afterthought and is excessively reliant upon verification monitoring and action when a positive result was returned. In reality, he said, the period of time from when you take the sample to when you obtain the result leaves a period in which people can become infected. Rather, he says, you should manage the system on the basis that it is present rather than on the basis that is not there.

In addition, one area which Milne said is often overlooked is when there are renovations or changes to the building. Typically, when this happens, the focus when commissioning the system can revolve around the physical commissioning in terms of things such as whether or not pipes are leaking. Issues such as water quality, he said, are often afforded a lower level of focus. When undertaking commissioning, he said, there needs to be a plan as to what to do around water quality as well as the physical aspects of commissioning.

Dr Vyt Garnys, managing director and principal consultant at technical risk management consultancy CETEC, agrees that there is a commonly held myth surrounding the disease being acquired only from cooling towers. Indeed, he said, risks can also occur in potable water systems with the bacteria being found in places such as shower heads, bathroom taps and outdoor sprinkler systems. Moreover, Garnys said whilst plumbing standards generally address risks associated with cooling towers, standards for potable water are still inadequate to properly manage the problem.

The important thing for building owners and managers, Garnys said, is to have a risk management plan in place for both cooling towers and potable water supply. This involves identifying and understanding the risks, knowing where to look out for the bacteria, how to manage the risks and the steps to take in the event that an infection occurs.

He says it is important to ensure that risk management advice is coming from professionals who understand both the microbiology of Legionella as well as the facilities water systems.

Finally, Garnys said it is critical to put the plan into action.

“A risk management plan that is not actioned is useless,” he said. “They’ve got to get the advice, do the sampling, get appropriate data which is meaningful and put it into practice as part of a key performance indicator of your risk management strategy for all of the overall risks which you have in a building.”

Tim Brumby, senior consultant, property risk at integrated risk management and compliance consultancy Greencap, says that although many building managers and facilities managers are aware about the disease, some areas of misconception still occur. One possible myth revolves around ideas that you can get legionnaires disease by swallowing water that in fact contains legionella. Also, he said, there is a misconception that you cannot get legionella from a shower head or that the main risk of legionella is from inside the building. On the latter point, he says that the inside of the building is usually not regarded as the main pathway.

In actual fact, he says, legionnaires is not in fact caught be swallowing but inhaling the respirable aerosols into the lungs to cause a lung infection. In relation to building systems, where we are talking about the risks which emanate from cooling towers (though risks also emanate from potable water), he says it is more likely that people will be exposed to those risks outside as opposed to inside.

Brumby said it is important for facilities mangers to be aware of their legal responsibilities which apply within their jurisdictions as well as some of the risk management strategies which constitute best practice. He encourages those in NSW to have their input within the current review process.

Finally, Milne says it is important to shift away from a reactive approach and toward proactive operational monitoring.

“It’s essentially a mind shift from not only relying on the water treatment contractor. Mostly the perception is that if we’ve got a guy who does our cooling towers then that’s our risk managed. That is not entirely correct,” he said.

“It’s a shift in mindset that we’ve got to move from verification to more operational monitoring.”