A Framework for Controlling Opportunistic Pathogens in Premise Plumbing Considerate of Disinfectant Concentration x Time (CT) and Shifts in Microbial Growth Phase

Abstract

Opportunistic pathogens (OPs) can naturally colonize premise (i.e., building) plumbing and are the leading cause of disease associated with potable water in the U.S. and many other countries. While secondary disinfectant is added by utilities prior to water distribution through pipes, the residual in water at the property line is sometimes insufficient to suppress OP growth. Conditions encountered in premise plumbing can further diminish disinfectant in water after it crosses the property line. This dissertation examines how multiple factors at play in drinking water distribution systems and premise plumbing influence OP growth in order to inform development of rational guidance to reduce incidence of waterborne illness. Operating an at-scale cross-linked polyethylene (PEX) plumbing system with one water flush per day, influent chloramine always decayed within four hours in stagnant pipes containing mature biofilms, which is 2-3 orders of magnitude faster than in the same water not contacting pipes. Chloramine often followed second order decay kinetics, though decay rate coefficients were highly variable with some taps eventually transitioning from second to first order decay over time or with increasing influent chloramine concentration. The rate of chloramine decay was unexpectedly reduced in the water heater tank compared to room temperature pipes, possibly due to lower surface-area-to-volume ratio and higher temperature within the tank. A complementary glass jar experiment confirmed that, contrary to expectations, chloramine could decay slower at the higher temperature of 37-39°C maintained in the water heater, compared to the cooler 19-30°C typical of the pipes. These findings demonstrate the need for disinfectant decay models specific to conditions encountered in premise plumbing. Nitrification, a key microbial process that can catalyze chloramine decay, was typically complete within 24 hours after water entered the stagnant pipes. Counterintuitively, the water heater had a relatively lower rate of nitrification along with some detectable denitrification. This work also showed that oxygen, essential for aerobic microbial growth, can permeate through walls of PEX pipe and enter into the water from the atmosphere of the building. Considering the unique array of conditions that were found to influence the persistence of disinfectants in premise plumbing, a new approach was proposed for managing OP risk, referred to herein as the "CT framework." CT was defined as the integral of the chlorine concentration (C) at a point in the premise plumbing versus water retention time (T). Legionella pneumophila was not detectable in pipes with a CT > 78 mg*min/L over a 24 hour period, which is comparable to reported CT thresholds for 3-log inactivation of biofilm-associated L. pneumophila in batch experiments. There was a tradeoff between control of L. pneumophila and Mycobacterium avium in the water heater, as M. avium increased by >1 log as influent chloramine and CT increased, while L. pneumophila decreased by >1.5 logs. Further research is needed to elucidate the influence of factors such as water storage tank hydrodynamics and sediment on the persistence of different OPs. Building water retention time was also found to be an overarching variable that governs microbial growth in some circumstances in premise plumbing. Total cell counts and L. pneumophila occurrence mirrored expected trends based on the classic microbial growth curve with phases of lag, exponential growth, stationary growth, and decay. The location in the plumbing system where each phase dominated depended on water retention time, disinfectant level, and temperature. The microbial growth curve considerations add an additional dimension to the CT framework for predicting L. pneumophila growth potential in premise plumbing. Specifically, elevated heat or chloramine, was able to temporarily suppress or even eliminate growth, but the phases of classic microbial growth could be restarted once disinfectant or very high temperatures were absent. Total cell counts and L. pneumophila typically peaked at a building water retention time of 7 days, demonstrating that once a week flushing guidance to protect public health may not be advantageous in all situations. Collectively, this work offers fundamental and practical insights into factors driving disinfectant decay and microbial proliferation in premise plumbing, offering a modified CT and microbial growth concept framework to help guide the management of OPs in premise plumbing.