cieh h&s training - east midlands councils_disease_the_london... · cieh h&s training aka...

CIEH H&S Training

AKA The London Boroughs’ Legionellosis

Incident Protocol

Toby Thorp MCIEH

City of London

‘London Outbreak Protocol’

London Outbreak Protocol

Today:

�Why bother? What’s it for?

� How was it created?

� How did London boroughs come to adopt it?

�What does it involve?

� How is it working in practice?

The next 30 minutes

London Outbreak ProtocolWhere?


‘London’ includes 33 different Local

Authorities

�Overall largest population density in the UK

� Boroughs are neighbours with at least 3 others, if not 6 or more for some.

� Legionella outbreaks will not respect those boundaries!

�We need to be prepared…

Why?


� Differing levels of officer experience and risk across boroughs

•Numbers of cooling towers, spas etc.

•Differing society structure and residential/commercial/industrial make-up

� The London 2012 Olympics was on the horizon

�Many people may live and work in different boroughs

Why?


Protocol purpose is to clarify the roles,

responsibilities and actions to be taken by all

the organisations involved

�Reducing the incidence of legionellosis

�Improving the consistency and efficiency of investigation

and management of risk of legionellosis, including

enforcement action

�Developing effective platforms and mechanisms for

partnership working

Why?


Protocol purpose is to clarify the roles,

responsibilities and actions to be taken by all

the organisations involved

�Efficient management of sporadic cases and incidents

(clusters and outbreaks)

�Improving public/community and business awareness of

legionellosis and supporting risk management strategies and

initiatives

Why?


London Boroughs Partnership &

Strategy Group key driver for protocol

�Working Group of 12 London boroughs formed with input from HSE and HPA (both the HPUs and the main laboratory at Colindale)

� Previous unfinished draft protocol and other regional protocols used as starting point

How?


All 33 London Local Authorities are

signed up to its use

� Protocol distributed through existing HSE and LA partnership groups

•Working Group, 4 x Quadrant groups and HSE Local Authority Unit

•Positive confirmation gained from all of adoption and all signed up to follow principles it lays down

Adoption


Potential outbreak should be planned

for in advance

� Assigned roles and responsibilities

� Dealing with single case/clusters

�Management of an outbreak

� Environmental sampling

� Technical/reference information

� Key contact list for all agencies/boroughs

What is it?


NHS

� Treatment of cases

� Laboratory testing – rapid urinary antigen testing

� Notify HPA of confirmed cases

� Support HPA/HPU

� Attend outbreak meetings

Roles and Responsibilities


Health Protection Agency

� Surveillance of Legionella infection

� Taking detailed case histories

�Maintaining log of cases and keeping records

� Liaison with LA, HSE, NHS, PCT, neighbouring HPU

� Supply specialist assistance e.g. Consultant Microbiologist, sampling

� Access to laboratory for environmental sampling



Local Authority

� Public Health enforcement

� H&S enforcement

� Assist/lead in field investigation

� Undertake sampling as necessary



HSE

� H&S enforcement

� Understand current instruction is not to undertake sampling

PCT

� Likely supply lead on Public Health via Director of Public Health



What constitutes an outbreak?

� Diagnosis via laboratory reported to HPU

� Single case vs cluster

� Single cases usually given desktop evaluation

� All single cases compared to records of preceeding 6 months

�Commonality or link suspected – escalate and/or determine outbreak status

Outbreak Investigation


Who should be on it? Not exhaustive

� Director of Public Health

� EHO representative(s)

�Consultant Microbiologist

� HPA representatives

�Clinicians as appropriate

� ELO (from HSE – as required)

Incident Control Team


� Review clinical, microbiological, epidemiological evidence received so far

� Seek common links

�What is the risk to the public, can it be controlled?

� Agree control strategy

� Agree investigation process

� Agree sampling strategy

� Decide communication links and information dissemination to other bodies PLUS the media

First steps


Emphasis needs to be on

� Control and prevention of further illness

� ID of premises where water systems not effectively managed

� Epidemiological data gathering

�Collection of robust information and evidence for any potential formal action

Control Strategy


Inevitably there is some compromise

� Emergency cleaning and disinfection should be prioritised over locating source

Each outbreak and investigation on its own merits

Control Strategy


� Draw up list of premises for inspection

•Likely those in vicinity of the home or workplace of each case and/or places they regularly visit with regard to potential environmental sources

� Allocate inspections and undertake

�Consider resource implications and speed at which inspections can take place

� Defined experience/competence for officers

�Cross-boundary assistance

Investigation


Inspecting suspect premises with CT’s

� How to determine which towers to visit?

� Draw up circles of radii – normally 250m, 500m and 1000m from the presumed centre of outbreak.

� Seek meteorological data – wind direction etc.

� Borough boundaries?

Investigation


Investigation – City GIS


Inspecting suspect premises with CT’s

� Draw up inspection programme for all likely suspect towers – starting with those in smaller radius unless other local knowledge available

� All identified premises likely to be contacted and advised as this will help ensure assistance (site engineer) upon arrival

• This may already have formed part of the control

strategy

Investigation


Closure of investigation

� Enforcement / Public Health actions taken as necessary dependant upon findings

� Public health investigation may well end before criminal investigation i.e. public risk removed

� Ensure a review/lessons learned stage is undertaken

Investigation


Essential during an outbreak

� Assists with ID of potential sources

�Compare results with clinical samples

� Assess effectiveness of any remedial action

Sampling Strategy


Not necessary to

support enforcement

action under HASWA

� Intervention can be undertaken based on risk alone

� Not current HSE policy to sample

Sampling Strategy


Need to agree protocol in advance of

sampling!

� Establish consistency

� Agree competence of those undertaking sampling

� Ensure powers/authorisation in place

�What plant/equipment should be sampled?

Sampling Strategy


Need to agree protocol

� How many samples/replicates?

�What information should be collected at same time as sample –

•Temperature, biocides in use etc.

�Which lab(s) to be used for analysis

� Agree sample storage and transport/pick-up arrangements

Sampling Strategy


Need to agree protocol

� Labelling details – site, location, date, time –as much information as possible

� How will chain of evidence be maintained from sample location to lab?

Sampling Strategy


Regular updates – now February 2012

version but still not used it ‘in anger’

� All quadrants sent representatives to a successful case study based training session ahead of Olympics

� Single cases have occurred but no particular cluster yet as far as we know

� Used for its handy contact list for all boroughs e.g. The Gemini

Current situation


Yes you can….

� Association of London Environmental Health Managers (ALEHM) website

� http://www.alehm.org.uk/discipline/health-and-safety

Can you see it?

cieh h&s training - east midlands councils_disease_the_london... · cieh h&s training aka...

Documents