A BACTEREOLQGECAL 3315?? OF DREMKER‘G FOUéé'é'AiééS Thesis fer i'he Emma 05’ 1125.. S. 563me STATE COLLEGE Ani‘ew King Fania “i934 “45* M? ‘ "NJ 1 v: “Ills ‘ * 1 , ...s v.‘ V “I 9" L; .-’t ’ new“ . _ A- t - ' - ’. I}. - *%A{‘Wwi s :u ‘. _ 15%;?“ ,- .‘;'~ 1:. 5.. .35 \-.9s_ A". 1"“? .s’r ‘ll. This is to certify that the thesis entitled A bacteriological study of drinking fomtaina . presented by Antone King routes has been accepted towards fulfillment of the requirements for Masque mm Date Jam 12 , 1954 Twas. '* “1“!”“5 mam-«*3 15* Lung. "’_' 13".‘3. “'¢l -r “’ iil-jérwrg V's\ Ma r professor \b_ 5 x! v ":2! .1’1 ‘ MSU LIBRARIES m K 'W AP“ U ] .ny/ :flgfoetfifi=fifiy RETURNING MATERIALS; Place in book drop to remove this checkout from your record. flfl§§_wi11 be charged if book is returned after the date stamped below. ‘T A BACTEBIOLOGICAL STUDY OF DRINKING FOUNTAINS BY Antone King Egntes A THESIS Submitted to the School of Graduate Studies of Michigan State College of Agriculture and Applied Science in partial fulfillment of the requirements for the degree of MASTER OF SCIENCE Department of Bacteriology and Public Health 195# ACKROWLEDGEHENT The author wishes to express sincere gratitude to Dr. w. L. Mallmann, without whose guidance and assistance, this thesis would not have been possible. 539’) 7"!)5‘) *‘ {j’d\)*‘l.’wl INTRODUCTION . . . . METHODS AND RESULTS DISCUSSION . . . . . SIMIARY . . . . . . LIST OF REFERENCES . TABLE OF CONTENTS LIST OF TABLES TABLE I. II. III. IV. V. VI. VII. VIII. IX. X. XI. Contamination occurring in a bubble type drinking fountain O O O O O O O O O O O 0 O O O O O O O O O Contamination occurring in an angle jet fountain not having an orifice guard . . . . . . . . . . . Contamination occurring in angle jet drinking fountains having an orifice guard. . . . . . . . . Contamination occurring in angle jet drinking fountains having an orifice guard. . . . . . . . . Recovery of S. faecalis from orifice and guard after running fountain on experimentally contam- inated bOWl O O O 0 0 O O O O O O 0 O O O O O O O 0 Recovery of S. faecalis from orifice with change in height of stream at increasing time of Operation.................... Recovery of S. faecalis from a wall at different distances from the fountain when the height of the stream was normal. . . . . . . . . . . . . . . Recovery of S, faecalis from a wall at different distances from the fountain when the height of the stream was subnormal . . . . . . . . . . . . . Recovery of §, faecalis from a wall at different distances from the fountain when the height of the stream was above normal. . . . . . . . . . . . The recovery of §. faecalis from aerosol above fountain O O O O O O O O O O O. O O O O O O O O O 0 Number of streptococci recovered from drinking fountain parts which had been sanitized previous to being used . . . . . . . . . . . . . . . . . . page IO 12 13 11.5 17 19 21 22 23 25 28 INTRODUCTION Health officials have long been aware of the potential hazards connected with water supplies for drinking purposes. Standards have been established in order that the public will tie assured a drinking water which would be above reproach. However, after the water has been tested and found to be fit for drinking, contamination may occur in the process of de- livery to the consumer. In most cases the transformation of a reliable drinking water to one which is potentially hazard- ous may be caused by the methods by which the water is dis- pensed. Insanitary drinking receptacles, such as glasses and cups, frequently contribute to the transmission of disease- producing bacteria. Evidence of pure water being contaminated by back siphonage and cross connections in water lines has been found. Most of these causes have been studied extensive- ly and steps taken to eliminate them. One of the most frequently used devices for dispensing water to the public is the drinking fountain. The drinking fountain is used by all peOple, the healthy and diseased a- like, hence the insanitary conditions of drinking fountains is of much importance to the public. In spite of the poten- tial disease hazard which may be associated with drinking fountains, there has been insufficient investigation of the role played by drinking fountains in relation to public health. In 1909 the health authoritieinn Kansas, realizing that the common cup was a public health hazard, passed the first law which prohibited its use in public places. They recommended that the bubble drinking fountain or single service cup replace the common cup. The bubble drinking fountain was considered by health officials to be the last word in supplying the public with safe drinking water. It was not until 1914 that Berry (1), conducting a study of bubble drinking fountains, reported that, instead of being a sanitary improvement over the common cup, the bubble foun- tain was as much of a public health menace as the former. Berry recovered organisms from the rim of the bubble cup and from the water within the cup. On the basis of these findings, she recommended that the bubble fountain be redesigned so that the stream of water may always be above the surface of the cup. Pettibone, Bogart and Clarke (2) made a study of bubble drink- ing fountains following an epidemic of streptococcus throat infections at the University of Wisconsin. Streptococci were recovered from 50 percent of the drinking fountains at the university. Since the water supply was of excellent character, it appeared that the fountains were the means of transmission. These workers in an experimental study found that test organ~ isms seeded on the bubble could be recovered from the fountain after 155 minutes. Experimenting with a fountain which sent out a stream from a 50° angle they were unable to recover any organisms from the fountain parts or stream and concluded that this design should be adopted. Whittaker (5) reported that 80 percent of 77 vertical jet_drinking fountains were contam- inated. He recommended that a suitable guard, placed over the jet, was desirable. Dieter (4) in a study on vertical drinking fountains found them to be quite unsatisfactory. He inoculated the stream with a glucose broth culture of Serratia marcesens and was able to recover the organism after five min- utes. Incorporating sputum in the culture, he was able to re- cover the test organisms after 48 hours. This was accounted for by edddying effects, caused by differences in the velocity of the water in the center and at the periphery of the stream, which carried the organisms down to the orifice. Sputum and debris containing organisms carried down in this manner, could supposedly adhere to the nozzle and be released and washed up for some time. Dunlap (5) reported that most of the problems associated with vertical drinking fountains were due to poor design. Dunlap, Hinnman and maffit (6) reported that both continuous and intermittent flow vertical type drinking foun- tains were not satisfactory from a sanitary point of View. These workers were of the Opinion that a slanting jet fountain with a guard over the orifice was perfectly safe. Hillis (7) recommended the use of a vertical jet fountain surrounded by a metal cage to protect the orifice from the user. After the introduction of the angle jet typecirinking fountain, it appeared that the problem of drinking fountain sanitation had been solved. Dieter (8) investigating angle jet drinking fountains, found a few cases of high contamina- tion. In a series of experiments with angle jet fountains he reported that results were erratic. Kitchens and Ross (9) undertaking a bacteriological study of drinking foun- tains, reported that bacteria remained from thirty minutes to two hours on fountain parts which had been experimentally contaminated. In one instance, the test organism Which was smeared on the bowl was recovered from the orifice. The au- thors stated that water splashing up from the bowl might well disseminate bacteria to the surrounding area. The possibility for the transmission of disease pro- ducing organisms from drinking fountains is not remote. Stiles (lO) recovered diphtheria organisms from a vertical jet drinking fountain. He also reported that the transmission of poliomyelitis virus from.drinking fountains was not an im- possibility. Hitchens and Ross (9) reported that tubercle ba- cilli were recovered from the drain pipe of a drinking foun- tain. They were also able to recover beta hemolytic strepto- cocci from all the fountain parts of the drinking fountain which they sampled. Birnkrant, Greenberg and Mbst (11) re- ported an outbreak of ameobic dysentery at a hospital. In- vestigating two drinking fountains which were of unquestionable character, they found cross connections in the fountain plumb- ing. Dieter (4) recovered Escherichia coli from.the orifice of a vertical jet drinking fountain. Dunlap, Hinman and Maffit (6), after reviewing the scope of drinking fountain sanitation recOmmended: VI 1. "All vertical jet fountains be condemned. 2. Host angle jet fountains be condemned. 3. That the orifices cannot be touched by the user's hands or lips. 4. That the guards of the orifices be designed so that material from the mouth cannot be deposited on them." Dieter (8) reported that the guards over the orifice are usually of little value, since users frequently touched them with their lips or face. In observing 1500 to 2000 drinkers he found that 40 percent of the drinkers touched their lips to the guard. A field observation conducted by the Lily-Tulip Cup Cor- poration (12) showed that in general, drinking fountains were greatly misused.. The survey showed that malpractices such as dragging clothes over the fountain parts, to spitting and blowing excretions into the bowl were not uncommon. Ingram (15), from a survey questionnaire sent to physi- cians, sanitarians and bacteriologists associated with public health agencies and universities, reported that "There is a dearth of epidemological evidence of what might be called positive evidence that drinking fountains are not involved as a vehicle of disease transmission whereas on the other hand, there does not exist a mass of circumstantial evidence which makes drinking fountains suspect if not proven vehicles." The effects of aerosols in connection with drinking foun- tain sanitation has not been investigated. As previously men- tioned, Hitchens and Ross (9) realized the possibility of transference of bacteria by splashing water from the bowl. Anderson, Stein and Moss (14), studying the effect of aerosol coritamination from common bacteriological techniques, demon- strated that when drops of media containing bacteria fell from a pipette on to a hard surface, the bacteria were dis- seminated by aerosols. They showed that these bacterial aerosols remained suspended for some time. The purpose of this study was to‘evaluate the drinking fountain from a public health standpoint. It was desirous to know the extent that drinking fountains were polluted; and what part they could play in the spread of disease-producing organisms from one person to another. Since many persons use the drinking fountains without touching the fountain parts with their mouth or faces, was it possible for them to be in- fected by organisms deposited on the fountain by previous users. Specific aims of this study were to determine: (A) The role of splashing in the spreading of organisms (B) The role of bacterial aerosols induced by splashing. KETHODS AND RESULTS This work was divided into two phases as follows: 1. A survey of drinking fountains in public places under normal conditions. 2. A study of drinking fountains in the labora- tory under controlled conditions. Part I The drinking fountains selected for the preliminary study were located in several public schools. The schools were se- lected so that all age groups would be represented. Further- more, an attempt was made to include drinking fountains of various design. Fundamentally, there are four types of drink- ing fountains; the bubble fountain, the vertical jet drinking fountain, the angle jet fountain without an orifice guard and ‘tho angle jet fountain with an orifice guard. many modifica- tions of these types were encountered, but for the sake of convenience in this discussion, any mention of a particular fountain investigated will fall into one of the four main types. Since the drinking fountains in public schools are used mostly during the recess periods, samples collected from the fountains were taken immediately after this period. Being present in the vicinity of the fountains while they were in use proved to be interesting, since the investigator was able to observe many of the habits of drinking fountain users. The technique used for sampling the fountain parts was the swab rinse method used in food and milk sanitation. In essence, the technique consists of rubbing a sterile cotton swab which has been moistened in sterile Butterfield buffer solution over the surface which is being examined. The swab is returned to a vial containing a certain volume of the buf- fer solution and transported to the laboratory for analysis. In this study 10 ml of solution was used. In studying the possible pollution of the drinking foun- tains, water samples were collected from the fountain to de- termine if the water was contaminated. The technique used to take the water sample was in accordance with Standard Methods (15). The water wasaallowed to run for two minutes after which a 100 ml sample was collected in a sterile salt-mouth bottle containing a few crystals of sodium thiosulfate. The water sample was transported to the laboratory for analysis. The fountain parts selected for sampling were the orifice, the bowl and the orifice guard when present. The swab rinse ‘ technique is a means of evaluating the degree of contamination in that clean versus dirty conditions can be detected. The test determines the approximate number of bacteria present. inasmuch as some organisms are left on the surface and not all the organisms are removed from the swab by the rinse water. With this in mind, the swabbing was done as carefully as possible. Immediately after sampling, the swabs and the water sam- ples were taken to the laboratory. Ten ml portions of the water sample were seeded into each of five tubes of double strength lauryl tryptose broth (Difco) and five tubes each of azide dextrose broth (Difco). The tubes were incubated at 370 and observed after 24 and 48 hours. Coliform and strepto- cocci indexes are reported as the most probable number. The swabs were shaken in the vials until the cotton was fluffy. This was done to insure thorough removal of organ- isms from the swabs. One, 0.1 and 0.01 ml portions of the swab rinse were plated out in tryptone glucose extrace agar (Difco) to ascertain the total number of organisms present. The plates were incubated at 37 C for 48 hours. Similar dilu- tions of the Swab rinse were seeded into each of three tubes of single strength azide dextrose broth. The tubes were incu- bated at 37 C for 48 hours after which they were observed for - growth.. Seligmann (16) reported that azide dextrose broth is an excellent selective medium for detecting streptococci. Tables I, II, III and IV show typical results obtained from several surveys. Streptococci were recovered from the fountain parts in almost 100 percent of the cases. The water samples tested showed no coliform.organisms. Table I shows the results ob- tained from a bubble type drinking fountain. Streptococci were recovered in large numbers from both the orifice and bowl. These data confirm the statement of Berry (1) 38 years ago, that bubble drinking fountains are insanitary. Since the water samples showed no coliforms yet showed the presence of 10 TABLE CONTAHINATION OCCURRING IN A BUBBLE TYPE DRINKING FOUNTAIN (Grades 9 - l2) Day MPH Streptococci/swab MPN Index of Water orifice bowl streptococci coliform l 450 430 2.2 O 2 3.6 1000/ 16 0 5 118 1000/ 39. 0 4 250 22 5.1 O 5 92 74 9.2 O 6 450 45 9.2 O 7 250 450 5.1 O 8 92 920 9.2 O ll streptococci, we can assume that the streptococci cane fron the water in the cup which was probably highly polluted inas- much as the orifice and bowl showed large numbers. Results from an angle jet drinking fountain, not having an orifice guard, are shown in Table II. Streptococci and coliforms were not found in the water sample, again indicating that the water itself was not contaminated. Streptococci were recovered from the bowl and orifice in all samples taken. Tables III and IV are the data obtained from angle jet fountains with orifice guards. Streptococci indexes from the bowl were approximately the same as with the other type fountains. The streptococci indexes from the orifices however were much lower. IEvidently the orifice guard was playing a part in reducing contamination of the orifice to some extent. Nevertheless, in nearly all trials, streptococci were recovered, indicating that the contamination was possible even when a guard was present. The guard itself showed the presence of streptococci. This was expected since often times people touch their lips or faces to the guard. Observation of the drinking fountain users showed that a large number of persons touched their lips to the orifice or orifice guard. Malpractices such as touching the fountain parts with the hands or clothes were also noticed. There appeared to be no Correlation between age groups and magnitude of pollution. The type of drinking fountain seemed to be the contributing factor. 12 TABLE II CONTANIKATION’OCC‘RRING IN AN ANGLE JET FOUNTAIN NOT HAVING AN ORIFICE GUARD (Grades 1 - 8) Day MPN Streptococci/swab MPN Index of Water orifice bgwl_ streptococci coliform 1 92 92 0 0 2 3.6 24 o 0 3 92 250 0 0 4 250 250 0 0 5 118 92 0 0 6 250 430 0 0 7 92 920 0 0 8 92 920 0 0 13 TABLE III CONTAMINATION OCCURRING IN ANGLE JET DRINKING FOUNTAINS HAVING AN ORIFICE GUARD (Grades 1 - 8) Day - MPN Streptococci/swab MPN Index of Water orifice g2§£d_ bggl_ streptococci coliform l 9.1 3.6 220 O O 2 O. 9.1 430 O O 3 0. 5.6 920 O O 4 45. 9.1 9.1 2.2 O 5 5.6 . 3.6 9.1 O O 6 O. 3.6 920 0 O 7 15. 9.1 147 O O 8 5.6 9.1 147 O _O 14 TABLE IV CONTAMINATION OCCURRING IN ANGLE JET DRINKING FOUNTAINS HAVING AN ORIFICE GUARD (Grades 9 - 12) Day MPN Streptococci/swab MPN Index of Water orifice ggg§g_ Egg; strgptococci coliform 1 250 9.1 430 O O 2 45 ' 9.1 250 0 0 3 3.6 3.6 O 5.1 O 4 9.2 9.1 24 O O 5 4.3 3.6 15 O O 6 3.6 O 3.6 O O 7 9.1 3.6 920 O O 8 24 9.1 - 43 O O Part II The investigation in this phase of the study was car- ried out in the laboratory. This study was undertaken to determine the mode of contamination of drinking fountains. From the preliminary studies it was obvious that drinking fountains could be rendered insanitary by improper use. It would, however, be desirable to know if drinking fountains could be vehicles of bacterial transmission through causes inherent in the construction of the fountain, namely, splash- ing of large drops containing bacteria and bacterial aerosols. Hitchens and Ross (9) stated that splashing could be a con- tributing factor in the spread of organisms from.drinking fountains. Three drinking fountains, all of which were of the angle jet type, were set up in the laboratory. The fountains dif- fered in the dimension of the bowl, the type of orifice and the type of orifice guard. The drinking fountains represented the types which are most commonly found in the field. Effect of Splash The fountains were thoroughly cleaned with a detergent and sanitized with water containing 200 ppm chlorine. Con- trol swabs were taken from the bowl, the orifice and the orif fice guard. In order to establish whether or not organisms from the bowl could be splashed up to the orifice or orifice guard it was necessary that these parts be free from any or- ganisms prior to the experiment. ie The test organism which was used throughout this study was Streptococcus faecalis. Ten ml of an 18 hour culture of ‘S. faecalis grown on azide dextrose broth was spread on the inner surface of each fountain bowl by means of a sterile swab. The water was turned on and allowed to run continuously for one hour periods after which samples were taken from the orifice and orifice guard. The swabs were placed in vials containing 10 m1 of sterile physiological saline. One ml por- tions of the swab rinse were seeded into azide dextrose broth tubes. The tubes were incubated at 57 C for 48 hours after which they were observed for growth. It is evident from the results shown in Table V that organisms on the bowl could be splashed on the orifice as shown by data obtained from foun- tain A. Fountain C did not manifest any contamination on the orifice or guard. This can be explained on the basis of design. The orifice of fountain A was within the bowl 223 §g_and about one inch from the bottom of the bowl. The orifice of fountain C was above the bowl and about four inches from the bottom of the bowl. The important point to notice is, however, that three hours after smearing, the test organism was splashed up from the bowl, showing that even with a continuous flow of water, the organisms were not washed down the drain. The next phase of this work was to study what effect the height of the stream had in the contamination of the drinking fountain. In order to simulate a person drinking from the fountain, an apparatus (see Figure l) was set up over the experimental Flt! 17 TABLE v RECOVERY OF S. FAECALIS FROH ORIFICE AND GUARD AFTER RUNNING FOUNTAIN ON EXPERIHENTALLY CONTAMINATED BOWL Tubes Showing Growth after 1 hr. 2 hrs. 3 hrs. 4 hrs. Fountain Parts Swabbed Fountain A orifice - / / - guard - - / - orifice ' - - - - guard - - - - orifice - - / - guard / - - - Fountain B orifice - - - - guard - - - - orifice - / - - guard - - - - orifice - - - - guard - - - - Fountain C orifice - - - - guard - - - - orifice - - - - guard - - - - orifice - - - - guard - - - - / indicates organisms present - indicates no organisms present 18 drinking fountain. The flask (E) contained the broth culture of the test organism. The culture was fed into the stream by means of a capillary (D) which could be adjusted so that the tip would be at the apex of the stream. The fountain was run intermittently employing a 10 second flow period and a five second off period. The height of the stream was adjusted so that several trials could be made with the stream at normal, below normal and above normal height. The fountain was sanitized as previously described and control swabs were taken from the orifice. The fountain was operated and experimentally contaminated for different periods of time. A swab was taken from the orifice at the end of each period. The swabs were rinsed in 10 ml of sterile physio- logical saline. One, 0.1 and 0.01 ml portions of the swab rinse were plated on azide dextrose agar. The plates were incubated at 57 C for 48 hours after which the colonies on the plates were counted. The results are presented in Table VI. From an examination of these data it is evident that the test organism was splashed on the orifice. Apparently when the stream of water fell in the bowl, splashing occurred and drops of water carrying the bacteria were disseminated. In one in- stance the test organism was recovered from the orifice after one minute of operation when the stream was at normal height. When the stream was above normal height, numbers of the test organism recovered was high; whereas recovery was almost negli- gible when the height of the stream was below normal. The re- sults indicate that there was an increase in the number of 19 TABLE ‘VI RECOVERY OF §. FAECALIS FROM ORIFICE WITH CHANGE IN HEIGHT OF STREAH AT INCREASING TIER OF OPERATION I Height of Stream Time of Sampling Trial I Trial II Normal High Low Normal High Low 1 minute 5 80 O O 8 O 5 minutes 1 50 O O 55 O 5 minutes 11 30 1 21 7 O 10 minutes 50 70 5 18 43 O 50 minutes ' 85 140 0 4O 61 4 60 minutes 71 110 O 62 115 0 Controls 0 O O O O O organisms recovered with increasing time of operation. It can be conjectured from these data that the organisms could be disseminated throughout the area around the fountain. The next study was concerned with the extent of splashing in relation to contamination of the area around the drinking fountain. A partition (See F, Figure 2) was designed so that the distance from the orifice to the partition could be varied. A section about 36 square inches was marked off on the parti- tion at a point perpendicular to the fountain and about the same height as the orifice. This section, as well as the drinking fountain, was sanitiZed before each trial at the various distances. The fountain was operated intermittently as described in the previous study for a period of 5 minutes. At the end of each period, the area was swabbed carefully with a sterile swab. The swabs were rinsed as before and l, 0.1 and 0.01 ml portions plated out on azide dextrose agar. The plates were incubated at 57 C for 48 hours, after which the colonies that developed were counted. This experiment was carried out with the heights of the stream at normal, sub- normal and above normal. The results of this study are shown in Tables VII, VIII and IX. These data verify the assumption that bacteria-laden droplets are disseminated quite readily. Even when the height of the stream was below normal, recovery of the organism was possible at a distance of approximately 27 inches from the fountain. Since the section of the parti- tion which was swabbed was in the trajectory plane of the splashing water it was expected that the number of organisms 21 TABLE VII RECOVERY OF §3 FAECALIS FROM A WALL AT DIFFERENT DISTANCES FROM THE FOUNTAIN WHEN THE HEIGHT OF THE STREAM WAS NORHAL Distance from Number of Organisms/swab orifice to partition Trial I Trial II 27 inches 510 490 25 " 1150 1120 25 " 560 960 21 " 450 1410 19 " 1850 1700 17 " 1800 1550 15 " 2120 1420 Controls None None 22 RECOVERY OF S. FAECALIS FROM A WALL AT DIFFERENT DISTANCES FROM THE FOUNTAIN WHEN THE HEIGHT OF THE STREAM WAS SUBNORH! Distance from Number of Organisms/swab orifice to partition Trial I Trial II 27 inches 0 O 25 " 1 0 23 " 0 0 21 " 15 150 19 " 41 19 17 " 80 1 15 n 155 25 Controls Tone None TABLE IX 5’] RECOVERY OF S. AECALIS FROM , WALL AT DIFFERENT DISTANCES FROM THE FOUNTAIN WHEN THE HE SET OF THE STREAM WAS ABOVE NORMAL Number of Organisms/swab Distance from orifice to partition Trial I Trial II 2'7 inches 1550 1790 25 " 1400 2170 25 " 1920 2950 21 " 1790 TNTC 19 " 5270 5120 17 " TNTC TNTC 15 " Trio TNTC Controls None None TNTC - Too numerous to count "Inning. “a“; .' "AIL *1 - ‘ " b«.'*—-v' - ’ “l'VTgn‘ .£:1, "I ' s‘—""‘.§a’.; *‘ — I -‘ ‘ L'K ' .. 735. .n- d- _. -.‘u- E.- - X" " o I. _ _-—. .A-cll “- .‘ A n 1;,._“ . ‘ ' ' “ ‘Q—m—W '- '- ii A recovered would be great. It is a well known fact that when . a liquid falls through air or when it falls on a surface, splashing or bubbling occurs. When the bubble bursts it releases into the air aerosols of small enough particle size to remain suspended for some time. It was established by this study that drops containing bacteria are thrown into the air. It is therefore logical to suspect that bacteria-laden aerosols were set up simultaneously. The following study was an attempt to detect the presence of bacteria in the air around the fountain. It was determined by preliminary tests that the area directly above the fountain was less liable to be in the path of splashing drops. The fountain was operated intermittently and experimentally con- taminated as previously described. Petri plates containing tryptose agar were exposed over the fountain at varying dis- tances. he agar plates were given a 10 second exposure and immediately covered. Fresh agar plates were held for ten sec- onds exposures until 50 minutes had elapsed. The plates were incubated at 57 C for 48 hours. The data in Table X show that bacterial aerosols were being evolved from the fountains. Both agar plates which were held one and two inches above the foun- tain developed colonies which were too crowded to be counted. Apparently large drOps, containing heavy populations of organ- isms, splashed onto the agar at these points. This effect was not observed on the plates held at the higher levels. Distri- bution of the colonies on the plates indicated that the area TABLE X TLE RECOVERY OF S, FAECALIS F13 nOM AEROSOL ABOVE FOUNTAIN Height Above Fountain Total Number of Colonies From 120 Agar Plates 15 inches 5 colonies 12 " 180 " " . 900 " " 3410 " " 5600 " ." 9400 " " 3150 " " .TNTC ' l—‘NCflhb-CJ‘ICBCD " TNTC 20 above the fountain was highly contaminated with bacteria- containing aerosols. Since the agar plates represented only a small area above the fountain, and the organisms recovered on the agar plates were subject to random distribution, the magnitude of the aerosols above the fountain was not demon- strated. The results of the survey of drinking fountains in pub- lic schools showed that the fountains were polluted. The experimental studies which are described in this paper showed that a drinking fountain could be contaminated by various means. With this information in hand the author decided again to ex- amine a drinking fountain which was used by the public and e- valuate it in the light of this information. The drinking fountain selected for this work is located in a large classroom building. This fountain is located near several classrooms, laboratories and offices and is frequently used throughout the day. The drinking fountain is an angle jet type with an ori- fice guard. The drinking fountain is a current model made by a leading manufacturer of drinking fountains. The fountain was in excellent operating condition at the time of the inves- tigation. The stream was at the proper height and the drain- age was rapid and complete. The fountain parts were thoroughly cleaned and sanitized as previously described. This was done in the early morning before anyone was using the building. Swabs of the bowl, ori- fice and orifice guard were taken for controls. 27 A sample of the water was also taken at the same time. The orifice, orifice guard and bowl were swabbed at 15 minute intervals, beginning 15 minutes after the fountains were first used. The swabbing continued in this manner until two hours had elapsed, then swabs were taken at the end of the third and fourth hours. The swabs were placed in vials containing 10 ml of sterile physiological saline and taken into the laboratory. The swabs were examined as previously described. From data shown in Table XI it is obvious that the drink- ing fountain became contaminated almost immediately after use by one person. The author did not observe any person misusing the fountain; hence it is assumed that the bacteria must have been rinsed from the mouth and lips of the drinkers. In most cases the orifice guard was contaminated, showing that the drinkers may have touched the guard with their lips or face. Since the orifice was well guarded and was not touched by any- one the contamination must have been due to splashing drops carrying the organisms or by aerosols set up by the Splashing drops. These data confirm the conclusions reached in the ex- perimental studies. TABLE XI NUKBER OF STREPTOCOCCI RECOVERED FROM DRIAKIRG FOUNTAIN PARTS WHICH HAD BEEN SANITIZED REVIOUS TO BEING USED Time of Sample Number of Streptococci Beginning 15 min. after Bowl Orifice Guard first person used the fountain 15 minutes 1050 O l 50 " 18 50 l 45 " ' 26 5 0 6O " 550 60 58 75 " - 80 O O 90 " 88 42 O 105 " 1255 102 12 120 " 920 81 5O 5 hours 240 6 O 4 " 190 3 1 DISCUSSION The results of these studies verify the assertions made by several early workers, that the drinking fountain is a potential health hazard. It was shown conclusively that the bubble type drinking fountain is a reservoir for bacteria of buccal origin. As early as 1914 this fact was established by Berry (1) yet it is not an uncommon thing to find bubble type fountains in schools, factories and on street corners. In the interest of public health the author strongly recom- mends that this type of drinking fountain be prohibited by law in public places. The new type angle jet fountain is a step in the right direction. However this investigator showed that it too may be a vehicle for the transmission of micro- organisms. The prediction that water splashing on the drink- ing fountains is capable of disseminating organisms was justi- fied. Bacteria which were seeded onto the stream in the same manner, which might take place when the fountain is in actual use, were later recovered from the orifice of the drinking fountain. Furthermore, it was demonstrated that bacteria seeded in the stream were splashed into the area in the im- mediate vicinity of the fountain. The test organism was re- covered from a wall 27 inches from the fountain. It was es- tablished that the height of the stream was a factor to be considered; the higher the stream the greater the splashing. Splashing was decreased as the height of the stream was lowered. 30 It must be remembered, however when the stream of water is low the chances of the users' lips coming in contact with the orifice and orifice guard increase. The possibility of bacterial aerosols being evolved over the fountain was investigated and demonstrated. Large numbers of organisms were recovered on agar plates held over the foun- tains at various distances while the fountain was in operation. From the results of these studies, it is apparent that the drinking fountain can contribute to the spread of patho- genic microorganisms even when the fountains are properly used. Splashing dro;s, containing organisms rinsed from the mouths and lips of infected persons, can be transmitted to the ori- fice of the drinking fountain and subsequently to the mouths or lips of the next drinker. Bacterial or viral aerosols over the drinking fountain could be a means of disease transmission from one person to another. SUIJIARY A survey of drinking fountains in public places revealed that insanitary conditions existed. In nearly 100 percent of he fountains examined, streptococci were recovered from the drinking fountain bowl, orifice and orifice guard. The bubble type fountain proved to be the greatest offender followed by the angle jet fountain without a guard over the orifice. There appeared to be no correlation between the age of the persons using the fountains and the amount of pollution. Wa- ter samples taken at the time of swabbing showed the water to be of excellent quality, hence the pollution was caused by the persons using the fountain. Experimental studies on drinking fountains revealed that bacteria could be transferred from the bowl of the drinking fountain to the orifice. Evidence of bacteria remaining on the bowl for several hours, even when the fountain was run continuously, was obtained. The height of the stream was shown to be a factor in the spread of organisms from the bowl to the other fountain parts. The number of bacteria recovered from the orifice increased when the height of the stream was increased. Bacteria seeded in the stream of the drinking fountain were recovered from the walls surrounding the fountain at a distance of 27 inches. It was shown that this was caused by splashing when the streams struck the bowl. 32 It was found that bacterial aerosols were created and disseminated over the drinking fountain. Drinking fountains are rapidly contaminated in normal use under the most ideal conditions. 5. 4. 10. ll. 12. LIST OF {EFERENCBS Berry, Jane L., 1914. Bubble Fountain Tests. Collected Studies from the Bureau of Laboratories, City of New York. Cited by Ingram, W. T., 1951. Mbdern Sanitatigg,5:54. Pettibone, D. F., Bogart, F. B., and Clark, P. F., 1916. The Bacteriology of the Bubble Fountain. Jour. Bact., 1:471. Whittaker, s. A., 1917. Drinking Fountains: Investiga- tions of Fountains at the Univ. of Minn., U. S. Public Health Service. LPublic Health Reports, 1:471. Dieter, Louis V., 1919. The Relative Sanitary Values of Different Types of Drinking Fountains, rart 1. The Amer- ican City, 21:452. Dunlap, J. H., 1919. Common Sense, Science and Drinking Fountains. The American City, 21:470. Dunlap, J. H., Hinman, J. J., and Maffitt, D. L., 1920. Progress Report of the Committee on Sanitary Drinking Fountains. Jour. Am. Water Works AssOc., 7:55. Hillis, D. s., 1919. Sanitary Drinking Fountains, U. 3. Navy med. Bull., 15:287. Cited by Ingram, W. T., 1951. Modern Sanitation, 5:55. Dieter, Louis V., 1919. The Relative Sanitary Values of Different Types of Drinking Fountains, Part II. The Amer- ican City, 21:549. Hitchens, A. P. and Ross, 0. A., 1945. Bubbling Drinking Fountains. Jour. Am. Water Works Assoo., 55:165. Stiles, G. W., 1951. Recovery of Diphtheria Organisms, Public Health Lab. 1:70. Cited by Ingram, W. T., Modern Sanitation, 5:55. Birnkrant, W. B., Greenburg, M. and Most, H., 1945. Amebiasis in a Hospital for the Insane. Amer. Jour. Pub. Iealth, 55:805. , 1945. How Kuch Are Drinking Fountains Costing In VIEal Manpower. Lily-Tulip Cup. Corporation. l5. 14. 31+ Ingram, W. T., 1951. The Drinking Fountain, Possible Disease Hazards. Hodern Sanitation, 5:56. Anderson, R. B., Moss, M. L. and Gross, N. A., 1952. Potential Infectious Hazards of Common Bacteriological Techniques. Jour. Bact., 64:475. Standard Hethods for the Examination of Water and Sewage, 9th Ed. 1946. Amer. Public Health Assoc. New York. Seligmann, E. B. Jr., 1949. Evaluation of Liquid Kedia for the Quantitative Determination of Streptococci from Soil and Water. M. L. Thesis. Rich. State College. E. am ‘3 0 mm D 0‘. . V . ,. p L . .. .§. \ .nx‘d ‘P I“) ....,1-../. . «W. T 4 . . .t ....v , {J ... I“. ww...~rlo. .J. i , ¢ .1 . -r‘ . . I. .. . .1.qu Wh$rwflm . 4... . . . . . taint- an... min”. a t. a. . y ‘ . \) . .. 5..-... o .l. . I . .v .A( D .9 *.4. .N‘ In ,....14 .u’." ..v ‘4?! 4 . \ . .... v.1 I. , . A. . f. .. a v . u, a..- a fa. tuna. .. .’. . . .' .ut'i . '. ~ .V. O .. - . .. - . I. (K... .4 . . -...|. . $1.. .. .ev... . l i . 0. ... \ n l . . u rt. l".... .V. ...\‘4 to . ‘..\...|\A um... ‘ "Q. ‘ Wk... _ ic, . .lfrt ‘ . I . .\ 1‘ ."o. . , . .. - . i ,v o 4 . " l ICHIGQN STRTE UNIV. LIBRRRIE 058llllll I :ll