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Project 4379: Research Needs for Opportunistic Pathogens in Premise Plumbing: Experimental Methodology, Microbial Ecology and Epidemiology Overview of Project, Drivers for Research and Outcomes Marc Edwards, Amy Pruden (PI), Joe Falkingham Pathogens of Concern Pathogen Disease(s) Host Organism Required? Mode of Exposure Legionella pneumophila Legionnaires’ disease or Pontiac fever in children Yes Inhalation or aspiration Pseudomonas aeruginosa Urinary tract infections, respiratory infections, dermatitis, soft tissue infections, bacteremia, bone and joint infections, GI infections No Wound infection; other modes of transmission are unknown Mycobacterium avium Pulmonary disease, cervical lymphadenitis (children) No Inhalation or aspiration Acanthamoeba Acanthamoeba keratitis No Wound infection Naegleria fowleri Primary amebic meningoencephalitis No Nasal aspiration 2 Opportunistic Pathogens Opportunistic pathogens in premise plumbing are now the primary source of water-borne infectious disease in developed countries Per year: Up to 18,000 Legionnaire’s and 30,000 MAC cases Biofilm, not fecal-associated Immunocompromised people particularly at risk Regulatory challenge- who’s responsibility? N. fowleri P.aeruginosa L.pneumophila Mycobacterium avium complex (MAC) Acanthamoeba Practical Drivers and Opportunities • Increased reporting/detection • Increased susceptible populations • • • • Main water distribution system upgrades Premise plumbing upgrades Green building/green devices Energy sustainability links These are all coming one way or another… 5 Microbial Ecology of Residential Hot Water Heater Systems: Role of Hot Water System Type/Design on Factors Influential to Pathogen Re-growth: Temperature, Chlorine Residual, Hydrogen Evolution and Sediment Randi Brazeau, Amy Pruden and Marc Edwards October 4, 2013 Background • Conventional Wisdom: Temperature is the Key – WHO vs. US temperature setting – 48 °C typically closer to 42-45 °C Pathogen Growth Water Heater Type – Stratification in Electric Water Heaters vs. Gas (Lacroix, 1999) – Pinellas County and CDC: Legionella incidence higher in buildings with hot water recirculation (Moore, et al., 2006) Variables of Hot Water Premise Plumbing that Can Lead to Pathogen Growth • Volumes per Day (Goldner, 1999) – Average range: 42 – 160 GPD – Extreme high: 360 GPD – Extreme low: vacation home • Type of Water Heater – Standard, Recirculation, On-Demand, Electric, Gas, Solar, etc. etc. etc. • • • • Temperature Setting Anode Rod Type Flow Velocity Pipe Material Experimental Design Electric Water Heater 60 0C H2 Anode Corrosion Biofilm Growth H2 Heating Elements Mg or Al Anode Rod Scale Buildup H2 H2 Biofilm Formation: Nutrients and Energy for Microbial Growth 350 Mg(OH)3, Al(OH)3, Fe(OH)3, Solids and Sorbed Nutrients Testing Conditions – By the Numbers High Use Low Use 49 °C • 54 gal/per/day • 3.14 per/family • 50 gal tank •3 turnovers/day • 8-hour Stagnation • 1/6 of High Use • 25% turnover – 2 times daily • 12-hour Stagnation • EPA recommended setting • Minimize scalding risk 60 °C • WHO, Canada, Australia, others • Control pathogen growth 48 °C and High Use TOP 2 3 BOTTOM RECIRC 50 Temperature (°C) 4 45 40 35 30 25 20 STAND Temperature (°C) 50 NO GROWTH 45 40 GROWTH 35 30 25 20 0.25 0.75 1.25 1.75 2.25 3.25 4.25 4.75 Time After Flush (hr) 5.75 6.75 7.75 Chapter 3: Internal Tank Temperature Results – Volumes at Risk! Water Heater Type Storage Volume (Tank) Below 46 °C Per Day High Use (% Tank) Tank setting 60 °C 49 °C STAND 31 78 RECIRC 22 100 Dissolved Oxygen – Legionella is a Microaerophile Hydrogen Generation in Systems 2500 Hydrogen (ppm) 2000 1500 STAND 4 x more H2! 6.5 x 1000 more H2! RECIRC DEMAND 500 0 High Use Low Use 0.2 mg C/mg H2 (Morton et al., 2005) BOTTOM OF TANKS 2.0 TOTAL CHLORINE (MG/L) 1.8 STAND @ 60 °C 1.6 1.4 STAND @ 48 °C 1.2 1.0 1 mg/L RECIRC @ 60 °C 0.8 0.6 RECIRC @ 48 °C 0.4 0.2 0.0 0 2 4 6 8 10 12 STAGNATION TIME SINCE FLUSHING (HR) 14 50 Temperature (°C) 45 Field Test DT = ~12 °C 40 35 30 Lab Test Temperature (°C) 25 45 43 41 39 37 35 33 31 29 27 25 DT = ~10 °C RECIRC @ 48 °C STAND @ 48 °C 0.0 2.0 4.0 6.0 8.0 10.0 Shower Time (min) 12.0 14.0 Short Circuiting COLD WATER MIXING! WOULD CHECK VALVE PREVENT THIS FROM HAPPENING? COLD WATER BYPASSES TANK ENTIRELY! Public Health Implications? • Potentially getting water straight from BOTTOM of tank – Cooler temperatures – More sediment • Pathogen nutrients? • Biofilm attachment? – Pathogen rich? • Reverse flow – Increased sheering of biofilm? AOC (food) Generation Mechanisms Four Potential Mechanisms 1. 2. 3. 4. Nitrification (Zhang et al. 2009) H2 oxidation (Morton et al. 2005) Sorption to Iron/Aluminum Sediments (Butterfield et al. 2002) Organics leaching from pipe materials (PEX) NH3 Cycling Humic/AOC Sorption During Flow NH3 NO3- Organics leaching from pipe material (PEX) FLOW H2 H2 H2 Biofilm Rust/Iron Sediments Pipe Wall H2 Evolution Photo Adapted from Edwards et al. 2006 AOC Generation Mechanisms • H2 oxidizing bacteria – Sacrificial anode (Al or Mg) corrodes producing H2 gas – Supports growth of hydrogen oxidizing bacteria – Typical Mg-anode: 44” long by 0.7” wide, 490g, 5 yr lifetime • 160 µg C/L everyday Photo Adapted from Edwards et al. 2006 Conclusions • Temperature is important, but it is more complicated than deciding on a set point • Recirculating systems have more H2, less chlorine, less oxygen, higher turbidity and higher metals than standard systems • Design and operation of hot water systems is important for comfort and health • Organic matter (food) can be generated in hot water systems