?dat??e?e?? ???

1
?dat??e?e?? ???µ??e?? se ??s???µe?a

• ????? ?a???d??
• ????????-?????ß???????
• ?a? ?????ß??????a? ??? ????a?

2
?? ?e??- p??? ????

• ? pa???? st??? p???te? asfa???? (?a? epa?????)
  ?e??? ap?te?e? ?s?? t?? s?µa?t???te?? ?p???e?s?
  t?? p???te?a? a??? ?a? t?? µe?a??te?? ?p???e?s?
  t?? d?e????? ?????t?ta? p??? t?? ft???te?e?
  pe?????? t?? p?a??t?.
• 4 d?? ????sµata d??????a? t? ?????, 2.2 e?
  ???at??, ?????? se pa?d?? lt 5 ?????? (15
  pa?d???? ???s?µ?t?ta?).

3
?d?? ?????s??

• ?at?p?s?
• ?µes?
• ?p? ta t??f?µa
• t? ???t??
• ?p?t??esµa
• Gast?e?te??t?da
• ??se?te??a
• ????µß?s?
• ?????? ?at?????e? ???µ??e??

• ??sp???
• ?p?t??esµa
• ?t?p? p?e?µ???a

4
?a?????te? ep?ß????s??

• ?????ß????????? (ßa?t???a, pa??s?ta, ???,
  µ???te?) ap?te???? t?? s????te?e? a?t?e?
  ep?d?µ???, 90 t?? s??????. ?ata?????? st? ?e??
  ?????? ap? ast??? ap?ß??ta, ß??????.
• ??µ???? ??? p??? s????? (8) a??? ?ta? s?µß???
  ?? ß??ße? st?? ??e?a e??a? s?ßa??te?e?(f?t?f??µa?
  a, ???a????t??a).
• ????? pa?ap?????ta t?? ap???µa?s?? (???s ??p)

5
?dat??e?e?? ep?d?µ?e? st?? ??? a?????a µe t??
a?t???????? pa?????ta 1999-2000
6
S?µe?a p????e?s?? t?? µ????s??
?d??f???? ??????ta? p??? ?e????? p????
epe?e??as?a ap???µa?s? ???t?a p????
??d??µese? ?d??d?t?se?? (p???d?a) ?t???a ????a p.?. ???s? ????a??? f??t???
7
?a??????? d??s?

• ?a??????? µ???????a??sµ?? ????a???? ???µ??e?? se
  ??? t?? p????sµ? a? ß?e???? st? ?e?? se ?at??????
  s?????t??s?- µ???sµat??? d?s? (??)
• ????t??? pa??????? p???a???? ???µ??e?? st??
  e?a?s??te? ?µ?de? (pa?d??, as?e?e??,
  ??????µ?????)
• ????????a??sµ?? a?????se?? ep??e????? t??
  ???a????pt???? ?d??t?te? t?? ?e??? (?e?s?, ?sµ?,
  ???µa). Ne?? d?s??est? de? e??a? ?at a?????
  ep????d???.

8
?????? ep?ß??s??

• ???a? ? ?????? ad?a??p???s?? af?? ap?µa?????e?
  ap? t? s?µa t?? a????p??
• ?p?p?pte? se ?at?stas? ad???e?a? (µ?
  ?a???e???t???? µ??f??)
• T??at??
• ? ?????? a?t?? ep??e??eta? ap? pa?????te? ?p??
  ? ????f??e?a, ? ?e?µ???as?a, ? a?ta????sµ??, ta
  ??ept??? s?stat??? t?? ?e???, t? e?d?? t??
  pa???????.
• ??µ?????a ß??µeµß????? (ß??f??µ).

9
HAV
coliforms
cysts
C F U s
streps
enterovirus
Rota
X ? ? ? ? ?
10
??????S ?????S?S

• ?p?te???? µ???? t?? f?s???? ?????da? t?? a????p??
  ?a? t?? a??t???? ???ast????
• ?p?????? se µe???? s?????t??s? sta ??µata
• ?????e???ta? µe ap???, ??????e? ?a? ft????
  µe??d???.
• ? pa???s?a t??? st? ?e?? ?p?d????e? ??p?a??d?
  ??pa?s?.

11
?e??te? ??pa?s??
????? ????ßa?t????e?d? Escherichia coli ????ßa?t???d?? E?te????????
???st??d?? d?a??ast??? (ep?fa?e?a?? ?e??) ?e?d?µ???da p????a???? (?e?? se d??e?a) ?????? a???µ?? µ???????a??sµ?? st??? 22ºC
?????? a???µ?? µ???????a??sµ?? st??? 37ºC Ba?t????f???? ??a t?? ??e??? t?? ap???µa?s?? ??te????? se e?d???? pe??pt?se??
12
??T?G???

• ????????
• Salmonella spp
• Shigella spp
• Vibrio cholerae
• Campylobacter jejuni
• E.coli 157H7
• Legionella pneumophila

• IOI
• Hepatitis A
• Enteric viruses
• ????S???
• Entamoeba histolytica
• Giardia lamblia
• Cryptosporidium parvum

13
Sa?µ?????a

• Sa?µ?????e? ?ast?e?te??t?d??(gt2000 t?p?? , ??????
  Salmonella enteritidis (????? ??)
• Sa?µ?????e? t?f?e?d??? ?a? pa?at?f?? (µ???? ??)
• ?? ep?d?µ?e? ?a?a?t??????t?a ap? e????t??? ??a???
  ?a? a??????e? de?te???e??? ??a?s? ap? µet?d?s?
  ap? ?t?µ? se ?t?µ?
• ? pa???s?a t??? se ?p??e?a ?e?? d????e? sf??µata
  st?? d?a?e???s? t?? s?st?µat??.

14
S??????a

• S??????e? ?ast?e?te??t?d?? (3 t?p??) ?a? ?
  Shigella dysenteriae (d?se?te??a)
• ???a? ap???e?st???? ?p????? t?? a????p??
• ???a? ?s???? pa?????a µe a?µat?d? ??p?a?a
• ? pa???s?a t??? ?p?d????e? p??sfat? µ????s?
• ????? µ???? ??

15
?aµp???ßa?t???d??

• ?p?????? 14 e?d?, ?????? Campylobacter jejuni
• ??e? s?et??? µ???? ??
• ?et?d?s? st? ?e?? ?????? µ?s? t?? pt????
• ?p?ß?????? ??a µe???? ??????? d??st?µa se µ?
  ??????µ??a ?e?? ?aµ???? ?e?µ???as?a?

16
??????? t?? ?????a?

• ??? t?p??, Vibrio cholerae 01 ?a? El Tor
• ???t? f??? ?????a, 1832.
• ?a???e? ?s???? e?te??t????? p?? p???a?e?
  d?ata?a?? t?? ??e?t????t??.
• ??e? µe???? ??.
• ??e? p???a??se? p????? ep?d?µ?e? ta te?e?ta?a 15
  ?????a( ?e?????, 1992) ?a? µ?a pa?d?µ?a st?? ?.
  ?µe???? (gt1.000.000 ????sµata ?a? 10.000
  ???at??). ????e?ta? ap? ?aµ??? ep?ped? ???e????
• Te??e?ta? a?ad??µe?? pa??????.

17
?p?d?µ?a ?????a? st?? ??ßa??a
18
Escherichia coli 0157H7

• ?a???e? ?s???? t????? t?p?? shiga ?a? p???a?e?
  d?se?te??a µe a?µat?d? ??p?a?a ?a? ??µ???t???
  ???eµ??? s??d??µ? (10)
• E?e? p??? µ???? ?.?
• ?????? ep?d?µ?e? (?aµp???, 1990, 243 ????sµata,
  S??t?a, 1991, 496 ????sµata. ??t????, 2.500/5000
  ?at??????!)
• ?p?te?e? a?ad??µe?? µ???????a??sµ?

19
??te?????

• ?e? p???ap?as?????ta? ??? ap? ???ta?? ??tta??.
• ?????? ?µ?de? (ade?????, norwalk, calici) ?a?
  ?????? ?? ??? t?? ?pat?t?da? ? ?a? ?
• ????a?e? e?af?? a??? ep?µ??a s?µpt?µata
• ? ?pat?t?da ? ap?te?e? a?ad??µe?? µ???????a??sµ?
  2? se s????t?ta ????sµ?t??
• ? ?pat?t?da ? ??e? ???e? µe???e? ep?d?µ?e? se
  ???sµ??e? ???e?(?aµp???, ??d?a, 1991, 79.000
  ????sµata)

20
???pt?sp???d??

• ???t???? ?pe????? ??a µe???? a???µ? ep?d?µ??? ?a?
  ????sµ?t??
• ? µe?a??te?? ?dat??e??? ep?d?µ?a
  (Milwaukee,1993,400.000 ????sµata).
• ???? µ???? µ???sµat??? d?s? (10 ??ste??)
• ????a?e? d??????a,?????? se a??s??atesta?µ?????
• ?a??µ??a p??ß??µata ap? aµ??ß?de? ?a? ????d?a.

21
??T?G??? S?? ???? ?O? ??S??????O?

• ?? ?e?? sta ??s???µe?a ap?te?e? s?µa?t??? p???
  e?d???s???µe?a??? ???µ??e??.
• ?e? ?pa????? safe?? ?d???e? ??a t?? p?????? t??
  ???µ??e?? ap? t?? p???t?ta t?? ?e??? sta
  ??s???µe?a.
• St?? ??? (1966-2001) ?ata???f?sa? 43 ep?d?µ?e? µe
  1400 ?a??t???/ ?t?? ap? ?dat??e?e?? ???µ??e?? se
  ??s???µe?a (?nnaissie et al, 2003).

22
?? fta?e? ??a ta a???µ??a pe??stat???

• ?a??? ??s???µe?a?? ?t???a? d??ß??s? t??
  s?????se??? d?µ??????a ß??f??µ?
• ???es? t?? as?e???
• µ?s? t?? ???t???
• t?? ???s?? p?s?µ?? ?e??? se ???? µ??f?
• pa????a
• ??s? ?at????? e??p??sµ?? p?? ?ep???e? µe ?e???
• ???µa ?a? µ????? a???µ?? pa??????? µp??e? ?a
  p???a??se? ???µ???. G?a t? ???pt?sp???d?? ?a? 1
  ????st? µp??e? ?a ???e? ???µ??? se
  a??s??atesta?µ?????.

23

• ?a pe??stat??? a?aµ??eta? ?a a??????? ????
• ??? ???a?s?? t?? p????sµ??
• ??? a???s?? t?? a???µ?? t?? a??s??atesta?µ????
• ??? a?aµe??µe??? a???s?? t?? e?d???s???µe?a???
  as?e???

24
(No Transcript)
25
Pseudomonas aeruginosa

• ????t??? pa?????? ßa?t????.
• ??e? a???µ??? a?t??? sta s?st?µata ?d?e?s?? d??t?
  ap?te?e? f?s??? ?????da ?t? ?e???
• 29.4 as?e??? se µ???da e?tat???? ?e?ape?a? st??
  ??? µ???????a? µe ste???? ?? a????e????a? ?a? st?
  ?e?? t?? ?a??µ?? (?rautmann et,al, 2001).
• ?p?d?µ????????? µe??te? de?????? ?t? 1400
  e?d???s???µe?a??? as?e?e?? /?t?? st?? ???
  pe?a????? ap? ?e?d?µ???da ?dat??e???? p????e?s??

26
Aeromonas hydrophila

• ????t??? pa?????? ßa?t????, ?????? se
  a??s??atesta?µ?????.
• Ga???a s?s??t?s? a???µ???? ???s?? ?e???
  ap????e?µ???? se de?aµe?? ??s???µe??? µe a???s?
  ???µ??e?? ap? ae??µ???da se as?e?e?? (Picard,
  1987)

27
?t?pa µ???ßa?t???d?a (NTMs)

• ????t??? pa?????a ßa?t???a
• Ba?ta????? ?a? s?? (1998) ???s ap?µ??????a? sta
  5 ????a ??s???µe?a t?? ??t?a? se p?s?st? 15.6
  t?? de??µ?t??.
• ?p?d?µ?a p?? p????????e se as?e?e?? µe HIV ap?
  Mycobacterium avum complex (MAC) s?s?et?st??e µe
  µ???a?? ta?t?p???s? µe e???µata st? ?e?? t??
  ??s???µe??? (Squier and Stout 1994).

28
?spergillus spp

• G???? pe??ßa????t???? ?f?µ???t??.
• ???e?t???? st?? ap???µa?s? t?? ?e???.
• ?????p?????ta? ??a ??s???µe?a??? ???µ??e?? ??????
  se as?e?e?? µe ?e??a?µ?a, µetaµ?s?e?s? ?a?d??? ?
  p?e?µ????, AIDS, s?ßa?? e??a?µata.
• Se µe??t? (Patterson, 2003) ?at????e t? 66
  as?e??? µe aspe??????s?.

29
(No Transcript)
30
(No Transcript)
31
?spergillus spp- p?? a????e?eta?

• S?????? ?e??e?ta? ae???e??? ???µ???.
• ?e??t? ?µ?? st?? ??? ap?de??e ?t? µ????? ?
  µet?d?s? e??a? ?dat??e??? (Anaissie, 2002).
• St??e??? ?. Fumigatus p?? ap?µ??????e ap?
  ?a?????pa?? ap?µ??????e ?a? ap? t? ?e?? st?
  µp???? t?? d?µat??? t??.
• ?f?µ???te? ap?µ??????a? st? 94 t?? de??µ?t??
  ?e??? µ???da? µetaµ?s?e?s?? µ?e??? pa?d?at?????
  ??s???µe??? st?? ???ß???a (Warris, 2001).
• St?? Tes/?? se µ???de? te???t?? ?ef??? p????
  de??µata ?e??? e??a? Aspergillus (Arvanitidou,
  2000).
• ? Aspergillus µp??e? ?a µetad??e? ?a? µ?s?
  µ????sta????d??? ae???e??? ef?s?? e??atasta?e?
  st?? ??s???µe?a??? de?aµe??? ?e??? ?a?
  p???ap?as?aste? st? ß??f??µ.

32
A??a d???t??? pa?????a

• Stenotrophomonas maltophilia
• Chryseobacterium spp
• Fusarium spp
• Cryptosporidium avum
• Io?
• ?spergillus spp

33
???f??µ

• ??µ?????e?ta? sta t????µata
• S??????, ?e?aµe??? s?????t??s?? ?e???,
• ??s???µe?a??? µ????s?s?e??? (a?ap?e?st??e? ??p),
  ?????? ???µat?st????
• ?p?te?e? ??a p???µa ???a????? ?a? a????????
  ep??a??se?? µe ßa?t???a.
• ?????e? st?? a???s? t?? ?????? ep?ß??s?? t??
  pa??????? st? s?st?µa ?a? st?? p??stas?a t??? ap?
  ta ap???µa?t??? (??????)

34
(No Transcript)
35
?dat??e?e?? ep?d?µ?e? se ??s???µe?a ap?
Ps.aeruginosa 1987-2001 (n10)
Reference S?µe?a ???µ???? Typing
Trautmann, 01 ??a?e?a, pe??t??a?? AP-PCR
Bert, 98 ??e?µ??e?, ???a ??µ??e?a DNA macrorestr analysis
Buttery, 98 ??µa, d??µa, ???a PFGE
Ferroni, 98 ???a ERIC-PCR, RAPD
Ezpeleta, 98 a?µa DNA fingerprint
Burucoa, 95 ? DNA typing
Richard, 94 ??µa, p?e?µ??e?, t?a?µa Phage typing
Kolmos, 93 a?µa Genotyping
Grundman, 93 ???a EXoA DNA probe
Worlitzsc, 89
36
?dat??e?e?? ep?d?µ?e? se ??s???µe?a ap? ?t?pa
????ßa?t???d?a 1987-2001 (n9)
Reference S?µe?a ???µ???? Typing
Von Reyn, 94 ???spa?t? PFGE
Kauppinen, 99 ???spa?t? AP-PCR
Hector, 92 ??a?µa, a?ap?/?? PFGE
Burns, 91 ??????? Plasmid profile
Benitez, 99 d??f??a PCR
Desplaces, 95 Sp??d. st??? Chr.restr frag pat
Picardeau, 97 ??µa, ?st?, st?µ???, ???a, ß?????? AFPL, RFLP, PFGE
37
?dat??e?e?? ep?d?µ?e? se ??s???µe?a ap? µ???te?
1987-2001 (n3)
E?d??/ Reference S?µe?a ???µ???? Typing
Fusarium solani Anaissie, 98 ???spa?t? RFLP, RAPD, IR-PCR
Exophiala Janselmei Nucci, 98 ???spa?t? RAPD
Aspergillus fumigatus Anaissie, 2000 p?e?µ??e? PCR, SSDP

38
?dat??e?e?? ep?d?µ?e? se ??s???µe?a ap? d??f??a
d???t??? pa?????a1987-2001 (n4)
Stenotrophomonas Maltophilia Weber, 99 ?e??t??a??, ??ap?. S?st?µa d??µa PFGE
Serratia marcescens Carlyn, 98 ??t?a, ??p?a?a PFGE
Acinetobacter baumannii Pina, 98 ???µa, t?a?µa PFGE Biotyping
Aeromonas hydrophila Picard, 87 a?µa Electrophoretic Esterase typing
39
???????

• ?e??s? t?? ???s?? ?e???
• ???s? ?e??? ????? p????e?s?? (eµf?a??µ???)
• ???s? p??f??a?t???? a?t?ß??s??
• ???s? f??t??? st?? e?s?d? t?? ?e??? t??
  ??s???µe???
• ???s? ?e??? ?????? p??d?a??af?? (s?ed??
  ap?ste???µ???) ??a t? ??p??µa e?d?s??p???,
  ß?????s??p??? (CDC).

40
Legionella pneumophila

• ??e?a ßa?t???a?? ???µ??? t?? ??t? a?ap?e?st????
  s?st?µat?? µe ???s?µ?t?ta 10-15 ?a? 40 st???
  e?d???s???µe?a???? as?e?e??.
• ?p???e? se d?? µ??f??
• ???et?? Pontiac
• ??ass??? ??s??
• ?etad?deta? µe µ????sta????d?a ap? t? te???t?
  pe??ß????? t?? a????p??.

41
S??T???S ????????S

• Te?µ???as?a 20-50ºC
• ?a???s?a ß??f??µ st??? s????e?
• ????µ??a ???a????/ a????a?a ??ata st? ?e??.
• ?a???s?a p??t????? st? ?e??.
• St?s?µ? ?e??
• ??f?? s?µe?a st? d??t??
• ?aµ??? ???
• ???e?p?? s??t???s?

42
S?S?????? ??? ?????????????? G?? ??????S?

• ?d?????ta s?st?µata ???µat?sµ??
• ???t?a ?d?e?s?? (?t???, p???t???a a?t?????t??)
• Te?µata µe ?e?? (s??t??ß???a, ?ata???te?)
• ??t?st???
• ?aµat??? ???t??- p?s??e? µe a??de?s?-
  ?e??ts??????e?
• S????e?- ?d??µas??
• ?d??t??at?e?a, a?ap?e?st???? s?s?e???.

43
?????? ??? ?????????????? G?? ??????S?

• ??S???????
• ??????????
• G??F???

44
??de??t??? ????sµata se ??s???µe?a

• ??? ??t?e?e? 2002, 9 ????sµata, 2 ???at??
• ?a??s? 2001, 12 ????sµata, 6 ???at??
• ?e?ß????? 2001, 7 ????sµata, 2 ???at??
• ?a??s? 2000, 4 ????sµata
• ?e?ß????? 2000, 1 ????sµa
• ??etta??a 2000, 2 ????sµata
• Maryland 1999, 5 ????sµata, 3 ???at??
• ??a??a 1999, 2 ???at??.

45
??e??e? st?? ????da, 1992-1997 (??e???? ?a?
?a???d??,??s????, 1997)

• 1234 de??µata
• 191 ap? ?p?pta ?t???a
• 1043 ??a p????pt??? ??e???
• ?p?te??sµata (?et??? de??µata)
• ?p?pta ?t???a 12.5
• ?????pt???? ??e???? 1.7
• ?????pt???? ??e???? ??/µe??? 10
• (40 t?? ?t?????)

46
?????aµµa p????pt???? e?????? se ??s???µe?a t??
?t???? 1996-2002

• 20 ??s???µe?a
• 7 de??µata a?? ?t????
• ??t??s? ?e?µ???as?a?
• ?d???e? ??a p??????
• ?p???t? eµp?ste?t???t?ta
• S??e??as?a µe t?? ep?t??p?? ???µ??e??
• 1? 3et?a 40 t?? ?t????? ?et???
• ?e?e?ta?a f?s? 1 ??s???µe??!

47
Od???e? p???????

• ??p??µa µe ?a?t? ?e?? ?a? ap???µa?s? µe UV se
  pe???d??? ??????? d?ast?µata.
• Sta?e?? ?e?µ???as?a ?est?? ?e??? gt60ºC
• ?a? ????? ?e?o? lt20ºC.
• Ap???µa?s? µe ??????? ß??se?, ?t??? ??p.
• S?st?µat??? s??t???s? ?d?????t?? ???µat?st????
• S?st?µa?t??? de??µat?????e?.

48
EU QLK4- 2000-0097

• Microbial Risk Assessment of Dental Unit Water
  Systems (DUWS) in General Dental Practice (GDP)
  in GreeceAthena MavridouJoanna Kamma,
  Georgia Mandilara

49
?a?????a se e??????? ?d??t??at?e?a (1)
Microorganisms WN42 SN42 AN42 BN31
Actinomyces odontolyticus 73.8 66.7 6.5
Capnocytophaga spp 2.4 6.5
Clostridium cadaveris/sporogenes 7.1 4.8 3.2
Clostridium tetanii 2.4
Clostridium acetobutilicum 2.4 7.1
Clostridium sondellii 2.4
Oral anaerobes (total) 88.1 83.3 16.1
50
?a?????a se e??????? ?d??t??at?e?a (2)
Microorganisms WN42 SN42 AN42 BN31
Enterobacteria spp.
Clostridium spp. 2.4
Pseudomonas aeruginosa 7.1 7.1 3.2
Legionella pneumophila 16.1
Mycobacterium spp. 2.4 7.1
Candida spp. 2.4
HBV (Blood) 23.8 16.7
51
(No Transcript)
52
?p?te?esµat???t?ta ap???µa?t????
????d?? ?e??? ????a ????ßa?t???d?a ????te? ??? ?a??s?ta
?p?sta ?? ? ß?asµ?? ???? ?a?? ???? ?a?? ???? ?a?? ???? ?a?? ???? ?a??
?????? ?a?? µ?t??a µ?t??a ?a?? µ?t??a
??t?st? ?sµ?s? ?a?? ?a?? ? ?a?? ???? ?a??
Cu/Ag ???? ?a?? ? ? ? ?
53
?p?te?esµat???t?ta ap???µa?t????
????d?? ?e??? ????a ????ßa?t???d?a ????te? ??? ?a??s?ta
d????s? ? ? ? µ?t??a ???? ?a??
?????s? ?a?? ? ? ???? ?a?? ???? ?a??
UV ?a?? ? ? µ?t??a ???? ?a??
??t??e? ?a?? µ?t??a ? ?a?? µ?t??a

54
????? ???S??S??S ???S?????S??????O?
??????? ???S????? S????S ??????S ??????S??S
? ???F??? ?p?f??? ???e ?at?stas?? a???µ???? ???d????(???s? µ??? e?e?µ???? ?e???)
?? ?????? ?p?p???? ap???µa?s?, ??e???? t?? s?????? t?? ???t??? ??a ß??f??µ
??? S????? F??t?? ?e???, ???s? a???a?????? ?e???, a?st???? ??e???? ?e??? ???s??
?V ???? S????? ?p?ste???µ??? ?e?? ??a ??e? t?? ???se??
55
??????S?O