Presentation on theme: "Bactiquant Water Rapid Onsite Screening for Assessing Legionella Risk Presented by Lisa Rogers."— Presentation transcript:
Bactiquant Water Rapid Onsite Screening for Assessing Legionella Risk Presented by Lisa Rogers
“Legionellosis emerged because of human alteration of the environment, since Legionella species are found in aquatic environments, and thrive in warm water and warm, damp places, such as cooling towers” Legionella and the prevention of legionellosis, WHO 2007
World Wide Since 1976, 35 outbreaks reported cases – 11 in NA (US/CA) – 14 in AUS/NZ – 10 in Europe Sources – 13 Cooling towers – 5 each, Spas/hot tub, DHW, AC, and 4 unknowns – Misc include potting mix, fountain, industrial systems
YearCityLocationCauseCases Fatality rate 2012 Québec City, Québec City, Canada Lower Québec CityPossibly cooling towerscooling towers1807 % 2012CalpCalp, SpainSpainAR Diamante Beach Hotel Possibly solar water heating system for spa and DHW 1817% 2012 ScotlandSW of EdinburghPossibly cooling towerscooling towers993% 2012ChicagoChicago,IllinoisIllinoisJW Marriott HotelDecorative Lobby Fountain1030% 2012Auckland, NZUnknownWater Source and/or ACAC119% 2012Stoke-on-TrentStoke-on-Trent, UKUKWarehouse, FentonHot tub195% 2012Pittsburgh, PAVA Hospitalunknown2227% 2013QueenslandQueensland, AUSWesley HospitalNYD, probably hot water system.250% 2013MemphisMemphis,TNTN24-Hour FitnessNYD probably pool or spa.30% 2013MilwaukeeMilwaukee,WIWINot yet determinedNot yet determined, ongoing Reynoldsburg, OH Wesley Ridge Retirement Comm Potable water system, ongoing WarsteinWarstein,GermanyGermanyWarsteinerWarsteiner BreweryAir conditioning, ongoing Florence, ALGlenwood Nursing Home Unknown, still under investigation. 13
Concerns CDC estimates 8,000 to 18,000 people are hospitalized each year in the U.S. Mortality rate is approximately 15% Legionella bacteria are found naturally in the environment French study found that L. pneumophila can travel airborne at least 6 km from its source Norway study found high velocity, large drift & high humidity in air scrubber… spread probably for >10 km WHO estimates the cost savings to implement preventive plans is $1-3M USD per life saved. (1200 x 1M= $1.2B)
Ideal Water Conditions Temperatures between 20° and 50°C (68° - 122°F) Optimal growth range is stagnant water 35° - 46°C [95° - 115°F] pH between 5.0 and 8.5 Available iron and copper Sediment/scaling promote growth of commensal microflora Other micro-organisms including algae, flavobacteria, and Pseudomonas, which supply essential nutrients for growth of Legionella or harbor the organism (amoebae, protozoa) Low biocide concentrations
Water Sampling Guidelines Table III:7-1. COLONY FORMING UNITS (CFU) OF LEGIONELLA PER MILLILITER ActionCooling TowerDomestic WaterHumidifier , Action 1: Prompt cleaning and/or biocide treatment of the system. Action 2: Immediate cleaning and/or biocide treatment. Take prompt steps to prevent employee exposure. Source : OSHA, 1999 CDC recently testified that there is no safe level !
Current Sampling Strategy Culture Plate Analysis 3-5 days for HPC 7-10 days for Legionella Planktonic, highly variable, overloading, background interferences PCR fast but expensive
How BQW can help Rapid test can be performed in mins Easy Sampling and Analysis EPA ETV verified methodology
+ Bacteria-enzyme Enzyme substrateFluorescent compound released Principle Method
Why is Bactiquant Technology interesting ? Culture-independent technique Quantification of a naturally occuring hydrolase enzyme activity present in bacteria High specificity to bacteria, little background interference Use of fluorescence technology = high sensitivity Concentration Step = increased sensitivity and significant reduction in detection time
Laboratory Comparison BQW
EPA ETV Report Excerpt Table 2: Linearity: BQ Value vs Concentration Test Organism Concentration Range (CFU/mL) Range of Average BQ values Slope Y- intercept Coefficient of Determination (R 2 ) Lake Water Indigenous Bacteria 3.7 x 10 2 to 6.0 x to Lake Water Indigenous Bacteria - without 1:5 dilution 3.7 x 10 2 to 3.0 x to P. aeruginosa ATCC x 10 2 to 8.0 x to Source Battelle / US EPA -2011
EPA ETV Study Excerpt High reproducibility Source Battelle / US EPA Test Iteration Adjusted Fluorescence (fu) 8.0 x 10 3 CFU/mL 4.7 x 10 3 CFU/mL 2.1 x 10 3 CFU/mL 8.7 x 10 2 CFU/mL Average Standard deviation RSD (%)
EPA ETV Report Excerpt Test Iteration BQV Fluorescence (flu) Indigenous Bacteria from Lake Water (3.7 x 10 2 CFU/mL) P. aeruginosa ATCC (4.7 x 10 3 CFU/mL) Analyst 1Analyst 2Analyst 1Analyst 2 Average Standard deviation RSD (%) RPD (%) Table 3. Bactiquant®-test Repeatability and Inter-Assay Reproducibility Table 3 summarizes the repeatability and inter-assay reproducibility results for Bactiquant ® -test using two bacterial cultures in water. Two different people analyzed 4 samples of each culture, using different fluorometers.
Critical care facility, Courtesy of Clinical Microbiology Institute, Viborg Hospital, Denmark X-axisSample No. (1-70) Y-axisLog10(adjusted fluorescence) and Log10(cfu) Legionella pneumophila serotype 2-14 BQ value 10 BQ value 100 BQ value 1000
Australia Case Study Wesley Hospital, Queensland: 2 cases, 1 death 5 Building, 560 bed facility Heat Treatment for 2 70C ( 158F) Over 3000 samples collected BQ, Legionella, HPC 13 days to reopen, 29 days fully operational BQ used to screen, verify cleaning efficacy and validate post treatment
Excerpt from: The Australian Hospital Engineer, September 2013 “CETEC made use of the Bactiquant® water technology for the rapid screening of total bacterial loading within the potable water network. This technology allowed CETEC in under an hour to obtain results superior to plate count for the network. The ability to obtain rapid results as compared to 4 to 10 day timeframe for conventional methods presented significant time, logistical and financial savings.”
New Studies The Danish Health Institute has started a two year project now with multiple sites looking at pre-screening as well as post treatment efficacy. Hopefully, some results from that study will be forthcoming later this year.
Pros and Cons Rapid onsite testing aids in identifying hotspots Validate the efficacy of cleaning methods Monitor for changes in system quickly HPC nor BQW a perfect predictor of Legionella Not a substitute for direct Legionella analysis
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