<h6>Feature Article</h6><h1 style="color: #00b1bf;"><span class="slider-header-bold" style="color: #00b1bf;">Case Study #2:</span> Legionella prevention: How to effectively remove Legionella from drinking water</h1><p class="blog-subhead">Efficacy assessment of the Ecas4 Water Disinfection System - related to the decrease of Legionella contamination in a drinking water heating system.</p> <img class="blog-image-main" src="https://www.ecas4.com.au/wp-content/uploads/2016/03/Case-Study-2_Image-1.jpg"> <h5>Case Study 2: St. Marien Hospital in Bonn</h5> <p class="intro-para">In this edition we continue to reveal the efficacy assessment of the Ecas4^® Water Disinfection System, through real life cases of reduced Legionella contamination in the drinking water heating systems of St. Marien Hospital in Bonn.<p> <h3>Background</h3> <p>The highly ramified and extended water piping of St. Marien Hospital in Bonn had been periodically inspected for Legionella in the past. The concentration of Legionella found in the hot water system repeatedly exceeded the recommendations contained in DVGW W 551. In order to temporarily reduce the concentration of Legionella, the hot water systems were periodically heated to higher temperatures; the issuance of hot water (over 70°C) from all taps in order to eliminate all contaminations was not possible for logistic reasons. Since continuous temperature increase was not feasible for economic and technical reasons, it was chosen to install an Ecas4 Water Disinfection System (WDS) positioned in the cold water station of the hospital to lower the concentration of Legionella to beneath the recommended threshold of 100 cfu/100 ml.</p> <h3>Methods</h3> <p>According to the manufacturer’s indications, the Ecas4 WDS produces an active ‘Anolyte’ substance which is injected in a concentration by volume of 0.3-0.8% directly into the water subjected to the treatment. This Ecas4‑Anolyte is produced on-site via an electrochemical process from a 0.5% sodium chloride solution (a saturated solution of salt and softened water). The Anolyte is collected in a back-up container and then injected into the pipes by a piston membrane dispensing pump in proportion to the amount of water subjected to the treatment. The dispensing operation is monitored by a contact water meter. By means of the implemented control functions (electrical conductivity, electrical current constancy), the manufacturer ensures the correct operation of the 0.5% sodium chloride solution and production of Ecas4-Anolyte.</p> <h3>Results</h3> <p>A decrease in the concentration of Legionella at all taps was found immediately after installing the disinfection system in the drinking water heating system of the central building/paediatric ward.</p> <img class="blog-image" src="https://www.ecas4.com.au/wp-content/uploads/2016/03/Case-Study-2_Table.jpg"> <p class="image-caption"><span class="image-caption-header">Table:</span> Results of Legionella monitoring in St. Marien Hospital during the installation of the Ecas4 Water Disinfection System (Sampling temperatures 43-58°C)</p> <p>Follow-up measurements taken after one month and after three months confirmed the success of the intervention. It was suggested to keep the Ecas4 WDS running in the building in the future and to monitor system efficiency at longer intervals. The positioning of the system in the cold water station was too far away from the target, i.e. the drinking water heating system of the central building/paediatric ward. As per §11 of the “Trinkwasserverordnung 2001” [German Drinking Water Code], the required concentrations of Ecas4 Anolyte in the cold water would not be allowed on in the long term. Alternatively, a possible treatment with a lower concentration of Anolyte for a longer time was deemed not advisable due to the waiting time and the high concentration of Legionella. After starting up the Ecas4 WDS, efficiency with considerably lower concentrations of Anolyte was obtained, supporting the initial hypothesis of being able to provide appropriate metering by using two separate systems.</p> <p>A decrease in concentration is currently in progress to ensure a maximum value of 0.3 mg/l of free chlorine at all taps as determined by the “Trinkwasserverordnung 2001”. According to our experience, this objective is feasible: long term success will be validated by further controlled monitoring.</p> <h3>Conclusions</h3> <p>As this analysis shows, it was possible to considerably decrease the concentrations of Legionella bacteria in the hot water piping of the central building/paediatric ward by means of 0.2 - 0.5 mg/l concentrations of Ecas4-Anolyte (measured as free chlorine).</p>

<h5>This article was featured in The Australian Hospital Engineer Journal, Spring 2014 (pg 40-41)</h5> <p><em>The Australian Hospital Engineer is the official journal of the Institute of Hospital Engineering Australia (IHEA). </em></p> <p><em>The IHEA is the relevant professional organisation for engineers and engineering facility managers employed in the private and public health care sectors, from the smallest to the largest facility, as well as consultants engaged in related work.</em></p>

<h6>Feature Article</h6><h1 style="color: #00b1bf;"><span class="slider-header-bold" style="color: #00b1bf;">Case Study #1:</span> Legionella prevention: How to effectively remove biofilm in cold, warm or hot water pipe systems</h1><p class="blog-subhead">Evaluation of two disinfection systems for Legionella eradication from a hospital water supply.</p> <!-- [et_pb_line_break_holder] --><img class="blog-image-main" src="https://www.ecas4.com.au/wp-content/uploads/2016/03/Case-Study-1_Image-1.jpg"><!-- [et_pb_line_break_holder] --><h5>Case Study 1: Hospital of Asti<br>Amedeo di Savoia Hospital, ASL TO2, Turin, Italy</h5> <p class="intro-para">Recent outbreaks of Legionella in healthcare facilities and commercial buildings around Australia have raised valid concerns that existing Legionella management systems may not be as effective as once thought.</p> <p>The active ingredient in Ecas4 (Electro-chemical anolyte solution) is hypochlorous acid, which is 80 times more effective than sodium hypochlorite in eliminating Legionella. Ecas4 also requires significantly less contact time to inactivate this harmful pathogen. Ecas4 both eliminates and prevents the biofilm that acts as the Legionella host in water piping systems, therefore providing superior eradication with less ongoing maintenance than is necessary for many existing water treatment systems.</p> <p>In this issue and the next, we will present the outcomes of two real life hospital water management case studies in which Ecas4 has been applied, in both new and existing facilities.</p> <h3>Background</h3> <p>Nosocomial infections are prevented using control measures against Legionella proliferation in the water distribution system. However, complete elimination of the bacteria has proved to be difficult to achieve with any disinfection approach. In this study the efficacy of two continuous dosing methods for the eradication of Legionella from a hospital water supply has been evaluated and compared.</p> <h3>Methods</h3> <p>Both approaches requires the continuous dosing of a biocide into the water system: System 1 involves the use of an electrochemically activated water (ECAS anolyte), containing hypochlorous acid at a neutral pH, while method 2 refers to a solution of hydrogen peroxide and silver. It is worth mentioning that the latter approach is not always applicable – for example, it is not permitted by German legislation, for the continuous treatment of drinking water.</p> <p>The two continuous disinfection systems were installed in the hospital in two distinct water supplies, both located after the hot water tank but before its distribution. Seven points within each water system were chosen for analysis. Before systems installation, two samplings were performed; after installation and the beginning of the disinfection procedures, eight samplings were periodically performed for five months. A total of seventy samples were analyzed for each system. Cultures were performed following a standard quantitative protocol (detection limit: 20 cfu/L).</p> <p>Samples (5 litres each) were concentrated by filtration; then, the washed suspensions were plated on BCYE, BMPA and MWY, incubated at 37°C for 15 days, to allow Legionella colonies counting and typing.</p> <h3>Results</h3> <p>System 1: Pre-treatment samples from water supply 1 showed Legionella contamination of 60-180 cfu/L in hot water tank and of 300-16000 cfu/L in distal points. After starting the continuous disinfection treatment (free chlorine 0.3-1.2 mg/L, mean 0.6 mg/L) all samples were negative.</p> <p>System 2: Pre-treatment samples from water supply 2 showed 180-24000 cfu/L. After starting the disinfection, at the level of 2 mg/L of hydrogen peroxide, the contamination was 20-15000 cfu/L; during the observation period the product showed variable concentrations and only in the second-last sampling, with higher concentration of product, the culture was negative. However, the contamination appeared again in the last sampling, with values up to 600 cfu/L.</p> <h3>Conclusions</h3> <p>System 1 proved to be effective in eradicating Legionella from the hospital water supply, with free chlorine concentration > 0.2 mg/L (level suggested by Italian legislation 0.2 mg/L). System 2, based on hydrogen peroxide and silver, was not efficient, at least at the concentration proposed by the manufacturer. For systemic disinfection modalities, the disinfectant levels must be carefully monitored.</p> <h3>Summary of results</h3> <p>After the six-month research at one of the twelve hot water circuits of the large Hospital of Asti, as documented by the adjacent report, the medical management decided to install the ECAS-Anolyte system on all hot water systems. The works were realized in October/November 2008. The experiences and current samplings were published in November 2009 at a congress of the ISS (National Institute of Health) in Rome by R.Broda – Health Department, Hospital of Asti and F. Migliarina – Technical Management, Hospital of Asti, entitled Prevention and control of legionellosis: experiences from the Hospital of Asti.</p> <h5>Tables: Amount of Legionella in hot water supply line, hot water return line and on defined points-of-use in the building in the period October 2008 - June 2009.</h5> <img class="blog-image" src="https://www.ecas4.com.au/wp-content/uploads/2016/04/Case-Study-1_Table-1.jpg"><p class="image-caption"><span class="image-caption-header">Table 1:</span> Hot water supply</p> <img class="blog-image" src="https://www.ecas4.com.au/wp-content/uploads/2016/04/Case-Study-1_Table-2.jpg"><p class="image-caption"><span class="image-caption-header">Table 2:</span> Hot water return</p> <img class="blog-image" src="https://www.ecas4.com.au/wp-content/uploads/2016/04/Case-Study-1_Table-3.jpg"> <p class="image-caption"><span class="image-caption-header">Table 3:</span> Sampling point-of-use hot water distribution</p>

<h5>This article was featured in The Australian Hospital Engineer Journal, Winter 2014 (pg 38-39)</h5> <p><em>The Australian Hospital Engineer is the official journal of the Institute of Hospital Engineering Australia (IHEA). </em></p> <p><em>The IHEA is the relevant professional organisation for engineers and engineering facility managers employed in the private and public health care sectors, from the smallest to the largest facility, as well as consultants engaged in related work.</em></p>