Microbiological risks associated with drinking water can be minimized by providing enhanced integrity monitoring of bacterial removal by water treatment processes. This study aimed to evaluate the efficacy of real-time bacteriological counters for continuously assessing the performance of a full-scale sand filter to remove bacteria. Over the course of an 8-day evaluation, online counting of bacteria was successfully performed, providing continuous bacterial counts in the sand filter influent and effluent over approximate ranges from 17 × 104 to 94 × 104 and from 0.2 × 104 to 1.3 × 104 counts/mL, respectively. Periodic variations were observed with online bacterial counts in the sand filter influent because of the changes in the performance of flocculation and sedimentation processes. Overall, online removal rates of bacteria determined during the full-scale test were 95.2-99.3% (i.e., 1.3-2.2-log), indicating that online bacterial counting can continuously demonstrate over 1.3-log removal in the sand filter. Real-time bacteriological counting technology can be a useful tool for assessing variability and detecting bacterial breakthrough. It can be integrated with other online water quality measurements to evaluate underlying trends and the performance of sand filters for bacterial removal, which can enhance the safety of drinking water.