The increase in legionellosis incidence in the general population in recent years calls for a better characterization of the sources of infection, such as showering. Water-efficient shower systems that use water atomization technology may emit slightly more inhalable bacteria-sized particles than traditional systems, which may increase the risk of users inhaling contaminants associated with these water droplets.
To evaluate the risk, the number and mass of inhalable water droplets emitted by twelve showerheads—eight using water-atomization technology and four using continuous-flow technology— were monitored in a shower stall. The water-atomizing showers tested not only had lower flow rates, but also larger spray angles, less nozzles, and larger nozzle diameters than those of the continuous-flow showerheads. A difference in the behavior of inhalable water droplets between the two technologies was observed, both unobstructed or in the presence of a mannequin. The evaporation
of inhalable water droplets emitted by the water-atomization showers favored a homogenous distribution in the shower stall. In the presence of the mannequin, the number and mass of inhalable droplets increased for the continuous-flow showerheads and decreased for the water-atomization showerheads. The water-atomization showerheads emitted less inhalable water mass than the continuous-flow showerheads did per unit of time; however, they generally emitted a slightly higher number of inhalable droplets—only one model performed as well as the continuous-flow
showerheads in this regard.
To specifically assess the aerosolisation rate of bacteria, in particular of the opportunistic water pathogen Legionella pneumophila, during showering controlled experiments were run with one atomization showerhead and one continuous-flow, first inside a glove box, second inside a shower stall. The bioaerosols were sampled with a Coriolis® air sampler and the total number of viable (cultivable and noncultivable) bacteria was determined by flow cytometry and culture. We found that the rate of viable and cultivable Legionella aerosolized from the water jet was similar between the two showerheads: the viable fraction represents 0.02% of the overall bacteria present in water, while the cultivable fraction corresponds to only 0.0005%. The two showerhead models emitted a similar ratio of airborne Legionella viable and cultivable per volume of water used. Similar results were obtained with naturally contaminated hoses tested in shower stall. Therefore, the risk of exposure to Legionella is not expected to increase significantly with the new generation of water-efficient showerheads.