Do you know the player? - Waterborne Illness investigation and surveillance a regulatory perspective

ABSTRACT
In the regulatory development of the Safe Drinking Water Act the public health goals (outcomes) are defined in the preamble of the proposed rule by the number of illnesses prevented, deaths avoided, etc. A risk factor of (10 -4 to 10-6) is typically used. In very simple terms, successful implementation and compliance with the provisions of the SDWA equals public health goals being achieved. While waterborne disease investigation and surveillance are not directly written in these rules, successful implementation of these regulations can play a role in reducing and preventing waterborne illness and outbreaks from occurring.

So why do outbreaks continue to occur? Why do the majority of outbreaks occur at groundwater non-community public systems? Why are many of those outbreaks associated with seasonal licensed establishments?

The SDWA is not intended to and does not allow us to measure the health of individuals, but the health of the public water supply serving the individuals. The questions raised previously have had an influence on the regulatory tools used by Minnesota’s Drinking Water Program to implement the SDWA, and allows us to better understand and identify environmental factors that may reduce and prevent waterborne illness and outbreaks, as well as being in a better position to participate and respond should an outbreak occur. In this presentation we will touch on key events and how they influenced our program, and how we have come to know our “players”.

An Innovative Web-Based Initiative to Educate Homeowners with Private Wells

Homeowners in small communities and rural areas without a public water supply often lack appropriate understanding of best practices for managing, operating, and protecting their private well. In this new nationwide technical assistance and training initiative, funded by the Rural Community Assistance Partnership (RCAP), through a grant from the US Environmental Protection Agency, a step-by-step education framework has been developed to assist well owners and other stakeholders in understanding groundwater hydrology, well fundamentals, well care best practices, and finding assistance locally. It will also help well owners understand how to sample their well, how to interpret sample results, and what they can do to protect their well and source water from contamination. The program leverages web-based content, including video, an email newsletter, and social media marketing to reach and educate homeowners on this important health topic. Outreach to public health officials, well drillers and other stakeholders is a significant component of the project. The material will be freely available on the web and will be highlighted in a repeated series of three live web-based training events that provide well owners the opportunity to ask questions and get practical answers. The Illinois State Water Survey and the Illinois Water Resources Center, at the University of Illinois, have collaboratively developed the curriculum for this program, under contract with RCAP.

Rainwater Harvesting Systems in Residential and Commercial Applications

image: aumusiclibrary.wordpress.com

The concept of capturing rainwater and storing it for later use is well documented from pre-Roman times and on all major continents. Rainwater Harvesting systems are a sustainable method of water collection that can be utilized effectively as a supplementary water supply without the construction of additional infrastructure. The ability to calculate the potential harvest of a given catchment area and then apply that water to the correct use (irrigation, toilet water, drinking water, etc.) will be an important part of construction in the 21st century around the world.

This presentation will seek to inform the audience as to the potential rewards and pitfalls of rainwater harvesting systems. It will specifically detail methods for designing high efficiency roof and conveyance systems, proper filtration for different treatment levels, pest prevention, sizing and selecting a storage tank, and proper pump/alarm systems. In addition this lecture will provide the basic tools necessary to calculate the effective harvest month by month for any application in relation to its climate, average rain/snowfall, catchment area/roof size and type, and other limiting factors. In addition it will go over the typical applications of rainwater and how to calculate estimated use of water for the application so as to provide a method for developing a cost/benefit analysis of rainwater harvesting for any given business or residence. Rainwater is practically a free, clean and quality source of water - the only cost is to collect and treat it. It can be used to help supplement a low producing well and storage of rainwater provides an emergency supply of water for fire protection, natural disasters, or loss of power. Most systems are flexible, adaptable, and easy to maintain as they can be retrofitted to an existing structure or designed and built during new home construction. In many cases, using collected rainwater will help decrease water and utility bills. It is a reliable water source to supplement costly irrigation. On top of everything else, collecting rainwater is socially acceptable and environmentally responsible.

An Approach For Protecting Unconfined Drinking Water Aquifers Against Effluent Contamination

Regions of the Mid-Atlantic outside of public water & sewer service areas typically rely upon on-site drinking water wells and wastewater discharge systems to meet sanitary needs. Unconfined aquifers that supply groundwater and receive wastewater discharges require a measure of protection against effluent-borne contamination, accordingly. Herein we explore soil and hydrogeologic evaluations supportive of large effluent discharges to drinking water aquifers (i.e. greater than 5,000 gallons per day). We will review wastewater disposal systems discharging to unconfined aquifers of the fractured crystalline rocks of the Piedmont and sandy deposits of the Atlantic Coastal Plain Physiographic Province. We will present an overview of site and subsurface characterization procedures, predictive analyses and regulatory approval processes. Case histories will include an effluent spray irrigation facility in woodlands of the Coastal Plain and a deep trench septic disposal system in the Piedmont. We will present and discuss representative soil profile descriptions, soil infiltration rates, monitoring well logs, wet season water levels, horizontal hydraulic conductivity and predictive groundwater impact analyses.

Temperature and Storage Duration Influence on Hygienic Quality of Polyethylene Terephthalate Bottled Military Packaged Water [POSTER]

The impact of temperature and storage time on military packaged water (MPW) quality was examined at four temperatures (23 ⁰C to 60 ⁰C) for 120 days. Polyethylene terephthalate (PET) bottles were filled in California and Afghanistan with reverse osmosis water purification unit (ROWPU) water using the expeditionary water packaging system (EWPS). No military exposure guidelines (MEGs) were exceeded, though USFDA and USEPA drinking water odor intensity limits were exceeded after 14 days of storage. During a 70 Day exposure period, Port Hueneme MPW total organic carbon (TOC) and total trihalomethane (TTHM) levels increased by a factor of 4 and 50, respectively. PET released organic contaminants into MPW and residual disinfectant generated TTHM contaminants. The drinking water odor intensity of Afghanistan MPW exceeded the USFDA and USEPA limits after only 14 days and increased by a factor of 4 by Day 120. Odor causing contaminants were not identified and water did not contain many volatile organic compounds, semi-volatile organic compounds, acetaldehyde, or formaldehyde contaminants. Antimony was detected in 77% of 60 ⁰C Afghanistan MPW at Day 28 and beyond and in all Day 120 waters at all temperatures, but its concentration never exceeded 50% of the MEG. Commanders, Preventive Medicine, and Veterinary Service personnel can integrate results of this work to improve force health protective decisions and doctrine.

Nitrates in Rural Groundwater Not From Farming; An Unexpected Finding Based on Forensic Geochemistry

Sharptown is located in an agriculturally dominated portion of Maryland and is supplied by four wells. Groundwater quality compliance samples reflect elevated nitrate concentrations for years. Non-point agricultural sources were thought to be the source, but detailed study of geochemical data trends has revealed a differing and surprising interpretation.

Two of Sharptown’s four wells are screened in an unconfined aquifer and one is screened in a confined aquifer. A fourth well is of uncertain design and might be open to both aquifers, either through a lack of adequate grout or the presence of an additional screen. As a component of other work being performed for the Town, we analyzed available water quality compliance data via End-Member Mixing Analysis. EMMA is a common surface water investigative technique; its application to groundwater is less common. We used chloride and nitrate as tracers; the two aquifers differ in their concentrations of these two constituents.

The EMMA revealed a previously unknown, probable point source of nitrate contamination. This interpretation was based on sharply disparate nitrate concentrations, and nitrate-to-chloride ratios, between two closely-spaced and similarly constructed wells. This suggested that the variable-concentration in one of the wells is affected by a seasonally-operative and proximal (to that one well) nitrate point source.

The lack of an equally plausible explanation suggests that the nitrate in this one well may originate more from a local sewer system leak than from historic and regional farming. Work is ongoing. and we are seeking to confirm this theory by sampling for Methylene Blue Active Surfactants (MBAS), an indicator of detergents and thus, of domestic sewage. MBAS is synthetic and any detectable presence would indicate a proximal point-source of detergent-laden wastewater. If the sewer system leak is confirmed, its repair may offer a more economical and assured means of nitrate reduction than either engineered treatment or agricultural source reduction through farmer education.

Ground Water Ammonia MN Case Study

Minnesota Department of Health (MDH) has detected in Minnesota’s water systems ammonia concentrations as high as 8 mg/L. Since the mid 1990s, MDH engineers have speculated that many MN water systems may be affected by high levels of ammonia in their drinking water, causing problems such as nitrification, taste and odor, loss of chlorine residuals and microbial influenced corrosion in their water distribution systems. As Minnesota is the State with the highest number of copper action level exceedance, MDH has conducted many studies to understand and mitigate Minnesota’s copper corrosion problems. The Ammonia Study was conducted to:

1. understand the extent and impact of ammonia on Minnesota’s community water supplies and its effects on disinfection;
2. evaluate influence of free ammonia on distribution systems’ bio-stability;
3. associate Minnesota’s copper corrosion problems to the presence of free ammonia in water distribution systems or nitrification; and
4. seek solutions/strategies to manage ammonia in water and to control nitrification.

The study found statewide, wide spread, occurrences of Ammonia and higher than expected levels of TOC in Minnesota groundwater sources. Evidence of chlorine residuals loss due to the presence of free ammonia was observed in the majority of systems, and evidence of nitrification/de-nitrification was observed in water distribution systems investigated.

The study identified areas of concerns and problems need to be addressed relating to ammonia in groundwater. It is disquieting to realize the assumption that DBPs are more of a concern to the surface water supplies may not hold true in Minnesota (and possibly in other states). Since ammonia is an unregulated contaminant by the Environmental Protection Agency and groundwater systems are not required to monitor for TOC, there are limited data available to states on ammonia and TOC. Since both ammonia and TOC cause compliance concerns for the Disinfection By-Protect Rule (DBPR), Total Coliform Rule (TCR), and the Lead and Copper Rule (LCR), understanding their occurrence and fates is essential in developing a free ammonia management, disinfection, and/or nitrification control strategy to minimize undesirable consequences led by these contaminants.

Final Barrier: A New Global Approach to Water Treatment

Final barrier provides water treatment at the source of consumption. This new approach to water treatment allows the removal of contaminants to lower levels than central treatment, removal of contaminants not addressed by central treatment, and removal of contaminants that are introduced during or after central treatment. Civil engineers and utility managers globally are beginning to recognize that treatment at the Point-of-Use (POU) may be more cost-effective than centralized treatment. Point-of-Use (POU) or Point-of-Entry (POE) devices have been tested and certified for many different classes of contaminants:

• Inorganics such as lead and copper
• Radium & Other Radionuclides
• Volatile Organic Chemicals such as disinfection byproducts
• Synthetic Organic Chemicals
• Microbiologicals such as bacteria, cyst and virus
• Aesthetic concerns such as particulates, taste and odor

This presentation of the final barrier concept will provide global examples of final barrier implementation, the US regulatory perspective, and guidance for residential consumers pursuing this emerging paradigm.

A Rise in Chlorides: A Case For Reducing Road Salt Application

Road salt application, since applied in earnest around the 1960’s, has followed a trend of increasing chloride levels in shallow wells (>200ft) and a rise in chloride in the Illinois River in Peoria, IL. Much of the recharge area for the regions aquifer is located near major highways, intersections, and rural routes. EPA’s delineation of chlorides for Class I potable groundwater standards is 200 mg/L. Some levels in the Tri-County region had levels as high as 1879 mg/L. Higher chloride levels in the drinking water pose issues for public health. Persons on a restricted sodium intake will find it hard to maintain safe sodium intake levels in simply drinking the recommended 8 glasses of water a day.

Tazewell County Health Department decided to host a workshop to educate local winter maintenance operators on appropriate technology, salt application techniques and salt storage to reduce the amount of salt runoff contamination to the areas water supply. Community partnerships were established and grant funding was solicited from Illinois American Water as well as the Central Regional Groundwater Committee, and the training was delivered through the expertise of national APWA speakers.

Over 90 participants were certified in snow and ice winter maintenance, and upon completion of the workshop, operators were armed with new information to apply. For the first time, multiple highway departments calibrated their trucks for more appropriate salt distribution; after which limited application of pounds per lane mile administered on the roads during snow events while still achieving desired road condition results. One highway department even constructed a makeshift tool to create a salt brine mixture to create more accurate distribution while also decreasing the amount of salt needed to apply. The second year, the planning for the workshop became even more sustainable by utilizing participants trained from the previous year in the calibration training. The Heart of Illinois Winter Maintenance Workshop has made a positive contribution to protecting local groundwater and drinking water; and intends to extend education to the community on perception of appropriate salt application necessary for safe roads and parking lots.

Survival of health significant bacteria in packaged drinking water: planktonic versus sessile life

In the present study an attempt has been made to evaluate the quality of packaged drinking water (108 samples) and experimental studies were carried out to determine the growth kinetics of health significant bacteria in various drinking water microcosms and biofilms developed on the walls of glass and PET containers. While HPC were analysed using R2A medium, membrane filter technique with appropriate media were used for the enumeration of Total Coliforms (TC), Faecal Coliforms (FC), and Faecal Streptococci (FS). Nutrient concentration in these samples was monitored using standard methods. Various types of drinking water microcosms prepared in triplicate for monitoring the biofilm analysis. The viable bacterial load was determined by plate count method using R2A medium and biofilm development was observed using Scanning Electron Microscope. Survival of selected microorganisms such as Escherichia coli, Pseudomonas fluorescence and Aeromonas hydrophila in bottled drinking water and biofilms were studied using microcosms. Risk associated with HPC bacteria were carried out in terms of antibiotic resistance analysis and virulence factors. The nutrient concentration of these water samples was very low and found to be within the permissible limits of WHO. Biofilm associated life was encountered in most samples and found to be higher in number than their planktonic counterparts. TC was encountered in most of the samples, FC and FS in 10% and 34% samples respectively. Significant positive correlations were found between TC and FC, HPC of water and TC and HPC of water and FC. The growth patterns of the biofilm associated bacteria indicated periodical build up and sloughing off biofilms. Many of the HPC bacteria from the drinking water were multi drug resistant and showed Beta haemolytic property. Survival kinetics of the selected bacteria showed that they were able to live better in biofilms, though the capabilities varied significantly among them. Biofilm development was more on glass surface. The result of the study calls for stringent monitoring of packaged drinking water quality by regulatory authorities and refrigeration of drinking water at all times by retail and wholesale vendors.

Community-Based Water Resiliency and All-Hazards Preparedness

A critical component of public health is the availability of clean, safe, and reliable drinking water. In the event of a water service interruption, communities must be prepared to face human health risks, as well as the risks to other critical community services such as food sanitation, patient care, and firefighting. To aid communities with this responsibility, the U.S. Environmental Protection Agency (EPA) launched the Community-Based Water Resiliency (CBWR) initiative in 2011.

The CBWR initiative raises awareness about how communities use water and provides resources to help build resiliency in emergencies that cause drinking water and wastewater service interruptions.   The CBWR electronic tool allows communities to assess their preparedness for, and resiliency to, water service interruptions from both man-made and natural events, and recommends resources that would aid in enhancing water resiliency.

This session will provide participants with training on the CBWR tool, including lessons learned from other communities who have implemented water resiliency programs. Participants of this session will better understand how to prepare for water service interruptions from all-hazards, including: hurricanes, tornadoes, drought, and many others. Session participants will also learn how increased preparedness enhances public health preparedness and community resiliency through scenario-based activities. After completing this training, participants will have the tools necessary to take CBWR back to their individual communities and begin implementation.

Emerging Contaminants: Pharmaceuticals in the Environment

Pharmaceuticals are emerging contaminants in water and, to date, cannot be removed as part of waste water treatment options. So what can be done to mitigate their effects upon the environment, yet maintain their efficacy for human and animal use? This presentation will present research about the nature and scope of these contaminants, which ones are the most pervasive, and will consider a lifecycle approach to mitigating and reducing the effects of unwanted, unused, or expired medications. Three recommendations will be discussed through context of pilot research projects conducted in the Southeastern Pennsylvania region: public education about medications as universal waste; the nature of switching medications within a short period and the prospective effects of short cycling on prescribing medications through economic modeling; and the potential implementation of an ecotoxicity model similar to the Swedish model in closed medical systems. Public education about treating medications as universal waste through a campaign in community pharmacies has increased public knowledge about this option by more than 33%. Examining electronic medical records in the Veterans Administration is showing that switching medications within a three-month period is common (>30%) among some classifications of pharmaceuticals and the implementation of short cycling can save healthcare costs as well as limiting the wasting of medications. Lastly, an analysis of ecotoxicity models implemented in Europe has suggested the possibilities of replication in the U.S., especially within closed systems like the Veterans Administration. As the population continues to gain weight, with its associated chronic diseases and continues to age with many health concerns requiring medications, pharmaceuticals will no longer be emerging but become a reality that environmental health and public health officials will need to grapple with in order to insure the perception of safe, viable drinking water.