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Managing biological risks within water supply networks is required for health care facilities and in all public facilities (établissements recevant du public, ERP) that are connected to the public hot water supply or that offer activities that could generate water droplets (ministerial statement of February 1, 2010). Managing this risk is always more demanding and complex for health care facilities (hospital centers, care homes, rehabilitation centers, etc.) than for other establishments, which are only required to track the presence of Legionella pneumophila in the hot water supply network. Restricted, high-risk departments require even closer monitoring (grafts, burns, invasive surgery, intensive care, etc.).
Regardless of the type of public space and the relevant regulations, putting a surveillance plan in place is necessary for tracking water quality within a network: points of entry, technical points, at-risk points of use (personal hygiene, whirlpool baths, human consumption, skin care and other specialized medical applications, etc.). The regulations specifically require:
• a risk analysis plan identifying critical control points, indicators to be tracked (temperature, free chlorine, conductivity, live aerobic flora, etc.) and tools that can be put into action (self-monitoring, biological or physico-chemical analyses);
• a maintenance strategy defining actions to be taken in the event that control point indicators are triggered (complementary analyses, cleaning and disinfection, purging, applying terminal filters, etc.);
• a file or notebook to record monitoring and maintenance activities.
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For technical, practical and economical reasons, it is not feasible to systematically track pathogenic micro-organisms at risk points (technical points, points of use). Instead, hospital regulations advise tracking indicators of the bacterial quality of the water, such as:
• biological or physico-chemical analyses carried out in a laboratory, based on a defined sampling strategy with standardized methodology;
• self-monitoring using simple measurements (for example, water temperature or chlorine content), taken frequently on site by technical staff.
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The biological analyses conducted in hospital settings depend on the eventual use of the water (technical points, hygienic use, human consumption, medical). These analyses primarily involve looking for:
• culturable aerobic micro-organisms (that can be grown at 22°C and 36°C): indicators of the level of biological contamination (or total flora);
• coliforms (total or heat-resistant): indicate fecal or environmental contamination;
• Escherichia coli: indicates fecal contamination;
• Entérocoques: indicate fecal contamination;
• Pseudomonas sp. and Pseudomonas aeruginosa: digestive, respiratory and muco-cutaneous pathogens that indicate environmental contamination;
• Legionella sp. and Legionella pneumophila: digestive, respiratory and muco-cutaneous pathogens;
• Staphylococcus sp. and Staphylococcus aureus: digestive, respiratory and muco-cutaneous pathogens that are problematic in a hospital context.
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