Controlling Legionella in Plumbing Systems. Presented by: Julius Ballanco, P.E. President, JB Engineering and Code Consulting, P.C.

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1 Controlling Legionella in Plumbing Systems Presented by: Julius Ballanco, P.E. President, JB Engineering and Code Consulting, P.C.

2 Legionnaires Disease Named after outbreak at Bellevue Stratford Hotel in July American Legion Members were struck 34 Died Wasn t the first outbreak

3 Legionnaires Disease A multisystem illness With deadly types of pneumonia Different forms of pneumonia Appears 2-10 days after exposure Traced to a family of bacteria called Legionnella

4 Pontiac Fever Named for outbreak in Pontiac, MI in 1968 Flue like, nonpneumonic and nonfatal Caused by a species of Legionnella Frozen bacteria tested after Philadelphia outbreak

5 Outbreaks Prior to St. Elizabeth s Hospital, Washington, DC patients became ill 14 died Oddfellows Convention, Bellevue- Stratford Hotel, Philadelphia 20 attendees became sick 2 died

6 Known Major Outbreaks Holiday Inn, Wisconsin 4 deaths Burlington, VT Hospital 3 deaths Brooklyn Hospital 2 deaths Connecticut Hospital 3 deaths Charles County, MD Hospital several deaths Louisiana Grocery Store mister 3 deaths Florida Hotel 4 deaths Staffordshire, England Hospital 28 deaths BBC, London 28 deaths Malaga, Spain Ice Rink 1 death Virginia Home Store Whirlpool Tub Display 14 cases Playboy Mansion, Los Angeles Many cases

7 Common Thread - Hospitals Legionnaires Disease is a common hospital associated infection or HAI Many incidents go unreported Hospitals don t look for Legionnaires Disease often with HAI

8 HAI - Major Concern Patient immune system is compromised Bacteria known to have greater effects on elderly and very young

9 Legionnella Bacteria Most Common Legionella Pneumophila At least another 24 Legionella bacteria have been identified

10 Legionella In Water Legionella bacteria in not new It appears in most water supplies from lakes, ponds, and river Bacteria grows on biofilm Higher temperatures result in more rapid growth of bacteria

11 What s A Biofilm Microorganisms which allow cells to adhere Attach to the pipe Irreversible attachment to maturation Slime on the inside of the pipe Grows on your teeth

12 Biofilm and Bacteria Bacteria attaches to the biofilm The biofilm forms a layer of protection for the bacteria Bacteria can multiply on the biofilm

13 Protection in Biofilm Biofilms adjust to their surroundings Provide a protective layer Allow bacteria to grow Resist antimicrobial agents

14 Growth Rate of Legionella 70 C, 158 F 60 C, 140 F 50 C, 122 F 40 C, 104 F 30 C, 86 F 20 C, 68 F 151 F Legionella dies within 2 minutes 140 F Legionella dies within 32 minutes 131 F Legionella dies within 5-6 hours F Ideal growth range F Legionella growth range 68 F Legionella dormant but can survive

15 Hot Water Scalds Temperature/Time/Burn Water Temperature F Min. Time for First Degree Burn Min. Time for Second and Third Degree Burn hours 7 hours minutes 45 minutes minutes 14 minutes minute 5 minutes seconds 25 seconds seconds 5 seconds second 2 seconds second Higher water temperatures increase the hazard to the occupants These temperatures can scald. Increased danger to young and old. Adjust table by lowering 10 º F for scald hazard

16 Types of Burns Scalding water can cause: 1 st Degree Burn 2 nd Degree Burn 3 rd Degree Burn A 3 rd Degree burn often requires extended hospitalization. 1 st Degree 2 nd Degree 3 rd Degree Redness Blisters Dead Skin

17 Catching Legionnaires Disease Legionnaires Disease is a result of inhaling legionella pneumophilia The bacteria must become an aerosol Victims breathe the bacteria

18 Means to Aerosol Bacteria Showers Aerated faucets Misters Humidifiers Whirlpool bathtubs Vegetable sprayers Handheld sprayers Water features

19 Killing Legionella Hot temperature Hyperchlorination Chlorine dioxide Ultraviolet radiation Copper/silver ionization Removing biofilm

20 ASPE Research indicated 131 F as the minimum temperatures to kill Legionella Above 122 F there is no growth Higher temperatures will kill Legionella faster Most hot water becomes tempered Hot Water

21 Chlorination 4 to 6 ppm of chlorine only provides 90 percent kill of legionella bacteria Drinking water is approximately 0.75 ppm of chlorine Chlorine dioxide can damage the plumbing components

22 Ultraviolet Radiation Good at controlling Long dwell time may be required Maintenance of system is high Filter required ahead of UV unit

23 Copper-Silver Ionization Copper-silver ionization is one of the most effective means of killing legionella bacteria Systems inject small quantities of copper and silver into the water

24 Plumbing Practices Avoid stagnant sections of piping Avoid section of the water piping that would allow the growth of biofilm Consider components that have stagnant water Shower heads Aerators

25 High Water Temperatures Water temperature is 145 F, with thermostatic mixing valve Downstream temperature is still in a range of legionella growth

26 ASSE Thermostatic Courtesy of Symmons Industries Mixing Valve If water heater is raised above 125 F a thermostatic mixing valve in necessary Valves must be located near the water heater. Water heater temperature should be above 140 F Downstream temperatures are prone for legionella growth.

27 Energy Conservation vs. Legionella Energy conservation advocate recommend turning the water heater temperature down This can increase the growth of Legionella in the water heater There must be a balance between safety and energy conservation Don t forget scald protection

28 Hospitals-No Aeration Use laminar flow aerators or no aerators on faucets in hospitals Avoid having any spray on outlets than can aerate tempered water

29 Supermarket Misters Supply misters directly with cold water If a reservoir is provided with unit, establish a maintenance policy Clean reservoirs once a week

30 Outdoor Misters Some recommend avoiding the use of outdoor cooling misters Use only cold water Drain water supply in supply pipes to prevent warm stagnant areas for biofilm growth Have a routine cleaning program

31 Whirlpools and Hydro Therapeutic Tubs Empty tubs after every use Educate customer on maintenance Don t fill display models with water and operate for days

32 Hospital Program Consider a maintenance program Test the water periodically for concentration of Legionella Identify possible sources of Legionella growth and develop a program to eradicate any biofilm

33 Automatic vs Manual Faucets Johns Hopkins study raised concerns with automatic faucets Comparison was to much older manual faucets Internal components of any faucet can have biofilm growth Lower flow rates don t clean component like previous faucets Don t shy away from automatic faucet

34 Questions

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