Group 2

1. Group 2 Nick Ashbolt, Bill French, Janne Forslund, Dan Fraser, Risto Aurola, Paul Byleveld, Jon Bender, David Smith, Fredrik Alfer, Ana-Maria de Roda Husman, Gary Toranzos, Paul, Hunter, Christine Moe, Steve Hrudey Reporters: Nik Bouskil & Anne O’Neill

2. Overarching considerations: Proactive approach to provide safe water Risk management based Primary issue: know your system

3. Risk Management Approach • A hazard is a biological, chemical, physical or radiological agent that has the potential to cause harm; • a hazardous event is an incident or situation that can lead to the presence of a hazard (what can happen and how); and • risk is the likelihood of identified hazards causing harm in exposed populations in a specified timeframe, including the magnitude of that harm and/or the consequences.

4. Simple risk scoring table for prioritizing risks • The likelihood and severity can be derived from technical knowledge and expertise, historical data and relevant guidelines.

5. Risks/Priorities: small systems, e.g. Low Likelihood Relative Severity Low High GW – surface influenced; No disinf’n SW – sewage impacted; Poor treat’t SW – wild an. impacted; OK treat’t GW – deep confined; with disinf’n

6. Small system definitions • What we called small systems (EU, US-EPA def’n) • >500 – 10,000 people served • <500 people served • [single dwellings not addressed, as covered by other regulations-approaches] • Characteristics also of importance: • Poor management structure (e.g. mayor calls the shots) • Limited resources (human & financial)

7. Key Issues identified for small systems (vote) • Training (18) • Management/Operational & cultural change (10) • Monitoring concerns (10) • Funding challenges (7) • Infrastructure needs (5) • Research & Technology (5) • Health risks (3) • Regulatory issues (1)

8. Key Issues identified for small systems

9. Social issues / incentives

10. Primary gaps in knowledge • Who is the operator, need a sociologic study • To include an interview of a range of operators • How are operators trained and what skills do they have, order a review process: • Concern is that technical training may be OK, but risk management operation/activities are wanting • Recommend a regional team of experts: • To analyze functioning of small systems • Include social scientists • May also train auditors of small systems

11. Priority 1: Training issues • There is a need for additional and more appropriate training of operators, managers and public health officials. • Experiences of those who regularly deal with small systems indicate that small systems personnel do not understand or appreciate the significance of their roles as protectors of public health nor do they fully understand their systems. • Additionally, operators of complex small systems (e.g. granular media filtration plants with chemical coagulation) have great difficulty in taking the concepts and skills learned in the classroom and applying them in their own plants.

12. Recommend: Basic Public Health Course • Good training materials should be developed and made available that are designed to educate operators and managers of small systems in regard to the public health aspects of providing drinking water to the public. • These materials should include a discussion of the fecal transmission pathways for pathogens and how piped water systems can become efficient vehicles of pathogen transport and distribution.

13. Training materials • Should also include materials to provide a complete understanding of the multiple barrier approach for protection of drinking water • i.e. source selection, source protection, intake/well design and construction, properly designed, constructed and maintained distribution, pumping and storage facilities, treatment, adequate pressures, monitoring, backflow protection, etc.

14. Further training need • Train-the-trainer materials should also be developed to enable technical assistance providers, trainers and regulators to properly present materials.

15. Problem solving/performance based training • Operators training and certification programs should require operators to develop performance-based problem solving skills that allow them to proactively identify treatment problems at their plant, determine possible causes and direct corrective actions. • Trend charting of performance data as the driver of the process control decisions is critical to thelong-term success.

16. Focus resources to get training courses closer to operators • Operators and managers lack the resources and time to attend training long distances from their systems. • Training needs to take place as close as possible to those to be trained thus maximizing training time and minimizing travel time. • Classes need to be designed to be as relevant as possible to small systems and plants and to the skills and educational level of the operators.

17. Use sanitary surveys as a training tool on site • For operators, managers and public health professionals to better understand their systems • Sanitary surveys have been a long-standing approach towards identifying hazards and vulnerabilities in a water supply, treatment and distribution system. • These require a skilled (usually a result of experience) assessment of a real system

18. Use sanitary surveys as a training tool • The skill required is the ability to recognize plausible sources and routes of water contamination combined with a commitment to the primary goal of assuring water safety • The skills and the assessment process of the sanitary survey provide an excellent opportunity for teaching operators, managers and public health officials what they should watch out for in their systems so that serious problems do not go unrecognized between subsequent sanitary surveys.

19. Management system

20. Management and operational issues • All levels of management must be committed to operating a quality system • Ensure there are communication and response protocols (know what to do, who to call) • Includes decision making/action at right level and in appropriate way • Data collected must be interpreted intelligently by operator (or passed on to someone who can) • There must be an appropriate response to data • E.g. jar testing if turbidity increases in surface water plants

21. Management and operational issues continued • Compliance data reported to health officials, inspectors and water operator simultaneously • Review whole water system and optimize (external help/support may be needed) • Before considering an upgrade, can the existing system be operated better ? • Advantages in consolidating small systems under one larger water utility • Technical support, economic benefits • Possibility of combining smaller systems

22. Recommendations continued • Establishment of small systems representative and advocate • To address / provide input to regulation development • Communication to operators/managers • Local meetings/seminars • Magazine • E-magazine • Web-based information

23. Monitoring concerns

24. Monitoring Issues Monitor analytes that can be managed / controlled (not just compliance) • Indicators of process efficacy and/or distribution system integrity • Measured at greater frequency than other indicators • Turbidity, chlorine residual (can provide continuous monitoring) • Total coliforms Recommendation: Operator should be able to perform these tests on site and use results to guide decisions about operation.

25. Monitoring Issues Monitor analytes that can be managed / controlled • For source waters: indicators to establish event contamination could include: • E. coli, coliphage, C. perfringens • Consider more frequent testing in areas at risk or during events of increased risk • Animal husbandry • Septic tanks • Wildlife • Fractured subsurface media • During high flows from rainfall, main breaks, etc. Recommendation: Need network of certified labs to provide services at reasonable cost. Results should be sent to operator & management

26. Operational water quality indicators

27. HACCP(hazard analysis critical control point) Initial steps (necessary to have a management structure in place) Construct & valid process flow diagram 1. Identify hazards and preventative measures 2. Identify Critical Control Points The seven principles of HACCP 3. Establish critical limits 4. Identify monitoring procedures Not only end product testing, but largely upstream for key control parameters 5. Establish corrective action procedures 6. Validate/verify HACCP plan 7. Establish documentation and record keeping

28. Monitoring: HACCP Framework • Start with sanitary survey to identify hazards and hazardous events (including microbial and chemical) • Should be revised on regular basis to capture changes

29. Monitoring: HACCP Framework 2. Identify key monitoring points and times for small systems • Surface vs. Groundwater system • Always monitor treated water at multiple points (operational and management points) • Increased monitoring and additional indicators during hazardous events (rainfall, main breaks, repairs, back flush periods, low pressure or pressure interruption)

30. Monitoring: HACCP Framework 3. Set response levels (target and trigger levels) • Identifying changes by tracking levels over time to create control chart to examine trends and deviations • Response should be to notify appropriate authority

31. Monitoring: HACCP Framework 4. Take action (operator and/or manager or health authority) • When is no action needed? • When is it appropriate to take corrective action (ie. adjust treatment, add further treatment, change treatment, flush distribution system, etc.) • When is it appropriate to issue boil water advisory? • When is it necessary to find alternate source?

32. Monitoring Issues • Cost-effective approaches need to be identified or developed • Methods that can detect groups of hazards (such as pesticides) • Simple screening techniques that could indicate need for further follow-up testing with a decision tree • Need robust analytical methods with tamper-resistant reporting methods

33. Health Risks from Small Water Systems • Small systems experience problems from “disinfectable pathogens” • Evidence from outbreaks • Occur in systems with no treatment or treatment failure • Acute vs. Chronic health risks • Different monitoring needs (need to monitor for acute risks more frequently because of greater fluctuation in raw water quality or treatment) • Chronic health risks could be related to site-specific characteristics (pesticide use, hazardous waste dumps) • Can be managed by improved operation and maintenance

34. Health Risks in Rural Areas • Rural areas are at greater risk of waterborne zoonoses because of the presence of more animals in the environment. • Tourists may be at greater risk of infection because they do not have immunity to local pathogens • Tourists may introduce new pathogens into isolated communities

35. Health Care in Rural Areas • Rural residents may have less access to health care so there may be greater consequences from infection (ie. more deaths from HUS) • Outbreaks in small systems may be more likely to be recognized because many cases may be seen by a single health care provider who would notice a cluster, however • May still be too few cases to be picked up • Health care providers in isolated areas may not be familiar with waterborne pathogens or realize that the infection may be waterborne.

36. Funding challenges

37. Funding challenges • Need for “user pays” principle • Water metering • Rational water use, awareness of issues • Informed funding • assessment of needs (risk assessment) • community involvement in decision • funding areas of need • avoid inappropriate action • State funding/loans (for capital) • Capital investment

38. “User pays” & Consolidation • To address limitation of funds • Undertake a comparison of payment schemes (e.g. with and without consolidation of systems) • Study international cases where consolidation has been successful • Such as in the state of Victoria, Australia

39. Actions - FIAT • Who does what when? • Finance • Implement • Awareness • Train

40. Good news boys! Its OK to drink the water now.

41. The 12 Elements of The Framework 1. Commitment to Drinking Water Quality Management 2. Assessment of the Drinking Water Supply System 3. Preventive Measures for DWQ Management 4. Operational Procedures and Process Control 5. Verification of Drinking Water Quality 6. Management of Incidents and Emergencies 7. Employee Awareness and Training 8. Community Involvement and Awareness 9. Research and Development 10. Documentation and Reporting 11. Evaluation and Audit 12. Review and Continual Improvement

42. Verification • This is the process that most people used to consider were the guidelines • Verification provides a final ‘catch all’ confirmation of the efficacy of the overall safety of the supply chain. • It primarily involves the assessment of faecal indicator bacteria and identified chemicals. • This may be undertaken by the supplier and/or the surveillance agency. • The frequency of sampling will be determined by the resources available. • Sampling frequencies for raw water sources will depend upon their overall quality, their size, the likelihood of contamination, and previous analytical results.

43. WHO Risk Management Framework HEALTH TARGETS Basic control approaches Tolerable risk Water quality objectives Other management objectives Assessment of Risk 1. Define measures and interventions (requirements, specifications) based upon objectives Assess environmental exposure RISK MANAGEMENT 2. Define key risk points and audit procedures for overall system effectiveness PUBLIC HEALTH OUTCOME 3. Define analytical verifications (process, public health)

44. Risk management cycle Hazard Identification Risk Policy Assessment Evaluation Risk Communication and Participation Policy Policy Implementation Development

45. Catchment to tap hazardous events leading to risks

46. Simple HACCP plan Risk Factor = Likelihood x Severity of Consequences. If a risk factor is 6 or greater, the hazard is to be considered further in the HACCP plan and monitoring and corrective actions should be devised.