title: Waterborne diseases prevention: evaluation of inspection scoring system for water sites according to water microbiological tests during the Athens 2004 pre-Olympic and Olympic period.
abstract: OBJECTIVE
  To evaluate the inspection grading system for water sites implemented during the Athens 2004 Olympic inspection programme.
  
  
  METHODS
  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.
  
  
  METHODS
  Athens, Thessaloniki, Patra, Volos, and Iraklio, Greece. Inspections and sampling conducted during a two year period before the 2004 Olympics.
  
  
  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.
authors.affiliation: University of Medicine, Faculty of Medicine, Department of Hygiene and epidemiology, Larisa, Greece. xhatzi@med.uth.gr
authors.forename: Christos
authors.initials: C
authors.lastname: Hadjichristodoulou
authors.forename: Varvara
authors.initials: V
authors.lastname: Mouchtouri
authors.forename: Anastasia
authors.initials: A
authors.lastname: Vousoureli
authors.forename: Athanasios
authors.initials: A
authors.lastname: Konstantinidis
authors.forename: Philipos
authors.initials: P
authors.lastname: Petrikos
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Velonakis
authors.forename: Panagiota
authors.initials: P
authors.lastname: Boufa
authors.forename: Jenny
authors.initials: J
authors.lastname: Kremastinou
mesh_terms: D003625:Data Collection; D004782:Environmental Health; D006115:Greece; D006285:Health Planning; D008828:Microbiological Techniques / Q000592:standards; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013551:Swimming Pools / Q000592:standards*; D014871:Water Microbiology / Q000592:standards*; D014881:Water Supply / Q000032:analysis / Q000592:standards*