Toolbox Approach of Source Tracking Human Sewage in Storm Drains

Public health departments are required by regulatory agencies to assess the concentrations of fecal indicator bacteria (FIB) such as Escherichia coli in the recreational waters as a means of determining relative risk for infection by sewage borne pathogens. However, the presence of E. coli in the environment does not discriminate between human and non human (birds and animal) feces, both of which may contain E. coli. County of Ottawa Health Department regularly monitors their watersheds for E. coli levels. Previous and recent monitoring at Dunton Park, Lake Macatawa exhibited high E. coli levels exceeding the state-allowed levels and often times beach closures. This high E. coli level remains a critical problem and puzzle in this watershed. Several storm drains and creeks open into the surroundings of Dunton Park area containing unknown discharges. Environmental Health Managers are in need of effective, easy, and low-cost methods to identify and pinpoint sources of human fecal contamination in storm drains and other sources that discharge into nearby water bodies. The microbiological quality of Dunton Park was evaluated and source tracked for human sewage using a toolbox approach, which combined 1) Canine scent tracking or human sewage-sniffing dogs, 2) Assessment of traditional FIB and 3) DNA based finger printing for human specific markers. The objective of this study was to deploy the sewage-sniffing dogs for source tracking human sewage in several storm drains, catch basin and creeks along the circumference of Dunton Park.

Water samples were collected and tested for traditional FIB and subjected to DNA fingerprinting based on positive signals obtained by sewage-sniffing dogs. The results of these three methods were correlated to provide weight of evidence data. This biological toolbox approach is helpful for providing significant information about the sewage sources in storm drains for implementing better management practices, thereby protecting environment and human health. This project is funded under Clean Michigan Initiative.

National Swimming Pool Codes – Junction of Health and Building Officials

In recent years there has been a steady increase of reported disease outbreaks where an aquatic venue was found to be the common source. In addition, every year there are tragic injuries and deaths in swimming pools. CDC is creating a Model Aquatic Health Code (MAHC) to improve the health conditions in these venues. The International Code Council (ICC) has created the International Swimming Pool & Spa Code (ISP&SC) governing pool and spa construction for enforcement by Building Code Officials. Meetings have taken place between CDC and ICC officials to explore how these codes can be complimentary.  In an early meeting, Jay Peters from ICC stated that he thought an arrangement could be reached where a “baton transfer” could occur between the building code officials after the design and construction phase to the environmental health officials for the on-going operation and maintenance phase of the aquatic venue.  The collaboration between the CDC and ICC needs to continue to create joint pool code strategies and explore the possibility of a joint code in the second version of the ISP&SC which will come out in 2015.  Environmental Health representatives are being considered for the ICC pool code committee for that second version. 

CDC, NEHA and other national organizations that represent EH professionals are likely to become more involved in the ICC’s code development processes.  The ICC creates codes dealing with areas including “green” buildings, sustainability, and property maintenance that need environmental health input. This move may also encourage more collaboration between the environmental health officials and building code officials at the local and state levels. Please consider joining CDC / ICC / NEHA for an informative session about how these efforts will integrate.

An Evaluation of Dual Bacteria Indicators for Urban Stormwater Control

Surface water quality standards for recreational waters were developed by EPA in the mid 1980’s based on epidemiological data gathered and published in August 1984 in an EPA report “Health Effects Criteria for Fresh Recreational Waters”.  In this report, the relationship between gastrointestinal illness and levels of E. coli and Enterococcus were observed and risk levels estimated.  Subsequent studies by EPA have found relationships between Enterococcus exposure levels and gastrointestinal illness rates.

In Texas, fresh water recreational standards are established in the Texas Surface Water Quality Standards.  E. coli is used to evaluate the risk associated with primary contact recreation and the standard established is set to achieve a risk of no more than eight illnesses per 1,000 swimmers, based on the risks established in the EPA report.  In urban watersheds in the Houston area, the E. coli water quality standard is not being achieved.  The levels of E. coli are quite often up to several magnitudes of order greater than the current standard of 126/100ml.  Many of these watersheds are greatly influenced by urban storm water run-off as well as discharges from wastewater treatment plants.  These discharges not only provide a continuous source of fecal bacteria, but also nutrients which may provide for continued survival and replication of E. coli.

To set priorities for management practices as well as to judge the success of those practices, the TMDL Bacteria Implementation Plan contains suggested provisions for the monitoring program to look at both E. coli and Enterococcus. Because of the potential for replication of E. coli in the waterways, a supplemental indicator is necessary to validate BMPs and their success. This presentation will look at the relationship of E. coli and Enterococcus in the data presented in the EPA studies, historical data from a non-urban watershed and the urban watersheds in the Houston area.

Biofilms in recreational water

From the surfaces of our teeth, to the depths of the ocean, wherever there is water, you will find biofilm.  Biofilms have existed for millions of years, however, only recently have we have started to understand part of their role in impacting public health.  In this talk, the basic structure of biofilms, why we are concerned about them, and what can make them vulnerable to treatments will be discussed.  When microorganisms such as bacteria, fungi, and algae gather together on a surface and then coat themselves with slimy substances, they have formed biofilm.  Biofilm is not necessarily dangerous, and can be very useful in nature and wastewater treatment plants for nutrient removal from water.   However, it can harbor some dangerous pathogens.  Many bacterial pathogens such as Legionella pneumophila  and Pseudomonas spp. like to live in biofilms and will often thrive and reproduce quickly in a biofilm environment.  Once a biofilm becomes established on a surface, it can be very difficult to treat.  Although swimming pool and spa sanitizers are very good at killing microorganisms that are free floating in the water, it is difficult for them to get down through the slime layers of biofilm and kill all potentially harmful organisms.

Whichever approach is taken to control biofilm, any product that claims to remove, prevent, destroy, repel or mitigate biofilm is considered a pesticide by EPA and requires registration.  Therefore, just like sanitizers and algaecides, products that claim to be effective against biofilm must be EPA registered.  Biofilms have developed efficient survival mechanisms during their eons of evolution.  However, in order to protect public health in our pools and spas, it is important to remember that the single most important practice is to maintain an EPA registered sanitizer residual in all parts of the pool or spa at all times.  This will help prevent the formation of biofilm, as well as help kill pathogens that have been released from existing biofilms.

Multivariable Risk Assessment of Swimming Pool and Spa Exposures [Poster]

The reported number of Recreational Waterborne Illness (RWI) outbreaks in the U.S. has increased from the initial reporting year in 1978.

From 2005-2006, RWI outbreaks peaked at 78 and 74% of the outbreaks were associated with treated water venues, including swimming pools and spas. The risk of ingesting pathogens during swimming in pool/spa water is influenced by four variables: swimmer behaviors (submerging head, swallowing water, etc.), pool structure (recirculation rate, disinfectant method, etc.), facility operation (chemical balance, maintenance schedule, etc.), and water contamination levels (i.e. pathogen concentrations). A comprehensive assessment that considers and combines these variables will be completed to determine the risk of contracting a waterborne disease from swimming in pool/spa water. Twelve pools and spas in Tucson, Arizona will be evaluated on structure, operation and contaminant levels by testing chemical concentrations (chlorine/bromine, pH, alkalinity and cyanuric acid) at multiple depths, assaying water samples for fecal coliform, Pseudomonas aeruginosa and heterotrophic Bacteria, and recording other relevant data. Swimmer behaviors will also be monitored using video surveillance, and swimmer ingestion rates will be quantified by comparing cyanurate concentrations in urine and pool water. The research will evaluate swimming behaviors that increase the risk of ingesting pathogens, and the influence that pool characteristics have on that risk. Data from the assessment will be modeled to determine the risk of swimming in different exposure scenarios, like lap swimming or diving, with consideration of pool water ingestion, recirculation rates, and chlorine, cyanuric acid, fecal coliform, Pseudomonas aeruginosa and heterotrophic Bacteria concentrations during the exposure period. Results from the research will be available in May, 2012.

Building an Aquatic Health Program of Excellence

In 2011, the Alexandria Health Department (AHD), in recognition of the excellence of their Aquatic Health Program, was honored as the winner of APSP’s Dr. Neil Lowry Memorial Award.

The key components of this highly successful program include:

• ¨ Program assessment
• ¨ Recruitment of excellent program leadership and staff
• ¨ A totally fee-supported program that enabled increased

o Staffing

o Equipment

o Outreach

• ¨ Use of seasonal EH staff positions to reduce the unit cost of pool evaluations (inspections)
• ¨ Frequent evaluations

o Every two weeks for seasonal pools

o Monthly for year-round pools

• ¨ Development of a risk-weighted measure of operational performance of pools and pool management companies (PMCs)

o 2008 - Began sharing data on PMC performance with all stakeholders

o 2010 – Began sharing annual rating data on operational performance of individual pools with pool owners

• ¨ Development of a new Aquatic Health Ordinance with stakeholder input

o Reflected most recent technology and environmental health science

o Required licensing of PMCs

o Enforcement mechanism for PMCs that repeatedly and flagrantly violate ordinance

o Adopted with no local industry opposition in March, 2010

• ¨ Outreach to stakeholders

o Web site information

o E-mails when tickets issued

o End of season deficiency letters

o Web posting of AHD evaluation reports

o Newsletter – published 3x per summer

o Semi-annual town hall-style meetings

o Awards for excellent performance by PMCs

As a result of these improvements:

• ¨ Consistency in the timeliness and quality of evaluations improved greatly

• ¨ Over a two year period:

o Health & safety violations per evaluation were reduced by 71%

o Ticketed violations were reduced by 59%

• ¨ Relations with pool owners and PMCs improved dramatically
• ¨ The best PMCs began using AHD’s data on their performance to market their companies
• ¨ Pool owners began choosing a PMC based on price AND performance, not just price
• ¨ Program became immune from budget cuts because it is self-supporting

Pool Safety: From Technology to Construction

The overall goal of this presentation is to explain how the pool industry got to this point in our history. I will cover how to minimize suction outlet entrapment hazards through proper construction and sound hydraulics. The presentation covers proper application of SVRS technology, as well as the installation and proper application of the Safety Vacuum Release System.

Understanding the dynamic forces involved in pool, therapeutic and circulatory systems can and will reduce the hazards associated with child suction entrapment. After testing and demonstrations in labs addressing differential hold down forces(DHDF), it has been proven that the avoidance of this scenario will in turn make pools and spas safer for our swimming public. The pool industry is generally unaware of this problem, however through proper education, we can help industry professionals to recognize this deadly issue and correct the misuse of powerful pumps and inadequate plumbing/piping techniques. Through proper education of this issue, there should be no reason why we can‘t stop suction outlet entrapment in our lifetime.