Bromine and Chlorine Disinfection of Cryptosporidium parvum Oocysts, Bacillus atrophaeus Spores, and MS2 Coliphage in Water.

Conventional water treatment practices utilizing chemical disinfection, especially chlorination, are considered generally effective in producing microbiologically safe drinking water. However, protozoan pathogens such as oocysts of Cryptosporidium parvum are very resistant to chlorine, which has led to consideration of alternative disinfectants for their control. Free bromine, HOBr, has not been evaluated extensively as an alternative halogen disinfectant for inactivation of Cryptosporidium parvum in drinking water or reclaimed water for non-potable uses. Bromine is a versatile disinfectant consisting of different chemical forms with persistent microbicidal efficacy under varied water quality conditions and is effective against a range of waterborne microbes of health concern. The objectives of this study are to (1) compare the efficacy of free bromine to free chlorine at similar concentrations (as milligrams per liter) for disinfection of Cryptosporidium parvum oocysts, Bacillus atrophaeus spores, and MS2 coliphage in a model buffered water and (2) evaluate the kinetics of inactivation of these microorganisms using appropriate disinfection models. Overall, at a target concentration of ∼5 mg/L, bromine averaged 0.6 log (73.8%) reductions of C. parvum oocyst infectivity after 300 min (CT: 1166 min·mg/L) and produced up to a 0.8 log reduction disinfectant activity. An ∼5.0 mg/L chlorine dose increased oocyst infectivity by only 0.4 log (64%) after 300 min (CT: 895 min·mg/L). Bacillus atrophaeus spores and MS2 coliphage treated with bromine and chlorine were reduced by 4 log10 (99.99%) for both disinfectants over the duration of the experiments.

Chitosan Coagulation Pretreatment to Enhance Ceramic Water Filtration for Household Water Treatment.

Viruses are major contributors to the annual 1.3 million deaths associated with the global burden of diarrheal disease morbidity and mortality. While household-level water treatment technologies reduce diarrheal illness, the majority of filtration technologies are ineffective in removing viruses due to their small size relative to filter pore size. In order to meet the WHO health-based tolerable risk target of 10-6 Disability Adjusted Life Years per person per year, a drinking water filter must achieve a 5 Log10 virus reduction. Ceramic pot water filters manufactured in developing countries typically achieve less than 1 Log10 virus reductions. In order to overcome the shortfall in virus removal efficiency in household water treatment filtration, we (1) evaluated the capacity of chitosan acetate and chitosan lactate, as a cationic coagulant pretreatment combined with ceramic water filtration to remove lab cultured and sewage derived viruses and bacteria in drinking waters, (2) optimized treatment conditions in waters of varying quality and (3) evaluated long-term continuous treatment over a 10-week experiment in surface waters. For each test condition, bacteria and virus concentrations were enumerated by culture methods for influent, controls, and treated effluent after chitosan pretreatment and ceramic water filtration. A > 5 Log10 reduction was achieved in treated effluent for E.coli, C. perfringens, sewage derived E. coli and total coliforms, MS2 coliphage, Qß coliphage, ΦX174 coliphage, and sewage derived F+ and somatic coliphages.

A systematic review of nosocomial waterborne infections in neonates and mothers.

BACKGROUND: Water is an important, overlooked, and controllable source of nosocomial infection. Hospitalized neonates and their mothers are particularly vulnerable to nosocomial waterborne infections. Our objectives through this systematic review were to: investigate water sources, reservoirs, and transmission routes that lead to nosocomial waterborne infections in neonates and their mothers; establish patient risk factors; compile measures for controlling outbreaks and recommended strategies for prevention; and identify information gaps to improve guidelines for reporting future outbreaks. METHODS: We searched PubMed, Web of Science, Embase, and clinicaltrials.gov. Peer-reviewed studies reporting contaminated water as a route of transmission to neonates and/or their mothers were included. RESULTS: Twenty-five studies were included. The most common contaminated water sources in healthcare facilities associated with infection transmission were tap water, sinks, and faucets. Low birthweights, preterm or premature birth, and underlying disease increased neonatal risk of infection. Effective control measures commonly included replacing or cleaning faucets and increased or alternative methods for hand disinfection, and recommendations for prevention of future infections highlighted the need for additional surveillance. DISCUSSION/CONCLUSION: The implementation of control measures and recommended prevention strategies by healthcare workers and managing authorities of healthcare facilities and improved reporting of future outbreaks may contribute to a reduction in the incidence of nosocomial waterborne infections in neonates and their mothers.

A systematic review of waterborne infections from nontuberculous mycobacteria in health care facility water systems.

Healthcare-acquired infections are an increasing problem for health care providers and policy makers. Water is an overlooked source of infectious microorganisms in health care facilities. Waterborne nontuberculous mycobacteria (NTM) are ubiquitous, and particularly problematic in health care facility water systems, and cause a variety of diseases. The purpose of this review is to assess health care associated NTM infections from health care facility water systems. We documented susceptible populations, modes of transmission, and the median attack rate (e.g. patients infected per patients exposed). We aimed to identify transmission risk factors and inform evidence-based policies for infection control and prevention. We searched Embase, PubMed, Web of Science and clinicaltrials.gov without date restrictions. English language articles with original data on NTM waterborne infections in health care settings were included. Randomized controlled trials, descriptive studies (case reports, case series), case-control studies, cohort studies, cross-sectional surveys, and quasi-experimental studies on nosocomial waterborne infections were included. Three investigators independently screened titles and abstracts for relevant articles, and one screened full-text articles. Data were extracted by one investigator, and a second confirmed accuracy for 10% of results. We included 22 observational studies. Immunocompromised, post-surgical, and hemodialysis patients were commonly affected populations. A range of exposure routes such as uncovered central venous catheters (CVCs), wound exposure, and contamination during surgical procedures was reported. The median attack rate was 12.1% (interquartile range, 11-27.2). Waterborne NTM infection affects susceptible patients through common, preventable exposure routes. Effective prevention strategies will require both medical and environmental health expertise, and inter-professional cooperation will optimize these efforts.

Chitosan Coagulation to Improve Microbial and Turbidity Removal by Ceramic Water Filtration for Household Drinking Water Treatment.

The use of porous ceramic filters is promoted globally for household water treatment, but these filters are ineffective in removing viruses from water. In order to increase virus removal, we combine a promising natural coagulant, chitosan, as a pretreatment for ceramic water filters (CWFs) and evaluate the performance of this dual barrier water treatment system. Chitosan is a non-toxic and biodegradable organic polymer derived by simple chemical treatments from chitin, a major source of which is the leftover shells of crustacean seafoods, such as shrimp, prawns, crabs, and lobsters. To determine the effectiveness of chitosan, model test water was contaminated with Escherichia coli K011 and coliphage MS2 as a model enteric bacterium and virus, respectively. Kaolinite clay was used to model turbidity. Coagulation effectiveness of three types of modified chitosans was determine at various doses ranging from 5 to 30 mg/L, followed by flocculation and sedimentation. The pre-treated supernatant water was then decanted into the CWF for further treatment by filtration. There were appreciable microbial removals by chitosan HCl, acetate, and lactate pretreatment followed by CWF treatment, with mean reductions (95% CI) between 4.7 (± 1.56) and 7.5 (± 0.02) log10 for Escherichia coli, and between 2.8 (± 0.10) and 4.5 (± 1.04) log10 for MS2. Turbidity reduction with chitosan treatment and filtration consistently resulted in turbidities < 1 NTU, which meet turbidity standards of the US EPA and guidance by the World Health Organization (WHO). According to WHO health-based microbial removal targets for household water treatment technology, chitosan coagulation achieved health protective targets for both viruses and bacteria. Therefore, the results of this study support the use of chitosan to improve household drinking water filtration processes by increasing virus and bacteria reductions.

Point-of-Use Removal of Cryptosporidium parvum from Water: Independent Effects of Disinfection by Silver Nanoparticles and Silver Ions and by Physical Filtration in Ceramic Porous Media.

Ceramic water filters (CWFs) impregnated with silver nanoparticles are a means of household-level water treatment. CWFs remove/deactivate microbial pathogens by employing two mechanisms: metallic disinfection and physical filtration. Herein we report on the independent effects of silver salt and nanoparticles on Cryptosporidium parvum and the removal of C. parvum by physical filtration in porous ceramic filter media. Using a murine (mouse) model, we observed that treatment of oocysts with silver nitrate and proteinate-capped silver nanoparticles resulted in decreased infection relative to untreated oocysts. Microscopy and excystation experiments were conducted to support the disinfection investigation. Heat and proteinate-capped silver-nanoparticle treatment of oocysts resulted in morphological modifications and decreased excystation rates of sporozoites. Subsequently, disk-shaped ceramic filters were produced to investigate the transport of C. parvum. Two factors were varied: sawdust size and clay-to-sawdust ratio. Five disks were prepared with combinations of 10, 16, and 20 mesh sawdust and sawdust percentage that ranged from 9 to 11%. C. parvum removal efficiencies ranged from 1.5 log (96.4%) to 2.1 log (99.2%). The 16-mesh/10% sawdust had the greatest mean reduction of 2.1-log (99.2%), though there was no statistically significant difference in removal efficiency. Based on our findings, physical filtration and silver nanoparticle disinfection likely contribute to treatment of C. parvum for silver impregnated ceramic water filters, although the contribution of physical filtration is likely greater than silver disinfection.

Quantitative dielectrophoretic tracking for characterization and separation of persistent subpopulations of Cryptosporidium parvum.

Microbial persistence to antibiotics is attributed to subpopulations with phenotypic variations that cause a spread of susceptibility levels, leading to the recurrence of infections and stability of biofilms. Herein, persistent oocyst subpopulations identified by animal infectivity and excystation assays during the disinfection of Cryptosporidium parvum, a water-borne pathogen capable of causing enteric infections at ultra-low doses, are separated and characterized by quantitative dielectrophoretic tracking over a wide frequency range (10 kHz-10 MHz). To enable the simultaneous and facile dielectrophoretic tracking of individual oocysts, insulator constrictions in a microfluidic channel are utilized to spatially modulate the localized field over the extent needed for defining oocyst trajectories and for obtaining high-resolution displacement versus time measurements under both, positive and negative dielectrophoresis. In this manner, by obviating the need for averaging dielectrophoretic data over a large collection region, the force response is more sensitive to differences in electrophysiology from sub-population fractions. Hence, the electrophysiology of sensitive and persistent oocysts after heat and silver nanoparticle treatments can be quantified by correlating the force response at low frequencies (<100 kHz) to the integrity of the oocyst wall and at high frequencies (0.4-1 MHz) to the sporozoites in the oocyst. This label-free method can characterize heterogeneous microbial samples with subpopulations of phenotypically different alterations, for quantifying the intensity of alteration and fraction with a particular alteration type.