Required water temperature in hotel plumbing to control Legionella growth

Legionella spp. occurring in hotel hot water systems, in particular Legionella pneumophila, are causing serious pneumonic infections, and water temperature is a key factor to control their occurrence in plumbing systems. We performed a systematic review and meta-analyses of the available evidence on the association between water temperature and Legionella colonization to identify the water temperature in hotel hot water systems required for control of Legionella. Qualitative synthesis and quantitative analysis were performed on 13 studies that met our inclusion criteria to identify the effect of temperature. The Receiver Operating Characteristic (ROC) curve identified 55 °C as a cutoff point for hotel hot water temperature with an Area Under the Curve (AUC) value of 0.914. The odds ratios (OR) for detecting Legionella at temperatures >55 °C compared to lower temperatures from a meta-analysis of three studies was 0.17 [95% CI: 0.11, 0.25], which indicates a strong negative association between temperature and Legionella colonization. A logistic regression on results from multiple studies using both molecular and culture methods found a temperature of 59 °C associated with an 8% probability of detectable Legionella. Only two studies reported sufficiently detailed data to allow a model of concentration vs. temperature to be fit, and this model was not statistically significant. Additional research or more detailed reporting of existing datasets is required to assess if Legionella growth can be limited below particular concentration targets at different temperatures.

Residential water heater cleaning and occurrence of Legionella in Flint, MI

After the Federal emergency in Flint, MI was declared in early 2016 in response to elevated lead-in-water and incidence of Legionnaires' disease, concerns arose that contaminants in residential water heaters could continue to contribute to poor quality tap water. Here, a comprehensive field survey of residential water heaters (n = 30) and associated water quality was conducted and the subsequent effects of an aggressive manual water heater clean-out was determined, including draining the tank and removing sediments via brushing and flushing. Before cleaning, inorganics accumulated in the tank sediments did not serve as a source of metals measured at hot water outlets. After cleaning, hardness- (calcium, magnesium, silica) and corrosion-associated inorganics (lead, iron, copper, aluminum, zinc) decreased by 64% in samples from sediment cleanout drain valves. Culturable L. pneumophila was only detected in 1 home (3.3%) prior to cleaning and 2 homes (6.7%) after cleaning, thus quantitative polymerase chain reaction was used to quantify potential effects on unculturable strains despite the limitation of differentiating live and dead cells. After the cleaning protocol, Legionella spp. and L. pneumophila gene numbers decreased or remained non-detectable in 83% and 98% of samples, respectively. Homes with less than 0.4 mg/L influent free chlorine tended to have quantifiable Legionella spp. gene numbers in water entering the home and had elevated L. pneumophila and Legionella spp. gene numbers throughout the home plumbing. Also, Legionella spp. and L. pneumophila gene numbers were highest for water heaters set at or below ∼42 °C and significantly decreased >51 °C, consistent with Legionella's preferred temperature range. Examination of the only home that had culturable L. pneumophila both before and after the cleaning protocol revealed that the organism was culturable from several sample locations throughout the home, including in water representative of the water main. Notably, the home was located in close proximity to McLaren Hospital, where an outbreak of Legionnaires disease was reported, and the water heater had a setpoint within the Legionella growth range of 44.2 °C. Considering that other factors were more strongly associated with Legionella occurrence and water heater sediment was not detectably mobilizing to tap water, it was concluded that water heater cleaning had some benefits, but was not an overarching factor contributing to possible human health risks.

Disparity in disinfection byproducts concentration between hot and cold tap water

The quality of water entering a distribution system may differ substantially from the quality at the point of exposure to the consumer. This study investigated temporal variations in the levels of regulated and non-regulated disinfection byproducts (DBPs) in cold and hot tap water in a home on a medium-sized municipal water system. In addition, samples were collected directly from the water plant with some being held in accordance with a simulated distribution system (SDS) test protocol. The location for this work was a system in western Massachusetts, USA that uses free chlorine as a final disinfectant. Very little short term variability of DBPs at the point of entry (POE) was observed. The concentration of DBPs in the time-variable SDS test was similar to concentrations in the cold water tap. For most DBPs, the concentrations continued to increase as the cold water tap sample was held for the time-variable SDS incubation period. However, the impact of heating on DBP levels was compound specific. For example, the concentrations of trihalomethanes (THMs), dichloroacetic acid (DCAA) and chloropicrin (CP) were substantially higher in the hot water tap than in the cold water time-variable SDS samples. In contrast, the concentration of trichloroacetic acid (TCAA) was lower in the heated hot tap water, but about equal to that observed in the cold tap water. The situation was more pronounced for dichloroacetonitrile (DCAN), bromodichloroacetic acid (BDCAA), bromochloroacetic acid (BCAA) and 1,1,1-trichloropropanone (TCP), which all showed lower concentrations in the hot water then in either of the cold water samples (instantaneous or time-variable SDS). The latter was viewed as a clear indication of thermally-induced decomposition. The ratio of unknown total organic halide (UTOX) to TOX was substantially lower in the hot tap water as the THM to TOX ratio became correspondingly larger. The results of this study show that DBP exposure in the home is not well represented by concentrations measured in cold water taps where most compliance monitoring is done.