Microbiological Health Risk Assessment ofWater Conservation Strategies: A Case Study in Amsterdam

Agung Kusumawardhana, Ljiljana Zlatanovic, Arne Bosch , Jan Peter van der Hoek

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The aim of this study was to assess the health risks that may arise from the implementation of greywater reuse and rainwater harvesting for household use, especially for toilet flushing. In addition, the risk of cross connections between these systems and the drinking water system was considered. Quantitative microbial risk assessment (QMRA) is a method that uses mathematical modelling to estimate the risk of infection when exposure to pathogens happens and was used in this study to assess the health risks. The results showed that using rainwater without prior treatment for toilet flushing poses an annual infection risk from L. pneumophila at 0.64 per-person-per-year (pppy) which exceeds the Dutch standard of 10−4 pppy. The use of untreated greywater showed a risk that is below the standard. However, treatment is recommended due to the ability of P. aeruginosa to grow in the reuse system. Moreover, showering and drinking with cross-connected water has a high annual infection risk that exceeds the standard due to contact with Staphylococcus aureus and E. coli O157:H7. Several measures can be implemented to mitigate the risks such as treating the greywater and rainwater with a minimum of 5-log removal, closing the toilet lid while flushing, good design of greywater and rainwater collection systems, and rigorous plumbing installation procedures.
Original languageEnglish
Article number2595
Pages (from-to)1-17
Number of pages17
JournalInternational Journal of Environmental Research and Public Health
Issue number5
Publication statusPublished - 2021


  • Cross connection
  • Drinking water
  • Greywater reuse
  • Human health risk
  • QMRA
  • Rainwater harvesting
  • Showering
  • Toilet flushing


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