Setty Karen E, Kayser Georgia L, Bowling Michael, Enault Jerome, Loret Jean-Francois, Serra Claudia Puigdomenech, Alonso Jordi Martin, Mateu Arnau Pla, Bartram Jamie
The University of North Carolina, Chapel Hill, Department of Environmental Sciences and Engineering, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, USA.
The University of North Carolina, Chapel Hill, Department of Environmental Sciences and Engineering, 170 Rosenau Hall, CB #7400, Chapel Hill, NC, USA; The University of California, San Diego, Department of Family Medicine and Public Health, 9500 Gilman Dr, 0628, La Jolla, CA 92093-0628, USA.
Int J Hyg Environ Health. 2017 May;220(3):513-530. doi: 10.1016/j.ijheh.2017.02.004. Epub 2017 Feb 24.
Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, seek to proactively identify potential risks to drinking water supplies and implement preventive barriers that improve safety. To evaluate the outcomes of WSP application in large drinking water systems in France and Spain, we undertook analysis of water quality and compliance indicators between 2003 and 2015, in conjunction with an observational retrospective cohort study of acute gastroenteritis incidence, before and after WSPs were implemented at five locations. Measured water quality indicators included bacteria (E. coli, fecal streptococci, total coliform, heterotrophic plate count), disinfectants (residual free and total chlorine), disinfection by-products (trihalomethanes, bromate), aluminum, pH, turbidity, and total organic carbon, comprising about 240K manual samples and 1.2M automated sensor readings. We used multiple, Poisson, or Tobit regression models to evaluate water quality before and after the WSP intervention. The compliance assessment analyzed exceedances of regulated, recommended, or operational water quality thresholds using chi-squared or Fisher's exact tests. Poisson regression was used to examine acute gastroenteritis incidence rates in WSP-affected drinking water service areas relative to a comparison area. Implementation of a WSP generally resulted in unchanged or improved water quality, while compliance improved at most locations. Evidence for reduced acute gastroenteritis incidence following WSP implementation was found at only one of the three locations examined. Outcomes of WSPs should be expected to vary across large water utilities in developed nations, as the intervention itself is adapted to the needs of each location. The approach may translate to diverse water quality, compliance, and health outcomes.
自2004年起，世界卫生组织推荐采用水安全计划（WSP），旨在主动识别饮用水供应的潜在风险，并实施预防性屏障以提高安全性。为评估水安全计划在法国和西班牙大型饮用水系统中的应用效果，我们分析了2003年至2015年期间的水质和合规指标，并对五个地点实施水安全计划前后的急性肠胃炎发病率进行了观察性回顾队列研究。测量的水质指标包括细菌（大肠杆菌、粪链球菌、总大肠菌群、异养平板计数）、消毒剂（游离余氯和总氯）、消毒副产物（三卤甲烷、溴酸盐）、铝、pH值、浊度和总有机碳，共约24万个手动样本和120万个自动传感器读数。我们使用多元、泊松或托比特回归模型评估水安全计划干预前后的水质。合规性评估使用卡方检验或费舍尔精确检验分析超过规定、推荐或运行水质阈值的情况。泊松回归用于检查受水安全计划影响的饮用水服务区域相对于对照区域的急性肠胃炎发病率。实施水安全计划通常会使水质保持不变或得到改善，同时大多数地点的合规性也有所提高。在所检查的三个地点中，只有一个地点发现实施水安全计划后急性肠胃炎发病率有所降低。由于干预措施是根据每个地点的需求进行调整的，因此发达国家大型水务公司的水安全计划成果预计会有所不同。这种方法可能会带来不同的水质、合规性和健康结果。
