Abstract
Study objectives
To evaluate the inspection grading system for water sites implemented during the Athens 2004 Olympic inspection programme.
Design
The relation between the standardised inspections results of 716 water supply systems and 289 public swimming pools, and microbiological test results of 2358 samples collected during inspections was examined.
Setting
Athens, Thessaloniki, Patra, Volos, and Iraklio, Greece. Inspections and sampling conducted during a two year period before the 2004 Olympics.
Main results
Swimming pools unsatisfactory inspection grading results were significantly associated with positive water microbiological test results (relative risk = 2.5, p<0.05). One of the six violations of swimming pools and five of the seven violations of water supply systems designated as “critical” water safety hazards in the inspection reports were significantly associated with positive microbiological test results. The receiver operating characteristic analysis identified the unsatisfactory score designed in the swimming pools standardised inspection report, as the ideal score (−15), in adequately producing positive microbiological test results (sensitivity 13.2%, specificity 89%).
Conclusions
This study shows the utility of standardised inspection grading systems in waterborne diseases prevention planning and implementation strategies of policy makers and regulators. Future water quality assessment should be based on the implementation of a robust standardised inspection system and reduce the need of microbiological tests.
Keywords: inspection, swimming pool, Olympic Games
Athletes and tourists used more than 400 swimming pools, during the Athens 2004 Olympic and Paralympic Games. About 3 500 000 spectators and 15 000 athletes consumed tap water from hotels, or Olympic venues during the same period. This exposure increased the potential for the spread of drinking and recreational waterborne diseases. Prevention of waterborne diseases was an objective for the Athens 2004 Organising Committee of the Olympic and Paralympic Games.1 Special regulations and procedures for waterborne diseases prevention were enacted in previous Olympic Games.2 World Health Organisation's guidelines suggest that water safety or quality is best described by a combination of sanitary inspection and microbial water quality assessment.3,4,5 Moreover it is important to use a standard reporting format for sanitary inspections and catchments mapping to ensure that information gathered by different staff is reliable and that information gathered on different water sources may be compared.3 Standardised inspections and microbiological sample testing have been conducted in water sites including water supply systems (of hotels and Olympic venues), and swimming pools to ensure provision of safe drinking water and recreational water during the pre‐Olympic and Olympic period.
Inspection scoring systems, integrated in environmental health surveillance programmes, have long been used by numerous public health agencies worldwide. Most inspection scoring systems refer to inspections of restaurants and other food premises. Many investigators have looked at the possible association between grading scores of food establishments and several public health outcomes ranging from positive microbiological results of environmental samples6,7 to community outbreaks.8,9,10,11,12,13,14,15,16,17
Few data exist regarding the utility of the scoring systems in the inspection of water sites. WHO recommended inspections of water sites by using a checklist, which includes the components of the water site from source to distribution, and incorporate all the potential points where hazards may be introduced. It is also recommended the hazards in the checklist to be quantified (hazard score). The proportion or percentage of points recorded as positive for risk during the sanitary inspection gives a sanitary risk score. These scores can then be arbitrarily associated with different levels of relative risk.18 Despite the recommendations, standardised inspection scoring forms of water sites have never been used extensively and tested in the past, while a lot of experience exists worldwide on standardised inspection forms for food premises.8,9,10,11,12,13,14,15,16,17
A surveillance programme of drinking water quality should not only include the municipality water supply system, but also the individual building supplies (for example, hotels, venues), as the building components (for example, water tank, treatment system) influence the water quality. The main objective is to provide safe water at the point of use.3 In this paper inspection grading scores of individual water supply systems (of hotels and Olympic venues) and public swimming pools are related to water microbiological test results from samples collected during inspections from the above sites. The relation between inspection grading scores and water microbiological test results has been studied to evaluate the inspection scoring system implemented in the Athens 2004 pre‐Olympic and Olympic inspection programme.
Methods
Environmental health inspection system
In 2001, the Hellenic Ministry of Health established the Olympic Planning Unit, which was responsible to devise a plan for the environmental health surveillance system and provide scientific support to the county departments of public health in Athens and the other four Olympic cities (Thessaloniki, Patra, Volos, and Iraklio). The final plan developed by the Olympic Planning Unit for environmental health surveillance concerned a number of targets of public health importance including potable and recreational water safety.1
Olympic preparations included registrations, standardised inspections, and water microbiological tests of public swimming pools and water supply systems of hotels and Olympic venues. Registrations conducted by on site visits using standardised registration forms. All public swimming pools and water supply systems of hotels and Olympic venues of the five Olympic cities were registered.19 The registry was important to relate the inspection results with the microbiological test results, to calculate the workload, and to schedule and prioritise the inspections.19 Moreover, in the registration form, permanent characteristics of the facilities were included: facility age, plumbing material (for example, copper), water system treatment (disinfection, softening, filtration). These factors were used as confounders in our study. Most of the inspected hotels and venues had their own water treatment system.
Standardised inspection forms
Environmental health inspections were performed using standardised forms, developed by the Olympic Planning Unit for the inspections conducted during the pre‐Olympic and Olympic period. The items included in the standardised inspection forms were based on requirements of National and European legislation, WHO guidelines, and the International Standardisation Organisation (ISO). The inspection forms were pilot tested during the test event in the summer of 2002 (Regatta 2002). After pre‐testing a final version was created and the inspectors underwent uniform training (practical and theoretical) and certification in standardised inspections by the Olympic Planning Unit personnel, before the implementation of the inspection programme.
The standardised inspection forms included all potential hazards (items) that might be cited during inspections. The items included were classified as “critical” and “non‐critical”. Critical items are violations “which are more likely to contribute to food or water contamination, illness, or environmental degradation and represent substantial public health hazards and [are] most likely associated with potential foodborne or waterborne disease transmission”.20
The swimming pool standardised inspection form included 48 scored items and nine of those were designated as “critical” (appendix 1). The inspection items were classified in seven group categories: permit, construction, support facilities, personnel, injury control, record keeping, and on site manually conducted tests. In each group category, several related items were included and negatively scored accordingly.
The water supply system standardised inspection form included 42 scored items and 10 of those were designated as “critical” (appendix 2). The inspection items were classified in seven categories: construction—maintenance, cleaning—disinfection, cold water distribution system, hot water distribution system, system protection cross connections—backflow, record keeping, and on site manually conducted tests.
Data available for each standardised inspection form included establishment name, unique code, inspection identification code, county, date of inspection, overall score, specific violations cited, inspectors, and time spent on inspection.
Scoring system and quantitative assessment
In each standardised inspection form, a standard number of scored items were included. All items were scored and contributed in the final score, but only the critical items were chosen to be scored with −3 points. The non‐critical items were scored either with −1 or with −2 points according to their importance and severity of violation. The final scoring of each item was decided after the pre‐testing of the standardised inspection forms during the first test event in 2002. For each of the standardised inspection form the total possible negative score was calculated to provide the denominator and develop the qualitative classifications.
For the standardised inspection form of water supply systems, the total possible negative score was calculated and classified qualitatively in the three following categories: (1) category A: satisfactory result (0 to −7 points, less than 10% of the total possible negative score, no critical violation), (2) category B: relatively satisfactory result (−8 to −14 points, 11% to 20% of the total possible negative score, or a critical violation) and (3) category C: unsatisfactory result (more than −14 points, more than 20% of the total possible negative score). For the standardised inspection form of swimming pools the classification was as follows: A: 0 to −7 points, B: −8 to −14 points, and C: more than −14 points. The classified categories were standardised and printed in each inspection form.
During inspection, all negative points from deficiencies were identified calculated and the overall negative score was categorised in one of the three categories described above. For example, when the total negative points of the non‐compliance items cited during inspection calculated at “−13”, the water site inspection result was “relatively satisfactory”. In this study, satisfactory grading results considered those with grade “A” and unsatisfactory grading results those with “B” or “C” grade.
The standardised inspection programme was fully computerised and frequencies of inspection results per inspector and municipality were routinely provided to identify extremes values.
Sampling and water microbiological testing
At the time of the sample collection, free chlorine, pH, and temperature were determined for each sample. Chemical parameters were determined using a test kit (Hanna Instruments HI 93710) and temperature, using a calibrated thermometer.
Sampling conducted in public swimming pools included collection of two to six samples, depending on the pool size and complexity: various parts of the pool at a depth of 5–20 cm, a site where the water velocity is low, away from any inlets and other points of the recirculation system.
Water samples collected from public swimming pools were tested for microbiological parameters in accordance with standard methods.21 The detection and enumeration of coliform bacteria, Escherichia coli, Staphylococcus aureus, Pseudomonas aeruginosa, and heterotrophic plate count (HPC) at 37°C were included in the microbiological parameters. Samples from swimming pools were considered positive when concentration of E coli was more than 0/100 ml, or S aureus of more than 30/100 ml, or coliform bacteria of more than 15/100 ml, or P aeruginosa of more than 0/100 ml, or HPC of more than 200 cfu/ml.
Sampling conducted in water supply systems of hotels and Olympic venues included collection of two to six representative samples, depending on the size of the building, from specific points: taps located in kitchen, cooling fountains, and water tanks.
Water samples collected from water supply systems were tested for microbiological parameters in accordance with the methods specified in the standing European legislation.22
Detection and enumeration of coliform bacteria, E coli, intestinal enterococci, and Clostiridium perfringens (including spores) were included in the microbiological parameters. Samples from water supply systems were considered positive when concentration of those microorganisms was more than 0/100 ml.23
The microbiological testing was conducted in the Central Public Health Laboratory, which participated in an external quality control scheme (EQUASE) before and during the research period.
Data entry and analysis
Two databases (one for water supply systems and one for swimming pools) were developed to record the establishments (registry database), two databases to record the inspection standardised forms and results for water supply systems and for swimming pools, and two databases to record the microbiological sample test results respectively. A unique code was given in each establishment to relate the inspection and microbiological results by using this code.
Data were analysed with Epi‐Info 2000 and SPSS for Windows Release 11.0.1 software by correlation analysis, t test, one way analysis of variance, and by χ2 test. Unadjusted relative risk (RR) and 95% confidence intervals (CI) were calculated to assess the risk of unsatisfactory standardised inspection scores of water sites to produce positive microbiological test results. To control for confounders (permanent characteristics of water site, for example, facility age) stratified analysis and logistic regression analysis were used. The receiver operating characteristic (ROC) curve was used to identify statistical cut off points.
Analysis was conducted using results of the first inspection and water sampling results taken on the same day for each establishment. Inspections and sampling that did not occur on the same day were excluded from the analysis. We did not include re‐inspection scores and microbiological test results from water samples collected after taking corrective actions.
Results
A total of 393 swimming pools and 997 water supply systems of 887 hotels and 140 Olympic venues were registered as potential inspection sites using standardised data collection forms in all five Olympic cities.
About 196 inspectors conducted the standardised inspections and the sampling in the Olympic cities in a two year period. During this period, a total of 716 standardised inspections together with water sampling (including 1686 samples) were carried out in water supply systems of hotels and Olympic venues and 289 standardised inspections together with water sampling (including 672 samples) in swimming pools for check monitoring of water microbiological quality.
Inspection scoring system evaluation
Environmental health inspection scores and violations of water supply systems and swimming pools were related to the water microbiological test results of those sites. The mean score of swimming pools with positive microbiological test results were significantly higher from the mean scores of inspections with negative microbiological test results (table 1).
Table 1 Mean inspection scores in association with check microbiological monitoring results.
| Water sites | Microbiological test results | p Value | |
|---|---|---|---|
| Positive | Negative | ||
| Swimming pools* | −9.1 | −7.2 | 0.02 |
| Water supply systems† | −6.96 | −7.12 | 0.66 |
*Tested for: heterotrophic plate count, coliform bacteria, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, †tested for: coliform bacteria, Escherichia coli, intestinal enterococci, and Clostiridium perfringens (including spores).
Moreover, the risk for producing positive microbiological test results was higher when unsatisfactory inspection grading results of swimming pools was recorded (RR = 2,51; table 2). There was not significant association between unsatisfactory inspection grading results of water supply systems and positive microbiological test results (table 2). By conducting analysis excluding microbiological results with total coliforms >0, or HPC>200, no difference was identified with our previous results.
Table 2 Association between inspection scores and positive check monitoring microbiological results.
| Water sites | A grading result | B or C grading result | RR of positive mtr by B or C grading result (95% CI) | p Value | ||
|---|---|---|---|---|---|---|
| Positive mtr | Rate (%) | Positive mtr | Rate (%) | |||
| Swimming pools | 5/60 | 8.3 | 48/229 | 21 | 2.51 (1.04, 6.04) | 0.01 |
| Water supply systems | 37/254 | 14.6 | 62/462 | 13.4 | 0.92 (0.63, 1.34) | 0.37 |
mtr, microbiological test results; RR, relative risk; CI, confidence interval.
An association was found between the water supply system age and unsatisfactory inspection results (table 3). The mean facility age of buildings with unsatisfactory results was 33.7, while the mean facility age of buildings with satisfactory results was 24.4 (p<0.001). The facility age was not found to be associated with microbiological test results (p = 0.3). Moreover, controlling for the other factors associated with positive microbiological test results and unsatisfactory inspection results of water supply systems (stratified and logistic regression analysis) there was no association among the inspection results and the microbiological test results. The same analysis was conducted for the swimming pools (controlling for cofounders) and the statistical significant association continued to exist after stratified and logistic regression analysis (table 3).
Table 3 Association between inspection results, microbiological test results, and selected system characteristics (confounders).
| OR* (95% CI) | |
|---|---|
| Water supply system characteristics | |
| Facility age >10 years | 0.9 (0.4, 2.1) |
| Water storage tank protected | 1.4 (0.7, 2.8) |
| Water storage tank accessible | 1.0 (0.5, 2.2) |
| Water system extensions | 1.0 (0.5, 2.1) |
| Backflow prevention | 1.1 (0.6, 2.1) |
| Plumbing material Cu‐PVC | 0.9(0.5, 1.4) |
| Plumbing material Cu | 0.8(0.5, 1.3) |
| Plumbing material PVC | 0.8 (0.5, 1.3) |
| Existence of indepedent disinfection system | 0.9(0.5, 1.7) |
| Existence of independent water treatment system (filtration) | 0.9 (0.5, 1.7) |
| Swimming pools characteristics | |
| Facility age >10 years | 2 (0.8, 6.1) |
| Indoor swimming pool | 3.0 (1.2, 8.9) |
| Use of liquid chlorine disinfectant | 3.0 (1.2, 9.2) |
| Use of dry chlorine disinfectant | 2.9 (1.1–8.8) |
| Use of gas chlorine disinfectant | NA |
| Use of algaecide chemicals | 2.5 (1.0, 7.7) |
| Existence of sand filtration | 2.8 (1.0, 9.8) |
| Existence of water heating system | 2.5 (1.0, 7.6) |
*Results of stratified or logistic regression analysis for the association of inspection results with microbiological test results. CI, confidence internals; NA, not applicable.
The area under the receiver operating characteristic (ROC) curve derived from the association between environmental health inspection scores and water microbiological test results of swimming pools was estimated 0.62 (95% CI 0.55, 0.69) (fig 1). The ROC curve identified −15.5 as the ideal negative score (cut off point), with a sensitivity of 13.2% and a specificity of 89% in adequately producing positive microbiological test results. Positive predictive value was estimated 21.2% (95% CI 9, 38.9) and negative predictive value 82% (95% CI 76.8, 86.5).
Figure 1 Receiver operator characteristic curve for inspection scores of swimming pools according to microbiological test results (area under the curve (AUC) = 62%).
Violations significantly associated with positive microbiological tests
During inspections of public swimming pools, six violations significantly associated with positive microbiological test results were found (table 4). One of those six violations was among those designated as “critical” water safety hazards in the standardised inspection form: free chlorine tested during inspection: 0.5–1 mg/l. The lack of free chlorine residual of 0.5–1 mg/l was associated with 20% of positive microbiological results (table 4).
Table 4 Violations associated with positive microbiological test results in swimming pools.
| Standard in violation | p Value | Percentage violations |
|---|---|---|
| Free chlorine manually tested during inspection: 0.5–1 mg/l | <0.0001 | 20 |
| Supervision of swimmers with skin infections before entering the swimming pool | <0.0001 | 13.5 |
| Water chemistry frequency measurement (two times per day disinfectant measurement, one time per day pH, and alkalinity measurement) | 0.003 | 13.5 |
| Guidelines for appropriate hygienic swimmers' behaviour displayed | 0.05 | 49.8 |
| Record keeping | 0.05 | 29.4 |
| Microbiological monitoring every two weeks | 0.05 | 21.8 |
During inspections of water supply systems we found seven violations significantly associated with positive microbiological test results (table 5). Of those seven violations, five were among those designated as “critical” water safety hazards in the standardised inspection form: free chlorine tested during inspection: 0.2–0.5 mg/l, microbiological monitoring every six months, the inside of cold water storage tank kept in good condition and free of debris, disinfection and cleaning of the system carried out every year, water at all taps and showers in guestrooms running for several minutes at least once a week.
Table 5 Violations associated with positive microbiological test results in water supply systems.
| Standard in violation | p Value | Percentage violations |
|---|---|---|
| Free chlorine manually tested during inspection: 0.2–0.5 mg/l | 0.0001 | 11.7 |
| Water storage tanks fitted with covers and insect screens fitted to any pipework open to the atmosphere | 0.0006 | 3.4 |
| Microbiological monitoring every six months | 0.001 | 51.4 |
| The inside of cold water storage tank kept in good condition and free of debris | 0.001 | 2.1 |
| Record keeping | 0.01 | 59.6 |
| Disinfection and cleaning of the system carried out every year | 0.01 | 20.9 |
| Water at all taps and showers in guestrooms running for several minutes at least once a week | 0.04 | 8.2 |
Discussion
We were interested in evaluating the inspection grading system in accordance with the microbiological test results. Water microbiological tests do not guarantee complete microbiological safety, but serve to provide information with which to judge the effectiveness of measures taken.23 Our data show that there is a correlation between unsatisfactory inspection grading results of swimming pools and positive microbiological test results. No close link was established between unsatisfactory inspection grading results of water supply systems and positive microbiological test results. The standardised inspection form and the scoring system for water supply systems should be examined to identify ways to avoid “false positives”—that is, falsely identified risk points.
What this paper adds
This study suggests the utility of inspection scoring systems in predicting microbiological contamination in swimming pools. Standardised environmental scored inspections of water sites may contribute to the prevention of waterborne diseases.
A variety of factors influenced the uniformity of water supply system inspections. Most of the inspectors underwent uniform training and certification in standardised inspections by the Olympic Planning Unit personnel, before the implementation of the inspection programme. No mechanism for formal periodic re‐standardisation after initial training existed. Water supply systems were rarely inspected in Greece before the study period, so inspections performed were difficult to standardise and was easily influenced by subjective interpretation. Swimming pools are regularly inspected by health departments every year, so inspectors are more experienced and inspections more easily standardised. Moreover, the water quality of samples collected from the distribution systems of the hotels and the Olympic venues is affected by the whole municipality drinking water system, including sources, delivery system infrastructure, treatment plants, and storage reservoirs. The inspection report included assessment only of the internal water supply system of buildings.
Combined analysis of sanitary inspection and water quality data can be used to identify the most important causes of and control measures for water contamination.2 The five of the seven violations significantly associated with positive microbiological test result of water supply system were successfully scored as critical. Items concerning “water storage tanks fitted with covers and insect screens fitted to any pipework open to the atmosphere” and “record keeping” were also included violations significantly associated with positive microbiological test result but were not considered as critical in the inspection form. One of the six violations significantly associated with positive microbiological test result of swimming pools was successfully scored as critical. Items concerning “supervision of swimmers with skin infections before entering the swimming pool, microbiological monitoring every two weeks, guidelines for appropriate hygienic swimmers' behaviour displayed, record keeping, and water chemistry frequency measurement (twice a day disinfectant measurement, daily pH and alkalinity measurement)” were also included violations significantly associated with positive microbiological test result but were not considered as critical in the inspection form. These factors should be considered to be scored as critical items in next versions of the standardised inspection forms. This analysis provided efforts to improve the inspection grading system by identifying issues related to potable and recreational water safety.
The ROC analysis showed −15.5 as the cut off point with a relatively low sensitivity, but high specificity. During inspections of swimming pools, unsatisfactory inspection result received those with total negative score of more than −14 points. These data show that the inspection scoring system for swimming pools was successfully designed. Efforts should be made to increase sensitivity, probably by splitting the inspection form into two sections: water safety and other issues (for example, support facilities and injury control).
Policy implications
A uniform standardised inspection system for water sites, based on research findings, should be developed, and included in environmental health inspection systems of public health authorities. Violations identified to be associated with positive microbiological test results in swimming pools and water supply systems should be considered in the future regulation revision.
Another report analyses swimming pool inspection data at six sites across the USA. Findings of that study underscore the utility of inspection data for public health decision making.24 In our study, the most commonly cited violations and the positive microbiological test results were helpful in identifying the need for increased training and vigilance by owners and operators. Thus, guidelines for safe swimming pools operation and standardised water disinfection guidelines were prepared and distributed to the facility owners, together with instructions to the public for healthy swimming.
Water supply systems and swimming pools on cruise ships have been thoroughly standardised inspected by the United States Public Health Service Vessel Sanitation Program conducted by the Centers for Disease Control and Prevention, based in Atlanta and the inspection score results have been compared with gastrointestinal illness among passengers on cruise ships.25 However, except for the ship's water supply system inspection score results, six more inspection categories including food safety issues were scored in the same inspection form. The study suggests that environmental sanitation inspections on cruise ships seem to decrease diarrhoeal disease rates and outbreaks among passengers.25 In our study no waterborne disease outbreak or case was linked to the water sites inspected during the Olympic environmental health surveillance programme. This may not be only attributed to the implementation of the inspection grading system. The underreporting of waterborne outbreaks worldwide and in Greece also might have influenced our results. During the study period, comprehensive disease surveillance was established and the underreporting of waterborne outbreaks seems unlikely. The inspection grading system may be an effective mechanism to protect public health not only during special events such the Olympic Games, but if modified it can be used in routine inspection programmes.
Further studies to determine the most efficient and effective methods for assessing factors associated with potable and recreational water safety will be important to help improve the inspection system. In studies concerning restaurant inspection systems, inspection scores compared with persons performing inspections,8 foodborne outbreaks,9,10,11,12,13,14,15 and the effect of inspection frequency on restaurant sanitation.12,26,27,28,29 Further analysis can be performed that examine the variation in scores on the bases of things mentioned above. The success of any grading system cannot be determined by a single measure, whether it is a measure of compliance, perception, epidemiological evidence, or cost effectiveness. Assessment based on a wide range of goals representative of the community interests is the more accurate although more difficult task.30
The standardised inspection forms used for the Olympic Games preparations should be implemented not only during special events such as the Olympics, but also on a regular basis. Through the gained experience, we are going to improve the standardised inspection forms for water sites to be used in the every day operation of the public health authorities.
This study suggests the utility of grading systems in inspections of water sites and the contribution in ensuring potable and recreational water safety. Microbiological water quality can be evaluated by environmental inspections of water sites such as water supply systems and swimming pools, but many improvements should be made to develop a robust grading system that would be tolerated in false positives without invalidating the system. While our inspection scoring system seems to be efficient in the assessment of microbiological water quality of the water sites, it should be further studied and improved. The establishment of the inspection programme in the Athens Olympic Games provided valuable experience in improving the inspection grading system and offered an added value for the public health system in Greece. The implementation of a reliable and uniform inspection programme for water sites will be useful for future Olympic Games.
Acknowledgements
The authors wish to acknowledge the contribution of all environmental health inspectors of the Olympic cities, the Ministry of Health for the financial support, the staff of the National School of Public Health, and the staff of the Central Public Health Laboratory. We would also like to thank Professor Maria Papapetropoulou, Dr Vasilis D Daniilides, and Mr George Panagakos.
Appendix 1
Critical items in the swimming pool inspection form
Free chlorine manually tested during inspection: 0.5–1 mg/l
Water is from an approved source.
Microbiological monitoring includes test for heterotrophic plate count, coliform bacteria, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa.
The water recirculation equipment is capable of recirculating the water through the filter at an appropriate rate.
The pH value is monitored
The residual chemical disinfectant is monitored
Properly installed outlets and drain grates to prevent suction entrapment.
Adequate rescue equipment and continuously available to lifeguards.
Adequate number of showers, toilets, hand washing facilities.
Appendix 2
Critical items in the water supply system inspection form
Shower heads are free of scale and dirt.
The water temperature in the water storage tank is below 25°C
The difference between the highest and lowest temperature recorded at the taps after one minute flow time is not greater than 10°C
When outlets are not in regular use, weekly flushing of these devices is carried out.
The water system is disinfected and cleaned if the system has been out of use for more than one month
Free chlorine tested during inspection: 0.2–0.5 mg/l
Microbiological monitoring every six months
The inside of cold water storage tank kept in good condition and free of debris,
Disinfection and cleaning of the system carried out every year
Water at all taps and showers in guest rooms running for several minutes at least once a week
Footnotes
Funding: none.
Conflicts of interest: none.
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