Copper-silver ionization is a disinfection process, primarily used to control Legionella , the bacteria responsible for Legionnaires' disease. There is strong evidence that treating water supplies in hospitals with this technique decreases the risk. [1]
Ionization can be an effective process to control Legionella in potable water distribution systems found in health facilities, hotels, nursing homes, and large buildings. In 2003, ionization became the first such hospital disinfection process to have fulfilled a proposed four-step modality evaluation; by then it had been adopted by over 100 hospitals. [2] Additional studies indicate ionization is superior to thermal eradication. [3]
A 2011 review found copper-silver ionization to be the only Legionella control technology which has been validated through a proposed four-step modality evaluation (need reference or description of "modality" in this context since it does not apply in all situations). [4]
Copper-silver ionization technology is recognized by the World Health Organization (WHO), the U.S. Environmental Protection Agency (EPA) to control Legionella within potable water distribution networks found in hospitals, hotels and other large type facilities. The level of ions generated has been reported to be usually below EPA Safe Water Drinking Act Lead and Copper Rule AL for copper. [3] The AL for copper in potable water is 1.3 ppm (Cu) and the SCL for silver is 0.1 ppm (Ag) (which is the same as 100 ppb).
It is important to collect and handle samples correctly in order to get accurate results. Suboptimal timing of specimen shipment for testing at reference laboratories may contribute to silver concentration above recommendations. [2] Industry leaders who manufacture copper-silver ionization technology recommend a copper concentration of 0.2 to 0.8 ppm and a silver concentration of 10 to 80 ppb, which are compliant with EPA drinking water standards. [5]
The British Health and Safety Commission regulates U.K. ionization, advising regular system monitoring to ensure ions reach all water circuits. Also, copper in drinking water is limited to 2 ppm (mg/L) by the European Community whereas Legionella control only requires 0.2 to 0.8 ppm in concentration...well below the permissible limits. Headquarters (ECH) in Brussels, Belgium, and silver is not prescribed by the ECH. [6]
The EU limits copper to 1.0 ppm—lower than the USA copper AL of 1.3 ppm. The EU does not have any guidelines for ionic silver concentrations—the US SCL is 0.1 ppm (100 ppb).
In February 2012, the European Commission issued a non-inclusion decision regarding the use of copper as a biocide in Europe. [7] This decision was based on a failure of industry to supply the commission with required information regarding copper and was not based on health or efficacy concerns. In response to this decision, five member states—Spain, the UK, Norway, Poland, and the Netherlands—have applied to the commission to allow for the continued use of copper as a biocide in their respective nations. [8]
In addition, the UK authority, the HSE, has issued a statement stating that the derogation application for the UK has been informally granted. [9] Industry has responded by forming a Taskforce to ensure full and long term compliance with the regulatory issues facing copper in the EU. [10]
Copper-silver ionization disperses positively charged copper and silver ions into the water system. [6] The ions bond electrostatically with negative sites on bacterial cell walls and denature proteins. [2] Over the long term, the presence of copper and silver ions destroy biofilms and slimes that can harbor Legionella , the bacteria responsible for Legionnaires' disease (legionellosis). [6] It can take 30 to 45 days for the copper and silver ions to penetrate a biofilm.
Flow cells (part of the ionization unit) should be cleaned periodically to maintain the system. In a hospital that is not defined as a public water system, this task may be delegated to the facility's utility engineers. [5] If a hospital is defined as a public water system, the maintenance personnel may be required to have a State-issued water treatment license. In the US, different states have specific regulations for hospitals and drinking water treatment that should be reviewed before going forward with installation of copper-silver ionization.[ citation needed ]
Forensic scientist Randy Fornshell of the Sedgwick County Regional Forensic Science Center explains that copper-silver ionization is a modern implementation of the ancient Greek practice of reducing bacteria in wine vessels by lining them with silver, and controlling algae and fungi with copper. Fornshell notes that copper-silver ionization has been effective in swimming pools (it is an alternative to chlorine) and is becoming adopted by larger municipalities. [11]
Replacing chlorination with copper-silver ionization to keep water safe was one response of Frederick Memorial Hospital, Frederick, Maryland, to new requirements in the 2001 Guidelines for Design and Construction of Hospital and Healthcare Facilities, issued by the American Institute of Architects. [12] Ionization is in many cases installed because more convenient and cost-effective than other approaches. [2]
It is possible to operate copper-silver ionization without exceeding the copper Action Level (AL) and silver secondary maximum contaminant levels (SMCLs) set by the U.S. Environmental Protection Agency in the Safe Water Drinking Act's Lead and Copper Rule (Title 40, Code of Federal Regulations, 40 CFR) in Part 141, Subpart I; and 40 CFR Part 143, respectively.[ citation needed ]
Legionella is a genus of pathogenic gram-negative bacteria that includes the species L. pneumophila, causing legionellosis including a pneumonia-type illness called Legionnaires' disease and a mild flu-like illness called Pontiac fever.
Water purification is the process of removing undesirable chemicals, biological contaminants, suspended solids, and gases from water. The goal is to produce water that is fit for specific purposes. Most water is purified and disinfected for human consumption, but water purification may also be carried out for a variety of other purposes, including medical, pharmacological, chemical, and industrial applications. The history of water purification includes a wide variety of methods. The methods used include physical processes such as filtration, sedimentation, and distillation; biological processes such as slow sand filters or biologically active carbon; chemical processes such as flocculation and chlorination; and the use of electromagnetic radiation such as ultraviolet light.
Indoor air quality (IAQ) is the air quality within and around buildings and structures. IAQ is known to affect the health, comfort, and well-being of building occupants. Poor indoor air quality has been linked to sick building syndrome, reduced productivity, and impaired learning in schools. Common pollutants of indoor air include: Secondhand tobacco smoke, air pollutants from indoor combustion, radon, molds and other allergens, carbon monoxide, volatile organic compounds, legionella and other bacteria, asbestos fibers, carbon dioxide, ozone and particulates. Source control, filtration, and the use of ventilation to dilute contaminants are the primary methods for improving indoor air quality in most buildings.
Tap water is water supplied through a tap, a water dispenser valve. In many countries, tap water usually has the quality of drinking water. Tap water is commonly used for drinking, cooking, washing, and toilet flushing. Indoor tap water is distributed through indoor plumbing, which has existed since antiquity but was available to very few people until the second half of the 19th century when it began to spread in popularity in what are now developed countries. Tap water became common in many regions during the 20th century, and is now lacking mainly among people in poverty, especially in developing countries.
Chlorine dioxide is a chemical compound with the formula ClO2 that exists as yellowish-green gas above 11 °C, a reddish-brown liquid between 11 °C and −59 °C, and as bright orange crystals below −59 °C. It is usually handled as an aqueous solution. It is also commonly used as a bleach. More recent developments have extended its applications in food processing and as a disinfectant.
A disinfectant is a chemical substance or compound used to inactivate or destroy microorganisms on inert surfaces. Disinfection does not necessarily kill all microorganisms, especially resistant bacterial spores; it is less effective than sterilization, which is an extreme physical or chemical process that kills all types of life. Disinfectants are generally distinguished from other antimicrobial agents such as antibiotics, which destroy microorganisms within the body, and antiseptics, which destroy microorganisms on living tissue. Disinfectants are also different from biocides—the latter are intended to destroy all forms of life, not just microorganisms. Disinfectants work by destroying the cell wall of microbes or interfering with their metabolism. It is also a form of decontamination, and can be defined as the process whereby physical or chemical methods are used to reduce the amount of pathogenic microorganisms on a surface.
A cooling tower is a device that rejects waste heat to the atmosphere through the cooling of a coolant stream, usually a water stream, to a lower temperature. Cooling towers may either use the evaporation of water to remove process heat and cool the working fluid to near the wet-bulb air temperature or, in the case of dry cooling towers, rely solely on air to cool the working fluid to near the dry-bulb air temperature using radiators.
An antimicrobial is an agent that kills microorganisms (microbicide) or stops their growth. Antimicrobial medicines can be grouped according to the microorganisms they act primarily against. For example, antibiotics are used against bacteria, and antifungals are used against fungi. They can also be classified according to their function. The use of antimicrobial medicines to treat infection is known as antimicrobial chemotherapy, while the use of antimicrobial medicines to prevent infection is known as antimicrobial prophylaxis.
The oligodynamic effect is a biocidal effect of metals, especially heavy metals, that occurs even in low concentrations.
Waterborne diseases are conditions caused by pathogenic micro-organisms that are transmitted in water. These diseases can be spread while bathing, washing, drinking water, or by eating food exposed to contaminated water. They are a pressing issue in rural areas amongst developing countries all over the world. While diarrhea and vomiting are the most commonly reported symptoms of waterborne illness, other symptoms can include skin, ear, respiratory, or eye problems. Lack of clean water supply, sanitation and hygiene (WASH) are major causes for the spread of waterborne diseases in a community. Therefore, reliable access to clean drinking water and sanitation is the main method to prevent waterborne diseases.
Portable water purification devices are self-contained, easily transported units used to purify water from untreated sources for drinking purposes. Their main function is to eliminate pathogens, and often also of suspended solids and some unpalatable or toxic compounds.
Swimming pool sanitation is the process of ensuring healthy conditions in swimming pools. Proper sanitation is needed to maintain the visual clarity of water and to prevent the transmission of infectious waterborne diseases.
Vaporized hydrogen peroxide (trademarked VHP, also known as hydrogen peroxide vapor, HPV) is a vapor form of hydrogen peroxide (H2O2) with applications as a low-temperature antimicrobial vapor used to decontaminate enclosed and sealed areas such as laboratory workstations, isolation and pass-through rooms, and even aircraft interiors.
Drinking water quality in the United States is generally safe. In 2016, over 90 percent of the nation's community water systems were in compliance with all published U.S. Environmental Protection Agency (EPA) standards. Over 286 million Americans get their tap water from a community water system. Eight percent of the community water systems—large municipal water systems—provide water to 82 percent of the US population.
Antimicrobial copper-alloy touch surfaces can prevent frequently touched surfaces from serving as reservoirs for the spread of pathogenic microbes. This is especially true in healthcare facilities, where harmful viruses, bacteria, and fungi colonize and persist on doorknobs, push plates, railings, tray tables, tap (faucet) handles, IV poles, HVAC systems, and other equipment. These microbes can sometimes survive on surfaces for more than 30 days.
An antimicrobial surface is coated by an antimicrobial agent that inhibits the ability of microorganisms to grow on the surface of a material. Such surfaces are becoming more widely investigated for possible use in various settings including clinics, industry, and even the home. The most common and most important use of antimicrobial coatings has been in the healthcare setting for sterilization of medical devices to prevent hospital associated infections, which have accounted for almost 100,000 deaths in the United States. In addition to medical devices, linens and clothing can provide a suitable environment for many bacteria, fungi, and viruses to grow when in contact with the human body which allows for the transmission of infectious disease.
Water chlorination is the process of adding chlorine or chlorine compounds such as sodium hypochlorite to water. This method is used to kill bacteria, viruses and other microbes in water. In particular, chlorination is used to prevent the spread of waterborne diseases such as cholera, dysentery, and typhoid.
Legionnaires' disease is a form of atypical pneumonia caused by any species of Legionella bacteria, quite often Legionella pneumophila. Signs and symptoms include cough, shortness of breath, high fever, muscle pains, and headaches. Nausea, vomiting, and diarrhea may also occur. This often begins 2–10 days after exposure.
Diving equipment may be exposed to contamination in use and when this happens it must be decontaminated. This is a particular issue for hazmat diving, but incidental contamination can occur in other environments. Personal diving equipment shared by more than one user requires disinfection before use. Shared use is common for expensive commercial diving equipment, and for rental recreational equipment, and some items such as demand valves, masks, helmets and snorkels which are worn over the face or held in the mouth are possible vectors for infection by a variety of pathogens. Diving suits are also likely to be contaminated, but less likely to transmit infection directly.
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