A Comprehensive Examination of the Contaminants in Drinking Water in Public Schools in California, 2017-2022.

OBJECTIVES: Reports of unsafe school drinking water in the United States highlight the importance of ensuring school water is safe for consumption. Our objectives were to describe (1) results from our recent school drinking water sampling of 5 common contaminants, (2) school-level factors associated with exceedances of various water quality standards, and (3) recommendations. METHODS: We collected and analyzed drinking water samples from at least 3 sources in 83 schools from a representative sample of California public schools from 2017 through 2022. We used multivariate logistic regression to examine school-level factors associated with lead in drinking water exceedances at the American Academy of Pediatrics (AAP) recommendation level (1 part per billion [ppb]) and state action-level exceedances of other contaminants (lead, copper, arsenic, nitrate, and hexavalent chromium). RESULTS: No schools had state action-level violations for arsenic or nitrate; however, 4% had ≥1 tap that exceeded either the proposed 10 ppb action level for hexavalent chromium or the 1300 ppb action level for copper. Of first-draw lead samples, 4% of schools had ≥1 tap that exceeded the California action level of 15 ppb, 18% exceeded the US Food and Drug Administration (FDA) bottled water standard of 5 ppb, and 75% exceeded the AAP 1 ppb recommendation. After turning on the tap and flushing water for 45 seconds, 2%, 10%, and 33% of schools exceeded the same standards, respectively. We found no significant differences in demographic characteristics between schools with and without FDA or AAP exceedances. CONCLUSIONS: Enforcing stricter lead action levels (<5 ppb) will markedly increase remediation costs. Continued sampling, testing, and remediation efforts are necessary to ensure drinking water meets safety standards in US schools.

Basal Cell Carcinoma and Sebaceoma Within Nevus Sebaceous of the Scalp.

This case describes the occurrence of basal cell carcinoma (BCC) and sebaceoma within a nevus sebaceous (NV), which has not yet been previously reported. This is significant to dermatologists as it emphasizes the importance of close monitoring of benign sebaceous nevi in the event that malignant transformation occurs, although such occurrences are rare. Prompt consideration for prophylactic excision of NS is warranted prior to malignant transformation.

Challenges of Detecting Lead in Drinking Water Using at-Home Test Kits.

Lead in drinking water remains a significant human health risk. At-home lead in water test kits could provide consumers with a convenient and affordable option to evaluate this risk, but their accuracy and reliability is uncertain. This study examined the ability of at-home lead test kits to detect varying concentrations of dissolved and particulate lead in drinking water. Sixteen brands representing four test kit types (binary color, binary strip, colorimetric vial, and color strip) were identified. Most kits (12 of 16 brands) were not suitable for drinking water analysis, with lead detection limits of 5-20 mg/L. Binary strips detected dissolved lead at drinking water-relevant levels but failed to detect particulate lead. Household acids (lemon juice and vinegar) improved the strip's ability to detect lead by dissolving some of the lead particulates to the point soluble lead exceeded 15 µg/L. These results illustrate the applications of at-home testing kits for drinking water analysis, highlight limitations and areas for possible improvement, and put forth a testing protocol by which new at-home lead test kits can be judged.

Tracking reduction of water lead levels in two homes during the Flint Federal Emergency.

A Federal Emergency was declared in Flint, MI, on January 16, 2016, 18-months after a switch to Flint River source water without phosphate corrosion control. Remedial actions to resolve the corresponding lead in water crisis included reconnection to the original Lake Huron source water with orthophosphate, implementing enhanced corrosion control by dosing extra orthophosphate, a "Flush for Flint" program to help clean out loose leaded sediment from service lines and premise plumbing, and eventually lead service line replacement. Independent sampling over a period of 37 months (January 2016-February 2019) was conducted by the United States Environmental Protection Agency and Virginia Tech to evaluate possible human exposure via normal flow (∼2-3 L/min) sampling at the cold kitchen tap, and to examine the status of loose deposits from the service line and the premise plumbing via high-velocity flushing (∼12-13 L/min) from the hose bib. The sampling results indicated that high lead in water persisted for more than a year in two Flint homes due to a large reservoir of lead deposits. The effects of a large reservoir of loose lead deposits persisted until the lead service line was completely removed in these two anomalous homes. As water conservation efforts are implemented in many areas of the country, problems with mobile lead reservoirs in service lines are likely to pose a human health risk.

Impact of blending for direct potable reuse on premise plumbing microbial ecology and regrowth of opportunistic pathogens and antibiotic resistant bacteria.

Little is known about how introducing recycled water intended for direct potable reuse (DPR) into distribution systems and premise plumbing will affect water quality at the point of use, particularly with respect to effects on microbial communities and regrowth. The examination of potential growth of opportunistic pathogens (OPs) and spread of antibiotic resistance genes (ARGs), each representing serious and growing public health concerns, by introducing DPR water has not previously been evaluated. In this study, the impact of blending purified DPR water with traditional drinking water sources was investigated with respect to treatment techniques, blending location, and blending ratio. Water from four U.S. utility partners was treated in bench- and pilot-scale treatment trains to simulate DPR with blending. Water was incubated in simulated premise plumbing rigs made of PVC pipe containing brass coupons to measure regrowth of total bacteria (16S rRNA genes, heterotrophic plate count), OPs (Legionella spp., Mycobacterium spp., Pseudomonas aeruginosa), ARGs (qnrA, vanA), and an indicator of horizontal gene transfer and multi-drug resistance (intI1). The microbial community composition was profiled and the resistome (i.e., all ARGs present) was characterized in select samples using next generation sequencing. While regrowth of total bacteria (16S rRNA genes) from the start of the incubation through week eight consistently occurred across tested scenarios (Wilcoxon, p ≤ 0.0001), total bacteria were not more abundant in the water or biofilm of any DPR scenario than in the corresponding conventional potable condition (p ≥ 0.0748). Regrowth of OP marker genes, qnrA, vanA, and intI1 were not significantly greater in water or biofilm for any DPR blends treated with advanced oxidation compared to corresponding potable water (p ≥ 0.1047). This study of initial bacteria colonizing pipes after introduction of blended DPR water revealed little evidence (i.e., one target in one water type) of exacerbated regrowth of total bacteria, OPs, or ARGs in premise plumbing.

Impact of Road Salt on Drinking Water Quality and Infrastructure Corrosion in Private Wells.

Increased road salt use and resulting source water contamination has widespread implications for corrosion of drinking water infrastructure, including chloride acceleration of galvanic corrosion and other premature plumbing failures. In this study, we utilized citizen science sampling, bench-scale corrosion studies, and state-level spatial modeling to examine the potential extent of chloride concentrations in groundwater and the resulting impact on private wells in New York. Across the sampled community, chloride levels varied spatially, with the highest levels in private wells downgradient of a road salt storage facility followed by wells within 30 m of a major roadway. Most well users surveyed (70%) had stopped drinking their well water for aesthetic and safety reasons. In the bench-scale experiment, increasing chloride concentration in water increased galvanic corrosion and dezincification of plumbing materials, resulting in increased metal leaching and pipe wall thinning. Our simple spatial analysis suggests that 2% of private well users in New York could potentially be impacted by road salt storage facilities and 24% could potentially be impacted by road salt application. Our research underscores the need to include the damage to public and privately owned drinking water infrastructure in future discussion of road salt management.

Effectiveness of Prevailing Flush Guidelines to Prevent Exposure to Lead in Tap Water.

Flushing tap water is promoted as a low cost approach to reducing water lead exposures. This study evaluated lead reduction when prevailing flush guidelines (30 s⁻2 min) are implemented in a city compliant with lead-associated water regulations (New Orleans, LA, USA). Water samples (n = 1497) collected from a convenience sample of 376 residential sites (2015⁻2017) were analyzed for lead. Samples were collected at (1) first draw (n = 375) and after incremental flushes of (2) 30⁻45 s (n = 375); (3) 2.5⁻3 min (n = 373), and (4) 5.5⁻6 min (n = 218). There was a small but significant increase in water lead after the 30 s flush (vs. first draw lead). There was no significant lead reduction until the 6 min flush (p < 0.05); but of these samples, 52% still had detectable lead (≥1 ppb). Older homes (pre-1950) and low occupancy sites had significantly higher water lead (p < 0.05). Each sample type had health-based standard exceedances in over 50% of sites sampled (max: 58 ppb). While flushing may be an effective short-term approach to remediate high lead, prevailing flush recommendations are an inconsistently effective exposure prevention measure that may inadvertently increase exposures. Public health messages should be modified to ensure appropriate application of flushing, while acknowledging its short-comings and practical limitations.

Evaluating Water Lead Levels During the Flint Water Crisis.

In April 2014, the drinking water source in Flint, Michigan was switched from Lake Huron water with phosphate inhibitors to Flint River water without corrosion inhibitors. The absence of corrosion control and use of a more corrosive source increased lead leaching from plumbing. Our city-wide citizen science water lead results contradicted official claims that there was no problem- our 90th percentile was 26.8 µg/L, which was almost double the Lead and Copper Rule action level of 15 µg/L. Back calculations of a LCR sampling pool with 50% lead pipes indicated an estimated 90th percentile lead value of 31.7 µg/L (±4.3 µg/L). Four subsequent sampling efforts were conducted to track reductions in water lead after the switch back to Lake Huron water and enhanced corrosion control. The incidence of water lead varied by service line material. Between August 2015 and November 2016, median water lead reduced from 3.0 to <1 µg/L for homes with copper service lines, 7.2-1.9 µg/L with galvanized service lines, and 9.9-2.3 µg/L with lead service lines. As of summer 2017, our 90th percentile of 7.9 µg/L no longer differed from official results, which indicated Flint's water lead levels were below the action level.

Elevated Lead in Water of Private Wells Poses Health Risks: Case Study in Macon County, North Carolina.

Recent research has indicated that lead in water of private wells is in the range of that which caused problems in Flint, Michigan. However, there is limited understanding of the mechanisms for water lead release in these systems. We evaluated water lead at the homes of two children with elevated blood lead in Macon County (North Carolina), which did not have identifiable lead paint or lead dust hazards, and examined water lead release patterns among 15 private wells in the county. Water lead release patterns differed among the 15 private wells. Problems with lead release were associated with (1) dissolution of lead from plumbing during periods of stagnation; (2) scouring of leaded scales and sediments during initial water use; and (3) mobilization of leaded scales during continued water use. Accurate quantification of water lead was highly dependent on sample collection methods, as flushing dramatically reduced detection of lead hazards. The incidence of high water lead in private wells may be present in other counties of North Carolina and elsewhere in the United States. The underestimation of water lead in wells may be masking cases of elevated blood lead levels attributed to this source and hindering opportunities to mitigate this exposure.

Distribution System Operational Deficiencies Coincide with Reported Legionnaires' Disease Clusters in Flint, Michigan.

We hypothesize that the increase in reported Legionnaires' disease from June 2014 to November 2015 in Genesee County, MI (where Flint is located) was directly linked to the switch to corrosive Flint River water from noncorrosive Detroit water from April 2014 to October 2015. To address the lack of epidemiological data linking the drinking water supplies to disease incidence, we gathered physiochemical and biological water quality data from 2010 to 2016 to evaluate characteristics of the Flint River water that were potentially conducive to Legionella growth. The treated Flint River water was 8.6 times more corrosive than Detroit water in short-term testing, releasing more iron, which is a key Legionella nutrient, while also directly causing disinfectant to decay more rapidly. The Flint River water source was also 0.8-6.7 °C warmer in summer months than Detroit water and exceeded the minimum Legionella growth temperature of 20 °C more frequently (average number of days per year for Detroit was 63 versus that for the Flint River, which was 157). The corrosive water also led to 1.3-2.2 times more water main breaks in 2014-2015 compared to 2010-2013; such disruptions have been associated with outbreaks in other locales. Importantly, Legionella spp. and Legionella pneumophila decreased after switching back to Detroit water, in terms of both gene markers and culturability, when August and October 2015 were compared to November 2016.

Inherent variability in lead and copper collected during standardized sampling.

Variability in the concentration of lead and copper sampled at consumers' taps poses challenges to assessing consumer health threats and the effectiveness of corrosion control. To examine the minimum variability that is practically achievable, standardized rigs with three lead and copper containing plumbing materials (leaded brass, copper tube with lead solder, and a lead copper connection) were deployed at five utilities and sampled with regimented protocols. Variability represented by relative standard deviation (RSD) in lead release was high in all cases. The brass had the lowest variability in lead release (RSD = 31 %) followed by copper-solder (RSD = 49%) and lead-copper (RSD = 80%). This high inherent variability is due to semi-random detachment of particulate lead to water, and represents a modern reality of water lead problems that should be explicitly acknowledged and considered in all aspects of exposure, public education, and monitoring.

Impact of Water Chemistry, Pipe Material and Stagnation on the Building Plumbing Microbiome.

A unique microbiome establishes in the portion of the potable water distribution system within homes and other buildings (i.e., building plumbing). To examine its composition and the factors that shape it, standardized cold water plumbing rigs were deployed at the treatment plant and in the distribution system of five water utilities across the U.S. Three pipe materials (copper with lead solder, CPVC with brass fittings or copper/lead combined pipe) were compared, with 8 hour flush cycles of 10 minutes to simulate typical daily use patterns. High throughput Illumina sequencing of 16S rRNA gene amplicons was employed to profile and compare the resident bulk water bacteria and archaea. The utility, location of the pipe rig, pipe material and stagnation all had a significant influence on the plumbing microbiome composition, but the utility source water and treatment practices were dominant factors. Examination of 21 water chemistry parameters suggested that the total chlorine concentration, pH, P, SO42- and Mg were associated with the most of the variation in bulk water microbiome composition. Disinfectant type exerted a notably low-magnitude impact on microbiome composition. At two utilities using the same source water, slight differences in treatment approaches were associated with differences in rare taxa in samples. For genera containing opportunistic pathogens, Utility C samples (highest pH of 9-10) had the highest frequency of detection for Legionella spp. and lowest relative abundance of Mycobacterium spp. Data were examined across utilities to identify a true universal core, special core, and peripheral organisms to deepen insight into the physical and chemical factors that shape the building plumbing microbiome.

Distribution system water age can create premise plumbing corrosion hotspots.

Cumulative changes in chemical and biological properties associated with higher "water age" in distribution systems may impact water corrosivity and regulatory compliance with lead and copper action levels. The purpose of this study was to examine the effects of water age and chemistry on corrosivity of various downstream premise plumbing pipe materials and configurations using a combination of controlled laboratory studies and a field survey. Examination of lead pipe, copper pipe with lead solder, and leaded brass materials in a replicated lab rig simulating premise plumbing stagnation events indicated that lead or copper release could increase as much as ∼440 % or decrease as much as 98 % relative to water treatment plant effluent. In field studies at five utilities, trends in lead and copper release were highly dependent on circumstance; for example, lead release increased with water age in 13 % of cases and decreased with water age in 33 % of conditions tested. Levels of copper in the distribution system were up to 50 % lower and as much as 30 % higher relative to levels at the treatment plant. In many cases, high-risks of elevated lead and copper did not co-occur, demonstrating that these contaminants will have to be sampled separately to identify "worst case" conditions for human exposure and monitoring.

NOM and alkalinity interference in trace-level hexavalent chromium analysis.

Three analytical methods were evaluated for hexavalent and trivalent chromium analyses in the presence of natural organic matter (NOM) and alkalinity. Each method was tested using a simulated tap water with 1 µg L(-1) Cr(VI) and 0.8 µg L(-1) Cr(III) and several concentrations of NOM and/or alkalinity. An ion chromatograph with post column reaction cell conforming to USEPA Method 218.7 could accurately quantify Cr(VI) in the presence of up to 8 mg CL(-1) NOM and up to 170 mg L(-1) as CaCO3 alkalinity, and no oxidation of chromium was observed when 0.8 µg L(-1) Cr(III) was also present. A high-performance liquid chromatography coupled with inductively coupled plasma (HPLC-ICPMS) method and a field speciation method were also evaluated. Each of these methods was unaffected by the presence of alkalinity; however, the presence of NOM created issues. For the HPLC-ICPMS method, as the concentration of NOM increased the recovery of Cr(VI) decreased, resulting in a 'false negative' for Cr(VI). However, for the field speciation method, Cr(III) was complexed by NOM and carried through the ion exchange column, resulting in a 'false positive' for Cr(VI).

Understanding how brass ball valves passing certification testing can cause elevated lead in water when installed.

The lead leaching potential of new brass plumbing devices has come under scrutiny as a significant source of lead in drinking water (>300 µg/L) of new buildings around the world. Experiments were conducted using ball valves that were sold as certified and known to have caused problems in practice, in order to better understand how installed products could create such problems, even if they passed "leaching tests" such as National Sanitation Foundation (NSF) Standard 61 Section 8. Diffusion of lead from within the device into water when installed can increase lead leaching by orders of magnitude relative to results of NSF testing, which once only required exposure of very small volumes of water within the device. "Normalization" of the lead-in-water result tended to produce estimates of lead concentration that were much lower than actual lead measured at the tap. Finally, the presence of flux could also dramatically increase lead leaching, whereas high water velocity had relatively little effect.

Rapid free chlorine decay in the presence of Cu(OH)2: chemistry and practical implications.

A rapid reaction between free chlorine and the cupric hydroxide [Cu(OH)2] solids commonly found on pipe walls in premise plumbing can convert free chlorine to chloride and rapidly age Cu(OH)2 to tenorite (CuO). This reaction has important practical implications for maintaining free chlorine residuals in premise plumbing, commissioning of new copper pipe systems, and maintaining low levels of copper in potable water. The reaction stoichiometry between chlorine and Cu(OH)2 is consistent with formation of CuO through a metastable Cu(III) intermediate, although definitive mechanistic understanding requires future research. Natural levels of silica in water (0-30 mg/L), orthophosphate, and higher pH interfere with the rate of this reaction.

Determination of total chromium in environmental water samples.

It is often desirable to quantify both dissolved Cr(VI) and total Cr in samples accurately. Various protocols are now being utilized to quantify the amount of total chromium in natural waters and each of these has possible interferences. This study describes the shortcomings of each method when particulate iron is present in a water sample, and a more rigorous digestion protocol is tested. Data from bench studies as well as a field survey of 21 water utilities are presented. Additionally, field data from several hundred water utility samples are presented to illustrate the potential for incomplete recovery of total chromium using accepted protocols.