APPLIED AND ENVIRONMENTAL MICROBIOLOGY, Apr. 1994, p. 1174-1178 Vol. 60, No.

4
0099-2240/94/$04.00+0
Copyright ©D 1994, American Society for Microbiology

Comparison of the Microbiological Quality of Water Coolers

and That of Municipal Water Systems
BENOIT LEVESQUE,I* PIERRE SIMARD,2 DENIS GAUVIN,1 SUZANNE GINGRAS,
ERIC DEWAILLY,1 AND ROBERT LETARTE2
Service Sante et Environnement, Centre de Sante Publique de Quebec, Ste-Foy, Quebec, Canada GJ V 2K8,' and
Departement de Microbiologie, Faculte de Medecine, Universite Laval, Ste-Foy, Quebec, Canada G1K 7P42
Received 5 August 1993/Accepted 17 January 1994

The microbiological quality of tap water and that of water from 50 water coolers located in residences and
workplaces were comparatively studied. In addition, different factors that might influence the bacteriological
contamination of water dispensers were examined. Aerobic and facultative anaerobic heterotrophic bacteria,
total coliforms, and two indicators for fecal contamination (fecal coliforms and fecal streptococci) as well as
three types of pathogenic bacteria (Staphylococcus aureus, Pseudomonas aeruginosa, and Aeromonas spp.) were
enumerated. It was found that 36 and 28% of the water dispenser samples from the residences and the
workplaces, respectively, were contaminated by at least one coliform or indicator bacterium and/or at least one
pathogenic bacterium. The respective proportions of tap water samples contaminated in a similar fashion were
18 and 22%, much less than those observed for water coolers (X2 = 3.71, P = 0.05). We were unable to discern
the dominant factors responsible for the contamination of water coolers, but cleaning the water dispenser every
2 months seemed to limit the extent of contamination.

In North America, the market for bottled water is in full
expansion. Its annual growth rate is estimated to be 25% (27).
The consumption of spring water (mineral salts, <500 mg/liter)
accounts for most of this increase. In the Canadian province of
Quebec, 900,000 persons out of a population of 6,800,000 now
drink bottled water (18).
Spring water contains a natural microflora composed mainly
of species of the genera Achromobacter, Flavobacterium, Al-
caligenes, Acinetobacter, Cytophaga, Moraxella, and Pseudomo-
nas (12, 24). Initial populations are small but can evolve rapidly
during bottling and storage (26). In the absence of treatment
(i.e., chlorination and ozonation), bacterial multiplication may
occur for 1 to 3 weeks after bottling, and the bacterial count
can reach 103 to 104 bacteria per ml at 37°C (10).
In addition to natural contamination, the product can also
be altered before it reaches the consumer. Contamination can
occur at any time during processing. In Wales, Hunter and
Burge (11) found Staphylococcus epidermidis and Staphylococ-
cus humanis in 6 of 52 bottles of water, which was attributed to
poor hygiene.
In Canada, Warburton et al. (27) reviewed the results of
tests of all bottled water samples collected by Health and
Welfare Canada between 1981 and 1989 and concluded that 2
to 3% of the samples contained coliform bacteria. Further-
more, Sekla et al. (25) analyzed 60 bottles of water from retail
stores and processing plants and found coagulase-positive
Staphylococcus aureus in two samples, coliforms in four sam-
ples, and Enterococcus spp. in one sample.
The aim of these studies was to determine if contamination
had occurred in the time between collection of the water at the
spring and its processing for commercial use. Such studies,
however, do not account for consumer behavior regarding the
preservation of the product.
In the province of Quebec, 30 to 50% of all complaints about
*
Corresponding author. Mailing address: Service Sante et Environ-
nement, Centre de Sante Publique de Quebec, 2050, boul. Rene-
Levesque Ouest, Ste-Foy, Quebec, Canada G1V 2K8. Phone: (418)
687-1090, ext. 296. Fax: (418) 681-5635.
1174
bottled water received by the Ministry of Environment were
related to water coolers (18). There are some 50,000 dispensers
in public places and in workplaces all over the province (18),
and there are possibly as many more in private residences. To
our knowledge, almost no data on the bacteriological quality of
the water in these dispensers exist. Moreover, the lack of
hygiene standards adds to the uncertainty surrounding health
risks that could be related to the use of water coolers.
The purposes of our study were to evaluate the microbio-
logical quality of spring water dispensed by water coolers in
residences and workplaces in the Quebec City region; compare
the microbiological quality of this water with that of municipal
tap water; and evaluate the importance of handling factors,
such as cleanliness and storage time, to the microbiological
quality of water coolers.
MATERIALS AND METHODS
Between 1 June and 1 August 1992, we selected and visited
residences and workplaces located in two municipalities of the
Quebec City region chosen on the basis of their similar sizes,
i.e., they had populations of around 60,000 inhabitants, and the
fact that they are served by different municipal water systems.
City 1 uses raw water of low quality which undergoes treat-
ment, whereas city 2 obtains its water from a less contaminated
source, and the water is only filtered and disinfected. Resi-
dences and workplaces were randomly selected from the
phone book and from the list of enterprises of the Commission
on Health and Security at the Work Place of the Province of
Quebec. A phone call was made to verify that a water cooler
was in use. To be included in the study, owners of water
dispensers had to have water supplied by a recognized com-
pany. We then selected 50 residences and 50 workplaces
divided equally between the two municipalities.
Each site was inspected, and the results were documented. A
questionnaire regarding the age of the water dispenser, the
amount of water consumed, the frequency and method of
cleaning, and related matters was filled out. Samples were
taken from the water cooler and from the most-often-used
VOL. 60, 1994 MICROBIOLOGICAL QUALITY OF WATER COOLERS 1175

faucet. To make sure that the samples were representative of TABLE 1. Proportions of contaminated water coolers and faucets
the water consumed, we did not flush before sampling, and in residences and workplaccs
there was no attempt to sterilize the outer surfaces of the Indicator % Contaminated water ' Contaminated faucets
faucets. In conjunction, water samples were collected for bacterium or coolers in: in:
bacterial analysis from 20 18-liter bottles of spring water pathogen and
(representing the five most important bottling companies in class of
the region) before installation of the bottles on water dispens- contamination Residences Workplaces Rcsidcenccs Workplaccs
ers. TC 30 14 18 4
The samples were collected in sterile 1-liter plastic bottles FC 8 0 4 8
containing 5 ml of a sterile sodium thiosulfate solution (1%). FS 2 0 2 0
They were kept at 4°C and analyzed within 24 h in a laboratory S. auireus 8 6 0 10
accredited by the Quebec Ministry of Environment. Since P. aeruginiosa 0)0 0 0
infectious diseases could be spread through drinking water Aeromnonas spp. 8 14 4 8
mainly by contamination with material of fecal origin (26), we Al 36 28 18 22
B") 30( 22 8 22
quantified three indicators of fecal contamination (total colif- BI' 62 62 2 12
orms [TC], fecal coliforms [FC], and fecal streptococci [FS]). B2"' 44 16 0 2
We also assayed the water for aerobic and facultative anaero-
bic heterotrophic bacteria, an indicator frequently used to -I FC and/or .1 FS and/or -I TC and/or - I pathogenic bacterium per I(1O
ml.
verify the microbiological quality of bottled water (26, 27). -I FC and/or -I FS and/or -1I TC and/or -I pathogenic bactcrium per
Finally, we quantified microorganisms known to be opportu- 100 ml.
nistic human pathogens (Pseudomonas aeruginosa, S. aureus, -1.000 aerobic and anaerobic heterotrophic bactcria per ml.
and Aeromonas spp.), recognizing the concern of the World d- 1(0,000 aerobic and anaerobic heterotrophic bacteria per ml.
Health Organization about P. aeruginosa in bottled water (20)
and the ubiquitous presence of S. aureus (3, 14) and Aeromo-
nas spp. (19) in the water environment. We also compared the proportions of contaminated water
The heterotrophic plate count (HPC) was determined by the dispensers in the workplaces and in the residences. For our two
pour plate method at 35°C for 48 h in accordance with the classes of contamination, there was no statistical difference in
technique described by the American Public Health Associa- the proportion of water coolers contaminated (class A, X, =
tion (1). TC, FC, FS, S. aurelis, and P. aeruginosa were 0.74, P = 0.39; class B, X, = 0.83, P = 0.36). As for tap water,
quantified by membrane filtration (1). Aeromonas spp. were the proportion of class B samples was higher for the work-
filtered (0.45-[Lm pore size) from 1- and 100-ml water dis- places than for the residences (X2 = 3.84, P = 0.05), while the
penser samples and 100-ml tap water samples. Each membrane proportions of class A samples were similar for the two
with filtered cells was placed directly on phenol red agar locations (X2 = 0.25, P = 0.62).
supplemented with 1% soluble starch and 10 ,ug of ampicillin A second sampling of the contaminated faucets of resi-
per ml as suggested by Palumbo et al. (21). dences and workplaces following a tap water flushing of 5 min
The results were divided into two classes according to their showed only one of the tap water samples (41 TC per 100 ml)
degrees of contamination. A sample of 100 ml was put in class to be contaminated.
A if it was contaminated by either one of the pathogens or one Various factors, such as socioeconomic status and the pres-
of the following indicators: TC, FC, or FS. Class B was similar ence of very young children in the case of residences and type
to class A except that the number of TC had to be 10 or more, of enterprise (service or industrial) as well as number of
the level considered unacceptable by the Qu6bec Ministry of employees in the case of workplaces, were considered in order
Environment for drinking water derived from a municipal to determine if they were related to the water coolers contam-
water system (17). inated at the class A or the class B level. Moreover, we
The data were sorted according to their origin (residence or documented the maximum storage time of bottles, the dura-
workplace). Tap water and the water dispensers were com- tion of use of a bottle after installation on the dispenser, the
pared by using the proportions of contaminated samples in frequency of cleaning of the water cooler, the interval between
classes A and B. The various factors that could influence the the last cleaning and sampling, and the type of cleaning.
quality of the water dispensed by water coolers were also Statistically, for the two classes of contamination, no factors
examined. Finally, residences and workplaces were compared
for each contamination class. To verify the statistical signifi-
cance of all these comparisons, we used the chi-square test
except when the conditions for that test were not met. In that TABLE 2. Comparison of the proportions of contaminated water
case, we used Fisher's bilateral test (4). coolers and faucets
Contamination in Contamination in Total
RESULTS Class of residences workplaces

The participation rates were 92% for the residences and

contamination % of cl of Ofp/of
% of '4 off
C' F" C F C F
90% for the workplaces. The results of microbiological analy-
ses performed on samples from the water coolers and tap A"d 36 18 0.04 28 22 0.49 32 20 0.05
water of each of the residences and workplaces appear in Table B" 30 8 0.005 22 22 1.00 26 15 0.05
1. Water dispensers and faucets are compared for each class of "% of C, percentage of water coolers that were contaminated.
contamination in Table 2. The results of the HPCs for the "% of F, percentage of faucets that were contaminated.
water coolers, tap water, and the 20 bottle samples are Significance level (X2 test).
-11 FC and/or -1 FS and/or -I TC and/or -I paithogenic bacterium per I ()(
presented in Table 3. It should be noted that none of these ml.
bottles was contaminated by either TC, FC, FS, or pathogenic "-I FC and/or 1I FS and/or -10 TC and/or -I pathogenic bacterium per
bacteria. 100 ml.
1176 LEVESQUE ET AL.
TABLE 3. Distribution of the HPCs for the samples
HPC (no. of % of water coolers in:
bacteria/mi) Residences Workplaces
0-10 10 8 50
11-100 8 2
101-1,000 20 28
1,001-10,000 20 46
10,001-100,000 32 12
> 100,000 10 4 0
Rangea 0-270,000 0-260,000
Mediana 7,000 1,990
a Number of bacteria per ml.
stood out at a significance level of 0.05 (residences, P - 0.25
for all the factors; workplaces, P - 0.16 for all the factors).
This may be due in part to the small sample size.
The quality and frequency of the cleanings were judged
against the recommendations made by the Quebec Bottlers
Association and the Quebec Ministry of Environment, which
stipulate that the reservoir should be scrubbed with a commer-
cial solution of sodium hypochlorite (6%) and rinsed every 2
months. Unfortunately, at the expense of the sample size, we
had to stratify our data further to look for the influence of the
frequency of cleanings when cleaning was done as recom-
mended. In the residences, only one water dispenser of the six
which were cleaned in the manner and at the interval recom-
mended was contaminated at the class A level, and none were
contaminated at the class B level. In contrast, 7 of the 12 water
dispensers which were cleaned in the manner recommended,
but not frequently enough, were contaminated at both levels. A
comparison of these two sets of conditions for the cleaning of
coolers using a Fisher test yielded probabilities of 0.15 for class
A and 0.04 for class B, indicating that despite the very small
sample size a benefit was derived from regular cleaning. On the
other hand, there was no difference between the dispensers
that were not cleaned in the manner recommended regardless
of the frequency of cleaning (class A, P = 1.0; class B, P =
0.61).
In the workplaces, when cleaning was in agreement with the
recommendations, 2 of 12 water dispensers were contaminated
at the class A level in contrast with 1 of 12 at the class B level.
When cleaning was not done in the manner recommended, the
proportions were 6 of 19 and 5 of 19, respectively (class A, P =
0.43; class B, P = 0.36). Cleaning the water coolers as
recommended seemed to influence the contamination, but the
difference was not statistically significant. On the other hand,
even when the cleaning was done in the manner recom-
mended, the contamination of water dispensers was not af-
fected by the cleaning frequency. Three water coolers of nine
cleaned at the interval recommended were contaminated at
the class A level, and two of nine were contaminated at the
class B level. Similarly, two and three of the nine water coolers
cleaned in the manner recommended, but not frequently
enough, were contaminated at the A and B levels, respectively.
A comparison of these two proportions using a Fisher test
yielded a probability of 1.0. It is possible that the higher level
of water consumption in the workplaces limited the risk of
contamination and the importance of regularly cleaning the
dispenser. The average consumption of bottles was 3.92 bottles
per month in the residences as opposed to 10.43 bottles per
month in the workplaces.
APPL. ENVIRON. MICROBIOL.
% of faucets in: %newof
Residences Workplaces bottles
64 45
30 18 15
18 12 35
2 4 5
0 2 0
0 0
0-2,400 0-12,000 0-6,000
12 1.5 14
DISCUSSION
As expected, none of the 20 unopened bottles of spring
water were contaminated by pathogenic or indicator bacteria,
although small quantities of heterotrophs were recovered
(Table 3). These small quantities of heterotrophs are in sharp
contrast to the higher quantities reported in the literature,
mainly from Europe (10, 26), and can be attributed to disin-
fecting processes (ozonation or UV irradiation) used by the
manufacturers in Canada, which reduce bacterial numbers to
low levels.
Interestingly, we found that the HPC in water coolers were
much higher than those in the faucets (Table 3). Moreover, the
distribution of HPC in the 20 new bottles was very similar to
the result obtained with the faucet samples, indicating that the
use of water coolers can promote the multiplication of hetero-
trophic bacteria.
In the residences, the water extracted from water coolers
was markedly more contaminated than the first streams of tap
water (Table 2). In the workplaces, however, the two sources
were equally contaminated. The fact that in workplaces faucets
are not often used and are not kept clean may be an explana-
tion. The follow-up on the 11 contaminated faucets revealed
that only 1 of them still showed signs of contamination after 5
min of flushing, thus pointing to the plumbing of the buildings
rather than the municipal water system as the source of
contamination.
To our knowledge, only one other study of the bacteriolog-
ical quality of the water dispensed by water coolers has been
done in North America. On the campus of Northeastern
University, Kozlowski et al. (13) sampled 10 water coolers once
a week over a period of 2 months to obtain HPCs. They found
concentrations ranging from 2 x 103 to 106 CFU/ml. On the
basis of these results, the authors insisted on the necessity of
cleaning water dispensers regularly.
As was the case in the above-mentioned study, we also
obtained an HPC of at least 103 CFU/ml for 62% of the water
dispensers we sampled. Generally, this indicator is used to
establish the effectiveness of the treatment methods used in
municipalities. The United States Environmental Protection
Agency estimates that 5 x 102 CFU/ml is the upper acceptable
limit on the basis of the potential of high HPCs to interfere
with detection of coliform bacteria (9).
Caution is needed when interpreting the public health
significance of HPCs for bottled water. As mentioned previ-
ously, bottled water is already contaminated with a natural
microflora essentially nonpathogenic for humans (7, 15). These
bacteria may be potentially pathogenic to more vulnerable
VOL. 60, 1994
individuals, however, such as infants and immunosuppressed
patients (26). A recent study found a relationship between
HPCs in water treated with reverse-osmosis filtration units and
the incidence of gastrointestinal problems (22).
The Quebec Ministry of Environment stipulates that spring
water should be bacteriologically pure and free of contami-
nants (23). Obviously, this regulation, like all qualitative
norms, is not precise. Health and Welfare Canada, however, in
its Food and Drug Act, specifies that mineral and spring water
must not contain coliforms (16). The World Health Organiza-
tion states that bottled water must be totally free of coliforms
and P. aeruginosa; the latter requirement was included because
of the vulnerability of children and the elderly to this organism
(20). In Europe, the Council of the European Community
states that natural mineral water (including spring waters low
in minerals) must not contain any parasite, pathogenic micro-
organism, Escherichia coli or other coliform, fecal streptococ-
cus, sulfate-reducing anaerobic bacterium, or P. aeruginosa,
and it stipulates that at 12 h after bottling the total number of
bacteria must not exceed 100 CFU/ml (6). In the United
States, only one 100-ml portion in the sampling procedure is
permitted to contain four coliforms or more, but the arithmetic
mean of the analytical units must not exceed one coliform per
100 ml (5). Whereas microbiological standards exist for bottled
water, the same product once installed on a dispenser is
generally not regulated and is rarely controlled.
Concerning our study, the proportion of water dispensers
contaminated at the A and B levels is disturbing. This contam-
ination is not related to the product itself but rather to the use
of a water cooler as the dispenser. Unfortunately, we were
unable to discern the dominant factors responsible for this
contamination, and this constitutes a great limitation in the
interpretation of the data. We must, however, look beyond the
statistics. Even if certain relationships were not statistically
significant, it is still revealing to look at the influence of
cleaning on contamination. Regular cleanings as recom-
mended should probably limit contamination.
As for the participants in our study, only 44% of those
possessing water coolers in residences and 36% of those
possessing water coolers in workplaces had been informed of
the necessity of cleaning the equipment, let alone how to do it.
Thus, a variety of products had been used, from baking soda to
vinegar and dishwashing liquid, instead of sodium hypochlorite
as recommended.
On the basis of results obtained with a sampling of initial
streams of water, the bacteriological quality of municipal tap
water is superior to the quality of the water dispensed by water
coolers in residential sites. In part because of more instances of
contaminated tap water in the survey of workplaces, there was
no statistical difference in contamination between the two
sources of water (Table 2). However, we demonstrated in a
follow-up sampling of the contaminated faucets that tap water
contamination may be derived from the plumbing of the
buildings. As with lead contamination (2), it is probable that
the longer the water has been standing in the tap, the greater
the potential there is for bacteria to accumulate if, of course,
there is a source of bacteria in the building's plumbing system.
It has been proposed that tap water should be permitted to
flow until it is at a constant cold temperature before use (2).
Our results indicate that we should be cognizant of the
quality of the water dispensed from water coolers. Although it
is possible to manufacture water dispensers which are less
likely to become contaminated (8), vendors and suppliers of
water dispensers should impress on their clients the need for
regular maintenance of the equipment.
In addition, studies determining the health impact of drink-
MICROBIOLOGICAL QUALITY OF WATER COOLERS 1177
ing water from dispensers should be undertaken, and public
health authorities should be made aware of water dispensers as
a possible source of contamination when investigating food- or
water-related epidemics.
ACKNOWLEDGMENTS
We express our sincere gratitude for the anonymous reviewers'
comments and the extensive editorial work done by R. F. Unz.
We also thank Caroline Gosselin, Lyne Audet, Michel Lavallde, Lise
C6te, Martin Handfield, Morris Goldner, and Jacques Grondin for
their valuable assistance.
REFERENCES
1. American Public Health Association. 1985. Standard methods for
the examination of water and wastewater, 16th ed. American
Public Health Association, Washington, D.C.
2. American Water Works Association. 1990. Lead control strategies.
American Water Works Association Research Foundation and
American Water Works Association, Denver.
3. Anrstrong, J. L., D. S. Shigeno, J. J. Calomiris, and R. J. Seidler.
1981. Antibiotic-resistant bacteria in drinking water. Appl. Envi-
ron. Microbiol. 42:277-283.
4. Bernard, P. M., and C. Lapointe. 1987. Mesures statistiques en
epidemiologie. Presses de l'Universite du Quebec, Quebec, Can-
ada.
5. Code of Federal Regulations. 1992. Bottled water quality standard.
Fed. Regist. 21:62-64.
6. Le Conseil des Communautes Europeennes. 1980. Directive du
conseil relative au rapprochement des legislations des etats mem-
bres concernant l'exploitation et la mise dans le commerce des
eaux minerales naturelles. Journal officiel des Communautes
Europeennes, 80/777/CEE.
7. Ducluzeau, R., S. Dufreesne, and J. M. Buchan. 1976. Inoculation
of the digestive tract of axenic mice with the autochthonous
bacteria of mineral water. Eur. J. Appl. Microbiol. 2:127-134.
8. Eckner, K. F. 1992. Comparison of resistance to microbial con-
tamination of conventional and modified water dispensers. J. Food
Prot. 55:627-631.
9. Environmental Protection Agency. 1989. Drinking water; national
primary drinking water regulations; filtration, disinfection; turbid-
ity, Giardia lamblia, viruses, Legionella, and heterotrophic bacte-
ria. Fed. Regist. 54:27486-27540.
10. Gonzalez, C., C. Gutierrez, and T. Grande. 1987. Bacterial flora in
bottled uncarbonated mineral drinking water. Can. J. Microbiol.
33:1120-1125.
11. Hunter, P. R., and S. H. Burge. 1987. The bacteriological quality of
bottled natural mineral waters. Epidemiol. Infect. 99:439-443.
12. Kolbel-Boelke, J., E. M. Anders, and A. Nehrkorn. 1988. Microbial
communities in the saturated groundwater environment. Microb.
Ecol. 16:31-48.
13. Kozlowski, L., T. Gorrell, J. Noll, and F. Rosenberg. 1992.
Bacterial contamination in bottled water dispensers, Q-7, p. 336.
Abstr. 92nd Gen. Meet. Am. Soc. Microbiol. 1992. American
Society for Microbiology, Washington, D.C.
14. LeChevallier, M. W., and R. J. Seidler. 1980. Staphylococcus
aureus in rural drinking water. Appl. Environ. Microbiol. 39:739-
742.
15. Leclerc, H. 1980. Les qualites bacteriologiques de l'eau minerale
d'Evian, p. 24-27. In De l'eau minerale d'Evian. S. A. des eaux
minerales d'Evian, Evian, France.
16. Loi des aliments et drogues et du reglement sur les aliments et
drogues. 1990. Article B.12.001-B.12-009. Division 12, Ministere
de la Sante nationale et du Bien-etre social, Ottawa, Canada.
17. Loi sur la qualite de l'environnement (Projet de loi 65). 1990.
Chap. Q-2, rule R4.1. Reglement sur l'eau potable, Editeur officiel
du Quebec, Quebec, Canada.
18. Ministere de l'Environnement du Quebec. 1991. Memoire sur un
projet de reforme de la reglementation en matiere d'eaux et de
glace commerciales et de purificateurs domestiques. Direction des
ecosystemes urbains, Division des eaux commerciales, Quebec,
Canada.
19. Moyer, N. P., G. Martinetti Luccini, L. A. Holcomb, N. H. Hall,
1178 LEVESQUE ET AL.
and M. Altwegg. 1992. Application of ribotyping for differentiating
aeromonads isolated from clinical and environmental sources.
Appl. Environ. Microbiol. 58:1940-1944.
20. Organisation Mondiale de la Sante. 1985. Directives de qualite
pour l'eau de boisson, vol. 1. Organisation mondiale de la sante,
Geneva.
21. Palumbo, S. A., F. Maxino, A. C. Williams, R. L. Buchanan, and
D. W. Thayer. 1985. Starch-ampicillin agar for the quantitative
detection of Aeromonas hydrophila. Appl. Environ. Microbiol.
50:1027-1030.
22. Payment, P., E. Franco, L. Richardson, and J. Siemiatycki. 1991.
Gastrointestinal health effects associated with the consumption of
drinking water produced by point-of-use domestic reverse-osmosis
APPL. ENVIRON. MICROBIOL.
filtration units. Appl. Environ. Microbiol. 57:945-948.
23. Reglement sur les eaux embouteillees. 1990. Chap. Q-2, rule R5.
Editeur officiel du Quebec, Quebec, Canada.
24. Schmidt-Lorenz, W. 1976. Microbiological characteristics of natu-
ral mineral water. Ann. Ist. Super. Sanita 12:93-112.
25. Sekla, L. H., J. Drummond, D. Milley, and W. Stackiw. 1991. Are
the alternatives to municipal water truly safer? Can. Med. Assoc.
J. 144(10):1273-1275.
26. Stickler, D. J. 1989. The microbiology of bottled natural mineral
waters. J. R. Soc. Health 4:118-124.
27. Warburton, D. W., K. L. Dodds, R. Burke, and M. A. Johnston.
1992. A review of the microbiological quality of bottled water sold
in Canada between 1981 and 1989. Can. J. Microbiol. 38:12-19.