4
Medium Priority Issues

Four of the white papers dealt with topics considered by the committee to have some potential impact on public health. These medium priority issues are biofilm growth, loss of disinfectant residual during nitrification and water aging, and intrusion. Control of these issues certainly should be considered as part of system-wide management.

BIOFILM GROWTH

Virtually every water distribution system is prone to the formation of biofilms, regardless of the purity of the water, type of pipe material, or the presence of a disinfectant. Growth of bacteria on surfaces can occur in the distribution system or in household plumbing. It is reasonably well documented that the suspended bacterial counts observed in distribution systems are the result of biofilm cell detachment rather than growth of organisms in the water (Characklis, 1988; Haudidier et al., 1988; van der Wende et al., 1989; van der Wende and Characklis, 1990). This phenomenon extends to autotrophic and heterotrophic organisms, coliforms (as noted in the TCR), and opportunistic pathogens. As a result of detachment, the biofilm can act as a continuous inoculum into finished water. The organisms can then be inhaled through bathing and showering or ingested.

The larger question is not whether biofilms are present, but whether biofilms are associated with disease. Biofilms in drinking water distribution systems are primarily composed of organisms typically found in the environment, and as such, are likely to be of limited health concern. These organisms are often enumerated by HPC, and yet epidemiological studies relating HPC counts to health effects are scarce due to their high cost and lack of funding, with only a few studies having been completed. In 1991, Calderon and Mood studied the impact of point-of-entry devices containing granular activated carbon on microbial water quality and health effects. Because granular activated carbon can enhance the growth of organisms detected by HPC, counts were elevated in the treated water. In this study, there was no correlation between elevated HPC and health effects. Other studies conducted by Payment et al. (1991a,b, 1997) in Canada suggested that there may be some association between distributed water, HPC counts, and gastroenteritis, but the findings were not clear.

Biofilms can be a reservoir for opportunistic pathogens. M. avium complex (M. avium and M. intracellulare; MAC) have been isolated from drinking water throughout



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Public Water Supply Distribution Systems: Assessing and Reducing Risks - First Report 4 Medium Priority Issues Four of the white papers dealt with topics considered by the committee to have some potential impact on public health. These medium priority issues are biofilm growth, loss of disinfectant residual during nitrification and water aging, and intrusion. Control of these issues certainly should be considered as part of system-wide management. BIOFILM GROWTH Virtually every water distribution system is prone to the formation of biofilms, regardless of the purity of the water, type of pipe material, or the presence of a disinfectant. Growth of bacteria on surfaces can occur in the distribution system or in household plumbing. It is reasonably well documented that the suspended bacterial counts observed in distribution systems are the result of biofilm cell detachment rather than growth of organisms in the water (Characklis, 1988; Haudidier et al., 1988; van der Wende et al., 1989; van der Wende and Characklis, 1990). This phenomenon extends to autotrophic and heterotrophic organisms, coliforms (as noted in the TCR), and opportunistic pathogens. As a result of detachment, the biofilm can act as a continuous inoculum into finished water. The organisms can then be inhaled through bathing and showering or ingested. The larger question is not whether biofilms are present, but whether biofilms are associated with disease. Biofilms in drinking water distribution systems are primarily composed of organisms typically found in the environment, and as such, are likely to be of limited health concern. These organisms are often enumerated by HPC, and yet epidemiological studies relating HPC counts to health effects are scarce due to their high cost and lack of funding, with only a few studies having been completed. In 1991, Calderon and Mood studied the impact of point-of-entry devices containing granular activated carbon on microbial water quality and health effects. Because granular activated carbon can enhance the growth of organisms detected by HPC, counts were elevated in the treated water. In this study, there was no correlation between elevated HPC and health effects. Other studies conducted by Payment et al. (1991a,b, 1997) in Canada suggested that there may be some association between distributed water, HPC counts, and gastroenteritis, but the findings were not clear. Biofilms can be a reservoir for opportunistic pathogens. M. avium complex (M. avium and M. intracellulare; MAC) have been isolated from drinking water throughout

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Public Water Supply Distribution Systems: Assessing and Reducing Risks - First Report the United States (Haas et al., 1983; duMoulin and Stottmeir, 1986; Carson et al., 1988; duMoulin et al., 1988; Fischeder et al., 1991; von Reyn et al., 1993, 1994; Glover et al., 1994). They have been implicated in infections and tuberculosis-like disease in the immunocompromised population, particularly those with AIDS (Horsburgh, 1991; Nightingale et al., 1992). The MAC is of such significant public health concern that the organisms are included on the EPA’s Contaminant Candidate List (CCL). Legionella species have been shown to proliferate in drinking water (Wadowsky and Yee, 1983, 1985; Stout et al., 1985; Rogers et al., 1994). These bacteria can be found in water heaters, shower heads, and cooling towers, where their release can lead to respiratory disease in sensitive individuals. Legionella are specifically mentioned in the EPA’s SWTR, with the maximum contaminant level goal set at zero. Both MAC and Legionella are more likely to proliferate in premise plumbing systems rather than the main distribution system. The elimination of biofilms is essentially impossible and their control is difficult. Attempts to eliminate them are complicated by the observation that conditions that reduce the numbers of organisms of one type may potentially select for others. In general, biofilms can be managed by removing organic matter during water treatment that would support biofilm growth, judicious use of disinfectants, good distribution hygiene practices such as flushing, minimizing the corrosion of iron pipe surfaces, and managing contamination from external sources. Biofilm management is ideally accomplished by best practices that also reduce the magnitude of other water quality problems such as disinfection byproduct concentration, corrosion, and aesthetic concerns. This is true for both the utility owned distribution system and premise plumbing. Biofilm growth is considered to be of medium priority because the potential for public health risk from this source of exposure is of lesser importance than phenomena included in the high risk category. The risks associated with biofilms appear to be most significant with opportunistic pathogens that may cause disease in the immunocompromised population. Because coliform regrowth in biofilms can lead to TCR violations, biofilm control can assist utilities in meeting the requirements of this regulation. Therefore, mechanisms for controlling biofilms may be of benefit both to reducing coliform levels and reducing the levels of opportunistic pathogens. LOSS OF RESIDUAL VIA WATER AGE AND NITRIFICATION This issue is related to an effect identified in two of the nine white papers—that of loss of disinfectant residual brought about by the aging of water and nitrification. Water age, which is considered to be synonymous with “hydraulic residence time,” depends on both the physical characteristics of the system (such as flow rate, pipe size, configuration, and the amount of storage) as well as its mode of operation. From the point of entry into a distribution system to an individual consumer tap, water may be in transport for days to weeks. Systems that are “looped” may have shorter maximum water ages than systems that contain long pipelines with dead end sections. A distribution system is not generally uniform in structure but consists of a network of various elements having different physical, chemical, and biological characteristics such as differing size pipes and pipe materi-

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Public Water Supply Distribution Systems: Assessing and Reducing Risks - First Report als, occurrence of pipe scales, and biofilms. Furthermore, some characteristics such as surface roughness may change with time, which in turn may influence the hydraulic residence time and the path water takes as it flows through the system. Unlike specific degradative processes influencing water quality that are considered in this report, retention time is a characteristic that only indirectly affects water quality. Many degradative processes are time dependent and, therefore, more adversely affect water quality with increasing retention time. The degradative processes that are most influenced by residence time can be attributed to reactions occurring in the bulk water and at the pipe wall interface. Biological nitrification is a process in which bacteria in distribution systems oxidize reduced nitrogen compounds (e.g., ammonia) to nitrite and then nitrate. It is an important process associated with nitrifying bacteria in distribution systems and long retention times in systems practicing chloramination. Like water age, it has a variety of direct and indirect effects on distribution system water quality. In the committee’s opinion, the most important problem exacerbated by both nitrification and by long retention times is loss of disinfectant residuals. Chlorine and chloramine loss during water aging is attributable to reactions with demand substances such as reduced iron in corrosion deposits, ammonia, and natural organic matter (NOM) both on the pipe surface and in the bulk phase. In so far as a residual in the distribution system is desirable, the microbial integrity of the system is compromised. Increased occurrence of microorganisms such as coliforms is associated with the loss of disinfectant residual (Wolfe et al., 1988, 1990). Similarly, the loss of chloramine residual driven by biological nitrification was deemed by the committee to be a significant health threat, and more important than the issue of high concentrations of nitrate and nitrite that result from nitrification. Indeed, a positive feedback loop between growth of nitrifying bacteria and chloramine loss can be established, since the loss of disinfectant residual removes one of the controls on the growth of these organisms. The precise influence of water age on water quality is complex and clearly system specific, complicating potential control strategies. Water age, unlike other causes of distribution system water quality degradation, such as backflow, cannot be eliminated, only managed within the framework of numerous constraints. Water age is determined by flow rate and the internal volume of the distribution system network, and it can be estimated using tracer studies, mathematical models, system models, and computational fluid dynamics models. The physical aspects of pipe sizes and network layout are important considerations in minimizing water age. Research indicates that “dead ends” and low velocities should be avoided (AWWARF, 2004). This would favor the use of small diameter pipes and careful consideration of flow paths (“looped” geometry). Current design practice, however, typically dictates a design not based on water needed at the tap but on peak flows associated with fire fighting. This tends to result in a design incorporating comparatively large pipes with resulting lower flow rates. Network operation is also an important determinant of water age at any particular point in the system. Water may be routed to avoid excessively long residence times. Periodic flushing of system elements associated with long water age may also minimize water quality degradation by removal of pipe scales and sediment associated with disinfectant consumption and release

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Public Water Supply Distribution Systems: Assessing and Reducing Risks - First Report of iron into the water. Finally, in the case of systems with multiple sources of supply, hydraulic modeling can be used to assess system operations to reduce maximum water age. A strategy to control nitrification involves periodically switching to free chlorine, which is thought to reduce the active microbial population, or wholesale replacement of chloramines with free chlorine or chlorine dioxide. Other control strategies include reducing the ratio of chlorine to free ammonia, increasing pH, reducing the residence time by managing the flow, lowering the TOC levels in the distribution system via advanced treatment, and maintaining a fairly high residual as well as a low level of free ammonia. The loss of disinfectant residual caused by increased water age and nitrification is considered a medium priority concern because it is an indirect health impact that compromises the biological integrity of the system and promotes microbial regrowth. See two sections below for further discussion of other, lower priority effects of water age and nitrification on distribution system water quality. LOW PRESSURE TRANSIENTS AND INTRUSION Ensuring safe distribution of treated water to consumers’ taps requires, among other measures, protection from intrusion of contaminants into the distribution system during low pressure transients. Intrusion refers to the flow of non-potable water into drinking water mains through leaks, cracks, submerged air valves, faulty seals, and other openings resulting from low or negative pressures. Transient pressure regimes are inevitable; all systems will, at some time, be started up, switched off, or undergo rapid flow changes such as those caused by hydrant flushing, and they will likely experience the effects of human errors, equipment breakdowns, earthquakes, or other risky disturbances (Boulos et al., 2004; Wood et al., 2005). Transient events can have significant water quality and health implications. These events can generate high intensities of fluid shear and may cause resuspension of settled particles as well as biofilm detachment. Moreover, a low-pressure transient event, arising for example from a power failure or intermittent/interrupted supply, has the potential to cause the intrusion of contaminated groundwater into pipes with leaky joints or cracks. This is especially important in systems with pipes below the water table. Dissolved air (gas) can also be released from the water whenever the local pressure drops considerably, and this may promote the corrosion of steel and iron sections with subsequent rust formation and pipe damage. Even some common transient protection strategies, such as air relief valves or air chambers, if not properly designed and maintained may permit pathogens or other contaminants to find a “back door” route into the potable water distribution system. In the event of a large intrusion of pathogens, the chlorine residual normally sustained in drinking water distribution systems may be insufficient to disinfect contaminated water, which can lead to adverse health effects. Low water pressure in distribution systems is a well-known risk factor for outbreaks of waterborne disease (Hunter, 1997), although there are limited field data (suggesting that additional field studies are needed). In 1997, a massive epidemic of

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Public Water Supply Distribution Systems: Assessing and Reducing Risks - First Report multidrug-resistant typhoid fever (8,901 cases of typhoid fever and 95 deaths) was reported in the city of Dushanbe, Tajikistan, which affected about 1 percent of the city’s population. Low water pressure and frequent water outages had contributed to widespread increases in contamination within the distribution system (Hermin et al., 1999). More recently (April 2002), a Giardia outbreak was reported at a trailer park in New York State causing six residents to become seriously ill (Blackburn et al., 2004). Contamination was attributed to a power outage, which created a negative pressure transient in the distribution system. This allowed contaminated water to enter the system through either a cross-connection inside a mobile home or through a leaking underground pipe that was near sewer crossings. During the same period (February 2001 to May 2002), a large-scale case-control study conducted in England of the risk factors for sporadic cryptosporidiosis suggested a strong association between self-reported diarrhea and reported low water pressure events (Hunter et al., 2005). Intrusion events can be controlled or prevented by developing and implementing best distribution system operational practices such as the requirement for maintaining a sufficient water pressure and an adequate level of disinfectant residual throughout the distribution system, leak detection and control, replacement and rehabilitation of nearby sewer lines, proper hydrant and valve operations, redesign of air relief venting (above grade), routine monitoring program (a sudden drop in the chlorine residual could provide a critical indication to water system operators that there is a source of contamination in the system), use of transient modeling to predict and eliminate potential weak spots in the distribution system, and more rigorous applications of existing engineering standards. Although there are currently insufficient data in the literature to indicate whether intrusion from pressure transients is a substantial source of risk to treated distribution system water quality, nevertheless intrusion is inherently a subset of backflow events, has health risks and is, therefore, an important distribution system water quality maintenance and protection issue.