Engineering Out Legionella in the New Normal

May 5, 2020

In episode 3 of LiquiTalks, Christoph and Chris give us a run down of what’s been going on in the water world in the midst of this “new normal” and Christoph shares his program titled, Engineering Out Legionella, targeting the plumbing engineering community presented as a CEU webinar. 

CHAPTER MARKERS:

1:11 – Chris recap of last week activities and overview of LiquiTech improvement activities;

5:37 – Christoph recap’s “Engineering Out Legionella” Webinar from previous week;

14:55 – Simulating usage calculator and impact of low flow fixtures recap;

25:15 – WELL Institute Overview

Resources:

Christoph: Welcome to this week’s episode of the LiquiTalks podcast. I’m Christoph Lohr, your host, and also the Director of Education and Strategic Projects at LiquiTech.

Chris Ebener: And joining again, is Chris Ebener. I am the Director of Engineering for LiquiTech and cohost of the show today.

Christoph: Well thanks Chris for joining me again, another week’s episode. I know you probably feel just as busy as I did. I guess let me start off by asking, what were you up to last week.

Chris Ebener: That’s a loaded question. It has been a bit of a roller coaster now, the last several weeks as it has been for everybody. But we’ve been working on several different strategies for not only operating in healthcare facilities, operating their domestic water treatment programs, but also, mixed use buildings from hotels and apartment complexes and office buildings as well. It’s been interesting to work in environments, not only where we’re protecting patients and ensuring outcomes by preventing waterborne pathogens, from infecting our most vulnerable right now, but also what to do in buildings that are currently occupied and are unable to be unoccupied for getting existing outbreaks and or positive culture results right now. In the market, I believe there’s a significant struggle to provide remediation in these types of structures and do so while moving quickly. We’ve been very fortunate as an organization that our leadership is very forward thinking.

Chris Ebener: And, we’ve been working for years not to prepare for a pandemic but to operate our equipment in such a way that it’s easy, it’s straightforward and highly effective.  And for me it’s really appreciating the investments we made. Almost 10 years ago now, in becoming an internet of things company, we’re providing not only connectivity to all of our devices, but also providing supervisory control, allowing us to not only assist our clients in maintaining their systems, but actively provide feedback and direct control over systems in this time where entire industries are furloughing employees. Staff staffing is low and full and hyper-focused, containing the current threat. So we’ve really been able to provide a level of service that’s unparalleled and I really appreciate those investments and just the ability to do that in this uncertain time but there are other things that have been very much in our favor. Everything from, again, contactless, non-hazardous maintenance, which is unusual in the drinking water treatment industry. We’re not providing, having to deal with the shipping of 50 gallon drums of chemistry, storage and moving them about in these facilities.

The advantages of solid state treatment are really coming to the forefront. Also our investments in automation and overall precision have been just incredibly fruitful in this period of time where there’s a lot of uncertainty and a lot of inability to get in front of equipment, we’ve really got a stable base for maintaining, equipment for our various partners.

Also, we’ve been really fortunate that our programs are structured in a very flexible way. We’ve been able to help our clients either increase or decrease services as necessary on the fly and help train them remotely and or again step in where they need help. What’s really kind of helped there is our really robust, approachable documentation.

Kudos to members of our team for really investing effort in making it easy for our clients to understand how to do the things that are necessary to maintain equipment and protect the residents and patients.  And last but not definitely not least, the investment and our engineering group from a consulting perspective and making sure we know how the various levels of building health that are out there from an infrastructure perspective in our portfolio, making sure we know where the deficiencies are and we’ve been communicating them along the way so that under these circumstances when things go wrong, we know what goes wrong.

And we’ve been working diligently to prevent infrastructure deficiencies that are further complicated by the current situation.  This is lead to just a great deal of trust within our partner organizations and really has allowed us to help bring better patient outcomes in this uncertain time as well as provide risk mitigation for those facilities that are currently unoccupied.

So that’s a long-winded way of saying, I’m incredibly grateful for the amount of innovation that we’ve put into providing this essential service during this time. And really appreciate it. Being able to pitch in and help right now in a situation where I can’t, it’s just totally unprecedented.

I know your week has been just as just as tumultuous. You’ve been all over the place. Can you, give us a little bit of an idea of what you’ve been working on.

Christoph: I was going to say, like so many folks, that’s getting used to the whole concept of having remote meetings.

My week was just a kaleidoscope of remote meetings across the company or country with several different entities out there. Just several folks just trying to bring education and the latest and greatest information to their fingertips. And I feel fortunate that we live in such a digital age where that’s been easier to do in spite of the difficulty of having social distancing, but I’d say the biggest event that really had just an incredible turnout. It was a webinar specifically a webinar for professional development hours that I did in conjunction with somebody we had a quick partnership with based out in New York city.

It’s actually now on LinkedIn. The recording is if you want to catch the whole program. It’s a great chance to kind of go back through and listen to it for free. But specifically, it was a presentation actually that I’ve given a couple of times before. Actually, in one sense, I gave it twice during the month of February, once here in Tempe, Arizona, and then again in Atlanta, Georgia for ASPE.

And then I gave it again in a couple of, smaller one-hour sessions. I’ve given that presentation out a couple of times for various chapters and whatnot. But the program titles called engineering out Legionella and it’s a program I started developing probably at the tail end of last year.

And it came down to being a kaleidoscope of all the information that I’ve learned over the last five years since I first really started this deep dive into this world of Legionella and just trying to bring the latest and greatest information to the plumbing, engineering community and specific, what I had seen was a sort of a disconnect between some of that information and what was available and validity of that information and trying to piece it together myself over the course of five years. It took a lot of effort. It took a lot of effort on my part. And trying to find a way to streamline that and it’ll take five years’ worth of research and learning and everything else and put it into either a seven hour or one-hour presentation as it were.

It’s a challenge. But I felt it was a pretty good session. And it was a great, I had a great reception post-meeting when I’ve had a number of folks, say a number of kind words to me about the presentation and that they liked it. And so, thank you, all of you that reached out to me and gave me the positive feedback. I really appreciate that, and I hope to do it again.  I’m hoping to be able to do some more sessions like that for continuing education units that are so critical to keeping engineers and plumbing designers certified. So, it was definitely a really good session.

We had over a hundred engineers, I think, on that call last week from New York and really great questions and follow up. And, and for being remote, it was still very interactive, which is always a positive.

Chris Ebener: It’s been really great to be able to help so many organizations, remotely right now. The digital tools are just awesome. As a follow up to that presentation I participated in a couple of calls with you where you really did have some great conversations out of that. If you were to kind of sum up that presentation to give people some insight as to the content, what’s the number one takeaway you would want people to walk away from after listening to that presentation?

Christoph: I think the biggest thing I would want them to take away from is that water is complex. And to think that we can simply do something and solve the problem.

I think that it’s unfortunately a little bit more nuanced than that. And I think just coming to that realization and understanding the complexity of the water systems that we as engineers, is that we design every single day and that we interact with every single day. That they have such a massive impact and they have effects on each other.

During my presentation, I have several slides and there’s two sort of concept slides that I have. One is the idea of a, if you imagine almost a Pentagon or a five-sided polygon, that has it each corner a different characteristic of water and what’s a contributing factor to a Legionella case. And you have temperature, you have water, age and disinfectant, residual flushing as the numbers one and two. You have air heating distal sites that are part of the plumbing fixture selection is item number three.

And that’s kind of the triangle part. That top part of the of that five-sided polygon that everybody kind of talks about. On the plumbing side, but there’s a whole component sort of underneath that surface of nutrients and water quality and how the nutrients can come in and help feed the biofilm or feed bacteria on that isn’t often spoken about.

And then also not spoken about is the whole concept of surface area and specifically water quality. And in the terms of total suspended solids and pipe size, many plumbing engineers realized that we oversize piping systems. But not just on the incoming cold water, hot water, but also hot water return systems.

That’s really important for us to right size the plumbing systems for those situations. The example that I used in the class, and it’s one actually that I heard a while ago, was if you were to take a pencil and you were to take a look at the tip of the pencil or pen, and you just take a look at that tip to a bacteria.

That tip is something that to us equates to the size of a football stadium. So, when you sit there and think that if you have particulate coming in with your water, total suspended solids, those are more locations for the bacteria to grow on. If you’ve up sized your hot water return system, one or two pipe sizes, those are more locations for the bacteria to biofilm to grow and attach themselves to proliferate. And the other thing that I kind of take with that slide is I have several arrows. And I think what I’ll do is we’ll post this presentation in PDF form for our listeners off our webpage if you want to take a look at it.

But basically, all these different individuals that have all these arrows going from one corner of this five-sided polygon to the other. And the reason for those arrows is basically to make this point that all these factors are interrelated. Just doing temperature by itself is not going to solve the problem.

And there’s things that have effects on other things, and if you pull on one side of that polygon, you may be creating a bigger issue for yourself. The subsequent slide that I have is this sort of spectrum. And from an engineering standpoint, engineers for so long haven’t really trained to be a sort of binary thinking.

We’re dealing typically like there might be multiple paths to the right answer, but there is a right answer. And unfortunately, this sense from an epidemiological standpoint, we’re dealing with shades of gray. I mean, even most epidemiology reports, they will never say a hundred percent success.

You’ll hear below non-detect or a 99.999% detection level. Or 99.999% success rate. And so you have this linear spectrum almost of things that increase the risk. You have things that reduce risks sort of in the middle or maybe not increasing the risk. And then on the left side, you have things that actively prevent and control.

And there’s a lot of things out there that have been built as prevention control measures that I talked through that are really risk reduction measures. Are there things that don’t increase the risk? Evidence-based data that’s out there really point to that. And then there’s other things and a lot of things that we try to focus on.

LiquiTech is on that prevention and control side. And so, there’s obviously the things that increase the risk. Things like stagnant water, the right temperature water, low disinfectant levels, all those things we know increase the risk of Legionnaires’ disease outbreak. And understanding that you have these shades of gray and depending on those factors above.

In one building, it can put you somewhere else in another building. And making sure that you’re looking at any given building holistically and not just trying to do the same cookie cutter solution in each building really becomes that much more important. And that’s, I would say, probably the most important factor for the folks that I present to, to understand, because it is a mind shift change from what engineers typically do.

it’s almost a learned skill or a learned mindset that that needs to take place in order to make that leap into this, realm. The other is that there’s really no excuse not to do anything anymore. And the legal profession is driving in that sense, positive change from from a human health standpoint.

But with ASHRAE 188 standard coming out in 2015, that standard, it really dictates now to engineers that they can’t just say, this is somebody else’s problem. They really need to be on the forefront and having these discussions. And so those two ideas, basically that there isn’t necessarily a single right answer, but they still have to try to do something for the engineers.

That’s a really important component. There’s a lot of onus on building owners that they need to follow it.  but there’s still definitely the standard of care has been raised because it was a groundbreaking standard. And its really kind of shaken up the industry and when you talk with lawyers or with your in house legal, if you’re an engineering firm, it really has had a big impact on that.

So it’s pretty interesting to see some of the trends that have resulted as due to this being released to the industry.

Chris Ebener: That’s really awesome. Kind of the highlight reel, and you did a really great job in that presentation of kind of digging deep into each of those topics.

I think it’s extremely poignant right now. And we can provide a little bit of kind of actionable insight. We were working on some modeling earlier this week on routine flushing to try and simulate usage.

And you’re building up some calculations and really realized. I call it an “aha “moment of really how big the impact of designing in low flow fixtures is when you don’t right size the piping to match how big of an effect that has on how long it took to turn over the water and that distribution system even to simulate normal usage.

Christoph: Yes, we built that calculation tool to help some folks out and I think we had those conversations about looking at what type of usage they should expect normally from a gallons per day standpoint. We have always known the National Academy of Sciences. They had an excellent consensus report that they released in the summer of 2019 and they pointed towards water saving. Fixtures should not be allowed in health care or long-term care facilities.

And I remember at the time, I brought that up on a couple of projects that I was involved with. And, it was a poignant statement and very needed point that I’m glad that they included it. But it was interesting this week when we built this calculation tool. We looked at basically a couple of scenarios, for a given facility type. And you had a gallons per day and gallons per day usage that for a simulated exercise load, basically, that was needed. Well, when we looked at for a normal flow rate, standard flow rate. Let’s say we assumed about one gallon per minute, which is your normal flow rate.

You would see maybe something in the range of a 6 to 10-hour exercise of flushing certain parts of the system and maybe flushing less than or equal to about 25% of the system.  Which, again, to get a fully simulated load for a building was pretty on par, but the water saving features, this is the part that this is unfortunately, one of the unintended consequences, and I’ve written on this in several instances and spoken about it and a number of folks in our industry have spoken about it when it happened back when we started this process. We’re reducing our water usage through plumbing fixtures. It’s been done a little bit in a vacuum, a well-intentioned. We want to be, especially since we need water every three days, we talk about it in our intro for this podcast, but you’d want every three days. And so it’s a scarce commodity.

And so we have very little fresh water in the grand scheme of things, we don’t want to compare it to all the oceans out there. And where those sources keep drying up. There’s droughts. I mean, here in Phoenix, our freshwater sources have been drying up.

And us being smart about our water usage is such an important factor. I understand the impulse, but unfortunately, when the decisions were made to start arbitrarily reducing the waterflow, the needed holistic approach was not taken. And we basically had a given pipe size that we reduced the flow from well to break it down in sort of non-engineering speak.

When you reduce the flow and you keep your pipe size the same, it means it takes longer. To get fresh water or water with disinfection in it from your plant to that same point, which means that the disinfection can break down all the chlorines and chloramines and you will end up with a situation where you have water with bacteria in it that has survived and they’ve out survived basically the bacteria and other pathogens.

And they found themselves in a spot where they can really proliferate. And unfortunately, when these low flow conditions have occurred, what was not addressed was the need to go back and redo the entire way sizing has been done for buildings for the last 70 years. It was unfortunate just dropping the flow rate.

And so what we’ve seen now is, especially since some of these measures were adopted, in part, correlation doesn’t necessarily equal causation, but a number of entities, again, the National Academy of Sciences being probably one of the most reputable ones have linked that decision is now affecting the increase in Legionnaires’ disease cases that we see, misdiagnosis is definitely a part of it, but we’ve created a condition now that has had terrible unintended consequences in the water quality coming in and it was well intentioned but the impact to having systems now that have older water in them.

And frankly, a lot of people experience that and have complained about that with their hot water temperature delivery times being reduced or feeling like they’ve had, making you hear some of the anecdotal conversations about low plumbing fixture usage, like showers being less than ideal and having to take a shower twice as long to wash shampoo out.

And that’s kind of all related to it in some degree, but really the biggest impact is that reduction in flow causing bacteria to be able to proliferate now in the piping systems, because the piping systems have never been adjusted to account for the new flows. And unfortunately, that’s been something that’s been going on now for the last 20 years.

And so, that’s definitely a compound. And I’m glad you brought that up, Chris. When we did our calculation tool. I mean, when you went from a one GPM fixture down to like in certain states like California that require a 0.35 gallon per minute a faucet, you now have to run basically every single fixture in your building for more than 24 hours to get the system flushed out to get that same flow.

And, actually I saw a person online today. I believe it was Mr. Andrew Bolton or Dr. Andrew Walton. And he had this great video that showed on Twitter and on LinkedIn where if you open up every single plumbing fixture building, they were never designed to do that. And so now you’re creating a hazard because there’s not enough pressure to get to every fixture and now you’re sucking in air.

I’m from your high zones into your system so you have a whole effect and pending on what it’s hooked up to, you could get a lot of nasty contaminants in the water. And so, again, this is just compounding on itself repeatedly. And unfortunately, there’s been, the law of unintended consequences has just come back time and time again and it’s seems to have been happening for the last 70 years

Chris Ebener: This is a great point that you have to get pointed and also understand that every protocol has to be tailored to a building. It’s unfortunate that’s the answer, but that’s the real answer here is that every institution, every building type PR has its own unique challenges.

So, the simple response of, oh, we’ll just go flush every fixture. It has secondary consequences. It must be calculated. It must be done in a thoughtful way with guidance and oversight and documentation so that you don’t run into secondary consequences and you don’t make problems worse.

Christoph: Definitely. Definitely. Well, and that topic of basically sustainable measures. One thing I don’t want our listeners to take away is that I’m in any way anti-green frankly. Even one of my certifications, my LEED AP® BD+C. I’m a lead accredited professional that I’ve held on to that registration since 2011 and I do believe that it’s important to have measures in place to save water.

But I would ask let’s try to be smart about it and make sure public health and safety aren’t impacted. A great example, there’s a couple of movies that I’ve watched. And when you look at the EPA numbers for freshwater withdrawal we focus on public health impacts and that really when especially for buildings and residences, a lot of that, is kind of the public water draw that draw accounts for only about a little over 10%. And maybe even an under 10% of our total freshwater usage in the US when you look at the grand scheme of numbers, almost 80%, I think it is actually right, 80% on the dot of freshwater withdrawals.

Go for two things. Thermo electric, power generation and irrigation. And I sit there, and I think about some of the situations we have in the US where we have crops and deserts that are very water intensive, such as avocados and almonds. Avocados need about 18 gallons of water per avocado.

And then, it’s about one gallon of water per almond. And we’re putting this in deserts, and we have situations in these areas where the water supply is going down. That’s the low hanging fruit is being smarter about our usage of accounts for such a larger percentage of the freshwater withdrawals and plumbing fixtures.

I also sit there and think about thermal electric power and actually a great example I use for my talk is right around the corner from me here in Phoenix, we have Palo Verde Nuclear Power Plant. One of the most incredible things that I found out about the power plant is they use wastewater from the west side of the city of Phoenix to use to cool their cooling towers. And they go through a purification process and to make sure, obviously it’s still not having an adverse effect on public health consequences. And so that to me is like a great example of where we can be smarter about our water usage.

And I talk a lot about the books. Another one I would encourage our readers to consider reading. Another one, by Seth Siegel, I think it was his first book, was let there be water, which talks about Israel’s use of water and how they’re a very water conscientious country. And it incredible to kind of see the measures they’ve taken and the smart measures that they’ve taken with their water.

And I think there’s some things that we can pull from there. So again, I’m not anti-green by any means. I certainly believe in being good stewards of the earth and that we need to take care  of this planet. But I also think that we need to be smart and not have things that are negatively impacting public health and safety.

Chris Ebener: I remember that slide on the division of freshwater usage in this country when I saw you speak at NSF Legionella conference last year. And, it was such an aha moment for me when you talk about measures to be taken. There’s so much to be gained on those kinds of commercial uses of water, which is why there’s so many initiatives out there to try and help businesses do that. But we just, we don’t think of that realm first and a lot of these measures ended up being a drop in the bucket compared to what we could get through investments

Christoph: Definitely, and the good news is because I don’t want obviously depress our listeners on all of this either, but one of the good pieces and this is a program that I’m personally very, very excited about, the Well Building Institute has come out with a well building program.

Some of the most initial green initiatives such as lead. They had a great start and the idea was to make things that use less energy and was good for people. And I think they maybe lost their way a little bit on the good for people part. I think they can get back to it and I’m excited about that.

But I do think that the well building program is really a reaction to that. And you look at the well building program and they don’t even address that topic of water conservation. They’re just looking at it from a standpoint of trying to make buildings that don’t make people sick and that people can have confidence.

And I think more than ever, especially in this COVID-19 crisis that we’re currently under, I think that this specific program. It is going to become a really key measure for us as a country, and maybe globally and specifically  the feature that I want to focus on from the well building program and that I talk a lot and I did talk about in this Engineering Out Legionella is their Feature 36, which is about water treatment. And in that water treatment section, they have parts one through five that talk about organic chemical removal, we’ve talked about, trihalomethanes and different sort of negative things in the water that can affect us badly. And talking about things like that are removed from the water before somebody drinks it, they have a part two is sediment filtration. Again, removing things in the water that that can have bacteria and everything growing on it, microbial elimination, we’re talking about technologies now that actively prevent and control microbials that come into to prevent them from effecting people. Water quality maintenance. The building owner is doing things to actively look at their situation and their building, and they have a program in place that’s actively happening.

And then the final one, which I have to give the well building program, almost a standing ovation maybe, and maybe it’s a standing ovation of one, but still standing ovation is the part five Legionella control. And the fact that they were progressively minded enough and that they realize, I don’t know how it got in there, but kudos to them.

Massive kudos to them for having basically taken the language from ASHRAE 188 which we talked about earlier, being kind of the standard right now out there and basically putting that into the specific feature on water treatment. What a great testament to that foresight that they had and the fact that they are trying to do the right thing and make sure that this big problem that has been created is now being owned.

I think for myself, any building that I see that has the well building program, I almost feel like we need to start almost like a campaign to really give kudos to those building owners. Because, especially in this new normal, I think that having buildings out there that don’t make us sicker is of the utmost important.

And I think maybe they were prescient about it. I’m very excited about the potential with that and I speak about that regularly as a possible and a really great development in the industry. I’m very excited to see how that kind of progresses.

And if you haven’t been to their website, I would encourage you all to go to labelling program. They have a number of great resources and had a chance to talk with a few of them. They seem like good folks that really just care about good building. So, definitely would encourage you all to the website and we’ll put that link on our transcript for this podcast.

Chris Ebener: Awesome. From a living in a healthier built environment perspective where we’re now spending more time than ever in our homes and then are also experiencing unprecedented environmental conditions in other buildings where we’re being totally unoccupied or repurposed for things they were never designed for. The concept of a health focused design methodology is just incredibly important now and in the future.

Christoph: Couldn’t agree with you more, Chris. Well, is there anything else that we didn’t talk about?

Chris Ebener: Well, we can’t talk for four hours, so I think we can assume that we’ve covered today’s topic.

Christoph: Right on.I think so too. Again, I’m Christoph Lohr, Director of Education and Strategic Projects at LiquiTech. You can connect with me on LinkedIn, Christophe Lohr, PE, or you can connect with me on Twitter @lohrthoughts.

Chris Ebener: And again, this is Chris Ebener. I’m the Director of Engineering for LiquiTech.  You can also find me at LinkedIn, at Chris Ebener or on Twitter @Chris_ebener. Love to chat with you.

Christoph: I agree, and it’s been fun pinging each other and thanks again for jumping on Twitter due to my nudging Chris. So well, thanks again all and we look forward to seeing you next week on episode number four of LiquiTalks.

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Chris Ebener

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