2016 Webinar Sponsors

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1 Copyright 2016 American Water Works Association 2016 Webinar Sponsors 2 Please consider the environment before printing. 1

2 Webinar Moderator Deirdre Mueller No Image Available Senior Communications Manager American Water Works Association Deirdre Mueller has been a communications and public affairs professional for the past 14 years. She currently works as Public Affairs Manager for the American Water Works Association. She is a graduate of Fordham University in the Bronx, NY. 3 Enhance Your Webinar Experience Close Programs Instant messengers Other programs not in use GoToWebinar Support 4 Please consider the environment before printing. 2

3 Webinar Survey Immediately upon closing the webinar Survey window opens Thank you 5 Products or Services The mention of specific products or services in this webinar does not represent AWWA endorsement AWWA does not endorse or approve products or services 6 Please consider the environment before printing. 3

4 Panel of Experts Claressa Lucas, PhD Microbiologist/ ELITE Program Coordinator Centers for Disease Control and Prevention Ross Cooper, M. S. Environmental Scientist III Bureau of Safe Drinking Water State of Nevada Ernest Conrad, PE, Environmental Engineer, Principal, Conrad Engineers 7 Agenda I. Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings: A Practical Guide to Implementing Industry Standards Claressa Lucas, PhD II. III. Real-world Problems of Implementing Legionella Control in Public Water Systems: A State s Perspective. Legionella: A Building Owners Perspective Ross Cooper, M.S. Ernest Conrad, PE 8 Please consider the environment before printing. 4

5 Ask the Experts Claressa Lucas, PhD Ross Cooper, M. S. Ernest Conrad, PE Enter your question into the question pane at the lower right hand side of the screen. Please include your name and specify to whom you are addressing the question. 9 Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings: A Practical Guide to Implementing Industry Standards Claressa Lucas, PhD Microbiologist/ ELITE Program Coordinator Centers for Disease Control and Prevention 10 Please consider the environment before printing. 5

6 Learning Objectives History of Legionella and legionellosis Review US guidelines and standards Tools for risk management 11 Philadelphia, PA Please consider the environment before printing. 6

7 13 Legionella Gram negative, aerobic rod More than 60 species Natural in freshwater Parasite of protozoa Fastidious on artificial media L. pneumophila sg1 (Lp1) most common pathogen 14 Please consider the environment before printing. 7

8 Favorable conditions for Legionella Temperature 77º - 108ºF Stagnation Scale and sediments Protozoa Lack of residual disinfectant 15 Events leading to Legionnaires disease Supply Water Susceptible Host Amplification Temperature Stagnation Scale and sediment Protozoa Absence of disinfectant Biofilm Aerosolization Showerheads Cooling towers Decorative fountains Whirlpool spas Transmission 16 Please consider the environment before printing. 8

9 Incidence (cases/100,000 pop.) AWWA Webinar Program: Legionella Control for Building Water Systems Potable water 1 Longer period of time Continuing source Epidemic curves Probable Definite Cooling tower 2 Explosive Point-source 1. Demirjian A. et al. Clin Infect Dis. 2015; 60(11): New York City, South Bronx, National incidence of legionellosis * Year Between 2000 and 2011, 249% increase in legionellosis (based on NNDSS*) 1 *National Notifiable Disease Surveillance System 1. Dooling K et al. MMWR. 2015; 64(42); Please consider the environment before printing. 9

10 US Guidelines and Standards VHA Directive 1061 (8/2014) ASHRAE Standard 188 (6/2015) AIHA Guideline (8/2015) NYC/NYS (8/2015 7/2016) Others in development (NSF 444, ASHRAE 12 revision, CTI 159, etc.) CDC Vital Signs Fact Sheet MMWR Article Toolkit 20 Please consider the environment before printing. 10

11 MMWR Key Points 9/10 Outbreaks preventable with WMP Hotels and healthcare Potable water, cooling towers, hot tubs, fountains Common deficiencies categorized L. E. Garrison et al. (2016) MMWR 65(22): Common Deficiencies Process failure Human error Equipment failure Unmanaged external change 22 Please consider the environment before printing. 11

12 Summary of Deficiencies 65% process failures 52% human error 35% equipment failure 35% unmanaged change 48% more than one 70% inadequate disinfectant 52% optimal growth temps 23 Limitations CDC investigations Acute remediation 4% cases linked to outbreaks 24 Please consider the environment before printing. 12

13 Toolkit Overview Developed using ASHRAE 188 Best practices from worldwide experts Framework for prevention Living document 25 Building conditions: Risk Assessment At risk occupants Large, complex systems Devices where Legionella grow and spread enance/wmp-risk.html 26 Please consider the environment before printing. 13

14 Key Elements of a WMP 27 Testing for Legionella No known safe level Part of an established program Identify areas of concern Identify distribution patterns Use with water quality parameters 28 Please consider the environment before printing. 14

15 Take Home Points Legionellosis incidence is on the rise Outbreaks are preventable Common deficiencies noted Comprehensive prevention strategies necessary Testing can help inform WMPs 29 Ask the Experts Claressa Lucas, PhD Ross Cooper, M. S. Ernest Conrad, PE Enter your question into the question pane at the lower right hand side of the screen. Please include your name and specify to whom you are addressing the question. 30 Please consider the environment before printing. 15

16 Real-world Problems of Implementing Legionella Control in Public Water Systems: A State s Perspective Ross Cooper, M. S. Environmental Scientist III Bureau of Safe Drinking Water State of Nevada 31 Rationale This presentation will help both operators/owners and regulators better understand the practical issues associated with Legionella and its treatment. 32 Please consider the environment before printing. 16

17 Today we will Run through real world instances. Offer a few lessons learned (some the hard way). Provide information on treatment applications. Uncover some pitfalls encountered. 33 Legionella is found naturally in fresh water But lakes and rivers do NOT have sufficient quantities of bacteria to cause transmission 34 Please consider the environment before printing. 17

18 Safe Drinking Water Act * A super quick primer * Community Public Water System (PWS) Regularly serves at least 25 year-round residents Non-Transient Non-Community (NTNC) PWS Regularly serves the same 25 people, but they don t live there 35 Surface Water Treatment Rule Surface Water Treatment Rule (SWTR) (USEPA, 1989a) All PWSs using chlorine and surface water (or ground water under the direct influence of surface water) monitor for the presence of residual disinfectant. The disinfectant level must be >0.2 mg/l at the Point of Entry and detectable within the distribution system. 36 Please consider the environment before printing. 18

19 Regulations The Stage 1 Disinfectants and Disinfection Byproducts Rule (Stage 1 DBPR) requires PWSs that use chlorine to maintain a maximum residual disinfectant level (MRDL) as running annual average less than 4.0 mg/l (USEPA, 1998). 37 Regulations The SDWA regulates contaminants that can be harmful to public health The US EPA sets Maximum Contaminant Levels (MCLs) Nevada adopts the standards by reference & maintains compliance and enforcement authority independent of US EPA 38 Please consider the environment before printing. 19

20 Regulatory Oversight Regulatory Oversight - NTNC Total Coliform Rule Lead & Copper Rule NV Regulations: Provide the public with reasonable assurance that water is satisfactory for consumption, ablutionary and culinary purposes. 39 So how does Nevada become involved? 40 Please consider the environment before printing. 20

21 Las Vegas *Photo courtesy of 41 On the News 42 Please consider the environment before printing. 21

22 Where NDEP & SNHD* Started High-rise Condo in the Press 2001, 2007,2008 Legionnaires Disease reported and SNHD investigate to find presence of bacteria, remediation is required Condo a installed chlorine dioxide system Condo Summer 2009 SNHD routine inspection - discussed chlorine dioxide equipment for Legionella treatment * Nevada Division of Environmental Protection Southern Nevada Health District (SNHD) 43 Regulations (last one!) Avoid such surprises as: Congratulations! You re a water system! If you treat water (even if from another supply), you become a separate PWS! 44 Please consider the environment before printing. 22

23 Forms of Treatment Continuous application of disinfectant: Chlorine Chlorine dioxide Monochloramine Copper/Silver ionization 45 Forms of Treatment (no residual) Ultraviolet Light Disinfection Ozone 46 Please consider the environment before printing. 23

24 Chlorine against Legionella Affected by chlorine concentration, contact time, ph, temperature, buffering capacity of the water, concentration of organic matter, and the number and types of microorganisms in the water system (in biofilms or free-living). 47 Chlorine Continuous chlorination can contribute to corrosion and leaks in plumbing systems May require the simultaneous use of corrosion-inhibiting chemicals. 48 Please consider the environment before printing. 24

25 Chlorine Lin et al. (2002) Relatively high doses of chlorine (2 6 mg/l) were needed for continuous control of Legionella in water systems. The effectiveness of chlorine increased with temperature, although chlorine residual decay also increased. 49 Biofilms- the association of Legionella with protozoa (Lin et al. 2002) Requires much higher doses of chlorine for inactivation. May explain why chlorine can suppress Legionella in water systems but often cannot prevent future recurrences. 50 Please consider the environment before printing. 25

26 Monochloramine Effective for controlling bacterial re-growth and controlling biofilms due to its ability to penetrate the biofilm. Excess ammonia can cause biofilm growth (USEPA, 1999c; LeChevallier et al., 1988a). 51 Potential water quality issues Corrosion, formation of DBPs, and nitrification. Monochloramine can impact kidney dialysis and should be removed from the dialysate water. Reacts with pipe scale differently than other disinfectants, resulting in lead leaching in system materials (Edwards and Dudi, 2004). 52 Please consider the environment before printing. 26

27 Chlorine Dioxide Water-soluble gas that can easily diffuse through cell membranes of microorganisms, therefore superior to chlorine in penetrating biofilms. Its use as a biocide can be maintained over a wider ph range than chlorine (Lin et al., 2011b). 53 Chlorine Dioxide Use regulated under the DBP Rule. Chlorine dioxide itself can cause acute health effects - MRDL of 0.8 mg/l. Chlorite is an acute DBP. The Stage 1 DBPR sets a maximum contaminant level (MCL) of 1.0 mg/l for chlorite. 54 Please consider the environment before printing. 27

28 The Issue with Chlorine Dioxide Chlorine Dioxide is an Acute Contaminant ClO 2 > MRDL = Public Notice within 24 hours Chlorite (a DBP) is a Chronic Contaminant Chlorite > MCL = Public Notice within 30 days Daily monitoring is required More frequent than chlorine or chloramines 55 Public Notice Mandatory Language: Some infants and young children who drink water containing ClO 2 [or chlorite] in excess of the MRDL could experience nervous system effects. Similar effects may occur in fetuses of pregnant women who drink water containing ClO 2 [or chlorite] in excess of the MRDL. Some people may experience anemia. 56 Please consider the environment before printing. 28

29 The Concern with Chlorine dioxide? Despite these issues, in some cases, it might still be a good way to go, that s a managerial decision that needs to be made. 57 What Happened With the High-rise Condo? Properties removed ClO 2 equipment and started looking for other options Super-heated hot water temperature at the unit Intermittent disinfection O&M hand addition Permanent disinfection physical equipment NDEP Decision #1 & #2 = Not a PWS Third Option = Regulated as a PWS 58 Please consider the environment before printing. 29

30 What Happened Next? Summer 2011 Major Hotel/Casino makes the news Las Vegas Strip Systems re-think intermittent, random hand chlorination Decision to install permanent chlorination on their hot water system NV has first NTNC PWS of this type Other properties also move forward with disinfection 59 What Happened Next? January 30, 2012 Another Property makes the news with a case of Legionellosis, which sadly results in a fatality. Once decided on preferred approach, planning happened quickly using the NTNC PWS model, and permit number issued on May 2 nd. Other properties are also now permitted preventative measure; others are following suit. 60 Please consider the environment before printing. 30

31 Equipment Zoned application on a large hotel tower with 35 floors Larger chlorine pumps to overcome 325+ psi to upper zones 61 Equipment Controls Replicated 5 times; one for each pumping zone 62 Please consider the environment before printing. 31

32 Where Are We Now? Continuing plan review for a number of properties Residential properties and casino/hotels Hospitals are evaluating options Plans must be prepared & stamped by a NV Professional Engineer PWS Permit to Operate follows Approval to Construct Applying the SDWA Which Rules apply, and how? 63 Coupon Corrosion Study 64 Please consider the environment before printing. 32

33 Regulatory Oversight in NV Regulatory Oversight - NTNC Disinfection Byproducts Rules Highly Recommend Baseline Data Collection for all Rules Regulatory Oversight Community CCR s required Inspections: NDEP & SNHD Cross connection control 65 Operator Certification in NV Community PWSs and NTNC PWSs require operation by a Certified Operator Chlorination = Distribution Operator ClO 2 treatment = Distribution & Treatment Operator(s) Systems are Graded based on population and complexity (1-4) Program is administered by NDEP 66 Please consider the environment before printing. 33

34 Ask the Experts Claressa Lucas, PhD Ross Cooper, M. S. Ernest Conrad, PE Enter your question into the question pane at the lower right hand side of the screen. Please include your name and specify to whom you are addressing the question. 67 Legionella A Building Owners Perspective Ernest Conrad, PE Principal, Conrad Engineers 68 Please consider the environment before printing. 34

35 NEW LEGIONELLA LAWS ARE COMING TO EVERY BUILDING OWNER 69 HOW OWNERS IN NEW YORK STATE & NEW YORK CITY ARE COMPLYING 70 Please consider the environment before printing. 35

36 Agenda BACKGROUND Why suddenly the big deal? WHERE to worry about it. HOW we (and soon you) will deal with it. WHAT does it cost? Please consider the environment before printing. 36

37 Background Laws created in New York always migrate west Local Law 77 of 2015 is here in NYC All buildings cooling towers & health care facilities domestic water now require Legionella control measures 16 people died from Legionnaires disease in one week s time in August 2015 in NYC 73 Background Some terminology: HPC Heterotrophic plate count CFU/ml bacteria colony forming units/ml Dip Slide Test quick bacteria test one day results Drift small water droplets carryover from a cooling tower Plume this is pure water vapor cloud from a cooling tower Ton 12,000 BTU s not 2,000 lbs. House Tank typical 10,000 gallon roof top water storage tank 74 Please consider the environment before printing. 37

38 WHERE to worry about it? Hotels This is where it was originally found in their cooling towers Health Care facilities This is where people of immune system risk are located Other buildings Schools/Universities 75 WHERE to worry about it? Other buildings Your office Your own home! 76 Please consider the environment before printing. 38

39 WHERE to worry about it? Cooling tower drift Bathroom shower AC unit condensate pan Public fountains Swimming pools Water park slides Ultrasonic humidifiers Vaporizers Spray bottles Inhalers CEPAP? Ice dispensers Any stagnant water source = 3 to 5 days 77 HOW we will deal with it The new cooling tower rules Water management program plan (MPP) 78 Please consider the environment before printing. 39

40 79 HOW we will deal with it The new cooling tower rules Weakly Dip slide testing Start up procedures Shut down procedures Twice yearly mandatory cleaning 90 day inspection & water testing 80 Please consider the environment before printing. 40

41 81 82 Please consider the environment before printing. 41

42 83 HOW we will deal with it The new cooling tower rules Emergency clean & disinfection rules Lots of new lessons from just this first year Legionella presence extremely rare HPC levels can be extremely high Summer hot weather effects Annual owner certification of program 84 Please consider the environment before printing. 42

43 WHAT does it cost? Your home 3-5 tons air cooled air conditioning $500 to $1000 ops cost Chances are its air cooled and no legionella impact 85 WHAT does it cost? Small mom & pop store 10 tons air cooled air conditioned unit Stay air cooled! Typical small retail/restaurant 25 tons cooling load Stay air cooled units 86 Please consider the environment before printing. 43

44 WHAT does it cost? Big Box stores tons cooling load Consider using air cooled units Office building 20 stories 300 tons load Must use water cooling tower 87 WHAT does it cost? High rise residential 20 stories 200 tons load Mixed use of water cooling towers Health Care hospital 10 stories tons cooling load Must use water cooling towers 88 Please consider the environment before printing. 44

45 WHAT does it cost? Schools/Universities tons load Usually need water cooling towers 89 WHAT does it cost? Typical MPP plan - $2, $5,000 HPC test - $150 4 times a year = $600 Legionella sample test - $500 4 times a year = $2, day inspection charge - $500 4 times a year = $2, Please consider the environment before printing. 45

46 WHAT does it cost? Annual certification fees - $5,000. Total program budget = $15,000 per year! 91 SO WHAT S NEXT? YOU ARE NEXT BE PREPARED Water drinking storage tanks & domestic water systems are next 92 Please consider the environment before printing. 46

47 Ask the Experts Claressa Lucas, PhD Ross Cooper, M. S. Ernest Conrad, PE Enter your question into the question pane at the lower right hand side of the screen. Please include your name and specify to whom you are addressing the question. 93 Bookstore Resources AWWA M48 Waterborne Pathogens, Second Edition Catalog No: Please consider the environment before printing. 47

48 Upcoming Webinars October 5 Innovative Aquifer Storage and Recovery Applications for Reuse and Drinking Water Projects October 13 GIS in Asset Management This webinar is sponsored by ESRI. October 19 Organized Chaos Problem Solving Approach to Startup and Commissioning of Treatment Facilities Register for a 2016 Webinar Bundle Individual Full Year Group Full Year 95 Upcoming Conferences Register for WQTC16 for the latest on Legionella and disinfection of contaminants. Register Online at: 96 Please consider the environment before printing. 48

49 Thank You for Joining AWWA s Webinar As part of your registration, you are entitled to an additional 30-day archive access of today s program. Until next time, keep the water safe and secure. 97 Presenter Biography Information Dr. Claressa Lucas earned her PhD at Emory University, Atlanta, Georgia and completed an ASM/NCID post-doctoral appointment in the CDC Tuberculosis Laboratory before joining the CDC Legionella Laboratory in She has participated in investigation of over 40 outbreaks of legionellosis or unexplained respiratory disease and conducted a dozen environmental studies. Dr. Lucas has authored articles on biofilm formation, strain distribution, and virulence determinants of legionellae and has assisted with development of legionellosis prevention strategies for government agencies and industrial societies. Since 2008, Dr. Lucas has coordinated CDC s ELITE program, a proficiency testing program for laboratories that culture Legionella from environmental samples, with over 200 participants worldwide. Ross Cooper is an Environmental Scientist III with the Bureau of Safe Drinking Water, Nevada Division of Environmental Protection, where he is the State authority on Consumer Confidence Reports. He has overseen the Lead and Copper Rule both locally and nationally, and is a contributing member to the National Drinking Water Advisory Council for the long-term revisions to the Lead and Copper Rule. Additionally, he has worked as a technical assistant on the National Sanitation Foundation task force and EPA Guidance Document task force for Legionella. He has worked for the Nevada Health District and the Nevada Division of Environmental Protection for the past eleven years, coming from a background in cytogenetics and the field sciences. He earned his Bachelor of Science degree in Cell and Molecular Biology, and received his Masters of Science degree in Environmental Toxicology from the University of Nevada, Reno. He has taught laboratories and courses in Biology at both the College and University level, and has guest lectured to several academic and professional entities throughout Nevada and the US. Ernest Conrad is the past president and founder of Landmark Facilities Group, Inc. located in Norwalk, Connecticut. The firm was established in 1988 with a primary business model specializing in environmental safety issues in buildings of all types and sizes. Conrad Engineers was established in 2010 as an engineering consulting firm to continue with a focus on environmental issues for both building and its occupant s health and wellbeing. Ernest holds a Bachelor of Science Degree in Civil Engineering and a Master s Degree in Environmental Engineering from Drexel University in Philadelphia Pennsylvania, and is a licensed professional engineer in 12 states. Ernest has achieved nationwide recognition through his many involvements in national organizations, which focus on building construction and occupant s safety. Over the recent 10 years he has been the chair of the Building Owners and Managers Association, New York (BOMA/NY) committee on Codes, regulations, and government affairs. Ernest is also past Vice-chair of the BOMA International Energy & Environment Committee. His expertise is a resource to BOMA as the alternate BOMA International voting member of the ASHRAE standards committees SSPC90.1 and SSPC189.1, which are the governing Standards that mandate energy efficiency in buildings nationwide in both existing and newly built facilities. Ernest has been a member of NYC Mayor s code development advisors on HVAC issues, ADA issues, and Green building issues. 98 Please consider the environment before printing. 49

50 CE Credits (CEUs) and Professional Development Hours (PDHs) AWWA awards webinar attendees CEUs. If you wish to take advantage of the opportunity to earn CEUs, visit Certificates will be available within 30 days of the webinar 99 How To Print Your CEU Certificate of Completion Within 30 days of the webinar, login to or register on the website. If you are having problems, please Once logged in, go to: My Account My Transcript Information To print your official transcript, click Print list To print certificates, click Download certificate 100 Please consider the environment before printing. 50

51 2016 Webinar Sponsors 101 Please consider the environment before printing. 51