Description | Specific Indicators | Corresponding Mandatory Objectives | Corresponding National Indicators | Data Sources | Survey Questions | Alternative Data Sources | Analysis Check List | Method of Calculation | Basic Categories | Indicator Comments | Definitions | Cross-References to Other Sections | References


Description

• The number of boil water advisories (BWAs) issued by the medical officer of health by household-days affected.
• The number of drinking water advisories (DWAs) issued by the medical officer of health by household-days affected.

• Boil water advisories by household-days affected.
• Drinking water advisories by household-days affected.

 
Corresponding Mandatory Objectives

Program Standard: Infectious Diseases, Safe Water

• To ensure that community drinking water systems meet the health-related chemical, physical, microbiological and radionuclide objectives as published in the Ontario Drinking Water Objectives (revised 1994) and the Guidelines for Canadian Drinking Water Quality (sixth edition).

• None

• Some public health units may have their own database for tracking BWAs and DWAs.
• The criteria for deciding to issue a BWA or DWA has not been consistent over time or across public health units. Comparisons over time or areas may be difficult.
• Ensure that methodologies were consistent for determining the number of households affected or note inconsistencies and limitations.

 
Method of Calculation

Sum each area affected by a drinking water advisory:
(total number of households affected by a drinking water advisory * number of days the advisory was in effect)

Basic Categories

• Geographic areas: public health unit. Can also be for a very small geographical area such as a village.
• Number of boil water advisories issued in a given year; number of drinking water advisories issued in a given year.
• Number of households affected by a water advisory.
• Number of persons affected by a water advisory may be available if the number of people in each household is known or can be estimated.
• Number of days the BWA or DWA was in effect.

Indicator Comments

• The Protocol for the Issuance of a Boil Water or a Drinking Water Advisory applies to all treated regulated/unregulated drinking water systems that are classified under the Drinking Water Systems Regulation (Ontario Regulation 170/03 (OR 170/03)) and other drinking water systems that do not fall under this regulation. The Protocol was revised and available for comment in 2001.¹ The Protocol was awaiting final approval as of April 2005.
• OR 170/03 made under the Safe Drinking Water Act, 2002 came into force on June 1, 2003. This regulation requires that owners/operating authority and testing laboratories of drinking water systems, give notice to the medical officer of health for the health unit in which the drinking water system is located of the exceedences of any health-related parameter in the Ontario Drinking Water-Quality Standards Regulation, encompassing microbiological, chemical and radiological standards. OR 170/03 also applies to schools, private schools, day nurseries, nursing, retirement homes, social and health care facilities in the broader public sector and private sector that have their own water supply system.¹
• A boil water advisory (BWA) is issued when there is: no disinfection or detectable disinfection residual in the distributed water; unacceptable microbiological quality in the treated water; epidemiological evidence that suggests drinking water is responsible for an outbreak; significant deterioration in source water quality; or situations where operation of the system would compromise public health (e.g. back-flow).¹
• A drinking water advisory (DWA) is issued whenever there is reason to believe that a condition exists with a drinking water supply that may result in a risk to consumers that cannot be corrected by boiling the water or by disinfection. DWAs may arise for the following reasons: a chemical standard is exceeded; a radiological standard is exceeded; or other condition judged to be hazardous that cannot be rectified by boiling the water.¹
• The medical officer of heath (MOH) has the responsibility for the advisory under the Health Protection and Promotion Act and for a BWA should alert the public to bring drinking water to a rolling boil for at least a minute to remove the risk of acquiring disease caused by bacteria or protozoa.
• Reporting drinking water advisories in terms of household-days provides information about the scale and impact of the advisory.
• The decision to issue a BWA or DWA is not made lightly, nor is it always clear-cut. Caution should be used when comparing data across health units and over time. The Walkerton Gastroenteritis Outbreak of May 2000² has also likely influenced the decision-making process. To more clearly outline the process, the Ministry has developed a protocol for the issuance of boil water and drinking water advisories. As well, the Council of Medical Officers of Health of Ontario (COMOH) and the Association of Supervisors of Public Health Inspection of Ontario (ASPHIO) struck a Boil Water Advisory Task Group³ to develop Implementation Guidelines for Boil Water Advisories. These measures should better standardize the issuance of water advisories.
• The number of households affected is calculated by public health inspectors who may issue advisories on a door-to-door basis or by water plants that can estimate the number of households they service. The number may or may not include businesses.
• Some water advisories may run over more than one time frame (e.g., December to February, running over two years). This needs to be described in the interpretation of the data.

• None

• Enteric disease incidence (Section 8: Infectious Diseases)
• Enteric disease hospitalization (Section 8: Infectious Diseases)

 
References

1. Ontario Ministry of Health and Long-Term Care, Public Health Branch. Protocol for the Issuance of a Boil Water or a Drinking Water Advisory: Safe Water Program, Spring 2001. URL: http://www.health.gov.on.ca/water/BWA_Protocol_Spring_2001.pdf
2. Walkerton Commission of Inquiry Reports URL: http://www.attorneygeneral.jus.gov.on.ca/english/about/pubs/walkerton/
3. Council of Medical Officers of Health of Ontario and the Association of Supervisors of Public Health Inspection of Ontario, Boil Water Advisory Task Group. Draft Implementation Guidelines for Boil Water Advisories. January 28, 2002.
4. Ministry of the Environment. Ontario Drinking Water Quality Standards. URL: http://www.ene.gov.on.ca/envision/gp/4465e.htm
5. Health Canada. Guidelines for Canadian Drinking Water Quality. URL: http://www.hc-sc.gc.ca/ewh-semt/pubs/water-eau/doc_sup-appui/sum_guide-res_recom/index_e.html
6. Ministry of Health and Long-Term Care. Boil / Drinking Water Advisory. URL: http://www.health.gov.on.ca/english/public/pub/watersafe/watersafe_boiled.html

 
Date of Last Revision: May 24, 2006 .