Premise Plumbing Research Articles

Development of a machine learning model to support low cost real-time Legionella monitoring in premise plumbing systems

Legionella pneumophila (L. pneumophila) is a pathogenic bacterium primarily known for causing Legionnaires’ Disease which is known for high mortality rates, particularly in the elderly. With caseloads continuing to increase, further research is needed to improve our understanding of optimized sampling schema and safe limits of L. pneumophila, in part to target improved treatment options and realistic population-level risk modeling. Particularly in healthcare and other high-risk locations these become crucial and time sensitive needs. Therefore, we conceptualized this research as a means of incorporating easily measured physiochemical water quality parameters and generalization of the unique ecology of building water systems to build a computational model that can allow for more rapid and accurate decision making. This research uses the specific machine learning (ML) method called statistical learning theory to incorporate concentration of host cells, such as native amoeba, and physiochemical water quality parameters to estimate the probability of observing ranges of Legionella gene copy concentrations. Using data from previously published research on Legionella prevalence in a large building, our ML method trains the model on the relative impacts of physiochemical parameters on likely amoeba host cell occurrences. The model is expanded to estimate host cell concentrations using correlations and regressions operated through LASSO algorithms. After categorization variables from these results are then used to inform a logistic regression to provide an estimate of the probability of Legionella gene copy concentration ranges. In summary, conventional results generated by logistic regression and multiple linear regression quantified the associations among ecological conditions in the water and ability to predict a likely range of Legionella concentration in a management focused way. Further, two ML methods, PCA and LASSO, demonstrated feasibility in accurate real-time monitoring of Legionella through physiochemical indicators as evidenced with good accuracy of predictions based for validation results. Furthermore results demonstrate the vital need to account for the impact of water quality on building on host cells, and via their quantified water microbial ecology, not just Legionella concentrations.

Statistical analysis of parameters affecting Legionella and total cell growth in premise plumbing systems within buildings: A field study based on an empirical data set

During the storage and distribution of water in buildings, the excessive growth of pathogens can deteriorate the quality of drinking water. This study aims to investigate the factors influencing this growth and propose technical measures for prevention. The analysis is based on an empirical data set comprising 1361 samples from 204 domestic premise plumbing systems. In 14 systems, ultrafiltration plants were installed as microbiological barriers. Legionella cultivation and flow cytometry were used to determine microbiological properties. The study identified elevated total cell counts in tapping valves and pipe end lines in numerous premise plumbing systems, indicating prolonged water stagnation prior to sampling, which facilitates microbiological growth. Higher contamination rates were observed in these systems, with peripheral taps often being contaminated in lieu of the entire system. These systems were classified as microbiologically unstable due to the relevantly higher total cell numbers at hot water taps compared to the hot water tank (>25%). Furthermore, these systems exhibited a Legionella contamination rate that was 22.3% higher than in microbiologically stable systems. In some cases, peripheral contaminations may not accurately represent the entire premise plumbing system. Increasing the discard volume during sampling from 1 L to 3–5 L could provide more precise results during standard testing. Legionella species were primarily detected in the first 1 L of water after tap activation. Additionally, statistically significant relationships were observed between direct temperature and total cell number, as well as between the presence of ultrafiltration and total cell numbers at cold water taps.

Estimating the risk of gastrointestinal illness associated with drinking tap water in Norway: a prospective cohort study

BackgroundThe delivery of safe drinking water has high public health relevance, as reflected in the Sustainable Development Goals (SDG6). Several precautionary actions have reduced the burden associated with infectious diseases in high-income countries; however, pollution in source waters, inadequate disinfection, and premise plumbing, along with an increased awareness that intrusion in the drinking water distribution system, represents risk factors for gastrointestinal illness linked to consume of drinking water. Sporadic cases of waterborne infections are expected to be underreported since a sick person is less likely to seek healthcare for a self-limiting gastrointestinal infection. Hence, knowledge on the true burden of waterborne diseases is scarce. The primary aim with the present study was to estimate the risk of gastrointestinal illness associated with drinking tap water in Norway.MethodsWe conducted a 12-month prospective cohort study where participants were recruited by telephone interview after invitation based on randomised selection. A start up e-survey were followed by 12 monthly SMS questionnaires to gather information on participants characteristics and drinking tap water (number of 0.2L glasses per day), incidence, duration and symptoms associated with gastrointestinal illness. Associations between the exposure of drinking tap water and the outcome of risk of acute gastrointestinal illness (AGI) were analysed with linear mixed effects models. Age, sex, education level and size of the drinking water supply were identified as potential confounders and included in the adjusted model.ResultsIn total, 9,946 persons participated in this cohort study, accounting for 11.5% of all invited participants. According to the data per person and month (99,446 monthly submissions), AGI was reported for 5,508 person-months (5.5 per 100 person-months). Severe AGI was reported in 819 person-months (0.8 per 100 person-months). Our study estimates that 2–4% of AGI in Norway is attributable to drinking tap water.ConclusionsThis is the largest cohort study in Norway estimating the burden of self-reported gastrointestinal infections linked to the amount of tap water drunk in Norway. The data indicate that waterborne AGI is not currently a burden in Norway, but the findings need to be used with caution. The importance of continued efforts and investments in the maintenance of drinking water supplies in Norway to address the low burden of sporadic waterborne cases and to prevent future outbreaks needs to be emphasised.

Effects of Copper on Legionella pneumophila Revealed via Viability Assays and Proteomics.

Cu is an antimicrobial that is commonly applied to premise (i.e., building) plumbing systems for Legionella control, but the precise mechanisms of inactivation are not well defined. Here, we applied a suite of viability assays and mass spectrometry-based proteomics to assess the mechanistic effects of Cu on L. pneumophila. Although a five- to six-log reduction in culturability was observed with 5 mg/L Cu2+ exposure, cell membrane integrity only indicated a <50% reduction. Whole-cell proteomic analysis revealed that AhpD, a protein related to oxidative stress, was elevated in Cu-exposed Legionella relative to culturable cells. Other proteins related to cell membrane synthesis and motility were also higher for the Cu-exposed cells relative to controls without Cu. While the proteins related to primary metabolism decreased for the Cu-exposed cells, no significant differences in the abundance of proteins related to virulence or infectivity were found, which was consistent with the ability of VBNC cells to cause infections. Whereas the cell-membrane integrity assay provided an upper-bound measurement of viability, an amoebae co-culture assay provided a lower-bound limit. The findings have important implications for assessing Legionella risk following its exposure to copper in engineered water systems.

Point-of-use filtration units as drinking water distribution system sentinels

Municipal drinking water distribution systems (DWDSs) and associated premise plumbing (PP) systems are vulnerable to proliferation of opportunistic pathogens, even when chemical disinfection residuals are present, thus presenting a public health risk. Monitoring the structure of microbial communities of drinking water is challenging because of limited continuous access to faucets, pipes, and storage tanks. We propose a scalable household sampling method, which uses spent activated carbon and reverse osmosis (RO) membrane point-of-use (POU) filters to evaluate mid- to long-term occurrence of microorganisms in PP systems that are relevant to consumer exposure. As a proof of concept, POU filter microbiomes were collected from four different locations and analyzed with 16S rRNA gene amplicon sequencing. The analyses revealed distinct microbial communities, with occasional detection of potential pathogens. The findings highlight the importance of local, and if possible, continuous monitoring within and across distribution systems. The continuous operation of POU filters offers an advantage in capturing species that may be missed by instantaneous sampling methods. We suggest that water utilities, public institutions, and regulatory agencies take advantage of end-of-life POU filters for microbial monitoring. This approach can be easily implemented to ensure drinking water safety, especially from microbes of emerging concerns; e.g., pathogenic Legionella and Mycobacterium species.

Containment of a KPC-CRE Outbreak Associated with Premise Plumbing in a Long-Term Care Facility— Minnesota, 2022-2023

Background: On March 23, 2022, the Minnesota Department of Health (MDH) was notified of Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella oxytoca isolated from a resident’s urine in long-term care facility A (LTCF-A). Carbapenem-resistant Enterobacterales (CRE) are reportable statewide with required isolate submission to MDH Public Health Laboratory (MDH-PHL), where carbapenemase production and mechanism identification is confirmed. Methods: MDH partnered with LTCF-A on a containment response, including infection prevention and control (IPC) measures, KPC-CRE education, and colonization screening. Rectal swabs were screened for carbapenemase genes by real-time PCR (Cepheid Xpert Carba-R), with positive specimens undergoing culture, isolation, and whole genome sequencing (WGS). MDH-PHL conducted WGS including multilocus sequence typing (MLST) and single nucleotide polymorphism (SNP) analysis to describe genetic relationships among isolates. When screening indicated a potential environmental source, due to species diversity and ongoing resident transmission, an environmental screening plan was developed including collection of premise plumbing samples from room faucets, aerators, sinks, toilets, and shared shower drains. Results: KPC-CRE was detected in 23 residents (urine, n=2; rectal swab, n=21) during March 2022–November 2023. 21 isolates comprising 10 Enterobacterales species were cultured from KPC-positive screening specimens. SNP analysis performed on bacteria of the same species demonstrated 5 distinct clusters of relatedness comprising 2-3 residents per cluster (Cluster 1: Klebsiella oxytoca, n=3; Cluster 2: Klebsiella oxytoca, n=3; Cluster 3: Escherichia coli, n=2; Cluster 4: Klebsiella pneumoniae, n=2; Cluster 5: Raoultella planticola, n=2). 7 KPC-positive resident specimens did not yield a culturable organism. KPC-CRE was detected throughout the premise plumbing including 8 of 9 shared shower room drains and 6 of 75 resident room sink drains. WGS and SNP analysis suggest relatedness among resident and environmental KPC-CRE isolates. Gaps in IPC measures including hand hygiene, use of personal protective equipment (PPE), environmental cleaning and disinfection, and sink hygiene practices were observed during onsite assessments. Use of an EPA-registered biofilm disinfectant in facility drains and repeated environmental sampling has demonstrated a decrease in KPC-harboring bacteria within the premise plumbing, but not complete elimination. Conclusion: Containing the spread of KPC-CRE within LTCF-A has been challenging due to environmental reservoirs of KPC-CRE along with insufficient implementation of IPC practices. Continued colonization screening has been necessary to detect newly colonized residents and reinforce efforts to increase IPC compliance. Strict implementation and adherence to IPC measures, including those that minimize the spread of KPC-CRE from facility premise plumbing, are needed to fully halt KPC-CRE transmission within LTCF-A.

Risks of stannous chloride without filtration for hexavalent chromium treatment

AbstractWith increasing interest in using stannous chloride without filtration to achieve hexavalent chromium maximum contaminant level compliance in California, there is new urgency to quantify its effects on water quality and risks to public health manifested in distribution and premise plumbing systems. Accordingly, a 12‐week groundwater pilot study was completed using ubiquitous premise plumbing materials under flowing (to waste) and stagnating conditions of hexavalent chromium‐containing groundwater following stannous chloride addition without filtration. Results quantified the accumulation and release of chromium and tin, with total chromium concentrations exceeding regulatory or acceptable levels under stagnating conditions. Sediment with elevated chromium, tin, arsenic, and manganese concentrations was also observed. Given these observations would likely occur and worsen over time in distribution systems that cumulatively serve large populations, the use of stannous chloride without filtration represents an unacceptable risk to public health compared to other, more well‐established, best available technologies.

Efficacy of chlorine-based disinfectants to control Legionella within premise plumbing systems

Legionella is an opportunistic waterborne pathogen that causes Legionnaires’ disease. It poses a significant public health risk, especially to vulnerable populations in health care facilities. It is ubiquitous in manufactured water systems and is transmitted via inhalation or aspiration of aerosols/water droplets generated from water fixtures (e.g., showers and hand basins). As such, the effective management of premise plumbing systems (building water systems) in health care facilities is essential for reducing the risk of Legionnaires’ disease. Chemical disinfection is a commonly used control method and chlorine-based disinfectants, including chlorine, chloramine, and chlorine dioxide, have been used for over a century. However, the effectiveness of these disinfectants in premise plumbing systems is affected by various interconnected factors that can make it challenging to maintain effective disinfection. This systematic literature review identifies all studies that have examined the factors impacting the efficacy and decay of chlorine-based disinfectant within premise plumbing systems. A total of 117 field and laboratory-based studies were identified and included in this review. A total of 20 studies directly compared the effectiveness of the different chlorine-based disinfectants. The findings from these studies ranked the typical effectiveness as follows: chloramine > chlorine dioxide > chlorine. A total of 26 factors were identified across 117 studies as influencing the efficacy and decay of disinfectants in premise plumbing systems. These factors were sorted into categories of operational factors that are changed by the operation of water devices and fixtures (such as stagnation, temperature, water velocity), evolving factors which are changed in-directly (such as disinfectant concentration, Legionella disinfectant resistance, Legionella growth, season, biofilm and microbe, protozoa, nitrification, total organic carbon(TOC), pH, dissolved oxygen(DO), hardness, ammonia, and sediment and pipe deposit) and stable factors that are not often changed(such as disinfectant type, pipe material, pipe size, pipe age, water recirculating, softener, corrosion inhibitor, automatic sensor tap, building floor, and construction activity). A factor-effect map of each of these factors and whether they have a positive or negative association with disinfection efficacy against Legionella in premise plumbing systems is presented. It was also found that evaluating the effectiveness of chlorine disinfection as a water risk management strategy is further complicated by varying disinfection resistance of Legionella species and the form of Legionella (culturable/viable but non culturable, free living/biofilm associated, intracellular replication within amoeba hosts). Future research is needed that utilises sensors and other approaches to measure these key factors (such as pH, temperature, stagnation, water age and disinfection residual) in real time throughout premise plumbing systems. This information will support the development of improved models to predict disinfection within premise plumbing systems. The findings from this study will inform the use of chlorine-based disinfection within premise plumbing systems to reduce the risk of Legionnaires disease.

Enhancing the DNA yield intended for microbial sequencing from a low-biomass chlorinated drinking water

DNA extraction yield from drinking water distribution systems and premise plumbing is a key metric for any downstream analysis such as 16S amplicon or metagenomics sequencing. This research aimed to optimize DNA yield from low-biomass (chlorinated) reverse osmosis-produced tap water by evaluating the impact of different factors during the DNA extraction procedure. The factors examined are (1) the impact of membrane materials and their pore sizes; (2) the impact of different cell densities; and (3) an alternative method for enhancing DNA yield via incubation (no nutrient spiking). DNA from a one-liter sampling volume of RO tap water with varying bacterial cell densities was extracted with five different filter membranes (mixed ester cellulose 0.2 μm, polycarbonate 0.2 μm, polyethersulfone 0.2 and 0.1 μm, polyvinylidene fluoride 0.1 μm) for biomass filtration. Our results show that (i) smaller membrane pore size solely did not increase the DNA yield of low-biomass RO tap water; (ii) the DNA yield was proportional to the cell density and substantially dependent on the filter membrane properties (i.e., the membrane materials and their pore sizes); (iii) by using our optimized DNA extraction protocol, we found that polycarbonate filter membrane with 0.2 μm pore size markedly outperformed in terms of quantity (DNA yield) and quality (background level of 16S gene copy number) of recovered microbial DNA; and finally, (iv) for one-liter sampling volume, incubation strategy enhanced the DNA yield and enabled accurate identification of the core members (i.e., Porphyrobacter and Blastomonas as the most abundant indicator taxa) of the bacterial community in low-biomass RO tap water. Importantly, incorporating multiple controls is crucial to distinguish between contaminant/artefactual and true taxa in amplicon sequencing studies of low-biomass RO tap water.

A point-of-use drinking water quality dataset from fieldwork in Detroit, Michigan

Drinking water quality sensor technology has rapidly advanced, facilitating the collection of rich datasets and real-time analytics. However, sensors have not yet been widely applied to monitor drinking water quality in premise plumbing. Richer quality of data in premise plumbing offers an improved understanding of the quality of drinking water present at the point-of-use. In this paper, online drinking water quality sensor nodes were temporarily installed in twenty-four homes in Detroit, Michigan. The water quality sensor nodes took measurements of five drinking water quality parameters every five minutes for four weeks. Additionally, free chlorine and lead were sampled periodically within each home. Together, these data make up a dataset that captures drinking water quality over time in a legacy city with an oversized drinking water system. This dataset offers more frequent measurements amongst more sample homes than are typically available in premise plumbing or at the tap. The data can be used to investigate temporal trends in drinking water quality, including diurnal patterns and anomaly detection. Additionally, this dataset could be utilized to evaluate water quality in comparison with other cities.

Reconsider the burn: The transient effect of a chlorine burn on controlling opportunistic pathogens in a full-scale chloraminated engineered water system

Nitrification is a serious water-quality issue in chloraminated engineered water systems (EWSs). Nitrification is often remediated by a chlorine burn (i.e., a free‑chlorine conversion), a short-term switch from chloramination to chlorination in EWSs. Opportunistic pathogens (OPs) are the dominant infectious agents in EWSs. However, the responses of OPs to a chlorine burn are unknown. This study for the first time assessed how a chlorine burn affected OPs in a full-scale EWS. We determined the impact of a 1.5-month chlorine burn on four dominant OPs (Legionella, Mycobacterium, Pseudomonas, and Vermamoeba vermiformis) in a representative full-scale chloraminated EWS in the United States. Legionella and Mycobacterium were the most abundant OPs. In the water main, the summed concentration of the four OPs during the chlorine burn [3.27 ± 1.58 log10(GCN·L−1); GCN: genome or gene copy number] was lower (p ≤ 0.001) than before the burn [4.83 ± 0.50 log10(GCN·L−1)]. After the burn, the summed concentration increased to 4.27 ± 0.68 log10(GCN·L−1), comparable to before the burn (p > 0.05), indicating a transient effect of the chlorine burn in the water main. At the residential sites, the summed concentrations of the four OPs were comparable (p > 0.05) at 5.50 ± 0.84, 5.27 ± 1.44, and 5.08 ± 0.71 log10(GCN·L−1) before, during, and after the chlorine burn, respectively. Therefore, the chlorine burn was less effective in suppressing OP (re)growth in the premise plumbing. The low effectiveness might be due to more significant water stagnation and disinfectant residual decay in the premise plumbing. Indeed, for the entire sampling period, the total chlorine residual concentration in the premise plumbing (1.8 mg Cl2·L−1) was lower than in the water main (2.4 mg Cl2·L−1). Consequently, for the entire sampling period, the summed concentration of the four OPs in the premise plumbing [5.26 ± 1.08 log10(GCN·L−1)] was significantly higher (p < 0.001) than in the water main [4.04 ± 1.25 log10(GCN·L−1)]. In addition, the chlorine burn substantially increased the levels of disinfection by-products (DBPs) in the water main. Altogether, a chlorine burn is transient or even ineffective in suppressing OP (re)growth but raises DBP concentrations in chloraminated EWSs. Therefore, the practice of chlorine burns to control nitrification should be optimized, reconsidered, or even replaced.

Quantitative Microbial Risk Assessment Framework Incorporating Water Ages with Legionella pneumophila Growth Rates.

Water age in drinking water systems is often used as a proxy for water quality but is rarely used as a direct input in assessing microbial risk. This study directly linked water ages in a premise plumbing system to concentrations of Legionella pneumophila via a growth model. In turn, the L. pneumophila concentrations were used for a quantitative microbial risk assessment to calculate the associated probabilities of infection (Pinf) and clinically severe illness (Pcsi) due to showering. Risk reductions achieved by purging devices, which reduce water age, were also quantified. The median annual Pinf exceeded the commonly used 1 in 10,000 (10-4) risk benchmark in all scenarios, but the median annual Pcsi was always 1-3 orders of magnitude below 10-4. The median annual Pcsi was lower in homes with two occupants (4.7 × 10-7) than with one occupant (7.5 × 10-7) due to more frequent use of water fixtures, which reduced water ages. The median annual Pcsi for homes with one occupant was reduced by 39-43% with scheduled purging 1-2 times per day. Smart purging devices, which purge only after a certain period of nonuse, maintained these lower annual Pcsi values while reducing additional water consumption by 45-62%.

Assessing the Impact of Stochastic Demands and Fixture Purging on Free Chlorine Residuals in Premise Plumbing Systems

Assessing the Impact of Stochastic Demands and Fixture Purging on Free Chlorine Residuals in Premise Plumbing Systems

Lead occurrence in North Carolina well water: importance of sampling representation and collection techniques

Private wells often lack centralized oversight, drinking water quality standards, and consistent testing methodologies. For lead in well water, the lack of standardized data collection methods can impact reported measurements, which can misinform health risks. Here, we conducted a targeted community science testing of 1143 wells across 17 counties in North Carolina (USA) and compared results to state testing data primarily associated with new well construction compiled in the NCWELL database. The goal of our study was to explore the impacts of sampling methodology and household representation on estimated lead exposures and subsequent health risks. At the household scale, we illustrated how sampling and analytical techniques impact lead measurements. The community science testing first draw samples (characterizing drinking water) had a 90th percentile lead value of 12.8 μg l−1 while the NCWELL database flushed samples (characterizing groundwater) had a value below the reporting level of 5 μg l−1. As lead was associated with the corrosion of premise plumbing, flushing prior to collection substantially reduced lead concentrations. At the community scale, we examined how the lack of representation based on household demographics and well construction characteristics impacted the knowledge of lead and blood lead level (BLL) occurrence. When simulating representative demographics of the well populations, we observed that the 90th percentile lead level could differ by up to 6 μg l−1, resulting in communities being above the USEPA action level. This translated to a 1.0–1.3 μg dl−1 difference in predicted geometric mean BLL among infants consuming reconstituted formula. Further, inclusion of less common well construction types also increased lead in water occurrence. Overall, under- and overestimations of lead concentrations associated with differences in sampling techniques and sample representation can misinform conclusions about risks of elevated BLLs associated with drinking water from private wells which may hinder investigations of waterborne lead exposure.

Bacterial communities of planktonic bacteria and mature biofilm in service lines and premise plumbing of a Megacity: Composition, Diversity, and influencing factors

Although simulated studies have provided valuable knowledge regarding the communities of planktonic bacteria and biofilms, the lack of systematic field studies have hampered the understanding of microbiology in real-world service lines and premise plumbing. In this study, the bacterial communities of water and biofilm were explored, with a special focus on the lifetime development of biofilm communities and their key influencing factors. The 16S rRNA gene sequencing results showed that both the planktonic bacteria and biofilm were dominated by Proteobacteria. Among the 15,084 observed amplicon sequence variants (ASVs), the 33 core ASVs covered 72.8 %, while the 12 shared core ASVs accounted for 62.2 % of the total sequences. Remarkably, it was found that the species richness and diversity of biofilm communities correlated with pipe age. The relative abundance of ASV2 (f_Sphingomonadaceae) was lower for pipe ages 40–50 years (7.9 %) than for pipe ages 10–20 years (59.3 %), while the relative abundance of ASV10 (f_Hyphomonadaceae) was higher for pipe ages 40–50 years (19.5 %) than its presence at pipe ages 20–30 years (1.9 %). The community of the premise plumbing biofilm had significantly higher species richness and diversity than that of the service line, while the steel-plastics composite pipe interior lined with polyethylene (S-PE) harbored significantly more diverse biofilm than the galvanized steel pipes (S-Zn). Interestingly, S-PE was enriched with ASV27 (g_Mycobacterium), while S-Zn pipes were enriched with ASV13 (g_Pseudomonas). Moreover, the network analysis showed that five rare ASVs, not core ASVs, were keystone members in biofilm communities, indicating the importance of rare members in the function and stability of biofilm communities. This manuscript provides novel insights into real-world service lines and premise plumbing microbiology, regarding lifetime dynamics (pipe age 10–50 years), and the influences of pipe types (premise plumbing vs. service line) and pipe materials (S-Zn vs. S-PE).

Water Supply and Firefighting: Early Lessons from the 2023 Maui Fires

Even though drinking water utilities are not meant to fight wildfires, they quickly become stakeholders, if not first responders, when their resources are needed for firefighting. The August 2023 wildfires on the island of Maui, Hawaii, USA, have highlighted weaknesses at this intersection. While attention has focused on the wildfire causes or water quality impacts afterward, few studies have analyzed the response. We review this extreme case to support disaster-response lessons for water utilities and to guide further research and policy. First, emergency water releases were not available in a timely manner. Second, fire and wind toppled power lines, causing power outages that inhibited pumping water. Third, many structures were a total loss despite water doused on them, consuming valuable water. Finally, water was lost through damaged premise plumbing in burned structures, further reducing system pressure. These conditions emphasize that water utilities need to access emergency water supplies quickly, establish reliable backup electricity, coordinate with firefighters on priority water uses, and shut valves in burned areas to preserve water. While further research will certainly follow, we present these early lessons as starting points.

Applying microelectrodes to investigate aged ductile iron and copper coupon reactivity during free chlorine application

In drinking water distribution systems, including premise plumbing, dissolved oxygen (DO) and free chlorine (FC) are common oxidants and ductile iron (DI) and copper (Cu) are commonly used pipe materials. Microelectrodes as a tool have been applied in previous corrosion research and were used in this study to collect quantifiable data and understand DO and FC reactivity and pH changes at the water-metal interface. Using microelectrodes, pH, DO, and FC profiles from the bulk water to near and at the surface of aged DI (154–190 d) and Cu (2 d and 86–156 d) coupons were investigated during periods of flow and stagnation (30 min). Using the measured microelectrode profiles, oxidant fluxes and apparent surface reaction rate constants were calculated to elucidate differences between DO and FC reactivity with the coupons. Microelectrodes were successfully applied to measure pH, DO, and FC profiles from the bulk water to near aged DI and Cu coupon surfaces; Cu coupons aged quickly and exhibited less reactivity at 2 d with DO and FC than aged DI coupons did after 154–190 d; and for the aged DI coupon experiments, orthophosphate presence stabilized pH profiles where without orthophosphate pH fluctuations of greater than 2 pH units occurred from the bulk water to the DI coupon surface.

Microbial and physicochemical water quality changes within distribution and premise plumbing systems during a chlorine conversion

A strategy for nitrification control within chloraminated drinking water systems (CDWSs) is to temporarily switch from chloramine secondary disinfection to free chlorine, also known as a free chlorine conversion (FCC). However, the long-term and beneficial effects of FCCs are unclear, especially regarding opportunistic pathogen occurrence. In this study, the impacts to microbial and physicochemical parameters were monitored throughout a CDWS implementing a FCC. Water samples were collected weekly for 4–6 weeks before, during, and after a FCC at eight locations: four distribution system and four residential sites. Monochloramine residual (mean±standard deviation) before and after the FCC averaged 1.8±0.9 and 1.6±1.0 parts per million (ppm) for all sites, respectively. Free chlorine levels averaged 2.3±0.9 ppm. There were no significant differences in turbidity and hardness at each location during the three time periods, but some were noted for pH, temperature, and orthophosphate levels across various sites and sampling periods. For all locations, heterotrophic plate count levels were lower during the FCC compared to the periods before and after. All samples from one residence were culture positive for P. aeruginosa which exhibited high levels before the FCC, decreasing levels during, and steadily increasing levels after. Additionally, one week prior to the FCC, sediment samples from two elevated storage tanks, ET-1 and ET-2, were analyzed with ET-1 displaying higher levels of culturable heterotrophic bacteria and molecularly detected total bacteria, Legionella spp., and nontuberculous mycobacteria (NTM), as well as presence of culturable P. aeruginosa and total coliforms compared to ET-2. Fourteen P. aeruginosa and total coliform isolates were whole genome sequenced with genetic differences observed depending on the sampling location and timepoint. Collectively, the observed differences in chemical and microbial parameters advocates for a better understanding of the effects associated with implementing FCCs to determine both their effectiveness and potential risks/rewards to water quality.

On-site filtration of large sample volumes improves the detection of opportunistic pathogens in drinking water distribution systems.

In this study, we compared conventional vacuum filtration of small volumes through disc membranes (effective sample volumes for potable water: 0.3-1.0 L) with filtration of high volumes using ultrafiltration (UF) modules (effective sample volumes for potable water: 10.6-84.5 L) for collecting bacterial biomass from raw, finished, and tap water at seven drinking water systems. Total bacteria, Legionella spp., Legionella pneumophila, Mycobacterium spp., and Mycobacterium avium complex in these samples were enumerated using both conventional quantitative PCR (qPCR) and viability qPCR (using propidium monoazide). In addition, PCR-amplified gene fragments were sequenced for microbial community analysis. The frequency of detection (FOD) of Legionella spp. in finished and tap water samples was much greater using UF modules (83% and 77%, respectively) than disc filters (24% and 33%, respectively). The FODs for Mycobacterium spp. in raw, finished, and tap water samples were also consistently greater using UF modules than disc filters. Furthermore, the number of observed operational taxonomic units and diversity index values for finished and tap water samples were often substantially greater when using UF modules as compared to disc filters. Conventional and viability qPCR yielded similar results, suggesting that membrane-compromised cells represented a minor fraction of total bacterial biomass. In conclusion, our research demonstrates that large-volume filtration using UF modules improved the detection of opportunistic pathogens at the low concentrations typically found in public drinking water systems and that the majority of bacteria in these systems appear to be viable in spite of disinfection with free chlorine and/or chloramine.IMPORTANCEOpportunistic pathogens, such as Legionella pneumophila, are a growing public health concern. In this study, we compared sample collection and enumeration methods on raw, finished, and tap water at seven water systems throughout the State of Minnesota, USA. The results showed that on-site filtration of large water volumes (i.e., 500-1,000 L) using ultrafiltration membrane modules improved the frequency of detection of relatively rare organisms, including opportunistic pathogens, compared to the common approach of filtering about 1 L using disc membranes. Furthermore, results from viability quantitative PCR (qPCR) with propidium monoazide were similar to conventional qPCR, suggesting that membrane-compromised cells represent an insignificant fraction of microorganisms. Results from these ultrafiltration membrane modules should lead to a better understanding of the microbial ecology of drinking water distribution systems and their potential to inoculate premise plumbing systems with opportunistic pathogens where conditions are more favorable for their growth.

Concurrent transmission of multiple carbapenemases in a long-term acute-care hospital.

We investigated concurrent outbreaks of Pseudomonas aeruginosa carrying blaVIM (VIM-CRPA) and Enterobacterales carrying blaKPC (KPC-CRE) at a long-term acute-care hospital (LTACH A). We defined an incident case as the first detection of blaKPC or blaVIM from a patient's clinical cultures or colonization screening test. We reviewed medical records and performed infection control assessments, colonization screening, environmental sampling, and molecular characterization of carbapenemase-producing organisms from clinical and environmental sources by pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing. From July 2017 to December 2018, 76 incident cases were identified from 69 case patients: 51 had blaKPC, 11 had blaVIM, and 7 had blaVIM and blaKPC. Also, blaKPC were identified from 7 Enterobacterales, and all blaVIM were P. aeruginosa. We observed gaps in hand hygiene, and we recovered KPC-CRE and VIM-CRPA from drains and toilets. We identified 4 KPC alleles and 2 VIM alleles; 2 KPC alleles were located on plasmids that were identified across multiple Enterobacterales and in both clinical and environmental isolates. Our response to a single patient colonized with VIM-CRPA and KPC-CRE identified concurrent CPO outbreaks at LTACH A. Epidemiologic and genomic investigations indicated that the observed diversity was due to a combination of multiple introductions of VIM-CRPA and KPC-CRE and to the transfer of carbapenemase genes across different bacteria species and strains. Improved infection control, including interventions that minimized potential spread from wastewater premise plumbing, stopped transmission.