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Richard Bentham, Ph.D.

Public and Environmental Health Microbiologist, Flinders University, South Australia

Greg Swafford Dr. Richard Bentham has over 30 years’ experience in research in microbial ecology with specializations in Legionella and contaminated land. This has resulted in research collaborations with Rio Tinto, SA Water and the Victorian Health Department. He was invited by the World Health Organization, with other internationally acclaimed experts, to consult on the control of Legionella, resulting in the 2007 WHO publication on this subject. Richard has provided expert legal advice relating to the majority of Legionnaire’s disease outbreaks in Australia. He has also provided expert advice and numerous Legionella risk assessment and risk management plans on Legionella control in cooling water systems, health care facilities, potable water systems and soils in Australia, New Zealand, Hong Kong and the U.S. He has also provided training programs on Legionella management and control for clients including ALCOA Australia, the Hong Kong College of Pathologists and AIOH.

Obstruction, Stagnation and Fermentation: Legionella in Health Care Facilities

Abstract: The built water environment (BWE) is ideally suited to opportunist microbial colonization. If bacteria and protozoa could make choices, then potable water systems would be near the top of the list.

This presents an ongoing challenge for facilities. Despite a global consensus that Legionella infections in health care are preventable, they persist. Perhaps we could blame some of that on our changing demographics and increasing susceptible population. Perhaps we could also accept that we could do things better.

The simplest strategy in controlling Legionella in a BWE is to keep water moving, which reduces stagnation, improves thermal control and introduces whatever disinfection is available. Unfortunately, other imperatives make water movement and temperature control a major challenge. Flow restriction (obstruction), overly complex systems (stagnation) and poor temperature control (fermentation) are often design features of buildings.

These issues are magnified by the current lock-downs in health and assisted care facilities. Re-commissioning of locked down facilities needs serious consideration of the impacts of obstruction, stagnation and fermentation. This presentation will provide data relating to these three critical factors and present some possible remedies.