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Program ID: Innovation Anthology #856
Program Date: 03/28/2017
Program Category: Alberta, Health and Medicine, Waste Management, Water

Dr Nicholas Ashbolt 2017: Plumbing, Pathogens and Probiotics

PROGRAM #856      INTERVIEW WITH DR. NICHOLAS ASHBOLT

March 28, 2017

MP3:    11.6 MB
TIME:  12:39 MINUTES

Intro:  Dr. Nicholas Ashbolt is a professor in the School of Public Health at the University of Alberta and holds the Alberta Innovates Translational Health Chair in Water.

DR NICHOLAS ASHBOLT


CC:  SO NICHOLAS, THE LAST TIME I SPOKE TO YOU, YOU HAD JUST ARRIVED HERE IN ALBERTA.  YOU HAD JUST TAKEN UP THE TRANSLATIONAL HEALTH CHAIR IN WATER AND YOU HAD QUITE A FEW THINGS ON THE GO.  YOU ARE NOW THREE YEARS INTO IT.  WHAT WOULD YOU SAY IS A GOOD STATUS REPORT?


NA:  Well basically we're very much on track, somewhat ahead in some areas.  We're working with the Provincial Government on regulatory reform of water services.  so starting with drinking water, we're adding to that ways that we might manage the risks, which are the greatest risks now through pathogens in water services, which is through aerosols of organisms which grow in our premise plumbing.   


So we've built a premise plumbing facility to look at alternative, in fact, somewhat probiotic approaches to control those pathogens.  


CC:  SO WHEN YOU SAY PREMISES, YOU'RE TALKING ABOUT WATER THAT GOES DOWN OUR TOILETS AND INTO THE SEWER?


NA:  I'm talking about initially the drinking water that arrives to our buildings.  So through our main conveyance systems, the distribution systems of drinking water, comes to us as very good quality drinking water here in Alberta.   


But in our buildings it can sit and stagnate in quite small diameter pipes where there's a lot of slime or biofilm on the walls of those pipes.   And in certain cases that can lead to growth of organisms like legionella milofana and other repiratory pathogens.    


So when we turn on the shower we can inhale, or turn on our spa baths, we can inhale these sorts of pathogens through aerosol.   


CC:  AND WHAT ARE WE DOING ABOUT IT AT THIS POINT?


NA:  At the moment there are no regulatory restraints on these, what we call opportunistic pathogens, ones that can grow in these premise plumbing situations.   


Some hospitals are fairly proactive about looking for and managing their plumbing in their large healthcare facilities. 


 But people at home who may have spa baths or holiday houses that are not used so often, sitting through the summer months, these sorts of organisms can grow in that sort of premise plumbing.   


And at the moment, we're not giving any guidance to either the general public and in some cases even institutions about what are the best ways to minimizethe  exposure to these sorts of organisms and quite frankly, in the first place, to stop them colonizing and growing in the plumbing of buildings.  


CC:  WHAT ARE SOME OF THE THINGS THAT YOU'VE DISCOVERED SO FAR?

 

NA:  The research side has been actually quite fascinating.  We're finding that plastic pipe which is more commonly used now, like PVC and some crossling polyethelene or PEX pipe, creates a different microbiome than we see on traditional pipe surfaces like copper pipe.   


And whilst there's less growth on copper pipe, less biofilm I mean by that, we actually see that the organisms that grow there support legionella.  It appears to be the case much more so than plastic pipe.   


So we're looking at can we have an upstream plastic pipe, we call it a selector, that selects for the right probiotic organisms, to see the downstream copper pipe in an existing say hospital or premise plumbing school facility, to see whether we can diliberately colonize it with preferential organisms that will suppress the growth of these opportunistic pathogens.   


Laboratory wise we've demonstrated that.  And we're now building up to a sort of pilot scale faciliy in a brand new laboratory that has just been built for this purpose.   


CC:  SO THEN THE UPSTREAM, THAT IS COMING FROM THE DRINKING WATER FACILITY INTO THE HOUSE, AND DOWNSTREAM WOULD BE THE SEWER GOING OUT?


NA:  So the upstream side, we're looking at modifying the quality of that water, rather than just throwing, for example, more chlorine or monochloramine, which is often used in hospitals to control legionella.  When we do that, we actually find that, yes, legionella may be controlled, but we then have an unintended consequence of that disinfectant which is the growth of non-tuberculos micro bacteria that also cause wound and lung infections, particularly in hospital settings.   


So more chlorine is not really the answer, hence, why we're looking at this probiotic approach.   


But on the downstream side, all that water goes down, if you like, down the sink and in the waste lines in buildings.  And in the U-bends in those, we find they also get colonized with bacteria and worse, they get colonized, particularly in healthcare settings, by antibiotic resistant bacteria.   


And in multi-rise buildings when you flush a toilet upstairs, there are some pressure waves that can pulse and aerosolize those resistant bacteria from the U-bendss back into the water of the hospital or the bathroom of that facility.   


And indeed, there have been some classic examples in Europe, where there have been antibiotic resistant bacteria chronically infecting people in the one room in hte hospital environment.  And it's realized that it is coming from the U-bends that are never cleaned out and never really maintained because people hadn't really realized the nature of this risk pathway before.   


 


CC:  SO WE'VE BEEN LEARNING RECENTLY ABOUT OUR OWN INTESTINES AND HOW OUR OWN PRO-PROBIOTIC AND BACTERIA, LIKE WHAT YOU'RE EATING AFFECTS YOUR HEALTH, IS AND WHAT COMES OUT THE OTHER END.  SO ESSENTIALLY THIS IS ALMOST THE SAME THINGS FOR THE ...PLUMBING GOING INTO THE HOUSE.   


NA:  Exactly.  It's a very good analogue.  The human microbiome work of the gastrointestinal tract is exactly the same techniques we're using to look at the microbiome of our premise plumbing system.   


And the same principles hold in that there is a healthy microbiome.  And when things, for example, you take antibiotics and you upset your natural balance, and then organisms like chlostrium diffosile is one example of a weed bacteria that will chronically grow and cause irritable bowel disease, we're seeing that our chlorination of water is actually causing the same sort of scenario.  It's upsetting the ecological balance that encourages the growth of some of these opportunistic pathogens.  So that's in the drinking water side.   


And then on the wastewater side, yes, we've got these zones that we never traditionally thought about as being problem.   

 

All of this leads us, particularly on the waste side, to think about that our gravity sewer system is not a sensible approach.   


So there are, for example, vacuum toilets that flush that most people may have come across on boats and trains and aircraft.  They are a very wise investment in a hospital because when you flush a toilet you aerosolize whatever pathogens the person before had excreted to some degree into the air.   


So the next person coming into that room or facility will touch surfaces or breathe in the air with those pathogens. 


But with a vacuum flush toilet, only a half a litre or so of water is use, which saves water, and 60 litres of air is used to move that residual down the sewer.  That's a much, much safer scenario.   


And so if we started to have these vacuum flush sewers and therefore removing our U-bends, because we don't need those U-bends in that sort of configuration, we'd have a much safer, particularly in a healthcare setting, waste management system.  

 

And the real benefit of all of that is not only in human health, but we can then recover the energy from that blackwater.  And if we connect it to the kitchens, for example, the food residuals, it is a far more efficient way of recovering the embedded energy in that food and fecal residual which, when we do the calculations, can supply more than total amount of energy used to treat all drinking and waste water services in a community.   


So we're coming out net positive in energy recovery.  


And it even gets better, that the energy residual, after we've stripped out the energy in the form of methane, we're left with ammonium and phosphorus which are traditionally pollutants which we have to spend a lot money and energy to remove.  We can actually precipitate those because they're at a higher concentration and produce a fertilizer called struvite that can turn those nutrients back out to agriculture where they came from in the first place.  


So we get ahead even further by this separation from the residual streams, the blackwater from the grey water, and having these vacuum type systems in premises, particularly in healthcare settings.   


CC:  SO I SEE THE DOLLAR SIGNS, THE ECONOMIC SIDE OF IT AND THE TECHNOLOGY SIDE OF IT.  WHAT WOULD IT TAKE TO MAKE THIS CHANGEOVER?


NA:  To make the change is really a multifaceted problem.  And then its quite fascinating in that sense.  It's part sociological in the sense of how people think about it.  It's also very much driven by current regulatory strains and government structures. 


So the way we're dealing with this conversion and rethinking is at multiple levels.  


So we're building an iconic development just on the outskirts of Edmonton in St. Alberta, where we are having our resource recovery centre.  We're having this as an iconic thing.  Somewhere where people are attracted to come and see and visit all the way from school age through university and consulting engineers and others so they can come and get a feel for a full scale operation of this type of technology.   


They can get a sense of the regulatory frames which need to be modified, which concurrently I'm working on with various Provincial Government regulatators.  


And thirdly we can work with the consulting engineers who need to sort of build some faith that these systems are reliable and rode past?


So until we have this full scale operational centre, it's actually a very difficult things.  And in fact aroundn te world, we don't see this transofmration happening overnight.  We do see it in certain locations, in Germany and the Netherlands and in Sweden, where it's beginning to take hold.  


It's such a fundamental rethinking, it really needs to be attacked on many, many fronts and in a very deliberate consistent way.  And ultimately we're working with social surveys to get a sense of where are Albertans today in their sense of reusing residual waters and nutrients.  How do feel about it?  And do they even feel there's a need to do so?  


So there are all these other pressures that end up ultimately being political pressure also  so our politicians will favour these sorts of alternatives because at the end of the day, we see the cost is about half the conventional way that we manage water services.  We end up with more energy being conserved.  So we halve also our greenhouse gas output and carbon footprints.  And quite frankly, its a lot healthier and safer for communities to operate this way.  


So from all the main determinants of sustainability, from an economic perspective, from a human health perspective and from an environmental health perspectives, we're better off.     


CC:  NOW YOU MENTIONED THE WORD BLACK WATER.  I'VE HEARD OF GREY WATER.  WHAT'S THE DIFFERENCE BETWEEN BLACK WATER AND GREY WATER?


NA:  Great question.  Well black water is the toilet residual water.  So when we flush the toilet, we call that the black water that goes down the drain.   


In some jurisdictions, and I like to also include the kitchen waste stream, is also fairly rich in food residuals.  And in fact, I would encourage the use of food waste disposal units because again, from an energy point of view, and energy recovery, we collect both the organics from the kitchen and the organics from the toilet.  That's the best way to recover the nutrients and the energy and reduce the curbside pickup of compostibles as well.   


So we actually have a more efficient way of collecting those residuals and making the most of them rather than curbside pickup, partial composting and the rest going to landfill.   


sorry.  So the black water is that composition, the toilet and the kitchen.  And the grey is everything else in the household.   


So when we wash our bodies, we wash our clothes, we wash our dishes, all of that is grey water.  


CC:  THANK YOU VERY MUCH, NICHOLAS.


NA:  Well thank you for the opportunity.  And I look forward to giving you another update in the near future.


Dr. Nicholas Ashbolt holds the Alberta Innovates Translational Health Chair in Water at the School of Public Health at the University of Alberta.






 





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