Gianni Gurnari

Italy

Medical spa environment is conceived as a place of health and wellness. A lot of thermal waters have been considered for a long time like real medicines able to provide demonstrable and lasting benefits in some serious pathologies. But the waters and the environments in which they are supplied or used are not exempt from the infectious problems related to the presence of factors that cotribute to spread some bacterias. Therefore, there is a hygienic risk for which the best remedy can be identified in a combination of measures and actions aimed to provide an effective prevention.

As in all the public areas, also in the thermal establishments there are crucial hygienic conditions due to various factors. Some of these are:

• the diffused presence of water, also in form of aerosol and atomization;
• the comforting and constant temperature;
• the complexity of plants exposed to conditions of stress and intense use;
• the alteration of the materials, above all of the water pipes, that generally suffer corrosion due to the chemical characteristics of the salty waters;
• the employment generally of non specialistic technologies;
• the variety of users.
However the greatest risk is connected to the possible presence of people affected by immune deficiency or not completely healthy who are more exposed to the risk related to the hygienic conditions rather than those in good health that are not affected by the presence of bacteria.

Others factors contribute to increase the levels of risk. They are generally little-known or neglected, altough they represent instead effective tools of prevention. Some of the most remarkable are:

• the correct realization of the circuits inside the thermal structure;
• the division of the wet zones from the others;
• the choice of right materials and components;
• the adoption of correct criterions of access in the various therapeutic zones;
• a correct maintenance including cleaning and disinfection in all the environments of the thermal structures.
Each of the parameters mentioned above contributes heavily to the presence of pathogenic bacterias. In fact if only one of those factorr occurs, the entire supply is affected. For instance the lack of separation between damp zones (swimming pools, therapeutic basins, area of atomization or humage, aerosol therapy) and non wet zones, involves inevitably the infectious migration between a zone and the other because of a formidable, uncontrollable vector of transport as water can be.

The interventions must be divided between structures to be realized and the existing ones.

The prevention starts in the reception area of the thermal establishment or medical spas where the consumers must be given clear indications on the rules that contribute to guarantee the hygiene of the environments.

In the existing establishments there can be or not changing rooms, divided for sex.

In every case it is necessary to have controlled access where at least the footwears must be replaced with proper coverings (disposable and to be recycled sterilized).

In the planning and realization of new establishments the changing rooms represent a crucial component of the access to the various departments. If they are separated for sex they must have only one entrance and only one access to the different areas distinguished by the reentry in the same locker room at the end of the curative cycle.

The presence of swimming pools, basins and Kneipp therapy forces the employment of appropriate antimycotic tubs and the presence of showers for cleaning body. Generally the use of the cap should be compulsary. Also in this case it deals to a controlled access that will be equipped with opportune technologies for the transit of costumers with disabilities (wheelchairs, et).

The wet zones mentioned above must be physically separated from all the other zones. The introduction of foods or drinks must be forbidden, even if preparated inside the structure, or introduced in sealed single wrappings.

The passage between the wet areas and the others must always be on checked access so that to guarantee that the access in the areas «water» is always possible after the disinfection at least of the feet (and relative footwears like slippers, flip-flop, clogs except those made of wood, et).

It appears evident that the search of the optimal thermal circuit implies strategic choices in the distribution of the functions. If this is feasible in new establishments, surely it can constitute a problem in the existing ones. But also in this case an accurate study on every structure can allow to find value-for-money sustainable solutions.

The most important rule must be a strict separation between «barefoot» areas (clean) and «shoes areas» (dirty).

The optimization of the thermal circuits represents without any doubt a first important contribution toward the prevention and the reduction of the costs of management.

But it is not enough: the improvement of the circuits quality should be achieved with accurate choices on the typology of the materials to employ and on the rationalization of the available spaces.

A great attention deserves the air conditioning of every place of the establishment, the correct illumination (both artificial and natural) and the quality of the technological plants.

The quality of the thermal offer also depends on the choice of the contents: among these the run for the access to the various areas and to the single functions assumes a determinant and strategic role for of the management.

In this sense it is also favorable the start of a new culture of the attention toward this aspect of the thermalism that has been neglected for too much time.

An appropriate study of the thermal circuits shold be the essential element in the realization oh the new structures.

Also on the existing ones there should be a progressive improvement aimed to obtain a better hygienic-sanitary prevention, which is very important in this type of industry.

In both cases the starting point is the raising of full awardeness in the customers and an appropriate management program that includes a life-long training of the operators about the new needs of health care.