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Rapid methods of testing and minimization of risk
• Dr Vyt Garnys – Principal Consultant & Managing Director
• Travis Hale – Consultant & Microbiologist
Dr Vyt Garnys – Principal Consultant & Managing Director
Dr Vyt Garnys – Principal Consultant & Managing Director
& Travis Hale – Consultant & Microbiologist
THE CUPLRIT
Source: Professor Elizabeth Hartland, Melbourne University.
THE CUPLRIT
Source: Professor Elizabeth Hartland, Melbourne University.
Sources
The role of monitoring in Legionella risk management
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Establishing a legionella risk management system
Analysing your risk
Managing your risk Responding to detections
of cases
Validation (Regulation)
Culture Rapid Molecular
Establishing a Legionella risk management system
• Assembling the risk management team
– Incorporate persons skilled in analytical techniques to allow expert judgement for selection of appropriate methods
• Skills and knowledge
– Determine if the facility can conduct testing in house, or if external analysis is required
– Educate the team to request appropriate methods, sampling and interpret results
Establishing a Legionella risk management system
• Developing, documenting and reviewing procedures – The Legionella risk management plan
– Detail when to use appropriate methods for routine, crisis and QA purposes.
Analysing risk
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Establishing a legionella risk management system
Analysing your risk
Managing your risk Responding to detections
of cases
Validation (Regulation)
Culture Rapid Molecular
Analysing risk
• Undertake a system analysis
– Plumbing
• Rapid analysis will form the first response for plumbing performance i.e. absence of Legionella
• Culture methods for speciation and regulatory (for now) requirements
• Molecular techniques for identifying sources of contamination and proliferation
Analysing risk
• Undertake a system analysis
– Clinical
• Rapid analysis will form the first response for the likelihood of clinical infection
• Culture methods - Beware of Viable but not culturable (VBNC)
• Culture for isolation and purification to prepare and store for molecular techniques if needed
• Molecular techniques for microbial typing to assess infection risk to patients
Analysing risk
• Undertake a system analysis
– QA / Benchmarking
• Institute a QA system that confirms precision, accuracy and data for accreditation
Analyzing risk
Analysing risk
• Identifying hazards, hazardous events and risk
• Rapid Analysis
– Rapid analysis for detailed, timely and cost effective mapping and screening of existing system performance
– Cost effective due to reduced delays for infection control
– Allows for more real-time trend analysis and response
– Can prevent precautionary action by the facility whilst waiting for culture results
Analysing risk
• Identifying hazards, hazardous events and risk
• Culture
– Slow response requires major disruptive precautionary actions (e.g. shutdowns, relocations of at-risk persons/patients)
– Low precision and variable accuracy makes decision making less certain
– Can be used for serotyping (e.g. SG1) but there is increasing recognition that many serotypes can be infective so this may become less of an advantage as compared to identifying presence/absence of any Legionella
Analysing risk
• Identifying hazards, hazardous events and risk
• Molecular
– Delays of several days since availability is limited
– Does not (yet) quantitate i.e. concentration
– Offers considerable capability for detailed typing, source and origin of infection thus reducing risk
Managing risk
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Establishing a legionella risk management system
Analysing your risk
Managing your risk Responding to detections
of cases
Validation (Regulation)
Culture Rapid Molecular
Managing risk
• Implementing controls
– Commissioning
• Rapid analysis allows for real-time and efficient data to allow the controls to be implemented
• Culture is of limited value if rapid technologies are available
• Molecular only for special situations to trace unexpected sources of infection
Managing risk
• Implementing controls
– Disinfection systems
• Rapid analysis allows for near real-time verification of control efficacy
• Culture can be used occasionally for compliance
• Molecular only for special situations
Managing risk
• Implementing controls
– Regular maintenance
• Rapid analysis allows for near real-time determination that maintenance practices have been sufficient
• Culture can be used for compliance
• Molecular only for special situations
Managing risk
• Implementing controls
– Exposure controls
• Rapid analysis allows for near real-time measurement to confirm that exposure controls are sufficient, minimizing potential exposure
• Culture can be used for compliance
• Molecular only for special situations (e.g. infection).
Managing risk
Potable water tank condition In the absence of guidelines.
Removed deposits by remediation.
Managing risk
Managing risk
• Monitoring
– Rapid techniques give the most timely response to avoid undetected infections
– Culture techniques for compliance and future molecular analysis (clinical risk), and occasional QA
– Molecular for special situations
• Documentation
– Using monitoring data, ensure adequate QA.
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Managing risk
In-line chlorine dosing
Responding to detections of cases
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Establishing a legionella risk management system
Analysing your risk
Managing your risk Responding to detections
of cases
Validation (Regulation)
Culture Rapid Molecular
Responding to detections of cases
• Corrective measures
– Rapid analysis allows for a prompt detection, trends and validation of remediation
– Culture techniques for compliance
– Molecular techniques for initial typing of sources and specific areas giving rise to clinical incidents
Responding to detections of cases
• Response to a suspected case of Legionnaire's disease
– Rapid analysis allows for minimization of time for medical and nursing decision making
– Culture techniques for compliance
– Molecular techniques for initial typing of sources and specific areas giving rise to clinical incidents
Responding to detections of cases
• What to do if the problem persists
– Rapid analysis allows for trend and location tracking and remediation efficacy
– Culture techniques too slow
– Molecular techniques for initial typing of sources and specific areas giving rise to clinical incidents
Validation (Regulation)
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Establishing a legionella risk management system
Analysing your risk
Managing your risk Responding to detections
of cases
Validation (Regulation)
Culture Rapid Molecular
Validation (Regulation)
• Rapid technologies must be assessed for reproducibility and accuracy
• Culture techniques for regulatory accreditation
• Molecular techniques to check culture techniques (e.g. serotyping)
Validation (Regulation)
Lp culture (10 days) vs Rapid (1 hour) technologies.
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Validation (Regulation)
Under-estimation of Bacterial counts by culture techniques.
POTABLE WATER?
QUESTIONS?
Dr Vyt Garnys
THANK YOU
Travis Hale
+61 3 9544 9111 | +61 2 9966 9211 | +61 7 3808 3948
