<h6>Feature Article</h6><h1 style="color: #00b1bf;"><span class="slider-header-bold" style="color: #00b1bf;">Case Study #3:</span> Legionella prevention: How to effectively remove pathogens from the water network</h1><img class="blog-image-main" src="https://www.ecas4.com.au/wp-content/uploads/2016/05/Case-Study-3_Image-2.jpg"><h5>Case Study 3: Ospedali Riuniti Marche Nord, Pesaro (Italy)</h5> <h3>Background</h3> <p>In October 2013, the Technical Manager (TM) of Ospedali Riuniti Marche Nord, a cluster of three hospitals in the province of Pesaro, contacted the group of Electrochemistry of the University of Ferrara (Italy). The TM wrote on behalf of his company, asking for an opinion on the so-called “anti-Legionella” systems.</p> <p>At that time, the Medical Direction was thinking to acquire a device for the continuous dosing of monochloramine; however, in order to select the best equipment, they desired to understand the characteristics of the many systems available on the market.</p> <p>The University of Ferrara was thus contacted on account of the presence in the literature of scientific contributions in support to a specific knowledge of that research team on the issue of disinfecting solutions prepared by means of electrochemical devices. The TM declared to have received the following answer:</p> <p><em>Water can be treated by using different oxidizing agents: chlorine dioxide, hypochlorite (usually the sodium salt), also in its neutral version (the so-called “anolyte”), ozone, chloramines and UV radiation are among the best known and applied. Typically, each of them has advantages and disadvantages. Chlorine dioxide and chloramines are typically considered because they do not lead to the formation of trihalomethanes. However, the former is highly dangerous for the infrastructures (it is corrosive for pipes, either in metal or in plastic) and the treated water is inevitably contaminated with chlorite (actually, ClO2 is synthesized by reaction between a chlorite salt and a strong acid). On the contrary, chloramines are slightly efficient oxidizers: to obtain disinfection, they must be added at concentrations 25 times higher than the dose needed by using active chlorine.</em></p> <p><em>Ozone is an interesting disinfectant: it does not produce unwanted by-products, but is not persistent (its “life time” in water amounts to a few tens of minutes, so it is necessary to rely upon another oxidant to ensure long-term effects).</em></p> <p><em>Ultraviolet radiations (UV) have the same flaw: they are effective at the point of application but do not guarantee any residual effect; moreover, they present additional disadvantages (especially the need for UV-transparent quartz surfaces, and the difficulties in treating large volumes of water: only low thicknesses can be considered, because the radiation is readily attenuated).</em></p> <p><em>Although often “mistreated”, active chlorine is still a widely applied disinfectant; its biocide properties have been known for centuries and do not require to be mentioned here in detail. In contrast, it is worth spending a few words on the so-called “speciation” of active chlorine. In water, chlorine may be present in different forms, depending on the pH: at alkaline pH, the stable form is the hypochlorite anion; at neutral pH, hypochlorous acid predominates, while at pH values below 2, chlorine is present as dissolved gas (toxic), with a tendency to leave the aqueous environment and to enter into the surrounding environment.</em></p> <p><em>The hypochlorite anion (ClO-) has a negative charge, while hypochlorous acid (HOCl) is a neutral molecule, and is thus able to approach without difficulty to microorganisms (on the contrary, the hypochlorite anion is subject to repulsive electrostatic interaction, since also the cell membrane of microorganisms is negatively charged). HOCl can cross the cell membrane exerting its oxidizing action inside the cell, with particularly deleterious effects. Hence its great bactericidal efficacy: it is about 80 times more effective than hypochlorite.</em></p> <p><em>Even the chemical action of the two species is different: HOCl acts mainly as a “source of hydroxyl radicals”, while the hypochlorite form is unfortunately a halogenating agent (it leads to the formation of trihalomethanes, when the water to be treated contains organic substances, thus including also microorganisms).</em></p> <p><em>Contrary to hypochlorite, HOCl is not available commercially, and must be synthesized prior to use: this is the function of some electrochemical reactors for the production of the so-called “anolyte”.</em></p> <p><em>Our research team has gained specific expertise in the field, and we have contributed to the development of a reactor particularly suitable for the production of a neutral hypochlorous acid-based anolyte. The device is marketed by ECAS4, a company based in Italy, who has been working on the subject for several years (their first patent dates back to 2005, while the improved version—developed with our involvement—is of the end of 2008). You can discuss with ECAS4 the various aspects of their product.</em></p> <h3>Methods</h3> <p>Following the University’s advice, in November 2013, the Medical Direction decided to test the ECAS4 water disinfection system (WDS) at the Muraglia hospital, a healthcare facility comprising 100 beds, with an average daily consumption of cold water that amounts to about 100 m³.</p> <p>The hospital was initially managed through a chlorine dioxide system, equipped with two storage tanks (3+3 m³); during years, the system was repeatedly modified in order to optimize its functioning but results have never been satisfactory.</p> <p>In order to perform the trial, a small ECAS4 device (WDS-40, which is able to produce 40 L per hour of Anolyte) was implemented in pavilion no. 5 (ground floor). The disinfecting approach requires the continuous dosing of the anolyte in the main hot water system; in Europe, dosing is normally done at levels between 0.6 and 1.2 ppm, in order to obtain a residual biocide content of about 0.3 ppm at distal points. Starting from November 20, 2013, water samples were collected monthly from 21 different sites distributed within the three levels of the pavilion. Particular attention was focused on eight points, which were considered most significant owing to the quantity and frequency of use (blue dots in figure 1).</p> <img class="blog-image" src="https://www.ecas4.com.au/wp-content/uploads/2016/03/Case-Study-3_Image-1.jpg"> <p class="image-caption"><span class="image-caption-header">Figure 1:</span> Location of sampling points; blue dots indicate the most significant points, based on quantity and frequency of use. The top red dot highlights the location of the WDS unit at the time of the initial trial; subsequently, a second dosing unit was placed in another room (pavilion 3, not shown), in order to treat the entire healthcare facility.</p> <p>The sampling method recommended by the laboratory charged with performing the analyses (ARPAM, the Regional Environmental Protection Agency of Marche, Italy) requires collecting aliquots (1 dm³) of hot water in special containers with chlorine inhibitors, without flaming the dispenser and without allowing a preliminary flowing of water. However, starting from May 2014, the removal of excessively worn aerators and the execution of a brief flushing (about 1 min) led to more stable results, thus allowing testing the actual bacterial concentration in the hot water system.</p> <h3>Results</h3> <p>The outcome of the experimentation is summarized in table 1, which collects the results of analyses performed by ARPAM on samples taken monthly during the trial (first 7 months); subsequent withdrawals confirmed the reduction of bacteria in a stable and generalized manner, throughout the whole water network.</p> <img class="blog-image" src="https://www.ecas4.com.au/wp-content/uploads/2016/03/Case-Study-3_Table.jpg"> <p class="image-caption"><span class="image-caption-header">Table 1:</span> Results of analysis (colony forming units, per litre) performed on the water sampled from the different locations. Muraglia hospital, November 2013–June 2014. ND: Not detectable.</p> <p>The average concentration at the beginning of the trial amounted to 3.8E+4 (38,000) CFU/L, while at the end of June, 2014, the value decreased to 6.0E+1 (60) CFU/L, with a 99.8% reduction of the total bacterial charge present in the medium.</p> <p>The number of sampling points initially contaminated (i.e., with bacterial load > 100 CFU/L) was equal to 18 out of 19 (94.7%), with 5 points out of 19 (26.3%) having a bacterial load exceeding 10,000 CFU/L. At the end of June 2014, the number of contaminated points dropped to 1 out of 19 (5.3%) and in no case the threshold of 10,000 CFU/L was exceeded.</p> <h3>Conclusions</h3> <p>Based on obtained results, the ECAS4 disinfection system was brought to the attention of the Medical Direction and the Health Service, owing to a number of peculiar characteristics:</p> <ul> <li>Simplicity of construction and consequent ease of use and maintenance of the machine.</li> <li>Remote monitoring made easy on portable devices.</li> <li>Consumable materials are easily available.</li> <li>Chemical inertness, non-toxicity and broad-spectrum biocide effect of the neutral anolyte, as supported by different studies and university researches.</li> </ul> <p>After the trial, the Medical Direction of Ospedali Riuniti Marche Nord decided to install 3 machines (WDS-40), for managing the Muraglia, San Salvatore and Santa Croce hospitals, respectively.</p> <p>In the San Salvatore healthcare facility, the area of installation comprises 240 beds, with a daily consumption of cold water that amounts to about 150 m3 (two dosing units were installed, to treat both the hot and cold water systems, connected to the same WDS).</p> <p>In the Santa Croce hospital, the water treated with the ECAS4 Anolyte serves 270 beds, with an average daily consumption of cold water of about 200 m3. The hospital was initially managed with four separate systems (three of them were based on chlorine dioxide disinfection agent), which were all replaced by a single ECAS4 system.</p>

<h5>This article was featured in The Australian Hospital Engineer Journal, Autumn 2016 (pg 50-51)</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;"> How hygienically safe are your hotel rooms?</h1><p class="blog-subhead">The Ecas4 approach for a fast and effective sanitisation</p> <img class="blog-image-main" src="https://www.ecas4.com.au/wp-content/uploads/2016/05/Hotel-Rooms_Blog_Image-1.jpg"><p class="intro-para">Hotels and accommodation facilities, in general, seek to offer their guests a clean, safe and pleasant environment. Very often, however, some residual dust or grime accumulates in the most hidden places, along with the bad smells of smoke or moulds, and can bring customers to have an unpleasant experience, which casts immediate discredit to the image of the entire facility.</p> <p>The smells are caused by one or more volatile chemical compounds. Smell is an emanation transmitted mainly through the air, but generated by substances and microorganisms present on surfaces (mainly in those porous and textiles). The human olfactory apparatus is directed to perceive odours and plays a strong emotional role, providing all relevant information to our subconscious. As a result, bad odours transmit unpleasant sensations, which we tend to immediately connect with an unhealthy environment, making the experience of stay absolutely negative.</p> <p>Since guest rooms are used for most of the residence time, they turn out to be particularly sensitive and thus in need of a thorough and careful cleaning.</p> <h3>How dirty can a hotel room be?</h3> <p>Of course, the problem is not linked to cleaning in the strict sense of the word, but rather to disinfection and bacterial contamination. What are the most contaminated surfaces we can find in a hotel room? According to an investigation carried out in 2012 by some researchers of the University of Houston (Texas, USA), on the top of the list, and without any surprise, the bathroom sink and the toilet are the worst. Subsequently, among the most contaminated, and therefore less sterile surfaces (from a bacterial point of view), are the television remote control devices and lamp switches. In contrast, the headboards, curtain rods and bathroom door handles are among the cleaner surfaces, from a hygiene point of view.</p> <p>According to Katie Kirsch, coordinator of the above-cited investigation, hoteliers and housekeeping operators are currently following an ineffective and often variable regulation, which is based almost exclusively on a visual approach and is therefore ineffective in determining the level of sanitation. There are no regulatory limits for the contamination of items in hotel rooms, the study said, but its findings suggest possible health risks, especially to people with compromised immune systems. Contact with contaminated surfaces can become a vehicle for infections, thus constituting a risk of outbreaks and possible loss of further business.</p> <p>In addition to the hard surfaces taken into consideration within the investigation of the American researchers, it is quite clear that carpets and curtains may be considered among the items of furniture most sensitive, being generally characterized by a low level of hygiene (they are the preferred receptacles for dust and mites). Particular attention should be paid also to cleaning the shower heads and the filters of air conditioning systems, because very dangerous bacteria, like e.g. Legionella, can hide where there is standing water.</p> <p>However, dealing with the problem in an effective manner does not imply to abound with detergents and disinfectants: these products should be used in adequate amounts, as their abuse could increase the resistance of microbes to them.</p> <h3>The Ecas4 Solution</h3> <p>Our proposal has a simple name: Ecas4. It means Engineering for health & hygiene, and comprises two parts: “ECAS” is the acronym for “electrochemically activated solution” and “4” refers to the unique, patented design of our electro-chemical reactor, which contains four chambers and a special hydraulic management, in order to produce a consistently pH-neutral aqueous disinfectant. The solution’s active agent is Hypochlorous acid (HOCl), the product that is also synthesized in the human body when we have to fight infections caused by different invading pathogens. Since HOCl is an oxidizer with cytotoxic properties (i.e., a biocide), microorganisms are not able to develop a specific resistance.</p> <p>HOCl is a potent chlorine-based biocide, but it does not possess the characteristics and the harmfulness of common chlorine-based sanitizers. In particular, the Ecas4 anolyte solution contains it at very low concentrations (< 0.05%) and the neutral pH of the solution is essential to make it an effective disinfectant (about 80 times more powerful than bleach). On the other hand, the product does not possess a very long stability, especially when in contact with organic substances and/or exposed to sunlight; under these conditions, it is enough to wait for a few minutes to allow for its volatilization/ decomposition.</p> <p>The Ecas4 anolyte can be used:</p> <ul> <li>as a normal liquid sanitizer, for hard surfaces, or</li> <li>as a fog (through a proper nebulizing device), to allow an effective treatment of every item present in the treated room (pieces of furniture, floor, walls, ceiling, areas not easily reachable and the environment in general), taking only a few minutes, depending on the size of the room.</li> </ul> <p>Commonly, the Ecas4 anolyte is dosed in the water network (without prejudicing the drinkability of the treated water) to avoid pathogen contamination (e.g. Legionella, MRSA). Treating the environment with the Ecas4 anolyte is not risky for the operator (who can remain in the room during the nebulization treatment). Yet, the oxidation capabilities of the Ecas4 anolyte are able to eliminate both organic and inorganic substances (cause of bad odours) as well as the microorganisms (bacteria, fungi, mould and viruses), thus making the environments clean and bacteriologically neutral from the point of view of odour.</p> <p>The Ecas4 anolyte is a rinse-free sanitizer; it is non-harmful and much less corrosive than other disinfectants (when used in concentrate form; in practice, the diluted solutions are even safer). It has been approved as a disinfectant for potable water, not only in Australia (Australian Water Quality Centre of SA: NATA-accredited lab of Dr Paul Monis) but also in Europe.</p>

<h5>This article was featured in LASA Fusion Magazine, Autumn 2016 (pg 11)</h5> <p><em>Leading Age Services Australia (LASA) is The Voice of the Aged Care Industry, speaking on behalf of the whole age services industry regardless of their ownership status. </em></p> <p><em>Leading Age Services Australia is the only truly national age services peak group. It represents all industry participants, and maintains an essential principle of inclusion at its core. More importantly, it is a collection of equals committed to a brighter future for the age services industry, and the older Australians who rely upon it.</em></p>

<h6>Feature Article</h6><h1 style="color: #00b1bf;"><span class="slider-header-bold" style="color: #00b1bf;">The Ecas4 Anolyte:</span> An Aspecific disinfection approach that mirrors the immune defence system of vertebrates</h1><!-- [et_pb_line_break_holder] --><p class="intro-para">About four billion years ago, life arose: simple microorganisms with the ability to extract energy from organic compounds or from sunlight, which they used to make a vast array of complex biomolecules from the simple elements and compounds on the Earth’s surface.</p> <p>The remarkable properties of living organisms arise from the thousands of different lifeless biomolecules. When these molecules are isolated and examined individually, they conform to all the physical and chemical laws that describe the behavior of inanimate matter.</p> <p>The smallest organisms consist of single cells and are microscopic. Larger, multicellular organisms contain many different types of cells, which vary in size, shape, and specialized function. Despite these obvious differences, all cells of the simplest and most complex organisms share certain fundamental properties, which can be seen at the biochemical level.</p> <p>Birds, beasts, plants, and soil microorganisms share with humans the same basic structural units (cells) and the same kinds of macromolecules (DNA, RNA, proteins) made up of the same kinds of monomeric subunits (nucleotides, aminoacids).</p> <img style="margin: auto;" class="blog-image" src="https://www.ecas4.com.au/wp-content/uploads/2016/05/Immune-System_01_large.jpg"> <p>All living cells have either a nucleus or a nucleoid, a plasma membrane, and cytoplasm. The plasma membrane defines the periphery of the cell, separating its contents from the surroundings. It is composed of lipid and protein molecules that form a thin, tough, pliable, hydrophobic barrier around the cell. The membrane is a barrier to the free passage of inorganic ions and most other charged or polar compounds.</p> <p>The organic compounds from which most cellular materials are constructed represent the ABCs of biochemistry. Shown here are six of the 20 aminoacids from which all proteins are built (the side chains are shaded blue). Likewise, nitrogenous bases (adenine, guanine, thymine, cytosine and uracil) are the important components of nucleic acids.</p> <img class="blog-image" src="https://www.ecas4.com.au/wp-content/uploads/2016/03/Immune-System_02.jpg"> <p class="image-caption"><span class="image-caption-header">Figure 1:</span> Six of the 20 aminoacids from which all proteins are built with side chains highlighted.</p> <p>Independently of the complex structure of the cell, the monomeric units are relatively simple molecules. In addition, most of them are characterized by the presence of specific groups (amino, –NH², and thiol, –SH), which are sensitive to oxidation reaction.</p> <p>Most disinfectants or biocides exert their action by damaging the cell membrane; in alternative, some neutral molecules can pass across the membrane and act against internal cell components.</p> <p>Notwithstanding their effectiveness, disinfectants are often criticized for possible side effects: formation of byproducts, but also induced resistance.</p> <h3>The Ecas4 Solution</h3> <p>The Ecas4 approach was inspired by observing how the immune system of vertebrates (the most developed living organisms) works. Nonspecific immunity is substantially based on the activity of neutrophils and macrophages leucocytes, which engulf foreign cells. Of great importance is the action of myeloperoxidase (MPO), an enzyme that produces hypochlorous acid (HOCl) from hydrogen peroxide (H²O²) and chloride anion (Cl¯), during the neutrophils’ respiratory burst.</p> <p>Hypochlorous acid possesses a particularly effective cytotoxic activity. Contrary to other forms of so-called active chlorine (i.e., hypochlorite and gaseous chlorine), the HOCl molecule is rather unstable, and cannot be stored and used at request. To produce it, the easiest and safest synthetic path is electrochemical production, through electrolysis of a brine solution.</p> <img class="blog-image" src="https://www.ecas4.com.au/wp-content/uploads/2016/03/Immune-System_03.jpg"> <p class="image-caption"><span class="image-caption-header">Figure 2:</span> Neutrophils release Hypochlorous acid to fight infection in the human body.</p> <p>Various approaches exist, which are all based on electrochemical cells, provided with or without a separator to avoid reaction or decomposition of products synthesized at the anodes upon contact with the cathodes. Only a few of them allow the synthesis of a biocide solution under well-controlled and reproducible conditions, and the number of useful devices is further reduced when the constraint of a product with a neutral pH is introduced. The latter is important, since it is linked with the reactivity of the active ingredient and of related chemical equilibria (i.e., conversion of the active chlorine to chlorite and chlorate). In addition, a neutral pH is safer for both the user and the target applications (e.g., minimization of corrosion problems).</p> <p>To meet with the above requirements, Ecas4 has developed and patented a technology that relies upon a reactor with four chambers (European Patent n. 1969159 B1). The approach represents an optimization of the technology for electrochemical activation of water originally proposed by the Russian school (V.M. Bakhir and coworkers), for the production of the so-called anolyte: a solution containing hypochlorous acid.</p> <h3>Benefits</h3> <p>The benefits deriving from the use of hypochlorous acid (active chlorine at neutral pH), compared to those of using hypochlorite (active chlorine at pH > 7.5) can be summarized as follows:</p> <ul> <li><p>Higher disinfectant efficacy of HOCl, with respect to ClO- (about two orders of magnitude); accordingly, lower concentrations are required to obtain comparable results.</p></li> <li><p>HOCl apparently behaves like a source of hydroxyl radicals, rather than as a chlorine-containing oxidizing agent, thus minimizing the risk of formation of undesired byproducts.</p></li> <li><p>A solution at neutral pH does not alter the characteristics of the treated liquid (often a potable water), and provides greater assurance concerning possible problems of corrosion for metal piping.</p></li> </ul> <p>With a second patent application (Australian Patent n. AU 2009315640 B2; Intern. Pat. Appl. n. WO 2010/055108 A1), the technology has been further improved, borrowing the zero-gap principle, i.e. with electrode in direct contact with the separating membrane, from the fuel cell and chlor-alkali industries. This allows to reduce the salinity of the diluted brine (with benefits in terms of stability of the anolyte and minimization of non-active chemicals), while reducing the possible heating due to ohmic drop (in general, heat is deleterious, both from a chemical point of view as for the stability of the electrodes and of the membrane).</p> <h3>Summary</h3> <p>The Ecas4 reactor mirrors our body’s defense system, allowing the synthesis of hypochlorous acid, a non-toxic, non-corrosive and non-hazardous active ingredient that can be used for a number of applications: disinfection of potable water; eradication of microorganisms from water networks; disinfection of surfaces and environments (when applied as a fog).</p> <p>The Ecas4 anolyte has no synthetic chemical residues, and it is effective in removing biofilms from water pipes or tanks. The Australian Water Quality Centre has recently verified Ecas4 efficacy and compliance within drinking water standards (AS/NZS 4020).</p> <p>The Ecas4 technology has been widely adopted for solving problems related to Legionella, in Europe (Italy, Germany, Spain and Slovenia), and it is now available in Australia. Noteworthy, the Legionella detection limits in Australia are not as rigorous as the European standards!</p>

<h5>This article was featured in The Australian Hospital Engineer Journal, Summer 2014 (pg 44-45)</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 #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>