The World Health Organization (WHO) defines “heterotrophs” as micro-organisms that require organic carbon for growth and Heterotrophic Plate Count (HPC) as colony counts using a simple, culture test on an organic carbon medium (WHO 2017). The bacteria population recovered in HPC tests can vary widely with temperatures, incubation times, nutrients, and methods used by the laboratory.
People are exposed to HPC bacteria much more from food than from water (WHO 2003). Tens of thousands of colony forming units (CFUs) per gram or milliliter have been found in dairy, meat, and vegetable products (Reynolds 2002).
Are HPC bacteria harmful?
After two days in Geneva in April 2002, a group of public health experts and microbiologists convened by WHO and NSF International to discuss the role of HPC in managing water systems reached a consensus that,
“There is no evidence, either from epidemiological studies or from correlation with the occurrence of waterborne pathogens, that HPC values alone directly relate to health risk” (WHO 2003).
The basis for the WHO group’s conclusion is simply that disease is caused only by pathogens, not by harmless bacteria:
“There is no evidence for a health effects link in the absence of pathogen contamination” (WHO 2003).
And, although most disease-causing (pathogenic) bacteria are heterotrophic, typical HPC tests will not detect pathogens because special media and techniques are needed to grow those organisms:
“There are opportunistic pathogens that may regrow in water but that is not detected in HPC measurements, including strains of Legionella and nontuberculous mycobacteria. …There is no evidence that HPC levels per se, as measured by established procedures, have a direct relationship to… organisms such as legionellae, Pseudomonas aeruginosa, and non-tuberculous mycobacteria” (WHO 2003).
Some studies have suggested high levels of harmless HPC bacteria can actually protect humans by out competing pathogens (Camper 1985). A University of Arizona study showed that HPC bacteria were antagonistic to pathogenic strains of Salmonella and E. Coli, reducing counts of pathogens added to water by more than 10-fold in one day and 10,000-fold in two days. Payment’s studies showed that faucet filters reduced gastrointestinal illness by up to 40% despite increasing HPC counts (Payment 1991; Payment 1997).
Validation versus control measure monitoring
For the type of water management program (WMP) outlined in ANSI/ASHRAE Standard 188-2015 and the Centers for Disease Control and Prevention (CDC) toolkit (CDC 2017)—and required for hospitals and nursing homes that receive reimbursements from the Centers for Medicare & Medicaid Services (CMS)—tests are generally performed for one of two purposes:
- To validate the overall effectiveness of the WMP in accomplishing its primary objective (e.g., to minimize Legionella), or…
- To monitor the performance of a control measure. For example, if a WMP control measure is to maintain hot water temperatures at all faucets within a certain range (limit), temperatures could be measured at faucets periodically to see if they are within that range.
The distinction between validation tests and control measure performance tests is important in determining the role of HPC in a WMP.
It depends on the system type
For a water management program (WMP) designed to minimize Legionella risk, consider each water system type separately based on scientific evidence, guidelines, and best practices for the role of HPC tests invalidation or control measure monitoring.
For plumbing (domestic water) systems. Since studies have shown no correlation between HPC results and Legionella in domestic hot or cold water systems, HPC tests should not be used to validate a domestic water system for Legionella control. Interestingly, however, we (HC Info) have recently received, from users of our LAMPS WMPs, anecdotal reports of high HPC levels associated with low Legionella but relatively high levels of Pseudomonas and mycobacteria. We look forward to scientific study of additional data.
WHO points out that HPC tests can indicate stagnation, inadequate temperatures, or low disinfectant levels in domestic water systems but other tests (e.g., temperature; chlorine) will likely be more useful for control measure monitoring.
For whirlpool spas: Data studied by Dr. Richard Miller of the University of Louisville (Miller 2002) have shown HPC to be a good indirect indicator of Legionella in whirlpool spas. Although Legionella tests will provide more direct and reliable feedback on Legionella concentrations in whirlpool spas, HPC tests could be used as an additional (and perhaps more frequent) validation test. For more information, see section 126.96.36.199 of ASHRAE Guideline 12-2000 and section 7.3 of ANSI/ASHRAE Standard 188-2015.
For cooling towers: HPC tests should not be used to validate Legionella control in cooling tower systems because studies have shown no reliable correlation between HPC and Legionella counts. In Garnett’s study of 100 cooling towers, Legionella counts greater than 100 CFU/mL were found only in towers with an HPC exceeding 10,000 CFU/mL and Legionella counts higher than 1,000 CFU/mL were found only in towers with an HPC exceeding 100,000 CFU/mL (Garnett 1993). But of the 1,100-plus towers studied by Miller, towers that tested positive for Legionella generally had a lower HPC than towers that tested negative. What’s more, some of the towers with extremely high Legionella counts had an HPC near zero (Miller 1993). Witherell found the same results as Miller—high Legionella counts with low HPC—indicating certain water treatment programs may reduce bacteria competing with Legionella for food, but not reduce Legionella, allowing Legionella to flourish (Witherell 1986).
Although they are not an appropriate validation method for Legionella in cooling towers, HPC tests may be required by regulations (e.g., in New York) and have been recommended for monitoring cooling tower treatment (CTI 2008; WHO 2007).
How do you use HPC in your water management program? Please comment below.
For Additional Reading
ASHRAE. 2015. Legionellosis: Risk Management for Building Water Systems. Atlanta: American Society of Heating, Refrigerating and Air-Conditioning Engineers. Available at https://www.ashrae.org/resources–publications/bookstore/ansi-ashrae-standard-188-2015-legionellosis-risk-management-for-building-water-systems
Camper AK, et al. 1985. Growth and Persistence of Pathogens on Granular Activated Carbon Filters. Appl. Environ. Microbiol. 50:6, 1378-1382.
CDC. 2017. Developing a Water Management Program to Reduce Legionella Growth & Spread in Buildings: A Practical Guide to Implementing Industry Standards. Atlanta: Centers for Disease Control and Prevention. Available at http://www.cdc.gov/legionella/maintenance/wmp-toolkit.html
CTI. 2008. Legionellosis Guideline: Best Practices for Control of Legionella. Houston, TX: Cooling Technology Institute.
Garnett HM, Gilmore K, Liu J. 1993. Legionella: An Unwelcome Pollutant. Environmental Technology 11; 393-400.
Reynolds KA. 2002. HPC Bacteria in Drinking Water: Public Health Implications? Water Conditioning & Purification, July.
Miller RD, Kenepp KA. 1993. Risk Assessments for Legionnaires Disease Based on Routine Surveillance of Cooling Towers for Legionellae. Presented at the 4th International Symposium on Legionella, 1992. In: Barbaree, J. M., R. F. Breiman, and A. P. DuFour, eds. Legionella: Current Status and Emerging Perspectives. Washington, D.C.: American Society for Microbiology; 40-43.
Miller RD, Koebel DA. 2002. Prevalence of Legionella in Whirlpool Spas: Correlation with total bacteria numbers. In: Marre R, et al, eds. Legionella. Washington, DC: ASM Press, 275-279.
Payment P, Richardson L, Siemiatycki J, et al. 1991. A Randomized Trial to Evaluate the Risk of Gastrointestinal Disease due to Consumption of Drinking Water meeting current Biological Standards. American Journal of Public Health vol. 81, no. 6.
Payment P, Siemiatycki J, Richardson L, et al. 1997. A Prospective Epidemiological Study of the Gastrointestinal Health Affects due to the Consumption of Drinking Water. International Journal of Environmental Health Research 7, 5-31.
Witherell LE, Novick LF, Stone KM, et al. 1986. Legionella in Cooling Towers. Journal of Environmental Health, November/December; 134-139.
Rusin P, Rose J, Haas C, Gerba C. 1997. Risk assessment of opportunistic bacterial pathogens in drinking water. Rev Environ Contam Toxicol. 152:57-83.
WHO. 2003. Heterotrophic Plate Counts and Drinking-water Safety: The Significance of HPCs for Water Quality and Human Health. Published on behalf of the World Health Organization by IWA Publishing, London. Available at http://www.who.int/water_sanitation_health/dwq/HPCFull.pdf.
WHO. 2007. Legionella and the prevention of legionellosis. Geneva: World Health Organization. Available at http://www.who.int/water_sanitation_health/emerging/legionella.pdf.
WHO. 2017. Drinking Water Parameter Cooperation Project. Support to the revision of Annex I Council Directive 98/83/EC on the Quality of Water Intended for Human Consumption (Drinking Water Directive). Available at http://ec.europa.eu/environment/water/water-drink/pdf/WHO_parameter_report.pdf.