ILMU KESEHATAN LINGKUNGAN

Referensi AirGuidelines for Drinking-water Quality (WHO 2006)

Page 71-764.3.1 Verification of microbial quality

Verification of microbial quality of water in supply must be designed to ensure the best possible chance of detecting contamination. Sampling should therefore account for potential variations of water quality in distribution. This will normally mean taking account of locations and of times of increased likelihood of contamination.

Faecal contamination will not be distributed evenly throughout a piped distribution system. In systems where water quality is good, this significantly reduces the probability of detecting faecal indicator bacteria in the relatively few samples collected.

The chances of detecting contamination in systems reporting predominantly negative results for faecal indicator bacteria can be increased by using more frequent presence/absence (P/A) testing. P/A testing can be simpler, faster and less expensive than quantitative methods. Comparative studies of the P/A and quantitative methods demonstrate that the P/A methods can maximize the detection of faecal indicator bacteria. However, P/A testing is appropriate only in a system where the majority of tests for indicators provide negative results.

The more frequently the water is examined for faecal indicators, the more likely it is that contamination will be detected. Frequent examination by a simple method is more valuable than less frequent examination by a complex test or series of tests.

The nature and likelihood of contamination can vary seasonally, with rainfall and with other local conditions. Sampling should normally be random but should be increased at times of epidemics, flooding or emergency operations or following interruptions of supply or repair work.

4.3.2 Verification of chemical quality

Issues that need to be addressed in developing chemical verification include the availability of appropriate analytical facilities, the cost of analyses, the possible deterioration of samples, the stability of the contaminant, the likely occurrence of the contaminant in various supplies, the most suitable point for monitoring and the frequency of sampling.

For a given chemical, the location and frequency of sampling will be determined by its principal sources (see chapter 8) and variability. Substances that do not change significantly in concentration over time require less frequent sampling than those that might vary significantly.

In many cases, source water sampling once per year, or even less, may be adequate, particularly in stable groundwaters, where the naturally occurring substances of concern will vary very slowly over time. Surface waters are likely to be more variable and require a greater number of samples, depending on the contaminant and its importance.

Sampling locations will depend on the water quality characteristic being examined. Sampling at the treatment plant or at the head of the distribution system may be sufficient for constituents where concentrations do not change during delivery. However, for those constituents that can change during distribution, sampling should be undertaken following consideration of the behaviour and/or source of the specific substance. Samples should include points near the extremities of the distribution system and taps connected directly to the mains in houses and large multi-occupancy buildings. Lead, for example, should be sampled at consumers taps, since the source of lead is usually service connections or plumbing in buildings.

For further information, see the supporting document Chemical Safety of Drinking-water (section 1.3).

4.3.3 Water sources

Testing source waters is particularly important where there is no water treatment. It will also be useful following failure of the treatment process or as part of an investigation of a waterborne disease outbreak. The frequency of testing will depend on the reason that the sampling is being carried out. Testing frequency may be:

on a regular basis (the frequency of verification testing will depend on several factors, including the size of the community supplied, the reliability of the quality of the drinking-water / degree of treatment and the presence of local risk factors);

on an occasional basis (e.g., random or during visits to community-managed drinking-water supplies); and

increased following degradation of source water quality resulting from predictable incidents, emergencies or unplanned events considered likely to increase the potential for a breakthrough in contamination (e.g., following a flood, upstream spills).

Page 121-125

7.1.1 Waterborne infections

The pathogens that may be transmitted through contaminated drinking-water are diverse. Table 7.1 and Figure 7.1 provide general information on pathogens that are of relevance for drinking-water supply management. The spectrum changes in response to variables such as increases in human and animal populations, escalating use of wastewater, changes in lifestyles and medical interventions, population movement and travel and selective pressures for new pathogens and mutants or recombinations of existing pathogens. The immunity of individuals also varies considerably, whether acquired by contact with a pathogen or influenced by such factors as age, sex, state of health and living conditions

Table 7.1 Waterborne pathogens and their significance in water supplies

PersistenceResistanceImportant

Healthin watertoRelativeanimal

Pathogensignificancesuppliesachlorinebinfectivitycsource

Bacteria

Burkholderia pseudomalleiLowMay multiplyLowLowNo

Campylobacter jejuni, C. coliHighModerateLowModerateYes

Escherichia coli PathogenicdHighModerateLowLowYes

E. coli EnterohaemorrhagicHighModerateLowHighYes

Legionella spp.HighMultiplyLowModerateNo

Non-tuberculous mycobacteriaLowMultiplyHighLowNo

Pseudomonas aeruginosaeModerateMay multiplyModerateLowNo

Salmonella typhiHighModerateLowLowNo

Other salmonellaeHighMay multiplyLowLowYes

Shigella spp.HighShortLowModerateNo

Vibrio choleraeHighShortLowLowNo

Yersinia enterocoliticaHighLongLowLowYes

Viruses

AdenovirusesHighLongModerate HighNo

EnterovirusesHighLongModerate HighNo

Hepatitis A virusHighLongModerate HighNo

Hepatitis E virusHighLongModerate HighPotentially

Noroviruses and sapovirusesHighLongModerate HighPotentially

RotavirusesHighLongModerate HighNo

ProtozoaNo

Acanthamoeba spp.HighLongHighHighNo

Cryptosporidium parvumHighLongHighHighYes

Cyclospora cayetanensisHighLongHighHighNo

Entamoeba histolyticaHighModerateHighHighNo

Giardia intestinalisHighModerateHighHighYes

Naegleria fowleriHighMay multiplyfHighHighNo

Toxoplasma gondiiHighLongHighHighYes

Helminths

Dracunculus medinensisHighModerateModerate HighNo

Schistosoma spp.HighShortModerate HighYes

Note: Waterborne transmission of the pathogens listed has been confirmed by epidemiological studies and case histories. Part of the demonstration of pathogenicity involves reproducing the disease in suitable hosts. Experimental studies in which volunteers are exposed to known numbers of pathogens provide relative information.As most studies are done with healthy adult volunteers, such data are applicable to only a part of the exposed population, and extrapolation to more sensitive groups is an issue that remains to be studied in more detail.

a Detection period for infective stage in water at 20 C: short, up to 1 week; moderate, 1 week to 1 month; long, over 1 month.

b When the infective stage is freely suspended in water treated at conventional doses and contact times. Resistance moderate, agent may not be completely destroyed.

c From experiments with human volunteers or from epidemiological evidence.

d Includes enteropathogenic, enterotoxigenic and enteroinvasive.

e Main route of infection is by skin contact, but can infect immunosuppressed or cancer patients orally.

f In warm water.

For pathogens transmitted by the faecaloral route, drinking-water is only one vehicle of transmission. Contamination of food, hands, utensils and clothing can also play a role, particularly when domestic sanitation and hygiene are poor. Improvements in the quality and availability of water, in excreta disposal and in general hygiene are all important in reducing faecaloral disease transmission.

Ingestion (Drinking)Inhalation andaspiration(Aerosols)Contact (Bathing)

Route of infection (Sepsis and generalized infection may occur)

* Primarily from contact with highly contaminated surface waters.

Figure 7.1 Transmission pathways for and examples of water-related pathogens

Drinking-water safety is not related only to faecal contamination. Some organisms grow in piped water distribution systems (e.g., Legionella), whereas others occur in source waters (guinea worm Dracunculus medinensis) and may

cause outbreaks and individual cases. Some other microbes (e.g., toxic cyanobacteria) require specific management approaches, which are covered elsewhere in these Guidelines (see section 11.5).

Certain serious illnesses result from inhalation of water droplets (aerosols) in which the causative organisms have multiplied because of warm temperatures and the presence of nutrients. These include legionellosis and Legionnaires disease, caused by Legionella spp., and those caused by the amoebae Naegleria fowleri (primary amoebic meningoencephalitis [PAM]) and Acanthamoeba spp. (amoebic meningitis, pulmonary infections).

Schistosomiasis (bilharziasis) is a major parasitic disease of tropical and subtropical regions that is transmitted when the larval stage (cercariae), which is released by infected aquatic snails, penetrates the skin. It is primarily spread by contact with water. Ready availability of safe drinking-water contributes to disease prevention by reducing the need for contact with contaminated water resources for example, when collecting water to carry to the home or when using water for bathing or laundry.

It is conceivable that unsafe drinking-water contaminated with soil or faeces could act as a carrier of other parasitic infections, such as balantidiasis (Balantidium coli) and certain helminths (species of Fasciola, Fasciolopsis, Echinococcus, Spirometra, Ascaris, Trichuris, Toxocara, Necator, Ancylostoma and Strongyloides and Taenia solium). However, in most of these, the normal mode of transmission is ingestion of the eggs in food contaminated with faeces or faecally contaminated soil (in the case of Taenia solium, ingestion of the larval cysticercus stage in uncooked pork) rather than ingestion of contaminated drinking-water.

Other pathogens that may be naturally present in the environment may be able to cause disease in people with impaired local or general immune defence mechanisms, such as the elderly or the very young, patients with burns or extensive wounds, those undergoing immunosuppressive therapy or those with acquired immunodeficiency syndrome (AIDS). If water used by such persons for drinking or bathing contains sufficient numbers of these organisms, they can produce various infections of the skin and the mucous membranes of the eye, ear, nose and throat. Examples of such agents are Pseudomonas aeruginosa and species of Flavo bacterium, Acinetobacter, Klebsiella, Serratia, Aeromonas and certain slow-growing (non-tuberculous) mycobacteria (see the supporting document Pathogenic Mycobacteria in Water; section 1.3).

Most of the human pathogens listed in Table 7.1 (which are described in more detail in chapter 11) are distributed worldwide; some, however, such as those causing outbreaks of cholera or guinea worm disease, are regional. Eradication of D. medinensis is a recognized target of the World Health Assembly (1991).

It is likely that there are pathogens not shown in Table 7.1 that are also transmitted by water. This is because the number of known pathogens for which water is a transmission route continues to increase as new or previously unrecognized pathogens continue to be discovered (see WHO, 2003a).

7.1.2 Persistence and growth in water

While typical waterborne pathogens are able to persist in drinking-water, most do not grow or proliferate in water. Microorganisms like E. coli and Campylobacter can accumulate in sediments and are mobilized when water flow increases.

After leaving the body of their host, most pathogens gradually lose viability and the ability to infect. The rate of decay is usually exponential, and a pathogen will become undetectable after a certain period. Pathogens with low persistence must rapidly find new hosts and are more likely to be spread by person-to-person contact or poor personal hygiene than by drinking-water. Persistence is affected by several factors, of which temperature is the most important. Decay is usually faster at higher temperatures and may be mediated by the lethal effects of UV radiation in sunlight acting near the water surface.

The most common waterborne pathogens and parasites are those that have high infectivity and either can proliferate in water or possess high resistance to decay outside the body.

Viruses and the resting stages of parasites (cysts, oocysts, ova) are unable to multiply in water. Conversely, relatively high amounts of biodegradable organic carbon, together with warm temperatures and low residual concentrations of chlorine, can permit growth of Legionella, V. cholerae, Naegleria fowleri, Acanthamoeba and nuisance organisms in some surface waters and during water distribution (see also the supporting document Heterotrophic Plate Counts and Drinking-water Safety; section 1.3).

Microbial water quality may vary rapidly and widely. Short-term peaks in pathogen concentration may increase disease risks considerably and may also trigger outbreaks of waterborne disease. Results of water quality testing for microbes are not normally available in time to inform management action and prevent the supply of unsafe water.

7.1.3 Public health aspects

Outbreaks of waterborne disease may affect large numbers of persons, and the first priority in developing and applying controls on drinking-water quality should be the control of such outbreaks. Available evidence also suggests that drinking-water can contribute to background rates of disease in non-outbreak situations, and control of drinking-water quality should therefore also address waterborne disease in the general community.

Experience has shown that systems for the detection of waterborne disease outbreaks are typically inefficient in countries at all levels of socioeconomic development, and failure to detect outbreaks is not a guarantee that they do not occur; nor does it suggest that drinking-water should necessarily be considered safe.

Some of the pathogens that are known to be transmitted through contaminated drinking-water lead to severe and sometimes life-threatening disease. Examples include typhoid, cholera, infectious hepatitis (caused by hepatitis A virus [HAV] or HEV) and disease caused by Shigella spp. and E. coli O157. Others are typically associated with less severe outcomes, such as self-limiting diarrhoeal disease (e.g., Norovirus, Cryptosporidium).

The effects of exposure to pathogens are not the same for all individuals or, as a consequence, for all populations. Repeated exposure to a pathogen may be associated with a lower probability or severity of illness because of the effects of acquired immunity. For some pathogens (e.g., HAV), immunity is lifelong, whereas for others (e.g., Campylobacter), the protective effects may be restricted to a few months to years. On the other hand, sensitive subgroups (e.g., the young, the elderly, pregnant women and the immunocompromised) in the population may have a greater probability of illness or the illness may be more severe, including mortality. Not all pathogens have greater effects in all sensitive subgroups.

Not all infected individuals will develop symptomatic disease. The proportion of the infected population that is asymptomatic (including carriers) differs between pathogens and also depends on population characteristics, such as prevalence of immunity. Carriers and those with asymptomatic infections as well as individuals developing symptoms may all contribute to secondary spread of pathogens.

Prior to commissioning a new drinking-water supply, a wider range of analyses should be carried out, including parameters identified as potentially being present from a review of data from similar supplies or from a risk assessment of the source.

4.3.4 Piped distribution systems

The choice of sampling points will be dependent on the individual water supply. The nature of the public health risk posed by pathogens and the contamination potential throughout distribution systems mean that collection of samples for microbial analysis (and associated parameters, such as chlorine residual) will typically be done frequently and from dispersed sampling sites. Careful consideration of sampling points and frequency is required for chemical constituents that arise from piping and plumbing materials and that are not controlled through their direct regulation and for constituents that change in distribution, such as THMs.

Recommended minimum sample numbers for verification of the microbial quality of drinking-water are shown in Table 4.5.

The use of stratified random sampling in distribution systems has proven to be effective.

4.3.5 Verification for community-managed supplies

If the performance of a community drinking-water system is to be properly evaluated, a number of factors must be considered. Some countries that have developed national strategies for the surveillance and quality control of drinking-water systems have adopted quantitative service indicators (i.e., quality, quantity, accessibility, coverage, affordability and continuity) for application at community, regional and national levels. Usual practice would be to include the critical parameters for microbial quality (normally E. coli, chlorine, turbidity and pH) and for a sanitary inspection to be carried out. Methods for these tests must be standardized and approved. It is recommended that field test kits be validated for performance against reference or standard methods and approved for use in verification testing.

Together, service indicators provide a basis for setting targets for community drinking-water supplies. They serve as a quantitative guide to the adequacy of drinkTable 4.5 Recommended minimum sample numbers for faecal indicator testing in distribution systemsaPopulationTotal number of samples per year

Point sourcesProgressive sampling of all sources over 3- to 5-year cycles (maximum)Piped supplies

10000050000012 per 10000 head of population plus an additional 120 samples

>50000012 per 100000 head of population plus an additional 180 samples

a Parameters such as chlorine, turbidity and pH should be tested more frequently as part of operational and verification monitoring.

ing-water supplies and provide consumers with an objective measure of the quality of the overall service and thus the degree of public health protection afforded.

Periodic testing and sanitary inspection of community drinking-water supplies should typically be undertaken by the surveillance agency and should assess microbial hazards and known problem chemicals (see also chapter 5). Frequent sampling is unlikely to be possible, and one approach is therefore a rolling programme of visits to ensure that each supply is visited once every 35 years. The primary purpose is to inform strategic planning and policy rather than to assess compliance of individual drinking-water supplies. Comprehensive analysis of chemical quality of all sources is recommended prior to commissioning as a minimum and preferably every 35 years thereafter.

Advice on the design of sampling programmes and on the frequency of sampling is given in ISO standards (Table 4.6).

4.3.6 Quality assurance and quality control

Appropriate quality assurance and analytical quality control procedures should be implemented for all activities linked to the production of drinking-water quality data. These procedures will ensure that the data are fit for purpose in other words, that the results produced are of adequate accuracy. Fit for purpose, or adequate accuracy, will be defined in the water quality monitoring programme, which will include a statement about accuracy and precision of the data. Because of the wide range of substances, methods, equipment and accuracy requirements likely to be involved in the monitoring of drinking-water, many detailed, practical aspects of analytical quality control are concerned. These are beyond the scope of this publication.

The design and implementation of a quality assurance programme for analytical laboratories are described in detail in Water Quality Monitoring (Bartram & Ballance,

Table 4.6 International Organization for Standardization (ISO) standards for water quality giving guidance on sampling

ISO standard no.Title (water quality)

56671:1980Sampling Part 1: Guidance on the design of sampling programmes

56672:1991Sampling Part 2: Guidance on sampling techniques

56673:1994Sampling Part 3: Guidance on the preservation and handling of samples

56674:1987Sampling Part 4: Guidance on sampling from lakes, natural and man-made

56675:1991Sampling Part 5: Guidance on sampling of drinking-water and water usedfor food and beverage processing

56676:1990Sampling Part 6: Guidance on sampling of rivers and streams

566713:1997Sampling Part 13: Guidance on sampling of sludges from sewage and

water-treatment works

566714:1998Sampling Part 14: Guidance on quality assurance of environmental water

sampling and handling

566716:1998Sampling Part 16: Guidance on biotesting of samples

566817:2000Sampling Part 17: Guidance on sampling of suspended sediments

13530:1997Water quality Guide to analytical control for water analysis

1996). The relevant chapter draws upon the standard ISO 17025:2000 General requirements for the competence of testing and calibration laboratories, which provides a framework for the management of quality in analytical laboratories.4.4 Management procedures for piped distribution systems

Effective management implies definition of actions to be taken in response to variations that occur during normal operational conditions; of actions to be taken in specific incident situations where a loss of control of the system may occur; and of procedures to be followed in unforeseen and emergency situations. Management procedures should be documented alongside system assessment, monitoring plans, supporting programmes and communication required to ensure safe operation of the system.

Much of a management plan will describe actions to be taken in response to normal variation in operational monitoring parameters in order to maintain optimal operation in response to operational monitoring parameters reaching operational limits.

A significant deviation in operational monitoring where a critical limit is exceeded (or in verification) is often referred to as an incident. An incident is any situation in which there is reason to suspect that water being supplied for drinking may be, or may become, unsafe (i.e., confidence in water safety is lost). As part of a WSP, management procedures should be defined for response to predictable incidents as well as unpredictable incidents and emergencies. Incident triggers could include:

non-compliance with operational monitoring criteria;

inadequate performance of a sewage treatment plant discharging to source water;

spillage of a hazardous substance into source water;

failure of the power supply to an essential control measure;

extreme rainfall in a catchment;

detection of unusually high turbidity (source or treated water);

unusual taste, odour or appearance of water;

detection of microbial indicator parameters, including unusually high faecal indicator densities (source or treated water) and unusually high pathogen densities (source water); and

public health indicators or a disease outbreak for which water is a suspect vector.

Incident response plans can have a range of alert levels. These can be minor early warning, necessitating no more than additional investigation, through to emergency. Emergencies are likely to require the resources of organizations beyond the drinking-water supplier, particularly the public health authorities.

Incident response plans typically comprise:

accountabilities and contact details for key personnel, often including several organizations and individuals;

lists of measurable indicators and limit values/conditions that would trigger incidents, along with a scale of alert levels;

clear description of the actions required in response to alerts;

location and identity of the standard operating procedures (SOPs) and required equipment;

location of backup equipment;

relevant logistical and technical information; and

checklists and quick reference guides.

The plan may need to be followed at very short notice, so standby rosters, effective communication systems and up-to-date training and documentation are required.

Staff should be trained in response to ensure that they can manage incidents and/or emergencies effectively. Incident and emergency response plans should be periodically reviewed and practised. This improves preparedness and provides opportunities to improve the effectiveness of plans before an emergency occurs.

Following any incident or emergency, an investigation should be undertaken involving all concerned staff. The investigation should consider factors such as:

What was the cause of the problem?

How was the problem first identified or recognized?

What were the most essential actions required?

What communication problems arose, and how were they addressed?

What were the immediate and longer-term consequences?

How well did the emergency response plan function?

Appropriate documentation and reporting of the incident or emergency should also be established. The organization should learn as much as possible from the incident or emergency to improve preparedness and planning for future incidents. Review of the incident or emergency may indicate necessary amendments to existing protocols.

The preparation of clear procedures, definition of accountability and provision of equipment for the sampling and storing of water in the event of an incident can be valuable for follow-up epidemiological or other investigations, and the sampling and storage of water from early on during a suspected incident should be part of the response plan.

Page 169-184

8.4 Treatment

As noted above, where a health-based guideline value cannot be achieved by reasonably practicable treatment, then the guideline value is designated as provisional and set at the concentration that can be reasonably achieved through treatment.

Collection, treatment, storage and distribution of drinking-water involve deliberate additions of numerous chemicals to improve the safety and quality of the finished drinking-water for consumers (direct additives). In addition, water is in constant contact with pipes, valves, taps and tank surfaces, all of which have the potential to impart additional chemicals to the water (indirect additives). The chemicals used in water treatment or from materials in contact with drinking-water are discussed in more detail in section 8.5.4.

8.4.1 Treatment achievability

The ability to achieve a guideline value within a drinking-water supply depends on a number of factors, including:

the concentration of the chemical in the raw water;

control measures employed throughout the drinking-water system;

nature of the raw water (groundwater or surface water, presence of natural background and other components); and

treatment processes already installed.

If a guideline value cannot be met with the existing system, then additional treatment may need to be considered, or water should be obtained from alternative sources.

The cost of achieving a guideline value will depend on the complexity of any additional treatment or other control measures required. It is not possible to provide general quantitative information on the cost of achieving individual guideline values. Treatment costs (capital and operating) will depend not only on the factors identified above, but also on issues such as plant throughput; local costs for labour, civil and mechanical works, chemicals and electricity; life expectancy of the plant; and so on.

A qualitative ranking of treatment processes based on their degree of technical complexity is given in Table 8.11. The higher the ranking, the more complex the process in terms of plant and/or operation. In general, higher rankings are also associated with higher costs.

Tables 8.128.16 summarize the treatment processes that are capable of removing chemical contaminants of health significance. The tables include only those chemicals for which some treatment data are available.

These tables are provided to help inform decisions regarding the ability of existing treatment to meet guidelines and what additional treatment might need to be installed. They have been compiled on the basis of published literature, which includes mainly laboratory experiments, some pilot plant investigations and relatively few full-scale studies of water treatment processes. Consequently:

Many of the treatments outlined are designed for larger treatment plants and may not necessarily be appropriate for smaller treatment plants or individual type treatment. In these cases, the choice of technology must be made on a case-by-case basis.

The information is probably best case, since the data would have been obtained under laboratory conditions or with a carefully controlled plant for the purposes of experimentation.

Actual process performance will depend on the concentration of the chemical in the raw water and on general raw water quality. For example, chlorination and removal of organic chemicals and pesticides using activated carbon or ozonation will be impaired if there is a high concentration of natural organic matter.

Table 8.11 Ranking of technical complexity and cost of water treatment processes

RankingExamples of treatment processes

1Simple chlorination

Plain filtration (rapid sand, slow sand)

2Pre-chlorination plus filtration

Aeration

3Chemical coagulation

Process optimization for control of

DBPs

4Granular activated carbon (GAC) treatmentIon exchange

5Ozonation

6Advanced oxidation processes

Membrane treatment

Table 8.12 Treatment achievability for naturally occurring chemicals for which guideline values have been establisheda,bArsenic+++++++++++++++