Faculty of Medicine Introduction to Community Medicine Course

(31505201)

Unit 3 Public Health/Environmental Health

Introduction to Water pollution Food Safety

Waste and Health

By

Hatim Jaber MD MPH JBCM PhD

23-10-2017

1

Every day in 2016, 15 000 children died before

their fifth birthday, 46% of them – or 7 000 babies – died in the first 28 days of life,

according to a new UN report.

Introduction to Unit 3 Public Health and Environment

4 lectures 1. Introduction to Public Health and Environment-- 16-10-

2017 2. Environment 1- Air pollution—18-10-2017

3. Environment : introduction to Water Quality and water borne diseases Food Safety and food borne diseases Waste and health- Management 23-10-2017 4. Occupational Health -25-10-2017

4

Presentation outline

Time

Water Quality, Quantity and Health Water pollution and Sources Water and contaminations

08:15 to 08:25

Water related diseases 08:25 to 08:40

Food Safety and health Food borne Diseases and HACCP

08:40 to 09:00

Waste definition and classification Waste and Health . Solid Waste Management

09:00 to 09:15

Waste Occupational Health Hazards Healthcare/Hospital Waste

09:15 to 09:30

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Water Quality and Health

• The quality of drinking-water is a powerful environmental determinant of health

• Water is essential for life, but it can and does transmit disease in countries in all continents – from the poorest to the wealthiest.

• The most predominant waterborne disease, diarrhoea, has an estimated annual incidence of 4.6 billion episodes and causes 2.2 million deaths every year

• Millions of people are exposed to unsafe levels of chemical contaminants in their drinking-water

• In 2015, 71% of the global population (5.2 billion people) used a safely managed drinking-water service – that is, one located on premises, available when needed, and free from contamination.

• 844 million people lack even a basic drinking-water service, including 159 million people who are dependent on surface water.

• Globally, at least 2 billion people use a drinking water source contaminated with faeces.

• Contaminated drinking water is estimated to cause 502 000 diarrhoeal deaths each year.

• In low- and middle-income countries, 38% of health care facilities lack an improved water source, 19% do not have improved sanitation, and 35% lack water and soap for handwashing.

How much water does an individual use?

In Jordan

Water supply per Capita (2000-2013)

General information of water sources Sources Quality Quantity Accessibility Reliability Cost

Groundwater

Good quality for deep

aquifers; poor to fair

for shallow aquifers

Good with little

variation

Depends on the

best location of

well; pumping

required unless

artesian well

Good,

maintenance on

pump required

regularly, must

not over pump the

aquifer

Moderate if need

to pump

Springs and

Seeps

Good quality;

disinfection

recommended after

installation of spring

protection.

Good with little

variation for

artesian flow

springs; variable

with seasonal

fluctuations likely

for gravity flow

springs.

Storage necessary

for community

water supply;

gravity flow

delivery for easy

community

access.

Good for artesian

flow and gravity

overflow; fair for

gravity

depression; little

maintenance

needed after

installation.

Fairly low cost;

with piped system

costs will rise.

Ponds and

Lakes

Fair to good in large

ponds and lakes; poor

to fair in smaller

water bodies;

treatment generally

necessary.

Good available

quantity; decrease

during dry season.

Very accessible

using intakes;

pumping required

for delivery

system; storage

required.

Fair to good; need

for a good

program of

operation and

maintenance for

pumping and

treatment

systems.

Moderate to high

because of need to

pump and treat

water.

Information of water sources

Streams and

Rivers

Good for mountain

streams; poor for

streams in lowland

regions; treatment

necessary.

Moderate: seasonal

variation likely;

some rivers and

streams will dry up

in dry season.

Generally good;

need intake for

both gravity flow

and piped

delivery.

Maintenance

required for both

type systems;

much higher for

pumped system;

riverside well is a

good reliable

source.

Moderate to high

depending on

method;

treatment and

pumping

expensive.

Rain

Catchments

Fair to poor;

disinfection

necessary

Moderate and

variable; supplies

unavailable during

dry season; storage

necessary.

Good; cisterns

located in yards

of users; fair for

ground

catchments.

Must be rain;

some

maintenance

required.

Low-moderate

for roof

catchments; high

for ground

catchments

Sources Quality Quantity Accessibility Reliability Cost

What’s the Quality of Our Drinking Water? Drinking water is defined as potable water used for domestic purposes, food, industries, and ice manufacturing.

Community asks for information:

Sodium Hardness Mineral content (TDS)

pH

Chlorine

Coliform Bacteria

Contamination

Standard conditions 1 Microbial Parameters 1.1 The maximum allowable limit for the TCC (MPN/100ml)

should be < 1.1 as a result of the Multiple Tube Test and 0 as result of the Membrane Filtration Test

.1.2 The sample should be free from a) Thermo tolerant coli form bacteria, and b) Enteric viruses and germs 2 Biological Parameters: Drinking water should be free from a) Any

pathogenic protozoa b) Any pathogenic nematode eggs c) Any free living pathogens,

and d) Fungus .3 Physical Characteristics The physical characteristics of water should

be as follows: a) Taste: Acceptable for the majority of people b) Odor: Acceptable

for the majority of people c) Color: The maximum allowable limit is 10 units –15 units d) Turbidity: The maximum allowable limits is 1 – 5 NTU

.4 Chemical Characteristics Where chlorine is used to disinfect the drinking water, the maximum allowable limit

for free chlorine supplied to the consumer is 0.2-1mg/l after 15 minutes from disinfection and 15 minutes before arriving to the consumer.

Parameters Related to Water Taste read as indicated in the following table. Note that the lower range level is obligatory for private wells.

Primary drinking water standards criteria

• Microorganisms - Giardia lamblia; Virus; Legionella;Turbidity

• Disinfection Byproducts- bromate, chlorite, trihomethanes; haloacetic acids

• Disinfectants- chloramines, chlorine and chlorine dioxides

• Inorganic Chemicals – Arsenic, barium, fluoride, copper, lead,

• Organic Chemicals – Benzine; Carbon tetrachloride; Dichloromethane

• Radionuclides – Uranium; Alpha particles; Beta particles and photon emitters

Secondary - Drinking water standards

Contaminant Secondary Standard

Aluminum 0.05 to 0.2 mg/L

Chloride 250 mg/L

Color 15 (color units)

Copper 1.0 mg/L

Corrosivity noncorrosive

Fluoride 2.0 mg/L

Foaming Agents 0.5 mg/L

Iron 0.3 mg/L

Manganese 0.05 mg/L

Odor 3 threshold odor number

pH 6.5-8.5

Silver 0.10 mg/L

Sulfate 250 mg/L

Total Dissolved Solids 500 mg/L

Zinc 5 mg/L

Community actions to improve WQ

Source of pollution What the communities can do

Agricultural: from

both agriculture

practices and

livestock rearing.

o Managing pastures to maintain vegetative cover and

stable soils

o Employing conservation farming technique

o Minimizing stock access to streams and damage to

stream banks

Storm water:

Generated by

rainfall storms

o Actively controlling erosion problems Constructing

farm dams to encourage water plant growth so that

they act as filters for run-off

Sewer o Maintaining and operating on-site household

wastewater systems (septic tanks and aerated

wastewater treatment units) to prevent nutrients

getting into streams or groundwater

Industrial o regulating industrial activities, as well as controlling

diffuse sources, to prevent water pollution

o Protecting local wetlands for their role in filtering

sediment and nutrients and providing a diversity of

wildlife habitat

o Reusing effluent where possible

Methods for purification

• Simplest is boiling

• Filtration

• Chlorination

• Ozone

• UV treatment

• Water guard (Sodium hypo chlorite)

• Distillation

Filters

• Sand filters for large communities

• Gravity filters for small communities

• Domestic household filters

• Filter cartridges ( for many types of ions)

• Activated carbon or charcoal filters

• Fluoride filters – CDN as a leader

• Reverse osmosis – More advanced

The working principles of some specific filters

1. Ozone filters – Through oxidation process, all organic, inorganic and biological substances are destroyed

2. Steam distillation – Natural methods which is able to remove Biological Entities, Heavy Metals, Organic Chemicals, Inorganic Chemicals & Radioactive Material

3. Carbon filters (Charcoal) – A good media for a wide range of contaminant like chlorine, pesticides, herbicides and inorganic materials

4. Far Infrared Light (FIR) - Very suitable for toxin removal

5. Ultraviolet Light – Very cheap to use – Deactivates the DNA of bacteria, virus and other pathogens

6. The ceramic water filters – Very cheap and affordable- removes dirt, microbes, virus and bacteria

7. CDN Fluoride filters- Single and combined

“These two filters are cheap and wananchi friendly”

Sand filters

UV filters

Ceramic water filters

CDN Single and combined Fluoride filters

Water pollution and Water related diseases

Pollutants Found in Runoff Sediment

Soil particles transported from their source

Biochemical Oxygen Demand (BOD) ● Oxygen depleting material Leaves Organic material

Toxics ● Pesticides Herbicides Fungicides Insecticides

● Metals (naturally occurring in soil, automotive emissions/ tires) Lead Zinc Mercury

● Petroleum Hydrocarbons (automotive exhaust and fuel/oil)

Debris Litter and illegal dumping

Nutrients ● Various types of materials that become dissolved and suspended in water (commonly found in fertilizer and plant material): Nitrogen (N)

Phosphorus (P)

Bacteria/ Pathogens

Originating from:

● Pets

● Waterfowl

● Failing septic systems

Thermal Stress Heated runoff, removal of streamside vegetation

Major Water Pollutants and Their Sources

Common Diseases Transmitted to Humans through Contaminated Drinking Water

What Can You Do? Water Pollution, Ways to Help Reduce Water Pollution

Diseases Related to Water

Water-borne

Diseases

Water-washed Diseases

Water-based Diseases

Water-related Diseases

Water-borne Diseases

Diseases caused by ingestion of water contaminated by human or animal excrement, which contain pathogenic microorganisms

Include cholera, typhoid, amoebic and bacillary dysentery and other diarrheal diseases

In addition, water-borne disease can be caused by the pollution of water with chemicals that have an adverse

effect on health

• Arsenic

• Flouride

• Nitrates from fertilizers

• Carcinogenic pesticides (DDT)

• Lead (from pipes)

• Heavy Metals

Water-washed Diseases

Diseases caused by poor personal hygiene and skin and eye contact with

contaminated water

These include scabies, trachoma, typhus, and other flea, lice and tick-borne diseases.

Water-based Diseases

Diseases caused by parasites found in intermediate organisms living in

contaminated water

Includes Schistosomiasis

and Dracunculiasis

Water-related Diseases

Water-related diseases are caused by insect vectors, especially mosquitoes, that breed

or feed near contaminated water.

They are not typically associated with lack of access to clean drinking water or sanitation services

Include dengue, filariasis, malaria, onchocerciasis, trypanosomiasis and

yellow fever

Other Water-borne diseases

• Bathing

• Swimming

• Other recreational activities that have water contact

• Agriculture

• Aquaculture

The Problem • ~80% of infectious diseases

• > 5 million people die each year

• > 2 million die from water-related diarrhea alone

• Most of those dying are small children

Other Consequences

• Lost work days

• Missed educational opportunities

• Official and unofficial healthcare costs

• Draining of family resources

Food Safety and health

Food security and safety

• Food security: availability of the right quality and quantity of food to supply the recommended daily nutrients to maintain good health and prevent malnutrition.

• Food safety: reflection of food sanitation and is related to safeguarding from the immediate or late health hazards resulting from biological, chemical , or physical contamination of food ( production, transport, distribution, processing, and subsequent use are properly handled )

What is Food Safety?

Food Safety is making a food safe to eat and free of disease causing agents such as:

• Too many infectious agents

• Toxic chemicals

• Foreign objects

What is Food Quality?

Food Quality is making a food desirable to eat with regards to good taste, color, and texture; bad food quality can be judged by:

• Bad color

• Wrong texture

• Smells bad

• Temperature

• Adulteration, contamination of food is major cause of ill health.

• The GIT is the usually portal of entry for many infectious and parasitic organisms.

• Food stuff readily become contaminated through human, insects and other intermediaries.

• Control of the cleanliness and composition of food is clearly important but it is more complex and difficult than ensuring a safe water supply

Food preservation:

Dehydration ( Drying ) Osmotic inhibition Heating to kill micro organisms Oxidation (eg. Use of sulphur dioxide ) Toxic inhibition (eg. smoking ). Low temperature inactivation (freezing ) Vacuum -packing

What are the Types of Food Hazards?

• Biological: bacteria, viruses, parasites

• Chemical: heavy metals, natural toxins, sanitizers, pesticides, antibiotics

• Physical: bone, rocks, metal

Biological Hazards in Food

Biological = Living Organisms

In Meat and Poultry:

• Salmonella bacteria (poultry and eggs)

• Trichinella spiralis parasite (pork)

On Fruits and Vegetables:

• E. coli bacteria (apple juice)

• Cyclospora parasite (raspberries)

• Hepatitis A virus (strawberries)

Chemical Hazards in Food

Chemical hazard: a toxic substance that is produced naturally added intentionally or un-intentionally

• Naturally-occurring:

– Natural toxins (aflatoxins, marine toxins)

• Added intentionally:

– Antibiotics, preservatives

• Added non-intentionally:

– Cleaning agents, Pesticide Residues

Physical Hazards in Food

Physical hazard: a hard foreign object that can cause illness or injury

• Inherent to the food or ingredient

– Bone fragment, feathers

• Contaminant during processing

– Stones, rocks, dirt, fingernails

Food borne Diseases

What are the foodborne illness risk factors

Food from unsafe source

Inadequate cooking

Improper holding temperature

Contaminated equipment

Poor personal hygiene

Microbiological pathogens

Food poisoning

Infective food poisoning Toxic food poisoning

Some bacteria produce toxins ,these toxins cannot be removed or inactivated by cooking. Examples Staphylococcus aureus, Clostridium perfringens

Occurs as a result of eating food contaminated with bacteria itself Examples; Salmonella, Listeria and Escherichia coli.

What is a Foodborne Illness?

Foodborne illnesses are caused by agents that enter the body through the ingestion of food.

• Every person is at risk of foodborne illness.

• May be serious for very young, very old, people with long term illness

• Reaction may occur in a few hours or up to several days after exposure

Symptoms

• Abdominal cramps, headache, vomiting, diarrhea (may be bloody), fever, death

What is the Impact of Foodborne Illness?

• The global incidence of foodborne disease is difficult to estimate • Up to 30% of the population annually

• Diarrhoeal disease is the second leading cause of death in children under five years old. It is both preventable and treatable.

• Each year diarrhoea kills around 525 000 children under five. • A significant proportion of diarrhoeal disease can be prevented

through safe drinking-water and adequate sanitation and hygiene.

• Globally, there are nearly 1.7 billion cases of childhood diarrhoeal disease every year.

• Diarrhoea is a leading cause of malnutrition in children under five years old – Food & Water Contamination – Malnutrition & Death in Infants & Children

Hazard Analysis Critical Control Point

Hazard

Analysis

and Critical

Control

Point (HACCP)

The HACCP It is the system that is required for any food

business or organisation in most countries.

The joint FAO / WHO Codex Alimentarius Commission recommends the HACCP approach to enhance Food Safety in all process of food production.

The goal of HACCP is to prevent and/or minimize risks associated with biological, chemical, and physical hazards to acceptable levels

What are the Steps involved in HACCP?

1. Identify hazards

2. Determine Critical Control Points (CCPs)

3. Determine safety limits for CCPs

4. Monitor CCPs

5. Corrective action

6. Record data

7. Verify that the system is working

Waste and

Health

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Waste Definition : Waste material are unwanted substance because the good part of them has been use or removed WASTE is the by- product

of human activities.

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TYPES OF WASTES

1. Human body wastes: urine and

feces

2. Excess materials and foods: trash

and garbage

3. Vegetation wastes: grass clippings

and tree branches

4. Construction and manufacturing

wastes (including excess heat and

noise).

5. Transportation wastes: carbon monoxide, nitrous oxides, hydrocarbons,

other gaseous pollutants and used motor oil

6. Energy production wastes: mining

wastes, electrical power (combustion

of coal), nuclear power (radioactive) wastes

and weapons production (radioactive) wastes

Types of waste

• Non Hazardous waste: refuse, garbage, sludge, municipal trash.

• Hazardous waste: solvents acid, heavy metals, pesticides, and chemical sludge

• Radioactive: high and low-level radioactive waste

• Mixed waste: Radioactive organic liquids, radio active heavy metals. ” ( Moeller, 2005).

Forms of waste

• Solid= refuse

• Liquid= sewage

• Gaseous

• Radioactive

• Hazardous

• Nonhazardous

Characteristics of wastes

• Corrosive: these are wastes that include acids or bases that are capable of corroding mental containers, e.g. tanks

• Ignitability: this is waste that can create fires under certain condition, e.g. waste oils and solvents

• Reactive: these are unstable in nature, they cause explosions, toxic fumes when heated.

• Toxicity: waste which are harmful or fatal when ingested or absorb.

Waste components

Jordan

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Other Definitions The following definitions are intended to serve as a guide and are not meant to be

arbitrary or precise in scientific sense 1. Food waste( garbage): - Food waste are the animal, fruit or vegetable

residues resulting from handling, preparation, cooking and eating of food.

Often ,decomposition lead to development of offensive odors. 2. Rubbish: - it consist of combustible and non combustible solid waste of

residential and commercial activities, excluding food waste. 3. Ashes and residues: - Materials remaining from the burning of wood, coal, coke

and other combustible waste.

4. Demolition and construction waste: - Demolition waste are waste from razed building and other structures.

5. Special Waste Are street sweepings, litter from municipal containers, dead animals and abandoned vehicles.

• 6.Treatment plant waste: Include solid and semisolid from water, waste water and waste treatment plant or facilities.

7. Agriculture Waste:- Results from diverse agricultural activities such as planting and harvesting of field crops, tree, the production of milk, production of animals for slaughter, animal excreta.

8. Hazardous waste: These are chemical, biological, flammable, explosive or radioactive waste which pose a substantial danger (immediately or over time) to human, animal or plant life . Usually occurs as liquid, but some times as gases or solid.

9. Green house effect: fluochlorocorbens destroy ozone layer which protect the earth from ultraviolet rays.

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Relation of waste with environment

The relationship between environment and improper storage, collection and disposal of waste is quite clear.

Public health authorities have shown that rats, flies, and other disease vector bread in open dumps and as well as in poorly constructed or poorly maintained housings, in food storage facilities.

The US Public health services (USPHs) has publish the result of a study tracing the relation 22 human diseases to improper solid waste management.

Data are also available to show that the illness/accident rate in sanitation workers is several time higher than industrial employees.

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-water such as impact, Ecological

also have been , and air pollutionattributed to improper management of

solid waste. -For example liquid from dumps and poorly engineered

landfills have contaminated surface and ground

water.

- In mining are the liquids leached from waste dumps

may contain toxic element or may contaminate

water supply with unwanted salts of calcium and

magnesium.

What is solid waste

• Solid waste is defined as any garbage, refuse, sludge from waste treatment plant, water supply treatment plant, or air pollution

control facility and other materials, including solid, liquid, semisolid, contained gaseous resulting from industrials, commercials, mining and agricultural operations from community activities ( Moeller, 2005).

Causal of increase in solid waste

• Population growth

• Increase in industrials manufacturing

• Urbanization

• Modernization

Modernization, technological advancement and increase in global population created rising in demand for food and other essentials.

This has resulted to rise in the amount of waste being generated daily by each household.

Impacts of solid waste on health

Chemical poisoning through chemical inhalation

Uncollected waste can

obstruct the storm water runoff resulting in flood

Low birth weight

Cancer

Congenital malformations

Neurological disease

Impacts of solid waste on health

• Nausea and vomiting

• Increase in hospitalization of diabetic residents living near hazard waste sites.

• Mercury toxicity from eating fish with high levels of mercury.

Impacts of solid waste on Environment.

• Waste breaks down in landfills to form methane, a potent greenhouse gas

• Change in climate and destruction of ozone layer due to waste biodegradable

• Littering, due to waste pollutions, illegal dumping, Leaching: is a process by which solid

waste enter soil and ground water and contaminating them.

• U.S. Environment Protection Agency (2009)

Disposal is the final disposition of solid wastes

in such a way as to prevent them from harming the environment or human health.

i. Sanitary landfills are sites or locations judged suitable for the in-ground disposal of solid wastes.

ii. Incineration is the burning or combustion of solid wastes.

iii. Recycling (resource recovery) is the collection and reprocessing of a solid waste "resource" so it can be reused.

iv. Source reduction is the reduction in, or elimination of use of materials that could become solid waste.

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Solid waste Disposal Methods

There is many methods of solid waste disposal the choice dependent upon cost and availability of land and labor

1. Dumping: - dumping in low lying area

2. Controlled tipping: - it differ from ordinary dumping that it is covered with earth at the end of the day.

3. Incineration: - Best for Hospital refuse by burning or where the place is not available.

4. Composting: - refuses and night soil or sludge together its end product is compost (samad) which contain nitrogen

5. Manure pits: - In villages where there is no system of waste collection a hole can be dig and waste in dump in it and everyday it is covered with earth when one is full other hole is dug.

6. Burial : - Suitable for small camps

II- HAZARDOUS WASTES

are those that are dangerous to human

health or to the environment.

Hazardous wastes are solid wastes that can: a. Cause or significantly contribute to an increase in

mortality or an increase in serious irreversible, or

incapacitating, reversible illness.

b. Pose a substantial present or potential hazard to

human health or the environment when improperly

treated, stored, transported, or disposed of, or

otherwise managed.

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Special or Hazardous waste Special waste include those from

hospitals, animal slaughter wastes and industrial waste.

These wastes are better to be described under title “hazardous waste”

Why they are considered hazardous? - Being non – degradable or persistent in nature - Can be biologically magnified. - Can be lethal - Many cause or tend to cause detrimental cumulative effects.

85

Methods must be developed for - Storage - Handling - Transport - Recycling and - Disposal of such wastes i.e. management of these waste are highly specialized and controlled.

86

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Classification of hazardous waste

Hazardous waste are considered in five categories

1. Radioactive

2. Chemical

3. Biological

4. Flammable

5. Explosive waste

(1) Radioactive substances Are those emitting ionizing radiation. Sub substance are hazardous because prolonged exposure to radiation often result in cancer or other genetic disorders. These radioactive substance may remain active for millions of years. Biological half life of U 232 =72 years U 236 = 23,420,000 years Radio active waste management is not responsibility of municipality.

88

Symptoms of radiation It can range from Headache, dizziness and vomiting, burning, hair fall to much more serious problems. Because it is genotoxic, it may also effect genetic material.

89

(2) Chemicals: - Most of chemical are highly toxic, genotoxic, corrosive, flammable, explosive. They can cause intoxication, burn or injuries. They can be classified into 4 groups. - Synthetic organic - Inorganic metals - Flammables - Explosive

90

(3) Biological The ability to infect other living organisms and ability to produce toxins are the most significant characteristics of a hazardous biological waste. Such as - needles - bandages - outdated drugs - malignant tissue during surgery - by products of industries biological conversion process

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(4) Flammables: - These may be in liquid; gaseous or solid forms. Typical example include organic solvent. Oil, plasticizers and organic sludge's. (5) Explosive:- As flammables and have potential hazards in storage and disposal.

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Hazardous waste management

a. Secured landfills are the least expensive method

of hazardous waste disposal when they are: i. Carefully designed and located ii. Monitored for leakage

b. Deep well injection is the pumping of liquid hazardous waste into wells below the aquifer.

c. Incineration of hazardous waste is the controlled combustion of hazardous waste.

d. Hazardous waste recycling is the process of reusing hazardous waste to produce a usable product, a process sometimes accomplished through "waste exchanges" in Europe.

e. Neutralization of hazardous waste is the

process of detoxifying the waste so it is less toxic,

corrosive, or otherwise hazardous.

f. Source reduction is the alteration of manufacturing

processes to reduce or eliminate the generation of

hazardous waste.

3.Hazardous waste cleanup

a. Since the disposal of hazardous waste was

unregulated before 1976, there exist many

hazardous waste sites around the United States.

b. The "Superfund" Law (CERCLA) was passed in

1980 and amended in 1986 to clean up such sites.

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Liquid waste (sewage) disposal

Definition: - “Sewage” is waste water from a community containing solid and liquid excreta derived from houses, street, yard washing and factories.

The term “sludge” is applied to waste water which does not contain human excreta. For example waste water from kitchen and bath rooms.

Composition of sewage

99 % of water Partly organic

1 % of solid

Partly inorganic

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Disease agent present in excreta Liquid waste contain several microorganism

particularly useful and harmful bacteria the organism may reach several millions per cubic

centimeter of liquid waste. Most of bacteria, worms and insect larvae as well

as algae considered useful organism that play on important role in treatment of liquid waste, particularly stabilizing the organic matter, which on anaerobic decomposition cause black coloration.

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A. Virus: - as those causing Poliomyelitis Epidemic viral hepatitis (A) and Viral gastroenteritis (rotavirus)

B. Bacteria:- i. As those causing: - Cholera Enteric fever Typhoid

Paratyphoid Bacillary dysentery, Malta fever, T.B food poisoning: - infective (salmonella F. P) - intoxication – Staphylococcal - Botulism - Cl. Welch

ii. Coliform Bacteria: - especially E.coli which is used as an indicator of water pollution with human waste, as it is present in the G.I. T. of healthy and diseased person

iii. Fungi and yeast: - e.g. C. albicans which cause monilial infection

iv. Parasites:- e.g. a. Cyst of amoebiasis

b. Ova of Ascaris, Ancylostoma, trichuris, hetrophytes, tapeworms, bilharzia. c. The parasite it self e.g. Traphazrites of trachomenas, Ascaris worms, parts of tape worm

Healthcare/ Hospital Waste

Health care waste 1. 80% can be dealt with normal domestic and urban waste management. 2. 15% pathological waste 3. 1% sharp waste 4. 3% Chemical and pharmaceutical waste 5. less than 1% special waste such as radioactive , cytotoxic, or pressurized container , broken thermometer and batteries Total waste per bed range from ½ to 4 kg

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• Hospital waste include all waste arising from healthcare establishments.

Responsibility for Waste Management

• Waste Management Team of the Hospital/ Clinic/ Lab. shall be responsible to ensure proper management of the waste generated in the Hospital/ Clinic/ Lab.

• Preparation and Monitoring of Plan

• • Periodic Review

• • Revision or updating

• • Implementation of WMP

• • Compliance

Waste Segregation • Waste Segregation z Different color coding has to

be assigned to various waste for effective segregation, as:

• i. Black : Non-Risk waste.

• ii. Red: Risk waste with Sharps.

• iii. Blue: Risk Waste without sharps.

• iv. Yellow: Radioactive waste

• v. Green: Chemicals like Mercury & Cadmium

All this segregation should be done by the individual user.

INFECTIOUS WASTE MANAGEMENT

PLANS

Components of an Infectious Waste Management Plan:

1. Designation of the waste that should be managed as infectious

2. Segregation of infectious waste from the noninfectious waste

3. Packaging

4. Storage

5. Treatment

6. Disposal

7. Contingency measures for emergency situations

8. Staff training

Color coding and type of container for disposal of biomedical waste

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Color coding Type of container Waste category

Treatment option

Yellow

Red

Blue/ white translucent

Black

Plastic bag Disinfected container/ plastic bags Plastic bags/puncture proof container Plastic bags

1, 2, 3, 6 3, 6, 7 4, 7 5, 9, 10

incinerator/ deep burial Autoclaving,/ microwaving/ chemical Autoclaving,/ microwaving/ chemical treatment and destruction and shredding

Disposal in secured land fill.

Best Practice Colour Coding

Colour

Description

Infectious Waste Minimum treatment / disposal required is incineration in a suitably licensed or permitted facility.

Infectious Waste Minimum treatment / disposal required is to be ‘rendered safe’ in a suitably licensed or permitted facility.

Cyto-toxic / Cyto-static Waste Minimum treatment / disposal required is incineration in a suitably licensed or permitted facility.

Offensive Waste* Minimum treatment / disposal required is landfill in a suitably licensed or permitted site. This waste should not be compacted in un-licensed/permitted facilities.

Domestic Waste Minimum treatment / disposal required is landfill in a suitably licensed or permitted site.

Sharps

Must be collected at the point of generation, in a leak-proof and puncture-resistant container

Containers must bear the international biohazard symbol and appropriate wording

Containers should never be completely filled, nor filled above the full line indicated on box.

Generator’s

Section

Transporter’s

Section

Treatment

Facility’s

Section

Main Principles of Solid Waste Management

• Reduce

• Reuse

• Re-cycle

We all can save the Earth

Image

: Fairfax

County So

lid W

aste M

anage

ment

Integrated Solid Waste Management:

•A set of plans to manage solid waste

•Adopted by many governments

•A means of achieving sustainability

Waste treatments

• Incineration:

• Solidification: solid waste are melted or evaporated to produce a sand like residue.

• Heat treatment: Heat applied at moderate temperature, is used in treating volatile solvents.

• Chemical treatment: is the application of chemical treatment in the treatment of corrosive solid.

Waste Disposal • Landfills: waste is placed into or onto the land

in disposal facilities.

• Underground injection wells: waste are injected under pressure into a steel and concrete-encased shafts placed deep in the earth.

• Waste piles: is accumulations of insoluble solid, non flowing hazard waste. Piles serves as temporary or final disposal.

Waste Disposal

• land treatment: is a process in which solid waste, such as sludge from wastes is applied onto or incorporated into the soil surface.

• Waste are disposed in flowing rivers in less developed countries.

Moeller, D. W. (2005). Environmental Health (3rd ed.). Cambridge, MA:Harvard University Press

Groups at risks due to solid waste

The groups at risk from the unscientific waste disposal include:

• Populations in areas where there is no proper waste treatment method.

• Children

• Waste workers

• Populations living close to waste dump

• Animals

SOURCES OF HUMAN EXPOSURES Exposures occurs through

• Ingestion of contaminated water or food

• Contact with disease vectors

• Inhalation

• Dermal

PREVENTIVE MEASURES

• Proper management of solid waste

• Involving public in plans for waste treatment and disposal

• Provide the public accurate, useful information about the whole projects, including the risks and maintain formal communication with public

• Educate people on different ways of handling waste.

PREVENTIVE MEASURES

Waste Minimization is a process of reducing waste produce by individuals, communities and companies, which reduces the impact of chemical wastes on the environment to the greatest extent.

Household level of proper segregation of waste, recycling and reuse.

Process and product substitution e.g. use paper bag instead of plastic bags.

Moeller,2005