Presentation on theme: "Bactiquant Water Rapid Onsite Screening for Assessing Legionella Risk"— Presentation transcript:
1Bactiquant Water Rapid Onsite Screening for Assessing Legionella Risk Presented by Lisa Rogers
2“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
3World Wide Since 1976, 35 outbreaks reported 2-800 cases Sources 11 in NA (US/CA)14 in AUS/NZ10 in EuropeSources13 Cooling towers5 each, Spas/hot tub, DHW, AC, and 4 unknownsMisc include potting mix, fountain, industrial systems
4YearCityLocationCauseCasesFatality rate2012Québec City, CanadaLower Québec CityPossibly cooling towers1807 %Calp, SpainAR Diamante Beach HotelPossibly solar water heating system for spa and DHW1817%ScotlandSW of Edinburgh993%Chicago,IllinoisJW Marriott HotelDecorative Lobby Fountain1030%Auckland, NZUnknownWater Source and/or AC119%Stoke-on-Trent, UKWarehouse, FentonHot tub195%Pittsburgh, PAVA Hospitalunknown2227%2013Queensland, AUSWesley HospitalNYD, probably hot water system.250%Memphis,TN24-Hour FitnessNYD probably pool or spa.30%Milwaukee,WINot yet determinedNot yet determined, ongoing20Reynoldsburg, OHWesley Ridge Retirement CommPotable water system, ongoing44Warstein,GermanyWarsteiner BreweryAir conditioning, ongoing165Florence, ALGlenwood Nursing HomeUnknown, still under investigation.13
5ConcernsCDC 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 environmentFrench study found that L. pneumophila can travel airborne at least 6 km from its sourceNorway study found high velocity, large drift & high humidity in air scrubber… spread probably for >10 kmWHO estimates the cost savings to implement preventive plans is $1-3M USD per life saved. (1200 x 1M= $1.2B)
6Ideal 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 8.5Available iron and copperSediment/scaling promote growth of commensal microfloraOther micro-organisms including algae, flavobacteria, and Pseudomonas, which supply essential nutrients for growth of Legionella or harbor the organism (amoebae, protozoa)Low biocide concentrations
7Water Sampling Guidelines Table III:7-1. COLONY FORMING UNITS (CFU) OF LEGIONELLA PER MILLILITERActionCooling TowerDomestic WaterHumidifier11001021,000Action 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, 1999CDC recently testified that there is no safe level !
8Current Sampling Strategy Culture Plate Analysis3-5 days for HPC7-10 days for LegionellaPlanktonic, highly variable, overloading, background interferencesPCRfast but expensive
9How BQW can help Rapid test can be performed in 15-30 mins Easy Sampling and AnalysisEPA ETV verified methodology
10+ Principle Method Enzyme substrate Fluorescent compound released Bacteria-enzymePrinciple Method
11Why is Bactiquant Technology interesting ? Culture-independent techniqueQuantification of a naturally occuring hydrolase enzyme activity present in bacteriaHigh specificity to bacteria, little background interferenceUse of fluorescence technology = high sensitivityConcentration Step = increased sensitivity and significant reduction in detection time
13EPA ETV Report Excerpt Table 2: Linearity: BQ Value vs Concentration Test OrganismConcentration Range (CFU/mL)Range of Average BQ valuesSlopeY-interceptCoefficient of Determination (R2)Lake Water Indigenous Bacteria3.7 x 102 to 6.0 x 1031542 to 156072.3822430.9138Lake Water Indigenous Bacteria - without 1:5 dilution3.7 x 102 to 3.0 x 1031542 to 111063.557390.9689P. aeruginosa ATCC 278538.7 x 102 to 8.0 x 103868 to 76550.95-1360.9923Source Battelle / US EPA -2011
14Adjusted Fluorescence (fu) EPA ETV Study ExcerptHigh reproducibilityTest IterationAdjusted Fluorescence (fu)8.0 x 103 CFU/mL4.7 x 103 CFU/mL2.1 x 103 CFU/mL8.7 x 102 CFU/mL111392612827991249212332607427101247311376601225591297411513650827681437511614625629451375Average11645619627561321Standard deviation39619614083RSD (%)22.214.171.124.3Source Battelle / US EPA -2011
15EPA ETV Report ExcerptTable 3. Bactiquant®-test Repeatability and Inter-Assay ReproducibilityTest IterationBQV Fluorescence (flu)Indigenous Bacteria from Lake Water(3.7 x 102 CFU/mL)P. aeruginosa ATCC 27853(4.7 x 103 CFU/mL)Analyst 1Analyst 2Average2363222568886691Standard deviation1525733393RSD (%)126.96.36.199.4RPD (%)6.02.9Table 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.
17BQ value 1000 BQ value 100 BQ value 10 Critical care facility, Courtesy of Clinical Microbiology Institute, Viborg Hospital, Denmark 2006.X-axis Sample No. (1-70)Y-axis Log10(adjusted fluorescence) and Log10(cfu) Legionella pneumophila serotype 2-14
18Australia Case Study Wesley Hospital, Queensland: 2 cases, 1 death 5 Building, 560 bed facilityHeat Treatment for 2 70C ( 158F)Over 3000 samples collected BQ, Legionella, HPC13 days to reopen, 29 days fully operationalBQ used to screen, verify cleaning efficacy and validate post treatment
21Excerpt 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.”Excerpt from: The Australian Hospital Engineer, September 2013
22New StudiesThe 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.
23Pros and Cons Rapid onsite testing aids in identifying hotspots Validate the efficacy of cleaning methodsMonitor for changes in system quicklyHPC nor BQW a perfect predictor of LegionellaNot a substitute for direct Legionella analysis
24Thank you for listening! Do you have any questions?Thank you for listening!
25Booth on Aisle 3000 Lisa Rogers Lrogers@mycometer.com 813-831-6511 Booth on Aisle 3000