Page 115 - Journal of Special Operations Medicine - Summer 2016

An Ongoing Series

An Evaluation of Common Cleaning Methods for
the Removal of a Clinical Isolate of Escherichia coli in
Personal Hydration System Water Reservoirs

Stephanie Helmus, DDS; Jauchia Blythe, PhD;
Peter Guevara, DMD, MAGD, ABGD; Michael A. Washington, PhD

ABSTRACT
Waterborne infection is an important cause of morbid- especially true for military personnel, who often perform
ity and mortality throughout the world. Personal hydra- strenuous activities under stressful and austere condi-
tion packs have been used by military personnel since tions, where a clean and reliable water source may not
the Gulf War and are now a common issue item. Since be readily available. Indeed, the degradation of infra-
military personnel tend to operate under austere condi- structure, population displacement, and loss of public
tions and may use a variety of water sources, prevent- services that occur during war have often been associ-
ing the acquisition of waterborne infections is extremely ated with increases in waterborne diseases. This has
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important. Further, since hydration pack water reservoir been demonstrated in conflict and natural disaster zones
replacements may not be available during combat op- in locations that are both geographically and culturally
erations, the development of a reliable cleaning protocol distinct. Personal hydration packs have been used by
4,5
for use in the field is essential. Several methods for clean- military personnel since the Gulf War and are now a
ing have been described. In the current study, three com- common issue item. The typical hydration pack (com-
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mon cleaning methodologies—bleach treatment, baking monly known as a CamelBak) consists of a backpack-
soda treatment, and proprietary CAMELBAK Cleaning type sack and a removable 2L to 3L water reservoir to
Tabs —were evaluated for the ability to remove Esch- which a drinking tube can be attached. Since military
™
erichia coli contamination from hydration pack water personnel tend to operate under austere conditions and
reservoirs. The study results suggest that the use of may use a variety of water sources, preventing the acqui-
bleach and proprietary CAMELBAK tablets should be sition of waterborne infections is extremely important.
encouraged since they both operate by releasing bacteri- Further, since hydration pack water reservoir replace-
cidal chlorine compounds into solution, which is more ments may not be available during combat operations,
effective at reducing post-treatment bacterial burden. It the development of a reliable cleaning protocol for use
should be noted that no method was 100% effective at in the field is essential.
completely eliminating bacteria from the reservoirs and
that mechanical cleaning was not attempted. Interestingly, although the US military has studied the in-
tegrity of particular hydration packs in a CBRN (chemical,
Keywords: CAMELBAK Cleaning Tab ; infection, water- biological, radiological, nuclear) environment, the ability
™
borne; hydration packs, personal; cleaning methodologies; of the current cleaning methods to eliminate pathogenic
Escherichia coli contamination microorganisms from the interior of the water reservoir
has not been evaluated. Several methods for cleaning
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have been described. These methods include draining the
reservoir and rinsing with bleach, draining the reservoir
Introduction
and cleaning with a baking soda solution, and cleaning
Waterborne infection is an important cause of morbid- with a variety of commercially available, water-soluble
ity and mortality throughout the world. Proper hydra- cleaning tablets. The evaluation of these methods using
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tion is an essential part of any physical activity. This is clinical bacteria is essential given that clinical isolates are
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