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[Music]
welcome to the podcast where we scale up
on our knowledge so we don’t scale up
our system scaling up h2o i’m your host
trace blackmore and we are at the very
last show of legionella awareness
month and i hope you have learned
something this month i hope you don’t
just learn
something about legionella this month
you use this to continue
learning because as i’ve said before
we as industrial water treaters getting
better information
to take to our customers so they can
make better decisions
folks we can end legionnaires
disease we can all be making better
decisions and that all
starts with knowledge so you
all have sent in your questions to me
and today we are going to answer those
questions now i’m going to answer some
of those questions
and i’ve got some very special guests
that are also going to answer those
questions
right along with me so with that
i want to make sure that we talk about a
few things before we get
into those questions and the first thing
is the association of water technologies
is having their interactive convention
september 30th through october 2nd
next week we’re going to be hearing from
awt president
tom branvold tom’s going to share his
story about being an industrial water
treater
but he’s also going to tell us all about
this year’s virtual convention yes
this year is going to be different let’s
face it what
hasn’t been different in the year of
2020
but in this case different isn’t bad
different is just different from what
we’re used to
and because it’s different we’re
actually going to have some tools that
we’ve never
had before and these tools are
going to enhance your experience in fact
these tools take care of a lot of issues
that i
have when i go to a conference in
person of course we all love going in
person but one of the things is
we cannot go to every single paper
because they have
multiple ones going on at the same time
well folks this year you can you
can see every single presentation
read about it you can get information
on it download all the handouts and
you are not limited to only being in one
place
at one time so that to me is huge
because i hate missing the things that i
want to see so again different doesn’t
necessarily have to be
bad different is going to give us some
more
tools than we normally do now tom’s
going to tell us
all about those tools and why we need to
be sure
that we attend this year’s virtual
convention
now if you haven’t registered it is not
too late to register
you can simply do that by going to
awt.org
and clicking on convention registration
they make it very easy for you to do
that
and then you can experience this year’s
virtual convention
now immediately following the awt
convention
is industrial water week that’s going to
be october 5th through 9th
and nation i’m so excited we have joined
forces with founder of the industrial
water week
james mcdonald that’s right so
james and i have joined forces you do
not
want to miss what we together have
in store for you of course each
and every day we’re going to bring you
a brand new carefully packaged
episode for your listening pleasure
and if you’ve forgotten the days of
industrial water week so we’re going to
be celebrating
pre-treatment on mondays boilers on
tuesdays cooling on wednesday
wastewater on thursday and then we wrap
it all
up with careers on friday
we have fun with this each and every
year you might remember a couple years
ago
this is where we started doing a
weekly podcast and since that time oh my
goodness have our
numbers grown the folks out there
and the scaling up nation of course you
know who you are you’re listening to me
right now
you have done a tremendous job of each
and every week
listening to these episodes and i think
by having it each and every week
you have been able to form a habit of
listening to scaling up h2o
and i am sure glad you did
so please stay tuned to hear all of the
fun ways
that james and i are going to enhance
your industrial water week experience
this year
well nation again i want to thank you so
much for
letting me know what questions you have
about legionella
this whole month it’s what can we learn
about the bacteria so
we can eliminate legionnaires disease
and i truly think we can if we start
making better decisions
so let’s listen to our first question
trace blackmore mark lewis here
hey thanks for bringing us legionella
awareness month
my question to you is with the many
different forms of legionella sarah
group one through 14
blue white etc is there a different
disinfection procedure for the different
types of legionellocera groups
should we disinfect at higher levels or
at lower levels for a longer time
depending upon the type
of legionella that we test positive for
knowing that we’re going to test
positive for something
at some time my question is is the
perceived disinfection procedure the
same for everything
or do we modify our disinfection
procedure
depending upon the type legionella we
have thanks for bringing us
legionella awareness month and thanks
for scaling up h2o
well to answer that question we have
none other than
friend of show dr janet stout
president of special pathogens
laboratory
so what do you think janet well the
answer
actually starts with how do we treat the
disease legionnaires disease
whether or not legionella demofula
causes the disease
orally genetimic daidii for example
causes the disease
the antibiotics that we use to treat
both of those
work just the same azithromycin
ciprofloxacin
levofloxacin doesn’t matter which type
of legionella species has infected the
patient
those antibiotics work equally well so
the same is true with disinfection
approaches
there might be slight differences in the
susceptibility of these
organisms to the disinfectant but not
enough to make
a real life difference because we’re
using so much
chlorine dioxide monochloramine copper
silver ionization
for example and so we use enough to
overcome even the slightest difference
in susceptibility
so if you have a water system that’s
colonized with legionella mcdadei
you would use the same disinfection
approach as if it was legionella
demophila
well janet thanks for that answer well
let’s go ahead and move on to
question number two
so tracy’s clear that there are more
breakouts of legionnaires disease in the
summer months
and why is that rather than the winter
months it seems the
warm weather may have an effect on the
disease itself
so the question is why do we have more
legionella
outbreaks and when i say legionella i
mean legionnaires disease and i do want
to take a moment to go over that in a
second but i want to finish asking the
question
why do we seem to have more outbreaks of
legionnaires disease
in the summer rather than winter so uh
first off uh just some terminology again
because the
better we speak the better uh we can
talk with our customers
so legionella is the bacteria that
infects us and legionnaires disease
is the same thing as saying
legionellosis so if you hear those terms
those are interchangeable and of course
that’s the pneumonia
form disease that we don’t want so
to answer that question it really
depends on what you’re looking at
so if we’re looking at utility water
like a cooling tower or maybe we’re
looking at pools and spas
people are more active in the summer
they’re going out they’re doing more
things of course there’s more load
on our cooling systems so those are
getting utilized more
so for those types of systems you will
see
an increase of legionnaires disease
detections within that time frame
now if we truly look at the culprit of
where most people
get legionnaires disease it’s from the
domestic water
and those systems use the same
pretty much all year round but as we
know
it’s those other systems like the
cooling tower that get
all of the press so really in answering
this question it really depends on
what piece of equipment that you are
looking at
and then determining when the biggest
month of outbreaks are but to simply
answer your question of course there’s
no way to simply answer
anything but since we have a limited
time on this show
i’m going to say it really depends on
what you’re looking at and if we are
looking at the cooling towers of course
we have more cooling towers in use
during the summer
and those cooling towers are being used
to their fullest capacity
during that time so that’s why
that would be the prime time that we
could see that
our next question has to deal with those
hot water systems that we were just
talking about
and this person wants to know how do we
mitigate the risk
in hot water systems now i’ve asked
my friend and fellow rising tide
mastermind member
brian fisk to help us answer that
question
when managing the hazards for domestic
water distribution the first step should
always be development of a water
management program to provide a
defensible backbone
that guides the decisions of the
facility’s teams
once the risk basis has been established
the team can properly analyze how they
can control
the hazards present the controls
available for domestic hot water systems
are temperature and residual oxidant
concentrations
by working through the guidance provided
by the regulatory drivers
the team will assess how to manage their
systems through what is called the
hierarchy of control
what this means is to work to control
the hazard through the solutions in a
way that goes from simplest to most
complex
once a control is established it should
be verified that is being implemented as
designed
and then its efficacy should be
validated before moving to more complex
controls
brian thanks for that of course if we
don’t have a plan
we really don’t know how to coordinate
everybody’s efforts and i know plans
don’t specifically say you
have to test but i got to tell you if
you’re running a plan
and you have no way to validate if it’s
working or not
i can’t think of any way to do that
other than
testing so with the hot water system
heck with all the systems that we’re
talking about here today
making sure that you understand the plan
making sure that there is a team
behind the plan and then the proper
people are executing
the items to make sure that wherever
there are some hazard locations
we are doing what we need to do we’re
testing to make sure that that is
working
and then we simply wash rent and repeat
let’s hear our next question hey trace
emma wilson here with innovative water
consulting how should buildings that
have still
not opened after the copen 19 shutdown
kind of prepare their building and
more so prepare their water system for
that reopening process
well thank you so much for that question
i’ve invited
my friend bill pearson to come on
scaling up h2o
and answer that question well some of
the services
you may need to ensure a safe reopening
will include disinfecting
and cleaning of water systems such as
cooling towers
and storage tanks certainly that are set
you know stagnant also flushing
protocols
will be very very important to ensure
that you have
been or are moving water through the
building getting rid of the old and
bringing in the new
is the only way you’re going to
establish disinfectant levels
you may possibly have to do a
disinfection
and flushing such as a hyperchlorination
of the building waters entire domestic
water supply
and systems hot and cold i would
certainly be remiss
not to emphasize at this time the role
of analytical testing of the building
water systems for legionella
this is the only way to ensure that your
conditions are
acceptable you may do this testing first
as a risk assessment
followed up by remediation or
some level of action plan but you always
want to validate the effectiveness of
any such
uh actions or remediations
and do legionella testing and last but
not least
the implementation of a water management
or safety plan on a long-term basis
well bill thank you so much for
answering that question hey thank you
for
all that you did in those years
where and i think it was ten plus years
where you were working hand in hand
with ashrae and awt making sure
both sides were staying informed as 188
was being developed now folks on episode
140 friend of show janet stout
visited us and this was actually a
special episode that we turned into a
podcast episode
from a webinar that we did
for our mastermind group so during the
pandemic while we were all staying at
home
we did 13 webinars that you can find at
scalinguph2o.com and you can go to our
resources page
you can see all of those webinars and
one of them
was janet talking about what we need to
expect when we’re reopening our
buildings
and then also how we should be talking
to our customers about that
well we turned that into a podcast so
you are welcome to
watch the webinar of course janet’s got
some great slides if you do it that way
but you can also go to episode 140 and
you can hear that
there as well where janet pretty much
takes the entire episode to answer
that question thanks again for that
question and we’ve got a lot
more all right let’s get another
question
from the scaling up nation
my question is about legionella sampling
where is the proper location
in a cooling tower to collect your
sample
and then how is that sample procedure
performed nation and searching
are scaling up h2o archives i think
janet answers this question
perfectly so if you will listen with me
as i take a sampling from episode
121 in the case of a cooling tower
what you want to do is answer the
question is the water treatment program
working to control legionella so you
don’t
collect the sample right where you added
the biocide
and right after you’ve added the biocide
you
collect the sample right before the next
dosing and away from where the dosing is
occurring
that tells you whether or not the
program is controlling legionella and
whether you need to make any adjustments
to that
so that’s how you collect the sample the
method of testing
what you want to make sure and remember
you know there’s a lawyer on my shoulder
what you want to make sure is that
you’re doing a standard method
in an accredited laboratory that knows
how to do
microbiology so you don’t want to be
doing legionella testing in your garage
you want it to be done
by people who are professionals why
because they will give you the right
result not just
a result right and it’s defensible
right always with the little lawyer on
my shoulder so
that’s a decision that you have to make
who’s going to be doing the testing and
what
method and it should be in an accredited
laboratory
you know there’s all kinds of
requirements for a laboratory for
accreditation and proficiency
to demonstrate that the methods that are
being done and by the people that are
doing them
are too standard and for legionella
standard culture is the gold standard
and of course i’ve mentioned before
janet stout is a friend
of the show great member of the scaling
up nation
great resource of knowledge when it
comes to
legionella she of course calls herself
a legionelogist so she has her phd
in legionelogy folks if you search back
through our archives
just like i did you’re going to find so
much
information of course this month we’re
just talking about legionella
and just talking about legionella i
think i already mentioned episode 140
where we’re talking about reopening
buildings
janet where i took the sampling was
episode 121 but she also was on the
previous
episode 120. we were talking all about
legionella we were talking about
how ashrae had updated their document
we had matt ferrigi come on on episode
83 and he talked all about
water management plans and folks the
list goes
on and on and on so i encourage you to
go
on scaling up h2o.com get on the search
bar
search for a topic that you are looking
for
and it’s going to pop up and you can
learn some more information
about it let’s go ahead and listen to
our next question
hey trace how you doing it’s chris
golden from taylor could you do me a
favor and explain the mechanism of how
legionella
can get into a system through the
drinking water municipal water system
thanks for all you do bud bye chris
thanks for that question
so many times we think or our customers
think
that if there’s legionella in water it
must mean that
something has failed and that’s not the
case
we need to look at the bacteria itself
and the fact of the matter is that that
bacteria legionella bacteria
is naturally occurring in fresh water
sources
so our drinking water it’s
it comes right in with that of course
our municipalities
do some things to sterilize but there
are long
runs that go throughout from where they
uh make the water safe for us to drink
to where they pump it to where we can
actually drink it
there are so many miles of piping
and of course that disinfection wears
off and then biofilm occurs
and we are bringing legionella into
the drinking water that we are bringing
into the system
now is that a huge deal well let’s look
at that
we know that legionella is naturally
occurring in fresh
water systems so why is it such a big
deal when it gets
into our facility systems
well that’s the issue we’ve now done
something with the water it’s now not in
a lake river or stream
it’s in a building system where it’s not
necessarily flowing and it can continue
to grow
so in lower populations probably not
that big of a concern
but as it continues to grow as it
continues to multiply
and then we put it into systems
that give it a delivery process where we
can
vaporize it we can turn it into a mist
and now we’re inhaling that
we’re getting it into our bodies and
that’s the concern
so it’s not that when we have a
legionella
management plan a water management plan
that we will never have legionella ever
ever ever
again folks that is impossible what a
plan states is that we realize that
legionella
is coming in with the water that we’re
getting from the city
because it’s it’s naturally occurring
but when it does
because we know it is we’re going to
test for it and we’re not going to allow
it to
multiply freely and then
just see what happens we’re going to
test for it when it gets to a certain
range
when we detect it we are going to knock
it down
with some sort of disinfection tool
we’ve talked about
several of them here today and we’re
going to continue talking about that
so chris i hope that answers the
question
and i think that’s where the term
legionella
is ubiquitous and then we hear a
customer says well if legionella’s all
around us
why do i need to test well that’s the
answer to that question you need to test
because we’re
changing the legionella that would be in
a lake river or stream and now we’re
cramming it into a system where it can
eat
grow and multiply and that
is the issue let’s listen to our next
question
during this time if you are a copenhagen
patient and have
uh contracted coronavirus uh are you
then more vulnerable trace to
legionnaires disease that does that put
you
at a higher risk or similarly vice versa
if you have legionnaires
are you more you know more susceptible
to coping 19
when we first started out legionella
awareness month
i gave a very high level view
of what the symptoms are with
legionnaires disease and a lot of you
had written in and said hey that sounds
maybe even similar to
the covid 19 symptoms
how do we tell them apart and folks
that’s really an issue right now
doctors are looking for covid19
i’m not sure how much they’re looking
for
legionnaires disease but the question
was
are you more susceptible if you’ve had
coven 19 to get legionnaires disease
and vice versa well on that first
episode this month
we talked about the people that are at
most risk
for legionnaires disease are
immunocompromised
individuals now the fact is we do
not know what the long-term effects of
covid19
are a lot of people make speculation but
folks let’s face it right now that’s all
it is
is speculation we’re going to learn as
we
live through this together as we have
everything
with covid 19. but if it does
weaken the immune system sure that’s
going to put you
in a more risk category
for legionnaires disease especially if
if you’re
getting exposed to that now people that
have had legionnaires disease well that
is a pneumonia folks that has to do
damage to your lungs so that’s meaning
that you’re also
immunocompromised based on that even if
you do
recover now the body is remarkable how
it
can recover from illnesses
but i would think that you
would also be more susceptible for
covin 19. so as i get more information
i will definitely share it with you i
did reach out to a couple of doctors and
unfortunately
they were not able to get back with me
in time for the airing of this episode
so as more information becomes available
i will be happy to share it with you
our next question comes from a person
that
runs a hospital system and
they want to know what is the best
course of action when legionella is
detected
what type of disinfection should they
use
so i asked my good friend brian waymeyer
to weigh
in on what the options are thanks for
the question
uh so the first part of the question is
how do you determine which secondary
disinfection program to use
well right now there’s pretty much four
main secondary disinfection
systems out there so there’s
monochloramine which is the santa pure
system
that can do the hot water there is
chlorine dioxide which i think there’s a
couple different manufacturers out there
copper silver which has its own issues
and then
good old-fashioned just you know sodium
hypochlorite or chlorine
and the second is you know with the
feedback available which disinfectant
shows the best long-term success
well i guess the jury would always be
out on that we’ve had a lot of good
success with monochloramine systems
uh you know the santa pure system is is
very good they are uh you know out of
uh baltimore very good company and it’s
it’s been shown to work very well
but it’s not always what i call a silver
bullet so there’s not a silver bullet
with any four of them
uh as i always will say a really good
water management plan
along with a secondary disinfection
system uh will go a long way
however i will caution everybody to make
sure that they do their homework
on those secondary disinfection systems
and the regulations within each state
each state has its own
uh certain regulations for instance uh
pennsylvania requires a licensed
operator to
as install any secondary disinfection
system
so cost wise you know most of them
for copper silver chlorine dioxide
monochloramine they’re they are
priced pretty much in the same range
uh depending on how big your system is
chlorine sodium hypochlorite is usually
of course you know the least expensive
but corrosion issues are always going to
be an issue with
all three of them except for the copper
silver
we have to i guess there’s some probably
some corrosion studies out there
and the last thing he says cost should
be also considered but overwrite other
considerations
well as i said that secondary
disinfection system though states
finding a license operator can be very
cost prohibitive
we did do a quote in pennsylvania for
a monochloramine system that required
a operating permit to do that system and
it was somewhere in the
150 thousand dollars to install and then
the operations
it was almost three thousand dollars a
month for that operator so hopefully
those answer some of your questions
well thanks so much for that brian of
course this month we learned
some different tests i know a lot of you
are using
different types of legionella tests out
there besides the culture
method and with that you have
contacted me and said you had some more
questions so i invited my friend
of course we’ve heard her several times
on the show already janet thank you so
much for all you do
she’s going to answer a couple of
questions that
you had so here’s dr janet stout once
more
well qpcr stands for quantitative
polymerase
chain reaction and qpcr
measures the amplification of a dna
sequence or a gene it measures
how many copies are made and how many
copies are made is dependent on how many
legionella bacteria
were in the sample to start with so for
example
if there were fewer legionella bacteria
to start with
it would require more cycles of
amplification
in order to reach a certain threshold of
detection
if there are more legionella bacteria in
the sample to start
then the threshold is reached faster we
can
use this to estimate the quantity
hence the q in qpcr the quantity of
legionella in the sample
so the accuracy of qpcr is totally
dependent on the sequence
of that gene that we’re using to probe
for the bacteria and we have found
that when you’re probing for the whole
genus
multiple species qpcr
is vulnerable to false positivity and
you’ve also heard of
the fact that pcr detects both dead and
live legionella
so there are little tricks to doing it
effectively
in our hands we’ve found the qpcr for
legionella neumophila
and legionella nemophila serogroup 1 to
be
very accurate so that’s why we do
that test just for legionella nemophila
yes no and specifically for legionella
anemophilus 0
1. so i hope that helps you understand
what exactly is qpcr
thank you so folks hopefully those terms
mean a little bit more now and you now
know where you can start using
those tests now uh jenna’s going to
answer
another question where we learn more
about these rapid tests
so now let’s hear a little bit more on
that from dr janet stout
here’s another good question what is the
advantage
of a quick legionella test well besides
stating the obvious that it’s fast
the question of kind of what’s the
advantage
has to do with how accurate that test is
and the accuracy in scientific terms is
is discussed as sensitivity and
specificity
what that means is is it truly positive
or is it truly negative
many of the quick tests suffer from lack
of
sensitivity meaning it’s legionella’s
there but they’re not detecting it
and some suffer from a lack of
specificity meaning that
they’re picking up something else giving
a false
positive it’s not really truly negative
so the answer to the question is you
have to know and delve a little bit
deeper
into the particular test to know how
sensitive and specific that test is and
if there are any problems for example
with false positivity
that could be a big problem like yelling
fire in a theater when there’s no fire
scale up nation again i want to thank
you for
thinking of what you did not know this
month
in legionella awareness month of course
we’re celebrating legionella awareness
month because of the legionella
conference that the
nsf normally has that pretty much this
very week
but they’ve postponed that to january
surprise another conference that has
been changed folks it’s just the time
that we live in 2020
what a year so but it is it is my hope
that you are continuing to learn you’re
continuing to ask each other questions
you’re continuing to educate everybody
around you that
needs to understand legionella bacteria
and legionnaires disease and i hope
if we do this next year
that we can report that we are just
such an educated society
that we are so low on legionella cases
legionnaires disease cases that it’s
just something we do
it’s just something we test but somebody
hardly gets sick because we start with
that good information
and we make better decisions from there
as i mentioned we got a lot of things
coming up
we’ve got tom branvold next week he’s
going to be sharing
everything you wanted to know but we’re
afraid to ask about
the virtual event that awt is having
instead of a
live conference and folks don’t just say
you’re not coming because it’s not going
to be a live conference
trust me there is going to be
reasons for you to be there and there
are going to be tools to allow you to
take advantage of things that you have
never been able to take advantage of
before
until the meantime which is next week
next friday when i bring you a brand new
episode
please continue learning and do
something
different to help us end
legionnaire’s disease have a great week
folks
[Music]
scouting up nation on episode 136 i
invited four members of the rising tide
mastermind to tell the scaling up nation
a little bit about being a member of the
rising tide mastermind
i asked conor parish to explain what our
weekly meeting
looks like and here’s what he said every
week we
are are able to meet and i think it’s
great that we do it weekly because it
keeps us
accountable but every week we meet for
an hour and it’s very structured that
hour
we come in and we check in to see is
there anything that
we need to follow up on our report to
the group from an accountability
standpoint that we
said we would get done by a certain date
and the nice thing is we
we record that and then follow up each
week to make sure
everyone is achieving what they were
supposed to do if we had reading
one of the things that’s nice about this
is we have a sign reading for books that
it’s not too cumbersome if you don’t
like to read but i think there’s a lot
of value
and the pace is great so we will discuss
any key points from the reading there at
the beginning and kind of work on some
general
you know housekeeping and then from
there we really start to dive in
uh to what we call being in the middle
which is where one of the members of the
group
each week comes with a problem that they
want to present
so this starts by that member describing
the problem
to the group and then indicating you
know what
is the goal that they want to accomplish
from you know the discussion that’s
about to ensue
so from there everyone will then spend
maybe 20 minutes or so asking clarifying
questions in which
everyone is doing exactly that asking
questions and the person in the middle
then
responds there’s no back and forth
dialogue at this point it’s just
clarifications
and then from there once we feel as a
group that the problem is
understood and all the questions are
answered we move forward
to providing recommendations each member
of the group
then you know gives them insight and
some feedback based on what
they heard to the person in the middle
who finally then kind of compiles all of
that advice
and says okay this is this is what i’m
taking away from the advice of the group
and here’s what you can expect from me
as far as
tackling the problem and hopefully
resolving it within the next couple
weeks depending on the scale the problem
well nation there’s the secret sauce
that is the format
of our meeting and it’s all about
getting where we’re going
faster but it’s also about making sure
we’re starting out in the right
direction
when was the last time you asked
yourself what was important to you
and are you doing the things that are
going to make those important things
happen those are the things that we’re
discussing in the rising tide
mastermind and can you imagine how much
more successful you would be
if you had a boardroom of people
helping you with your issues letting you
know what your blind spots are
and holding you accountable to get the
things
done you said were important
to you go to scaling up h2o.com forward
slash
mastermind to see if the rising tide
mastermind
is right for you and if it’s not
it’s okay but please find a group
that is right for you we are not built
to do life alone