Hot Water Distribution Systems Research Articles

Thermal disinfection of hotels, hospitals, and athletic venues hot water distribution systems contaminated by Legionella species

Legionella spp. (> or = 500 cfu liter(-1)) were detected in 92 of 497 water distribution systems (WDS) examined. Thermal disinfection was applied at 33 WDS. After the first and second application of the disinfection procedure, 15 (45.4%) and 3 (9%) positive for remedial actions WDS were found, respectively. Legionella pneumophila was more resistant to thermal disinfection than Legionella non-pneumophila spp. (relative risk [RR]=5.4, 95% confidence intervals [CI]=1-35). WDS of hotels with oil heater were more easily disinfected than those with electrical or solar heater (RR=0.4 95% CI=0.2-0.8). Thermal disinfection seems not to be efficient enough to eliminate legionellae, unless repeatedly applied and in combination with extended heat flushing, and faucets chlorine disinfection.

Risk Factors for Contamination of Hotel Water Distribution Systems by Legionella Species

The Legionella colonization frequency at 385 Greek hotel hot and cold water distribution systems was 20.8%. Legionella contamination was associated with the presence of an oil heater (odds ratio [OR]=2.04, 95% confidence interval [CI]=1.12 to 3.70), with the sample temperature (OR=0.26, 95% CI=0.1 to 0.5), with seasonal operation (OR=3.23, 95% CI=1.52 to 6.87), and with the presence of an independent disinfection system (OR=0.30, 95% CI=0.15 to 0.62). The same water temperatures, free-chlorine levels, and pHs differently affect the survival of various Legionella spp.

Nosocomial transmission of Legionella pneumophila to a child from a hospital's cold-water supply

Human Legionella infections mainly consist of community-acquired and nosocomial pneumonia and rarely affect children. We describe a nosocomial infection with Legionella pneumophila, serogroup 1, subgroup OLDA, in an immunocompromized 2-y-old girl at a paediatric clinic. L. pneumophila identical to that of the patient was found in the hospital's cold-water but not in the hot-water distribution system. Transmission of Legionella to the girl most probably occurred by Legionella-contaminated cold water mixed and heated by water from the hot-water system. Mixing of hot and cold water probably occurred through thermostatic water mixing valves connected to showers regulated by a handle at the shower head. Nosocomial Legionella infection might thus have occurred, although circulating hot water temperatures never dropped below 53 degrees C and cultures for surveillance of Legionella from central parts of the hot-water system have been consistently negative. Legionellae were successfully eliminated from the hospital's cold-water distribution system by hot water flushing at 73 degrees C for 1h.

Resistance of Legionella to disinfection in hot water distribution systems

The efficiency of various disinfection treatments against Legionella was tested on a hot water distribution system (HWDS) pilot unit. The results demonstrated clearly that most Legionella in the networks were fixed in the biofilm at the surface of the pipe (more than 98% for each loop). Chemical treatments (continuous chlorination, hyperchlorination, hydrogen peroxide and peracetic acid mixing) commonly used for the eradication of Legionella in hot water distribution networks appeared to be inadequate for eradicating the bacteria in the biofilm. Unfortunately, the biofilm contained most of the pathogens in an HWDS whereas legislation is only restricted to the Legionella concentration in the water phase. Thermal treatment appeared to be efficient to disinfect most of the biofilm but seemed to promote the biofilm re-growth as well. It was then concluded that the best solution to prevent Legionella contamination in hot water distribution systems would be to have perfect control of the temperature in the networks (temperature > 55 degrees C at all points). Nevertheless, in many cases it is difficult to have such control, so during the time necessary to modify networks, the best solution to control Legionella proliferation appears to be to apply a treatment shock (thermal or chlorination as a function of pipe characteristics). These treatments must be followed by a continuous chlorination that is totally controlled and equipped with alarm systems. This study demonstrates that biofilm sampling devices must be installed in hot water distribution systems to anticipate Legionella contamination and correctly determine the efficiency of the treatments.

Persistent Legionella pneumophila colonization of a hospital water supply: efficacy of control methods and a molecular epidemiological analysis

After a nosocomial outbreak caused by Legionella pneumophila serogroup 5, the hospital water distribution system, which was found to be colonized by L. pneumophila serogroups 5 and 6, was decontaminated by the superheat and flush method and by installing an additional heat-shock unit in one of the hot water circuits. This unit exposed the recirculated water to a temperature of 80 degrees C. The efficacy of the decontamination measures was evaluated by monitoring the temperatures and legionella concentrations at different parts of the hot water distribution system. The genetic diversity of the colonizing legionella flora was examined using two genotyping methods: amplified fragment length polymorphism analysis (AFLP) and random amplified polymorphic DNA (RAPD) analysis. Selected serogroup 6 strains were also analyzed by sequence-based typing (SBT). The results indicated that long-term eradication of serogroup 5 strains was never achieved. Only one serogroup 6 strain was never isolated after the superheat and flush. In all, according to genetic fingerprints, the diversity of Legionella strains in a hospital water system remains stable over the years regardless of the use of recommended disinfection procedures.

Legionella waterline colonization: detection of Legionella species in domestic, hotel and hospital hot water systems

An evaluation was made of the prevalence of Legionella species in hot water distribution systems in the city of Bologna (Italy) and their possible association with bacterial contamination (total counts and Pseudomonadaceae) and the chemical characteristics of the water (pH, Ca, Mg, Fe, Mn, Cu, Zn and Total Organic Carbon, TOC). A total of 137 hot water samples were analysed: 59 from the same number of private apartments, 46 from 11 hotels and 32 from five hospitals, all using the same water supply. Legionella species were detected in 40.0% of the distribution systems, L. pneumophila in 33.3%. The highest colonization was found in the hot water systems of hospitals (93.7% of samples positive for L. pneumophila, geometric mean: 2.4 x 10(3) CFU l(-1)), followed by the hotels (60.9%, geometric mean: 127.3 CFU l(-1)) and the apartments with centralized heating (41.9%, geometric mean: 30.5 CFU l(-1)). The apartments with independent heating systems showed a lower level of colonization (3.6% for Legionella species), with no evidence of L. pneumophila. Correlation analysis suggests that copper exerts an inhibiting action, while the TOC tends to favour the development of L. pneumophila. No statistically significant association was seen with Pseudomonadaceae, which were found at lower water temperatures than legionellae and in individual distribution points rather than in the whole network. The water recirculation system used by centralized boilers enhances the spreading of legionellae throughout the whole network, both in terms of the number of colonized sites and in terms of CFU count. Differences in Legionella colonization between types of buildings are not due to a variation in water supply but to other factors. Besides the importance of water recirculation, the study demonstrates the inhibiting action of copper and the favourable action of TOC on the development of L. pneumophila.

Distribution of bacteria in a domestic hot water system in a Danish apartment building

Bacterial growth in hot water systems seems to cause problems such as bad odor of the water, skin allergies and increased heat transfer resistance in heating coils. In order to establish a basis for long-term suppression of bacterial growth, we studied the distribution of bacteria in a Danish domestic hot water system. Heterotrophic plate counts (HPC) were measured in both water and biofilm samples from various sampling sites in the system. In hot water samples, where the temperature was 55–60°C, the HPC were 10 3–10 4 CFU/mL at incubation temperatures of 25°C or 37°C and 10 5 CFU/mL at 55°C or 65°C. In the cold water (10°C) supplying the hot water system, the HPC at 25°C or 37°C was lower than in the hot water, and no bacteria were found after incubation at 55°C or 65°C. HPC constituted from 38% to 84% of the AODC results in hot water but only 2% in cold water, which showed a high ratio of culturable bacteria in hot water. Biofilm samples from the hot water tank and the inner surface of the pipes in the cold and hot water distribution system were collected by specially designed sampling devices, which were exposed in the system for 42 days. The quasi-steady-state number of bacteria in the biofilm, measured as the geometric mean of the HPC obtained between 21 and 42 days, was five-fold higher in the hot water pipe (13×10 5 CFU/cm 2 at 55°C) than in the cold water pipe (2.8×10 5 CFU/cm 2 at 25°C). There was no significant difference between the number of bacteria in the biofilm samples from the top, middle and bottom of the hot water tank, and the number of bacteria in the biofilm counted at 55°C ranged from 0.6×10 4 to 1.7×10 4 CFU/cm 2. The surfaces of the sacrificial aluminum anodes and the heating coils in the hot water tank also contained high bacterial numbers. The measured number of bacteria in water and biofilm samples was related to the dimensions of the hot water system, and calculations showed that the majority of bacteria (72%) were located in the biofilm especially in the distribution system, which accounts for the greatest surface area. Free-living bacteria accounted for 26% and only a minor part of the bacteria were in the sludge in the hot water tank (2%).

Biofilm formation in a hot water system

The biofilm formation rate was measured in situ in a hot water system in an apartment building by specially designed sampling equipment, and the net growth of the suspended bacteria was measured by incubation of water samples with the indigeneous bacteria. The biofilm formation rate reached a higher level in the hot water distribution system (2.1 d(-1) to 2.3 d(-1)) than in the hot water tank (1.4 d(-1) to 2.2 d(-1)) indicating an important area for surface associated growth. The net growth rate of the suspended bacteria measured in hot water from the top, middle and bottom of the hot water tank, in the sludge, or in the water from the distribution system was negligible. This indicated that bacterial growth took place on the inner surfaces in the hot water system and biofilm formation and detachment of bacteria could account for most of the suspended bacteria actually measured in hot water. Therefore, attempts to reduce the number of bacteria in a hot water system have to include the distribution system as well as the hot water tank.

A case report of false negative Legionella test results in a chlorinated public hot water distribution system due to the lack of sodium thiosulfate in sampling bottles

AbstractWe examined samples from the showers and the central water distribution system of a public building with an indoor swimming pool. The pool was used for school and recreational activities and as a sports therapy facility for patients with coronary heart disease. The building's hot water system was contaminated with Legionella pneumophila. Due to the building's intricate piping system, several attempts to completely eliminate legionellae by thermal and chemical disinfection had failed, so an external sanitation company was charged with the installation of a continuous chlorination device in order to keep Legionella concentrations low. The laboratory which was contracted by the sanitation company to monitor bacteria levels after installation of the chlorination device used sampling bottles without sodium thiosulfate and repeatedly reported an absence of Legionella. However, up to 69,000 colony forming particles (CFP) of Legionella pneumophila (Lp) per litre and up to 171 CFP/ml of heterotrophic bacteria could be detected when parallel samples were collected in bottles containing sodium thiosulfate at standard concentrations. Laboratories, epidemiologists, public health officials and technical staff who may be in charge of delivering, preparing or using sterile sampling devices for the collection of environmental samples to be tested for legionellae should be aware that cultures can return false negative results if the sampling containers used to collect chlorinated drinking water or chlorinated pool water samples do not contain a neutralising agent to instantly inactivate residual halogen biocides. False negative results may lead to a false sense of security regarding the safety of water systems or the success of disinfection measures, and may thus endanger public health or even hinder the epidemiological clarification of outbreaks.

Controlling Legionella in Hospital Water Systems: Experience with the Superheat-and-Flush Method and Copper-Silver Ionization

To evaluate the effect of copper-silver ionization on Legionella colonization and nosocomial legionnaires' disease and to compare the efficacy of metal ions versus the superheat-and-flush method of disinfection. Prospective determination over a 36-month period of copper and silver ion concentrations in the recirculating hot-water system, Legionella colonization of the hospital water distribution system, and cases of nosocomial legionnaires' disease. Retrospective comparison of results with the previous 13 years, during which the superheat-and-flush method was used. The Pittsburgh Veterans' Affairs Health Care System (University Drive Division) acute-care hospital. Three copper-silver ionization systems were installed on the hot-water distribution system in November 1994. The average number of cases of legionnaires' disease per year and the percentage of distal sites positive for Legionella pneumophila for the superheat-and-flush method versus the copper-silver ionization method was six cases with 15% positivity versus two cases with 4% positivity, respectively. The reduction in Legionella colonization after copper-silver ionization was significant (P<.05) compared to the superheat and flush. Mean copper and silver ion concentrations (mg/L) were 0.29 and 0.054 from hot-water tanks, and 0.17 and 0.04 from distal outlets, respectively. We conclude that a properly maintained and monitored copper-silver ionization system was more effective than the superheat-and-flush method for reducing the recovery of Legionella from the hospital water distribution system.

Controlling Legionella in Hospital Water Systems: Experience With the Superheat-and-Flush Method and Copper-Silver Ionization

AbstractObjective:To evaluate the effect of copper-silver ionization on Legionella colonization and nosocomial legionnaires' disease and to compare the efficacy of metal ions versus the super-heat-and-flush method of disinfection.Design:Prospective determination over a 36-month period of copper and silver ion concentrations in the recirculating hot-water system, Legionella colonization of the hospital water distribution system, and cases of nosocomial legionnaires' disease. Retrospective comparison of results with the previous 13 years, during which the superheat-and-flush method was used.Setting:The Pittsburgh Veterans' Affairs Health Care System (University Drive Division) acut-care hospital.Intervention:Three copper-silver ionization systems were installed on the hot-water distribution system in November 1994.Results:The average number of cases of legionnaires‘ disease per year and the percentage of distal sites positive for Legionella pneumophila for the superheat-and-flush method versus the copper-silver ionization method was six cases with 15% positivity versus two cases with 4% positivity, respectively. The reduction in Legionella colonization after copper-silver ionization was significant (P&lt;.05) compared to the superheat and flush. Mean copper and silver ion concentrations (mg/L) were 0.29 and 0.054 from hot-water tanks, and 0.17 and 0.04 from distal outlets, respectively.Conclusions:We conclude that a properly maintained and monitored copper-silver ionization system was more effective than the superheat-and-flush method for reducing the recovery of Legionella from the hospital water distribution system.

Controlling Legionella in Hospital Water Systems Experience With the Superheat-and-Flush Method and Copper-Silver Ionization

Objective:To evaluate the effect of copper-silver ionization on Legionella colonization and nosocomial legionnaires' disease and to compare the efficacy of metal ions versus the super-heat-and-flush method of disinfection.Design:Prospective determination over a 36-month period of copper and silver ion concentrations in the recirculating hot-water system, Legionella colonization of the hospital water distribution system, and cases of nosocomial legionnaires' disease. Retrospective comparison of results with the previous 13 years, during which the superheat-and-flush method was used.Setting:The Pittsburgh Veterans' Affairs Health Care System (University Drive Division) acut-care hospital.Intervention:Three copper-silver ionization systems were installed on the hot-water distribution system in November 1994.Results:The average number of cases of legionnaires‘ disease per year and the percentage of distal sites positive for Legionella pneumophila for the superheat-and-flush method versus the copper-silver ionization method was six cases with 15% positivity versus two cases with 4% positivity, respectively. The reduction in Legionella colonization after copper-silver ionization was significant (P&lt;.05) compared to the superheat and flush. Mean copper and silver ion concentrations (mg/L) were 0.29 and 0.054 from hot-water tanks, and 0.17 and 0.04 from distal outlets, respectively.Conclusions:We conclude that a properly maintained and monitored copper-silver ionization system was more effective than the superheat-and-flush method for reducing the recovery of Legionella from the hospital water distribution system.

Occurrence of heterotrophic bacteria and fungi in cold and hot water distribution systems using water of different quality

The microbiological quality of cold and hot water samples of 67 Finnish buildings was studied. Most of the buildings were apartment buildings receiving their cold water from municipal groundwater or surface water plants. Disinfection with chlorine was applied in all the surface water plants and 33% of the groundwater plants. Water samples in buildings were taken from incoming cold water, from the hot water main just before and after the heat exchanger, and from a tap or shower in an apartment. The viable counts of mesophilic bacteria and fungi and total cell counts were higher in cold than in hot water samples. In hot water, the microbial counts were higher in samples from taps and showers than from the mains. In taps and showers, the decrease in hot water temperature probably increased the microbial numbers. Thermophilic bacteria appeared with high numbers in all the hot water samples, but thermophilic fungi were found in only one sample. Bacterial biomass and mean cell volume were greater in processed surface water than in processed groundwater samples. Disinfection with chlorine reduced the viable plate counts, although the chlorine concentration was extremely low in the water samples studied.Key words: heterotrophic bacteria, fungi, distribution system, groundwater, surface water.

Occurrence of legionellae in hot water distribution systems of Finnish apartment buildings.

The occurrence of legionellae in the hot water distribution systems of 67 buildings located in different parts of Finland was studied. Most of the buildings were apartment buildings. They had different hot water temperatures, and some received their cold potable water from surface water plants and some from ground water plants. Hot water samples were taken from taps, showers, and water mains just before and after the heat exchanger. Legionella pneumophila was isolated from 30% of the distribution systems. In the legionella-positive samples the legionella concentration varied from < 50 to 3.2 x 10(5) colony-forming units (cfu)/L (mean 2.7 x 10(3) cfu/L). The highest concentration of legionellae was found in the shower water. Legionellae appeared more often and with higher concentrations in hot water systems using cold water processed in surface water plants than in hot water systems associated with ground water plants. A high organic matter content in surface waters might favor the occurrence of legionellae and also the growth of other heterotrophic microbes. Mean water temperature just after heating was slightly higher in the legionella-negative systems than in the legionella-positive systems (53.5 vs. 51.5 degrees C).

Isolation of Legionella pneumophila from the cold water of hospital ice machines: implications for origin and transmission of the organism.

Although the mode of transmission of L. pneumophila is as yet unclear, the hot water distribution system has been shown to be the reservoir for Legionella within the hospital environment. In this report we identify a previously unrecognized reservoir for L. pneumophila within the hospital environment, ie, the cold water dispensers of hospital ice machines. The cold water dispensers of 14 ice machines were cultured monthly over a 1-year period. Positive cultures were obtained from 8 of 14 dispensers, yielding from 1 to 300 CFU/plate. We were able to link the positivity of these cold water sites to the incoming cold water supply by recovering L. pneumophila from the cold water storage tank, which is directly supplied by the incoming municipal water line. This was accomplished by a novel enrichment experiment designed to duplicate the conditions (temperature, sediment, stagnation, and continuous seeding) of the hot water system. Our data indicate that significant contamination of cold water outlets with L. pneumophila can occur. Although no epidemiologic link to disease was made, the fact that the primary source of a patient's drinking water is from the ice machines warrants further investigation of these water sources as possible reservoirs.

Survival of Legionella pneumophila in a model hot water distribution system.

A virulent strain of Legionella pneumophila was inoculated into an enclosed system supplied with unsterilized water from a domestic hot water supply. Growth of bacteria was monitored over 10 weeks. An increase in the number of organisms other than legionellas occurred but few amoebae were observed and none could be cultured. Viable counts of L. pneumophila in the circulation fluid decreased slightly. However, particles of debris which accumulated in the apparatus and which were stained by the indirect fluorescent antibody technique were found to be almost totally composed of L. pneumophila. On dismantling the apparatus Legionella was isolated in moderately high numbers from several different types of surfaces, particularly natural rubber and silicone.

The pitting corrosion of copper tubes in hot water

The electrode potential of copper tube used in hot water distribution system in buildings rises gradually with time of exposure and then attains to a critical value of pitting potential after a long incubation period. The process of potential rise proceeds in two stages. The first stage is the formation of a cuprous oxide layer in the potential range ≦ 60 mV(SCE) and the second stage is due to the reactions of chlorite ions accumulated in the cuprous oxide layer in the potential range > 60 mV(SCE). Oxyacids and oxyanions of chlorine formed in the water, to which chlorine gas or hypochlorite was added for sterilizing process, accelerate the formation of cuprous oxide layer in the first stage, and the reaction of chlorite ions increase the electrode potential of copper tube in the second stage.

POTABLE WATER SUPPLY AS THE HOSPITAL RESERVOIR FOR PITTSBURGH PNEUMONIA AGENT

Both legionnaires' disease and pneumonia caused by Pittsburgh pneumonia agent (PPA) are endemic in the Veterans Administration Medical Center, Pittsburgh. 85% of cases of legionnaires' disease and 100% of the cases of PPA were acquired in hospital. A selective dye-containing medium which allows visual discrimination of Legionella pneumophila and PPA has been used in a large-scale environmental survey of the hospital. Samples from 53 sites, including hot-water storage tanks, showerheads, mixing valves, and taps from 19 wards, were cultured. PPA was isolated from 2 sites and L. pneumophilafrom 33 sites. Water from a tap in the surgical intensive-care unit yielded 6 colony-forming units (CFU) of PPA/0·1 ml and 300 CFU of L. pneumophila/0·1 ml after centrifugation. Water from the outlet valve of a hot-water storage tank yielded 10 CFU of L. pneumophila/0·1 ml and when concentrated by centrifugation also yielded 2 CFU of PPA/0·1 ml. PPA and L. pneumophila share the same environmental niche, but isolation of PPA is more difficult. It seems that the reservoir for PPA in the VA Medical Center is the hot-water distribution system. PPA and L. pneumophilawere simultaneously isolated from the lung tissue of a patient in this hospital who died of hospital-acquired pneumonia; this finding supports the hypothesis of a common reservoir and mode of transmission for the two organisms.