The theoretical adhesion of Pseudomonas aeruginosa and Escherichia coli on some plumbing materials in presence of distilled water or tap water.

The main aim of this work was to determine the most appropriate materials for the installation of a water system according to the characteristics of the water that passes through it. To this end, we conducted an investigation of the effect of two types of water (SDW: sterile distilled water and STW: sterile tap water) on the properties of bacterial surfaces and the theoretical adhesion of two bacteria (Pseudomonas aeruginosa and Escherichia coli) on six plumbing materials. Contact angle measurements were used to determine the surface energies of bacteria and materials. XDLVO theory was used to estimate the interactions between bacteria and plumbing materials. The results showed that water had a clear impact on the electron donor character and the hydrophobicity of the bacterial surfaces. Also, the predictive adhesion showed that all tested materials could be colonized by P. aeruginosa and E. coli ([Formula: see text]<0). However, colonization became thermodynamically less favorable or unfavorable (increase in [Formula: see text] values) with SDW and STW, respectively. Finally, the results suggest that the choice of the most suitable material for a drinking water installation is related to the quality of the water itself.

Replicable simulation of distal hot water premise plumbing using convectively-mixed pipe reactors.

A lack of replicable test systems that realistically simulate hot water premise plumbing conditions at the laboratory-scale is an obstacle to identifying key factors that support growth of opportunistic pathogens (OPs) and opportunities to stem disease transmission. Here we developed the convectively-mixed pipe reactor (CMPR) as a simple reproducible system, consisting of off-the-shelf plumbing materials, that self-mixes through natural convective currents and enables testing of multiple, replicated, and realistic premise plumbing conditions in parallel. A 10-week validation study was conducted, comparing three pipe materials (PVC, PVC-copper, and PVC-iron; n = 18 each) to stagnant control pipes without convective mixing (n = 3 each). Replicate CMPRs were found to yield consistent water chemistry as a function of pipe material, with differences becoming less discernable by week 9. Temperature, an overarching factor known to control OP growth, was consistently maintained across all 54 CMPRs, with a coefficient of variation <2%. Dissolved oxygen (DO) remained lower in PVC-iron (1.96 ± 0.29 mg/L) than in PVC (5.71 ± 0.22 mg/L) or PVC-copper (5.90 ± 0.38 mg/L) CMPRs as expected due to corrosion. Further, DO in PVC-iron CMPRs was 33% of that observed in corresponding stagnant pipes (6.03 ± 0.33 mg/L), demonstrating the important role of internal convective mixing in stimulating corrosion and microbiological respiration. 16S rRNA gene amplicon sequencing indicated that both bulk water (Padonis = 0.001, R2 = 0.222, Pbetadis = 0.785) and biofilm (Padonis = 0.001, R2 = 0.119, Pbetadis = 0.827) microbial communities differed between CMPR versus stagnant pipes, consistent with creation of a distinct ecological niche. Overall, CMPRs can provide a more realistic simulation of certain aspects of premise plumbing than reactors commonly applied in prior research, at a fraction of the cost, space, and water demand of large pilot-scale rigs.

WaSH CQI: Applying continuous quality improvement methods to water service delivery in four districts of rural northern Ghana.

Continuous, safely managed water is critical to health and development, but rural service delivery faces complex challenges in low- and middle-income countries (LMICs). We report the first application of continuous quality improvement (CQI) methods to improve the microbial quality of household water for consumption (HWC) and the functionality of water sources in four rural districts of northern Ghana. We further report on the impacts of interventions developed through these methods. A local CQI team was formed and trained in CQI methods. Baseline data were collected and analyzed to identify determinants of service delivery problems and microbial safety. The CQI team randomized communities, developed an improvement package, iteratively piloted it in intervention communities, and used uptake survey data to refine the package. The final improvement package comprised safe water storage containers, refresher training for community WaSH committees and replacement of missing maintenance tools. This package significantly reduced contamination of HWC (p<0.01), and significant reduction in contamination persisted two years after implementation. Repair times in both intervention and control arms decreased relative to baseline (p<0.05), but differences between intervention and control arms were not significant at endline. Further work is needed to build on the gains in household water quality observed in this work, sustain and scale these improvements, and explore applications of CQI to other aspects of water supply and sanitation.

Airborne route and bad use of ventilation systems as non-negligible factors in SARS-CoV-2 transmission.

The world is facing a pandemic of unseen proportions caused by a corona virus named SARS-CoV-2 with unprecedent worldwide measures being taken to tackle its contagion. Person-to-person transmission is accepted but WHO only considers aerosol transmission when procedures or support treatments that produce aerosol are performed. Transmission mechanisms are not fully understood and there is evidence for an airborne route to be considered, as the virus remains viable in aerosols for at least 3 h and that mask usage was the best intervention to prevent infection. Heating, Ventilation and Air Conditioning Systems (HVAC) are used as a primary infection disease control measure. However, if not correctly used, they may contribute to the transmission/spreading of airborne diseases as proposed in the past for SARS. The authors believe that airborne transmission is possible and that HVAC systems when not adequately used may contribute to the transmission of the virus, as suggested by descriptions from Japan, Germany, and the Diamond Princess Cruise Ship. Previous SARS outbreaks reported at Amoy Gardens, Emergency Rooms and Hotels, also suggested an airborne transmission. Further studies are warranted to confirm our hypotheses but the assumption of such way of transmission would cause a major shift in measures recommended to prevent infection such as the disseminated use of masks and structural changes to hospital and other facilities with HVAC systems.

High prevalence of contamination of sink drains with carbapenemase-producing Enterobacteriaceae in 4 intensive care units apart from any epidemic context.

We report a high prevalence (28%) of sink drains contaminated with carbapenemase-producing Enterobacteriaceae (CPE) in 4 intensive care units with a history of CPE carriage in hospitalized patients within the previous 5 years, but apart from any current epidemic context. Carbapenemase genes, particularly blaVIM and blaNDM, were identified by polymerase chain reaction in sink drains in which no CPE was detected, but very few data are available in the literature concerning their presence in sink drains.

Controlling Legionella pneumophila in water systems at reduced hot water temperatures with copper and silver ionization.

BACKGROUND: Hospital-acquired Legionnaires' disease is associated with the presence of Legionella pneumophila in hospital water systems. In the United Kingdom, the Department of Health recommends maintaining hot water temperatures >55°C and cold water temperatures <20°C at the point of delivery to prevent proliferation of L pneumophila in water systems. In this study, we evaluated the efficacy of copper and silver ionization to control L pneumophila at deliberately reduced hot water temperatures (43°C) within a newly installed water system in a new building linked to a large health care facility in the United Kingdom. METHODS: One thousand, five hundred ninety-eight water samples were collected between September 2011 and June 2017. Samples were tested using accredited methods for L pneumophila, copper and silver ion levels, and total viable counts. Energy consumption and water usage data were also collected to permit carbon emission calculations. RESULTS: The results of 1,598 routine samples from September 2011 to June 2017, and the recordings of temperatures at outlets in this facility, demonstrated effective (100%) L pneumophila control throughout the study period with an average hot water temperature of 42°C. The energy savings and reduction of carbon emissions were calculated to amount to 33% and 24%, respectively, compared to an equivalent temperature-controlled system. Water system management interventions were required to achieve consistently adequate levels of copper and silver across outlets. CONCLUSIONS: This study demonstrated that it is possible to control L pneumophila independent of temperature when copper and silver ionization is introduced into a new building in conjunction with an appropriately managed water system.

Evaluation of lead release potential of new premise plumbing materials.

Premise plumbing materials such as pipes, valves, fittings, and faucets are made of various materials, including plastic, stainless steel, copper, and brass/bronze. Although lead pipe has been banned for its use in drinking water supply by most countries in the 1980s, lead is still commonly used as an additive in many plumbing materials for its flexibility and malleability. Certified leaching tests for plumbing materials are usually conducted using relatively mild solutions over short periods which may not reveal the true risk of lead exposure when these materials are used. The objective of this study is to investigate the extents of lead release from commonly used premise plumbing materials into drinking water. The maximum lead leaching potential for pluming material was operationally determined using high strength acidic EDTA solutions (pH 4, EDTA = 100 mg/L) for a stagnation time of 3 days for a total period of up to 1 month. Lead leaching from each plumbing material was also evaluated using reconstituted tap water. Brass- and bronze-based plumbing materials were found to release dangerous levels of lead. Surface lead weight percentage obtained using SEM-EDX and lead weight percentages of the material body obtained using strong acid digestion were found to positively correlate with lead release. A re-examination of the appropriateness of current certified leaching tests and a more stringent regulation on the use of lead as an additive for plumbing materials should be considered.

The dependence of chlorine decay and DBP formation kinetics on pipe flow properties in drinking water distribution.

Simultaneous chlorine decay and disinfection byproduct (DBP) formation have been discussed extensively because of their regulatory and operational significance. This study further examines chemical reaction variability in the water quality changes under various hydrodynamic conditions in drinking water distribution. The variations of kinetic constant for overall chlorine decay (kE) and trihalomethane (THM) formation were determined under stagnant to turbulent flows using three devices of different wall demand and two types of natural organic matters (NOM) in water. The results from the comparative experiments and modeling analyses show the relative importance of wall demand (kw), DBP-forming chlorine decay (kD), and other bulk demand (kb') for pipe flows of Re = 0-52500. It is found that chlorine reactivity of virgin NOM is the overriding factor. Secondly, for tap water NOM of lower reactivity, pipe flow properties (Re or u) can significantly affect kE, the THM yield (T), formation potential (Y), and the time to reach the maximum THM concentration (tmax) through their influence on kinetic ratio kD(kb'+kw). These observations, corroborating with turbidity variations during experiments, cannot be explained alone by chlorine dispersion to and from the pipe wall. Mass exchanges through deposition and scale detachment, most likely being flow-dependent, may have contributed to the overall chlorine decay and DBP formation rates. Thus for the simultaneous occurrence of chlorine decay and DBP formation, model considerations of NOM reactivity, pipe types (wall demand), flow hydraulics, and their interactions are essential.

Biofilms in shower hoses.

Shower hoses offer an excellent bacterial growth environment in close proximity to a critical end-user exposure route within building drinking water plumbing. However, the health risks associated with and processes underlying the development of biofilms in shower hoses are poorly studied. In a global survey, biofilms from 78 shower hoses from 11 countries were characterized in terms of cell concentration (4.1 × 104-5.8 × 108 cells/cm2), metal accumulation (including iron, lead, and copper), and microbiome composition (including presence of potential opportunistic pathogens). In countries using disinfectant, biofilms had on average lower cell concentrations and diversity. Metal accumulation (up to 5 µg-Fe/cm2, 75 ng-Pb/cm2, and 460 ng-Cu/cm2) seemed to be partially responsible for discoloration in biofilms, and likely originated from other pipes upstream in the building. While some genera that may contain potential opportunistic pathogens (Legionella, detected in 21/78 shower hoses) were positively correlated with biofilm cell concentration, others (Mycobacterium, Pseudomonas) had surprisingly non-existent or negative correlations with biofilm cell concentrations. In a controlled study, 15 identical shower hoses were installed for the same time period in the same country, and both stagnant and flowing water samples were collected. Ecological theory of dispersal and selection helped to explain microbiome composition and diversity of different sample types. Shower hose age was related to metal accumulation but not biofilm cell concentration, while frequency of use appeared to influence biofilm cell concentration. This study shows that shower hose biofilms are clearly a critical element of building drinking water plumbing, and a potential target for building drinking water plumbing monitoring.

Field campaign on sediment transport behaviour in a pressure main from pumping station to wastewater treatment plant in Berlin.

As part of the project KURAS, the Berliner Wasserbetriebe realized a field campaign in 2015 in order to increase the process knowledge regarding the behaviour of transported sediment in the pressure main leading from the pumpstation to the wastewater treatment plant. The field campaign was conducted because of a lack of knowledge about the general condition of the pressure main due to its bad accessibility and the suspicion of deposits caused by hydraulic underload. The practical evidence of the sediment transport performance of this part of the sewer system, dependent on different load cases, should present a basis for further analysis, for example regarding flushing measures. A positive side-effect of the investigation was the description of the amount of pollutants caused by different weather conditions in combined sewer systems and the alterations of the sewage composition due to biogenic processes during transport. The concept included the parallel sampling of the inflow at the pumpstation and the outflow at the end of the pressure main during different weather conditions. By calculating the inflow to the pressure main, as well as its outflow at different flow conditions, it was possible to draw conclusions in regard to the transport behaviour of sediment and the bioprocesses within an 8.5 km section of the pressure main. The results show clearly that the effects of sedimentation and remobilization depend on the flow conditions. The balance of the total suspended solids (TSS) load during daily variations in dry weather shows that the remobilization effect during the run-off peak is not able to compensate for the period of sedimentation happening during the low flow at night. Based on the data for dry weather, an average of 238 kg of TSS deposits in the pressure main remains per day. The remobilization of sediment occurs only due to the abruptly increased delivery rates caused by precipitation events. These high pollution loads lead to a sudden strain at the wastewater treatment plant. It was found that the sediment transport behaviour is characterized by sedimentation up to a flow velocity of 0.35 m/s, while remobilization effects occur above 0.5 m/s. The assumption of bad sediment transport performance in the pressure main was confirmed. Therefore, the results can be used as a basis for further analysis, for example regarding periodical flushing as a means of cleaning the pressure main. The findings, especially regarding the methods and processes, are transferable and can be applied to other pressure mains in combined sewer systems. Besides the outlined evaluation of the sediment transport behaviour of the pressure main, the collected data were used in the project to calibrate a sewer system model, including a water quality model for the catchment area, and as a contribution towards an early physically based sediment transport modelling in InfoWorks CS.

Particle separation from road runoff by a decentralised lamella system - laboratory tests and experiences in the field.

A new decentralised settling system based on the principle of lamella separation was developed for the treatment of road runoff. Two different laboratory test methods, the DIBt (Deutsches Institut für Bautechnik) procedure and our own approach, were applied in order to evaluate the efficiency of the system based on the separation of fine mineral particles and a mixture of mineral and organic particles, respectively. Overall efficiencies (88% after DIBt and 61% according to our own method) were comparable to results obtained for commercial systems. The lamella system was then applied in the field for 1 year to treat runoff from a road area of 420 m2. The amount of solids separated that was calculated from a mass balance (10.1 kg) was consistent with the amount of sediments measured (8.6 kg). However, the average separation efficiency was only 30% in the field study. This is related to the size and composition of the particles in runoff, which are not represented well by the material used for the test procedures. It is concluded that the test methods should be improved, and that more field studies are needed in order to obtain a better understanding of the settling behaviour of particles in road runoff.

Management of Risks From Water and Ice From Ice Machines for the Very Immunocompromised Host: A Process Improvement Project Prompted by an Outbreak of Rapidly Growing Mycobacteria on a Pediatric Hematopoietic Stem Cell Transplant (Hsct) Unit.

BACKGROUND In 2011, pediatric hematopoietic stem cell transplant (HSCT) patients were moved from an older hospital to a new children's hospital. To minimize bacterial growth in the new hospital's water during construction, the plumbing system was flushed and disinfected before occupancy. However, 6 months after occupancy, an increased incidence of rapidly growing mycobacteria (RGM) was detected in clinical cultures. Over 10 months, 15 pediatric HSCT patients were infected, while no pediatric HSCT patients had been infected in the preceding 12 months. OBJECTIVE To determine the cause of the outbreak and to interrupt patient acquisition of RGM. METHODS Water samples were collected from water entering the hospital and from drinking water and ice machines (DWIMs) from the old and new hospitals. Total heterotrophic plate counts (HPCs, CFU/mL) of water were undertaken, and select isolates were identified as RGM. RESULTS The cause of the outbreak was increased bacterial levels in the water (including RGM) in the DWIMs in the new (2011) hospital. Tests revealed higher HPCs in drinking water and ice from the DWIMs in the new hospital than in the DWIMs in the old hospital. Ultimately, HPCs were reduced by several different interventions. CONCLUSION In response to an RGM outbreak, HSCT patients were banned from ingesting DWIM ice and water and bottled water was provided. Since this interverntion 4 years ago, no additional RGM isolates have been identified in HSCT patient cultures. Our measures to reduce HPCs to goal levels in drinking water from DWIMs were successful, but the HPCs for ice have not consistently reached the goal of <500 CFU/mL. Infect Control Hosp Epidemiol 2017;38:792-800.

Methylobacterium spp. as an indicator for the presence or absence of Mycobacterium spp.

OBJECTIVE/BACKGROUND: A published survey of bacteria in showerhead biofilm samples revealed that Methylobacterium spp. and Mycobacterium spp. seldom coexisted in biofilms. METHODS: To confirm that information, biofilm samples were collected from household plumbing of Mycobacterium avium patients and Methylobacterium spp. and M. avium numbers were measured by direct colony counts. RESULTS: The results demonstrated that if Methylobacterium spp. were present, Mycobacterium spp. were absent, and the opposite. CONCLUSION: The data demonstrate that microbial populations in biofilms can influence the presence or absence of opportunistic premise plumbing pathogens and, thereby, increase the range of strategies to reduce exposure to waterborne pathogens. Finally, by assessing for the visual presence of methylobacteria as pink pigmentation on showers and shower curtains, homeowners and managers of hospitals and other buildings can quickly determine whether a premise plumbing biofilm sample has mycobacteria with a high degree of assurance.

Evaluation of Lead Release in a Simulated Lead-Free Premise Plumbing System Using a Sequential Sampling Approach.

In this pilot study, a modified sampling protocol was evaluated for the detection of lead contamination and locating the source of lead release in a simulated premise plumbing system with one-, three- and seven-day stagnation for a total period of 475 days. Copper pipes, stainless steel taps and brass fittings were used to assemble the "lead-free" system. Sequential sampling using 100 mL was used to detect lead contamination while that using 50 mL was used to locate the lead source. Elevated lead levels, far exceeding the World Health Organization (WHO) guideline value of 10 µg · L(-1), persisted for as long as five months in the system. "Lead-free" brass fittings were identified as the source of lead contamination. Physical disturbances, such as renovation works, could cause short-term spikes in lead release. Orthophosphate was able to suppress total lead levels below 10 µg · L(-1), but caused "blue water" problems. When orthophosphate addition was ceased, total lead levels began to spike within one week, implying that a continuous supply of orthophosphate was required to control total lead levels. Occasional total lead spikes were observed in one-day stagnation samples throughout the course of the experiments.

Designing a tap to meet multiple criteria.

Managing outbreaks of Legionella and Pseudomonas aeruginosa in hospital washrooms remains a serious issue, with individual infection prevention and control (IPC) teams tasked with deciding which strategies and products are most suitable for their hospital. While determining the most effective infection control can be challenging even for experienced IPC personnel, commercial tap manufacturers face the equally demanding task of designing sufficiently versatile and effective products to meet the requirements of a wide range of healthcare facilities. With its new H64 product, however, Bristan believes it has the answer. Product manager, Chris Tranter, explains.

DNA Persistence in a Sink Drain Environment.

Biofilms are organized structures composed mainly of cells and extracellular polymeric substances produced by the constituent microorganisms. Ubiquitous in nature, biofilms have an innate ability to capture and retain passing material and may therefore act as natural collectors of contaminants or signatures of upstream activities. To determine the persistence and detectability of DNA passing through a sink drain environment, Bacillus anthracis strain Ames35 was cultured (6.35 x 107 CFU/mL), sterilized, and disposed of by addition to a sink drain apparatus with an established biofilm. The sink drain apparatus was sampled before and for several days after the addition of the sterilized B. anthracis culture to detect the presence of B. anthracis DNA. Multiple PCR primer pairs were used to screen for chromosomal and plasmid DNA with primers targeting shorter sequences showing greater amplification efficiency and success. PCR amplification and detection of target sequences indicate persistence of chromosomal DNA and plasmid DNA in the biofilm for 5 or more and 14 or more days, respectively.

Distribution system water age can create premise plumbing corrosion hotspots.

Cumulative changes in chemical and biological properties associated with higher "water age" in distribution systems may impact water corrosivity and regulatory compliance with lead and copper action levels. The purpose of this study was to examine the effects of water age and chemistry on corrosivity of various downstream premise plumbing pipe materials and configurations using a combination of controlled laboratory studies and a field survey. Examination of lead pipe, copper pipe with lead solder, and leaded brass materials in a replicated lab rig simulating premise plumbing stagnation events indicated that lead or copper release could increase as much as ∼440 % or decrease as much as 98 % relative to water treatment plant effluent. In field studies at five utilities, trends in lead and copper release were highly dependent on circumstance; for example, lead release increased with water age in 13 % of cases and decreased with water age in 33 % of conditions tested. Levels of copper in the distribution system were up to 50 % lower and as much as 30 % higher relative to levels at the treatment plant. In many cases, high-risks of elevated lead and copper did not co-occur, demonstrating that these contaminants will have to be sampled separately to identify "worst case" conditions for human exposure and monitoring.

Preventing childhood scalds within the home: Overview of systematic reviews and a systematic review of primary studies.

OBJECTIVE: To synthesise and evaluate the evidence of the effectiveness of interventions to prevent scalds in children. METHODS: An overview of systematic reviews (SR) and a SR of primary studies were performed evaluating interventions to prevent scalds in children. A comprehensive literature search was conducted covering various resources up to October 2012. Experimental and controlled observational studies reporting scald injuries, safety practices and safety equipment use were included. RESULTS: Fourteen systematic reviews and 39 primary studies were included. There is little evidence that interventions are effective in reducing the incidence of scalds in children. More evidence was found that inventions are effective in promoting safe hot tap water temperature, especially when home safety education, home safety checks and discounted or free safety equipment including thermometers and thermostatic mixing valves were provided. No consistent evidence was found for the effectiveness of interventions on the safe handling of hot food or drinks nor improving kitchen safety practices. CONCLUSION: Education, home safety checks along with thermometers or thermostatic mixing valves should be promoted to reduce tap water scalds. Further research is needed to evaluate the effectiveness of interventions on scald injuries and to disentangle the effects of multifaceted interventions on scald injuries and safety practices.