Demystifying Dental Practice Legionella Risk Assessments: What You Need to Know

The Legionella risk assessment often seems like an enigmatic entity, weaving through the complexities of dental practice management. What is its essence, and why does its understanding elude so many? Is it a one-off obligation? Who should conduct it, and when is the right time?

Let's unravel the mystery by taking a step back and examining the entire process from the beginning.

The cardinal principle of healthcare providers is to "first, do no harm." Beyond this, employers have a legal obligation to ensure a safe working environment. When hazards like fire, asbestos, or Legionella are identified, a suitable risk assessment must be conducted to evaluate and advise on eliminating or managing these risks.

Legionella bacteria, residing in water systems, can proliferate and become a health threat if conditions are favourable. It can be transmitted via aerosols, potentially causing infections and, in severe cases, death.

Assessing the risk of Legionella growth in a building's water system demands a deep understanding of plumbing, microbiology, and legislation. The risk assessment must consider the population exposed to the bacteria and the presence of aerosols. While all water systems need evaluation, not all are deemed high risk. Certain buildings or water systems fall into a higher risk category due to inherent risks.

Inherent Risk: The risk associated with a system before any action has been taken to control it.

Healthcare premises inherently carry elevated risk due to the susceptibility of those exposed to aerosols from water systems. The presence of aerosol-generating equipment in dental practices further classifies these premises as having inherently higher risk.

Moving Forward:

Initiate with a thorough Legionella Risk Assessment, conducted by a competent risk assessor. While it might be tempting to opt for a quick, one-page template, doing so risks a non-compliant assessment, jeopardising both your patients and your business.

Once the assessment is in hand, don't let it gather dust on a shelf. Understand the identified issues and implement measures to manage the risks. Due to the high inherent risk in dental practices, a comprehensive management plan (written scheme of control) and regular monitoring are essential.

As with all risk assessments, the Legionella assessment requires regular reviews.

Legionella Risk Assessment Review Requirements: The Guidance

ACoP L8 - HSE Approved Code of Practice:

Regular reviews are necessary, particularly if there's reason to believe the original assessment may no longer be valid.

British Standard BS 8580:01 2019:

For simple assessments of inherently low-risk water systems, competent personnel can conduct the risk review. However, complex systems with inherently higher risks, especially in healthcare settings, benefit from periodic reviews involving expert assistance. Systems with higher inherent risk may require more frequent reassessment, ranging from annually to every 2-3 years, depending on site-specific risks.

It is unlikely that circumstances will be so stable that a risk assessment will not need reassessing within this period, in particular, due to staff and management changes. In reality, so many changes occur with time that it is difficult to keep track of them all, for example, general ageing and deterioration of the system and its equipment or materials.  

When to Review the Assessment Externally?:

On or before the recommended review date as stipulated in the original risk assessment document. Given the heightened inherent risk in dental practices, it is advisable to conduct reviews at least every two years, unless otherwise specified in your risk assessment.

Can I Review the Assessment Internally?

Yes – but only if you are competent to do so. You must have suitable training, experience and knowledge about the regulations, guidance, plumbing and operation of hot and cold, and other water system as well as good understanding of the conditions favourable for legionella growth.

Internal audit process should be in place, for example, regular formal review of the performance of the risk control measures. This would typically range from monthly to annually dependent upon the perceived risk. The output of this review process is a determination of the need for formal reassessment of the risk.

Other Circumstances Triggering a Review:

The original risk assessment should be formally reassessed (sooner than before a due date) when there are significant changes to ensure that it remains valid, for example, when there are:

·      changes to the water system or its use;

·      changes to the use of the building or part of the building in which the system is installed;

·      changes to the availability of information about risks or control measures

·      indications that control measures are no longer effective;

·      new construction works or system modifications planned; or

·      changes to the key personnel, contractors and service providers.

In summary, unravelling the intricacies of Legionella risk assessments is pivotal for ensuring the safety of healthcare environments, especially within dental practices. Given the inherent risks tied to water systems, this is not just a singular obligation but mandates regular reviews, conducted at a frequency essential for document validity. In healthcare, these reviews should be carried out at least every two years, with the involvement of an expert assistance. By adhering to established guidelines and adopting a proactive approach, healthcare facilities can navigate these intricacies, ensuring a continual commitment to safety and well-being.

Stay vigilant, stay compliant, and prioritise the health of all those under your care.

If you're seeking assistance with your risk assessment review, please don't hesitate to click here. We're ready to provide the support and expertise you need.