A Risk Management Framework for Recreational Water

Transcription

1 A Risk Management Framework for Recreational Water Dr. Andrew Papadopoulos Department of Population Medicine Coordinator, Master of Public Health University of Guelph CIPHI (Ontario) Annual Conference September 17, 2013

2 Outline The public health issue The current regulatory state The use of E. coli as a measurement tool A multi-barrier approach Moving forward

3 The Issue Timeliness of E. coli test Varying standard of number of E. coli per 100mL of recreational water There is a lack of supporting epidemiological evidence that supports the current standard or any other standard Is current method most effective, both in terms of scarce resource consumption and public health?

4 Potential Burden of Illness According to Ontario Parks, approximately 9 to10 million persons use their parks per year Wasaga Beach estimated 2 million visitors annually

5 Current MOHLTC Program The goal of the Safe Water Program Standard: Prevent or reduce the burden of water-borne illness and injury related to recreational water use Boards of Health are required to manage service delivery to their recreational facilities and water front activities program in accordance with the protocols under this standard Must undertake assessment and surveillance, develop policies and health promotion strategies, prevent disease, and protect human health

6 OPHS: Beach Management and Recreational Water Protocols Under the protocols, Boards of Health have the following reporting requirements Provide Safe Water Program common data elements Conduct surveillance of public beaches and recreational water facilities Conduct surveillance of water-related illnesses

7 OPHS: Beach Management and Recreational Water Protocols Provide education for owners and operators Implement a recreational water management program to reduce risks of illness or injury from recreational activities Provide 24/7 on-call response for issues relating to recreational water activities

8 OPHS: Beach Management and Recreational Water Protocols Surveillance and Inspection a) Pre-season assessment i. Inventory of public beaches ii. Historical and epidemiological data iii. Environmental survey b) Routine public beach surveillance Sampling program (as per water sampling methodology) Special consideration for frequency & timing of sampling and items ii and iii as noted above

9 OPHS: Population Health Assessment and Surveillance Protocol Under the protocol, BOH have the following reporting requirements BOH must conduct surveillance of water-related illnesses associated with recreational activities Conduct epidemiological analysis of surveillance data, monitor trends (spatial and temporal), and vulnerable populations

10 Trigger for Action Currently Ontario s 36 boards of health use 100 E.coli per 100 ml (based on a geometric mean of at least 5 samples) as a trigger value for action

11 Testing Standards: Canada Ontario 35 BOHs use 100 E. coli limit Canada s guideline value of 200 Other Provinces Use the 200/400 E. coli/100 ml value; with variations Some allow for use of thermo-tolerant coliforms Quebec uses water quality grades (A-D) below 200

12 Risk Management Framework: Applying A Multi-barrier Program Components of a risk management framework Environmental (sanitary) survey Wave conditions Land use activities Number of bathers Animal/bird activities Inspection and assessment Risk-based assessment approach Predictive models

13 Risk Management Framework: Applying A Multi-barrier Program Surveillance and monitoring initiatives Sampling program Epidemiological data Laboratory testing and diagnostic services Laboratory turnaround time = 24 hours to report indicator results

14 Risk Management Framework: Applying A Multi-barrier Program Public Communication and Notification Develop risk communication plan Evaluation Conduct an evaluation of program

15 Moving Forward Research is required to create an evidence-based recreational water use program that can be communicated and shared with partners and stakeholders The establishment of a risk management framework that could aid BOHs in a predictive model capacity is required

16 Moving Forward The group recognized that it was of paramount importance to analyze the current threshold for action of 100 E. coli per 100 ml A robust communication plan that is well understood by partners and stakeholders, including the public and the media must be developed

17 Thank you... Questions or Comments? Andrew Papadopoulos