Controlling Legionella in Plumbing Systems Presented by: Julius Ballanco, P.E. President, JB Engineering and Code Consulting, P.C.
Legionnaires Disease Named after outbreak at Bellevue Stratford Hotel in July 1976 221 American Legion Members were struck 34 Died Wasn t the first outbreak
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
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
Outbreaks Prior to 1976 1965 St. Elizabeth s Hospital, Washington, DC 1974 81 patients became ill 14 died Oddfellows Convention, Bellevue- Stratford Hotel, Philadelphia 20 attendees became sick 2 died
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
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
HAI - Major Concern Patient immune system is compromised Bacteria known to have greater effects on elderly and very young
Legionnella Bacteria Most Common Legionella Pneumophila At least another 24 Legionella bacteria have been identified
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
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
Biofilm and Bacteria Bacteria attaches to the biofilm The biofilm forms a layer of protection for the bacteria Bacteria can multiply on the biofilm
Protection in Biofilm Biofilms adjust to their surroundings Provide a protective layer Allow bacteria to grow Resist antimicrobial agents
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 95-115 F Ideal growth range 68-122 F Legionella growth range 68 F Legionella dormant but can survive
Hot Water Scalds Temperature/Time/Burn Water Temperature F Min. Time for First Degree Burn Min. Time for Second and Third Degree Burn 111.2 5 hours 7 hours 116.6 35 minutes 45 minutes 118.4 10 minutes 14 minutes 122 1 minute 5 minutes 131 5 seconds 25 seconds 140 2 seconds 5 seconds 149 1 second 2 seconds 158-1 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
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
Catching Legionnaires Disease Legionnaires Disease is a result of inhaling legionella pneumophilia The bacteria must become an aerosol Victims breathe the bacteria
Means to Aerosol Bacteria Showers Aerated faucets Misters Humidifiers Whirlpool bathtubs Vegetable sprayers Handheld sprayers Water features
Killing Legionella Hot temperature Hyperchlorination Chlorine dioxide Ultraviolet radiation Copper/silver ionization Removing biofilm
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
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
Ultraviolet Radiation Good at controlling Long dwell time may be required Maintenance of system is high Filter required ahead of UV unit
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
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
High Water Temperatures Water temperature is 145 F, with thermostatic mixing valve Downstream temperature is still in a range of legionella growth
ASSE 1017- 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.
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
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
Supermarket Misters Supply misters directly with cold water If a reservoir is provided with unit, establish a maintenance policy Clean reservoirs once a week
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
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
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
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
Questions