Talassoterapia - Benchmarks e Normas Internacionais

SEMINÁRIO INTERNACIONAL
“Turismo de saúde na Nazaré: dos banhos quentes à talassoterapia”

“Enquadramento legal e regulamentar da
Talassoterapia em Portugal e na Europa”

Benchmarks e normas internacionais

JOÃO PINTO BARBOSA
Nazaré, 24.03.2012


Benchmarks
Tunísia | França | Alemanha


Benchmarks
TUNÍSIA
Lei da Talassoterapia
Décret 2006-3174 du 30 Novembre

Cadre Juridique
L’activité de la thalassothérapie est sous la tutelle du ministère de la santé pour le
volet médical et du ministère du tourisme pour le loisir et l’hébergement.

Normes et conditions de création et d’exploitation d’un
centre de thalasso
A - Chapitre I : Dispositions générales | Articles 1 à 6
B - Chapitre II : Qualité de l’eau de mer et conditions de son utilisation | Articles 7 à 11
C - Chapitre III : Normes en locaux et équipements | Articles 12 à 23
D - Chapitre VI : Normes d’exploitation | Articles 24 à 33
E - Chapitre V : Normes en personnel | Articles de 34 à 41


A - Chapitre I : Dispositions générales | Articles 1 à 6

Article 2 : Prestations offertes par le centre de thalasso : héliothérapie – fangothérapie – algothérapie –
exercice sur terrain de sable – psammothérapie ¹ – cures de boissons

B - Chapitre II : Qualité de l’eau de mer et conditions de son utilisation | Articles 7 à 11

Article 7 : Obligation d’une étude écologique détaillée du site marin, de la flore
marine et terrestre et des installations avoisinantes

Article 9 : Conditions de prélèvement de l’eau de mer : mêmes caractéristiques que
l’eau au large,pas d’altérations du gôut,de la couleur ni de l’odeur.
Limites acceptables des paramètres physico-chimique :
Salinité = 35-40 g/l
Ph = 7.5 -8.4
Densimètrie = 1025-1032

Article 11 : Conditions du captage,du transport , du stockage, de l’utilisation et du
rejet de l’eau de mer

¹ Psammothérapie | Ammothérapie:
Bains de sable chaud qui ont des effets considérables dans les troubles ostéo-articulaires
² Densimètrie
Mésure des densités | Mésure des poids de un liquide


C - Chapitre III : Normes en locaux et équipements | Articles 12 à 23

Article 17 : dispositifs spéciaux d’éclairage et de climatisation pour les saisons
opportunes ; température du centre toujours entre 18-25ºc
D - Chapitre VI : Normes d’exploitation | Articles 24 à 33

Article 24 : Normes des piscines à eau de mer et renouvellement quotidien de 50%
de l’eau grâce à un système hydraulique
E - Chapitre V : Normes en personnel | Articles de 34 à 41

Article 35 : Le directeur du centre exerce à temps plein. Il est souhaitable qu’il soit
médecin, s’il ne l’est pas il doit être assisté par un directeur technique médecin

Fonte: La Législation Tunisienne en matière de Thalassothérapie (Dr.Sadok)


Benchmarks
FRANÇA
Carta de Qualidade da France Thalasso

Valeurs fondamentales de la Thalassothérapie : utilisation de l’eau de mer naturelle, site privilégié en bordure
de mer

Les centres de Thalassothérapie doivent adhérer à la CHARTE QUALITÉ
du syndicat et respecter l’ensemble de ses engagements

1. Un site privilégié en bordure de mer, un environnement préservé.
Pas de thalassothérapie en ville, à la montagne ou ailleurs, mais uniquement en extrême bordure du littoral
dans un site d’exception. 

2. L’utilisation d’une eau de mer naturelle.
L’eau de mer est la plus équilibrée des eaux thermales. Vivante et chauffée à température de confort elle
permet la recharge de l’organisme par passage des minéraux et oligo-éléments à travers la peau. Sa
conservation n’excédera pas plus de 24 heures.


3. Une surveillance médicale pour une cure sereine.
Une consultation médicale d’entrée de cure est conseillée. Le médecin établira avec vous votre planning et
répondra à vos besoins de conseils avant votre cure.

4. Une équipe de professionnels qualifiés et attentifs.
Les soins doivent être prodigués et encadrés par un personnel compétent, formé aux différentes techniques de
soins : kinésithérapeutes, hydrothérapeutes, diététiciens, moniteurs de sport, esthéticiennes...

5. Une garantie d’hygiène et de sécurité optimales.
Les centres de thalassothérapie sont soumis à des contraintes réglementaires très rigoureuses et sont contrôlés
régulièrement concernant notamment la qualité de l’eau de mer et des produits marins utilisés pour les cures.

6. Des installations conformes et entretenues.
Les centres agrées disposent d’équipements de haute technologie, adaptés et de qualité, révisés en
permanence pour satisfaire aux normes et optimiser l’utilisation de l’eau de mer
Bains hydromassants multijets parfois équipés en chromothérapie , Baignoires de Douche Sous-marine
Consoles de réglage pour jets ou douches diverses, Les rampes d’Affusions, dynamiques ou statiques
Les jets sous-marins en piscine, Les cabines d’enveloppements d’algues
Les aérosols marins, Les piscines de kiné balnéothérapie
Les installations "sèches", cabines de massages, salle de rééducation ou de gymnastiques, salles de relaxation.

 
Fonte: Charte Qualité France Thalasso (FRANCE THALASSO : Syndicat officiel de la Thalassothérapie en France)


Benchmarks
ALEMANHA
Standards de Qualidade

DEFINIÇÃO

Thalassotherapy is a remedial treatment using the natural healing powers of the sea.

The effective combination of cold or heated sea water, the clean sea breeze, sunshine, and treatments using
processed algae, chalk, silt and sand can alleviate and cure many illnesses.

Maritime air is free of pollen, dust and many other harmful pollutants. Also called 'maritime aerosol', it carries
salt molecules that have a mucolytic and anti-inflammatory effect on bronchial tracts.

The sun and its UV radiation in the right amount, has a positive effect on bones, the immune system and
psychological wellbeing.


Seawater with its high natural salt content, alleviates inflammations and nourishes the body through the skin
with essential minerals.

The wave swell and bathing in the surf break strengthen muscles and stimulates blood circulation, the rhythmic
sound of the sea has a calming effect.

Body packs and face masks made of algae, chalk ¹, silt ² and sand contain many nutrients, act to purify, are anti-
inflammatory and improve the appearance of the skin.

¹ Chalk / Calcite
soft compact calcite, CaCO3, with varying amounts of silica, quartz, feldspar, or other mineral impurities, generally gray-white or yellow-white and derived chiefly from fossil seashells

² Silt / Lodo
A sedimentary material consisting of very fine particles intermediate in size between sand and clay


All services that have been awarded the quality seal of approval Prävention im Kurort - Resort Prevention
Services - meet strict quality criteria and thus ensure a longer lasting rejuvenating effect:

An effective preventative service consists of a wholistic approach that includes exercise, nutrition and
relaxation, as well as improving communication skills, inner motivation and self-confidence. Depending on the
weakness, an individual health and prevention focus is set.

Health care education and health training ensure a lasting preventative effect. Only when we know what is and
isn't good for us can we make small changes in our daily habits, and achieve a more grounded, healthier lifestyle
in the long term.

Medical supervision is provided at the resort by your resort physician. Right from the beginning you can discuss
what you'd like to achieve in the prevention program. An individual treatment program is created in
consultation with you. At the conclusion of your stay, you'll meet with the resort physician and discuss how you
feel and how you can continue treatment at home.

Use of local natural remedies is an indispensable part of every preventative treatment program.

You can either pay privately for a preventative resort holiday or request a refund from your health insurance.


Movement Sea,
& Movement
Relaxation &
Vitality

Preço balcão Preço balcão
Reembolso Reembolso
Preço Final Preço Final
(28%) (24,6%)


Normas e standards internacionais
ISO Health Tourism Services
Europe Spa Med


TC 228/WG 2 Health Tourism Services

ISO/DIS 28621 (Draft International Standard)
Medical spas using natural resources -- Service requirements

ISO/AWI 17679 (Approved Work Item)
Wellness spa -- Service requirements

ISO/AWI 17680 (Approved Work Item)
Thalassotherapy - Service requirements

“Spa” has been defined by ISO 18513:2003 as acknowledged health resorts, with specific natural factors – natural remedies of the soil (for example, mineral spring), the sea, or the climate –
sometimes complemented by appropriate health treatments. Under the definition, there is also a note stating that in some countries “spas” are specifically recognized and regulated. The note
clearly reflects the will of ISO/TC 228 stated in ISO/TC 228 Business Plan which is to respect the principle of cultural identity and cultural differences while looking for a quality service to the
client.
Remark:
ISO 18513:2003 |Tourism services - Hotels and other types of tourism accommodation -- Terminology


Medical Spa using natural resources ¹ Acknowledged health resort, with specific natural
factors such as natural resources of the earth or the climate used in health treatments, under
medical supervision.

Wellness Spa An establishment based on provision of secluded space with relaxing ambience
and wellness programs/treatments for the promotion of health and total well-being which
cannot be considered under the category of beauty or medical service practices. Its effort is to
provide care and enhancement of health through holistic approach, aimed at rejuvenating and
relaxing body, mind and spirit.

Thalassotherapy Treatment using sea water and substances directly extracted from the sea
environment, in a marine site, under medical supervision, which is at the same time
therapeutic and preventive, promoting wellbeing and health care, using simultaneously
marine elements, sea water, algae, marine mud, sands and any other substance directly
extracted from the sea environment :

¹ NATURAL RESOURCES
Natural resources of the earth, within this group there are: Healing waters | Healing gases | Peloids | Climate
Specific natural local products
There is a wide range of local remedies, including mineral baths, saline baths, thermal baths, peloid path,
Kneipp Therapy, Thalassotherapy.


THALASSOTHERAPY
Contents 5 – Personal requirements
Foreword 5.1 GENERAL REQUIREMENTS
Introduction 5.1 5.2 QUALIFICATIONS
1. SCOPE 5.2.1 Medical and para-medical staff
2. NORMATIVE REFERENCES 5.2.2 Technical staff
5.3 TRAINING
3. TERMS AND DEFINITIONS
6 CARE ELEMENTS: RAW MATERIALS
4. FACILITIES AND EQUIPMENT 6.1 Sea Water
4.1 Facilities 6.2 Seaweed and marine mud
4.1.1General 7 HYGIENE GOOD PRACTICES
4.1.2 General Services Arears 7.1 General requirements
4.1.2.2 Reception 7.2 Hosting capacity of thalassotherapy centers
4.1.2.3 Office administrative 7.3 Access to thalassotherapy centers
4.1.2.4 Dressing Room 7.4 Raw materials’ quality control
4.1.2.5 Sanitary Facilities 7.5 Maintenance of equipment
4.1.3 Technical Area 7.6 Maintenance and cleaning
7.7 Linen management
4.1.4 Health care areas
7.8 Staff
4.1.4.1 Medical Unit 8 Services to customers
4.1.4.2 Infirmary 8.1 Information
4.1.4.3 Dry areas 8.2 Claims
4.1.4.4 Humid aereas 9 SELF-CONTROL
4.2 Equipment 9.1 General
4.2.1 General 9.2 Self-control plan
4.2.2 Lighting and ventilation 9.3 Records
4.2.3 Heating and air conditioning systems
4.2.4 Equipment to treat waste sea water
4.2.5 Drinking water supply


THALASSOTHERAPY
1. Scope
This International Standard establishes the requirements for the provision of services in thalassotherapy centers
using marine environment´s beneficial effects with curative or preventive purposes, aiming at ensuring:
- Good quality services responding to customer´s implicit and explicit needs
- The respectful use of the thalassotherapy concept and, very specifically, the implementation of hygiene and
safety principles.

This International Standard does not deal with the therapeutic virtues supposed to be offered by thalassotherapy
nor does it cover decisions that correspond to the medical profession. This International Standard does not apply
to accommodation nor to catering services.

3.11 Thalassotherapy
treatment using sea water and substances directly extracted from the sea environment, in a marine site, under
medical supervision, which is at the same time therapeutic and preventive, promoting wellbeing and healthcare,
using simultaneously marine elements, sea water, alga, marine mud, sands and any
other substance directly extracted from the sea environment.

4.11 Facilities and Equipment (General)
The thalassotherapy center shall comply with national legislation in force to get such recognition.

The thalassotherapy center facilities shall be located at a maximum of 1000 m from the coastline
in a healthy natural environment and in an area of non polluted water.


EuropeSpa med is the seal of quality for health resort hotels and clinics as well as medical wellness
centres. Visitors are treated over a period of at least two and ideally three weeks according to a
medical plan drawn up by a doctor. Then again, preventive measures may only last a few days if the
aim is to generally prevent disease or make the guest aware of health issues. Both treatment and
prevention have medical aspects, which is why the seal is known as EuropeSpa med.

EuropeSpa med brings clarity.
It's the most stringent audit in medical prevention. About 1,000 criteria have been distilled from
around 30 national and international standards and regulations governing aspects like safety,
hygiene and the treatment infrastructure. The test criteria have been developed in conjunction
with a Committee of Experts and with the support of health insurance companies. To be awarded
the EuropeSpa med seal of quality, health resorts and clinics have to undergo an on-site inspection
lasting two or three days carried out by independent auditors. And they only pass if they meet at
least 80% of all the criteria as well as certain basic requirements.


THALASSOTHERAPY should only be described as such if they meet the following
EUROPEAN SPAS ASSOCIATION criteria:

1) Therapeutical concept for defined indications under medical control.
2) Situated directly by the sea under the direct influence of sea climate.
3) Sea water for inhalation and/or bathing for example in tubs or in pools or in the sea.
4) Products of the sea such as mud or algae for different treatments.
5) Helio Therapy primary use of natural sunbeams and if weather conditions are unfavourable; the
sunlight can be replaced by artificial UV rays.
6) Sea air containing a low level of harmful substances and allergens to be used at long stays in the
fresh air.
7) Regulated stays in the fresh air and training neat the seaside.
8) Measures accompanying health: detention, healthy food and activity of the body.


Minerva Med. 1969 May 2;60(35):1695-702. Rheumatology (Oxford). 2005 Apr;44(4):539-46. Epub 2005
[The use of thalassotherapy in dermatology]. Feb 3.
[Article in Italian] Spa treatment for primary fibromyalgia syndrome: a
Dalla Torre G, Mazzucco G. combination of thalassotherapy, exercise and patient
PMID:5790013[PubMed - indexed for MEDLINE] education improves symptoms and quality of life.
Zijlstra TR, van de Laar MA, Bernelot Moens HJ, Taal E,
Zakraoui L, Rasker JJ.
Dermatol Monatsschr. 1976 Sep;162(9):746-9. PMID:15695301[PubMed - indexed for MEDLINE] Free full
[Influence of helio- and thalassotherapy text
on vitamin-A and beta-carotene levels in psoriasis].
[Article in German] Z Gesamte Inn Med. 1969 Feb 1;24(3):92-3.
Zlatkov NB, Babushkina N, Stransky L. [Treatment results in hypertensive patients after
PMID:992183[PubMed - indexed for MEDLINE] thalassotherapy].
[Article in German]
Liebisch I, Teichmann G, Mahlau G, Sparre R.
Fortschr Med. 1978 Mar 16;96(10):504-11. PMID:5796646[PubMed - indexed for MEDLINE]
[Thalassotherapy; indications, contraindications].
[Article in German] Rheumatol Int. 2008 Dec;29(2):147-52. Epub 2008
Schultze EG. Jul 4.
PMID:564852[PubMed - indexed for MEDLINE]
Thalassotherapy for fibromyalgia: a randomized
controlled trial comparing aquatic exercises in sea
Padiatr Padol. 1975;10(4):330-5. water and water pool.
Pulmonary function in asthmatic children during thalassotherapy. de Andrade SC, de Carvalho RF, Soares AS, de Abreu
Etspüler R, Voget KP, Siegmund M, Eigelsreiter H, Blanck P, Fenner A. Freitas RP, de Medeiros Guerra LM, Vilar MJ.
PMID:1215066[PubMed - indexed for MEDLINE] PMID:18600327[PubMed - indexed for MEDLINE]


E para concluir…


EM PREPARAÇÃO NA
UNIÃO EUROPEIA

European Parliament resolution of 27 September 2011 on Europe, the world's No 1 tourist destination – a
new political framework for tourism in Europe (2010/2206 INI)

58. Takes note of the fact that demographic developments in Europe will give rise to continuing growth in
health tourism and in spa tourism in particular; calls on the Commission, in view of the fact that there are a
variety of Community rules covering spa-tourism issues, to consider the possibility of tabling a single
legislative proposal on spa tourism in order to give the sector a controlled organic structure, encouraging its
competitiveness and specifying immediately that spa companies operating in the Member States, as providers
of health services, are excluded from the scope of Directive 2006/123/EC¹; stresses the relevance of the new
legislation on cross-border healthcare and considers that these must be enforced in strict compliance with the
criteria and conditions imposed by the new legislative framework, in order to ensure fully satisfactory
implementation.

¹ DIRECTIVE 2006/123/EC OF THE EUROPEAN PARLIAMENT AND OF THE COUNCIL of 12 December 2006 on services in the internal market


OBRIGADO PELA ATENÇÃO

JOÃO PINTO BARBOSA
Nazaré, 24.03.2012

Talassoterapia - Benchmarks e Normas Internacionais

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