Name : Roll No: Subject:

Dr. Nawal Kishore Prasad 112205 PUBLIC HEALTH CARE

PUBLIC HEALTH CARE

Q.1) Discuss the basic concepts of Health. What are public Health Concepts of Disease control? How the different levels of Prevention, promote the Health of the Community?

Ans: Concept of Health There are a number of things you want to do, but there are times when you find that you are not well enough to do all that you want to do. Even on a regular morning, when every member of the house is getting ready, there is so much to do - someone wants breakfast, your sister wants her shirt to be ironed, your little brother realizes that his shoes are not polished. Your mother is trying to cope up with everything. You want to share some responsibilities with your mother, but you do not have enough energy to do so, because your body is so weak that it can not take extra stress. This shows that your body can function effectively only when it is healthy. Definition of health You may say health is the absence of disease. According to the World Health Organization, Health is a state of complete physical, mental and social well being and not merely the absence of disease. Can you now list the signs of good health? Also, can you tell why this listing is necessary? Yes, you are right. If you know the signs of good health, you can recognize a healthy person, or know if you yourself are in a state of health. Signs of Good Health To look for signs of good health, we must examine all the three aspects-physical, mental and social. A. Physical health A person who enjoys good physical health is one who 2

is energetic has good posture weighs normal for age and height has all body organs functioning normally has a clear and clean skin has bright eyes has good textured and shining hair has a clean breath has a good appetite gets sound sleep Physical health is easy to detect and describe. A person is physically healthy if he or she looks alert and responsive. B. Social heath A person with good social health gets along well with people around has pleasant manners helps others fulfills responsibility towards others A person is socially healthy if he or she can move in the society confidently with others. C. Mental health Mental health implies control on emotions sensitive to the needs of others confidence in one s own abilities freedom from unnecessary tensions, anxieties and worries A person is mentally healthy if he or she is relaxed and free from any worries.

Public Health Concepts of Disease control (1) Personal hygiene (2) Exercise.
3

(3) Rest and sleep (4) Posture (5) Clean home environment (6) Our eating habits (7) Climate and clothing (8) Safety measures at play and work (9) Influence of smoking, alcohol and drugs

Personal Hygiene Personal hygiene means keeping oneself clean. There are some activities you perform everyday in order to keep yourself clean. Can you list these? Yes, some of these are going to the toilet, cleaning your teeth, having a bath, cleaning your eyes, washing your hands before and after eating, wearing clean clothes, combing your hair, etc. Rest and Sleep Although regular exercise is essential for the upkeep of health, regular rest and sleep are equally necessary. This is for the tired muscles to relax. Do you remember what happens after you wash a lot of clothes in a day? Your arms start aching and you feel very tired. At that moment, you feel you cannot do any more work. But after sitting for some time, you feel fit and start doing something else. Posture Have you noticed that some people walk and sit with their back straight and some others walk with their backs bent? Which do you think looks better? The straight back or the curved back? Yes, the straight back looks much better and is also the correct way to walk and sit. The manner in which one sits or walks is known as posture. Clean Home Environment A clean and healthy environment around you does a lot in keeping you in good health. You have already learnt how to keep your environment clean in lesson 10. It would be helpful to go back and read that lesson once again. Our Eating Habits
4

The food we eat can affect our health in many ways. So it is very important to know which foods to choose and why. All of you know food is very important for us. Food is required:(a) provide energy in our body (b) build muscles and bones (c) protect the body from diseases Climate and Clothing You have already studied about clothes and the need for clothes in lesson 8. If you like, you can go back and read it once again. You know that clothes are made of various fabrics which are suitable for different types of climate. Safety Measures at Play and Work You know that safety has a direct influence on your health. If the environment around you is not safe, your health will immediately suffer. If floors are slippery or stairs uneven, or the roof top has an unprotected edge, there may be accidents. You will study more about safety measures to be taken at home and the consequences of not observing safety measures in lesson 29 in this course. We can say that in order to maintain a healthy life, one must take precautions every where - at home, in the play ground, on the roads, at work, etc. Influence of Smoking, Alcohol and Drugs SMOKING Smoking is a habit. It does the most harm to your body, whether it comes from pipes, cigars or cigarettes. It is due to the harmful carbon monoxide and nicotine. They damage many different parts of the body. When people first smoke (breathe the smoke into their lungs), their eyes start watering and they may cough. It is very important to break this habit. Continuous smoking become a cause for cancer of the lungs and mouth. It also makes a person prone to heart diseases and heart attack. ALCOHOL Like smoking, drinking alcohol becomes a habit. Although young people start
5

drinking under peer pressure, they soon become addicted to it. Alcohol slows down working of the brain. As a result, the person becomes disoriented or confused. Excessive consumption of alcohol can delay responses. This is why people under the influence of alcohol are not permitted to drive. Alcohol consumption leads to hardening of arteries and may result in heart attacks. Thus, drinking is a habit everyone must avoid at all costs. DRUGS Drugs are the medicines used to cure illness, reduce pain and prevent the spread of disease. Drugs have been used for thousands of years. There are many sources from which they are obtained basically, they come from chemicals in the roots, leaves, seeds and juices of plants. Drugs are beneficial to us when taken in the prescribed dosage only. When overdoses of certain drugs like cocaine, morphine, are taken, the person becomes addicted to them. Over a period of time, this may prove fatal and the person may die.

Levels of Prevention 1. Primary -concerned with health promotion activities that prevent the actual occurence of a specific illness or disease 2. Secondary -promotes early detection or screening and treatment of disease and limitation of disability. This level of prevention is also called HEALTH MAINTENANCE. 3. Tertiary -directed towards recovery or rehabilitation of a disease or condition after the disease has been developed

Primary prevention is the most cost effective form of health care. Its target is the community as a whole. Second, we have the secondary prevention, in which the activity is focus in treating the disease, promoting early detection and screening. It also called as the health maintenance phase. The U.S. Preventative Services Task Forces Guide to Clinical Preventive Services (2d edition, 1996), they describe
6

secondary prevention as those persons who have already develop risk factors, it identifies and treat asymptomatic patient or those who have preclinical disease but the condition is not clinically apparent. Focusing on early case finding, screening is one of the examples of secondary prevention, other examples are breast self exam, newborn screening and genetic counseling. Its target is that population who are at risk. Secondary prevention reduce the severity of diseases, decrease the duration of illness, through early diagnosis thus it may give a prompt intervention. Through case finding, it also have an impact in minimizing the sufferings of the people, thus maximize well being. Lastly, the tertiary prevention that deals in rehabilitating phase, leading towards recovery. It refers to prevention initiatives, as with this level of prevention, it made to restore to highest function, to have an optimal reconstitution, thus have a support adaptation to risk.

For me, it would be cost effective to be addressed the health concern on the three levels of prevention because with this, we might bale to assess one s needs and problem, and by that we could also determine other factors that contribute to the problem. In any setting, this levels of prevention is always present, it cannot be avoided or just neglected by the health care providers, because this three preventions is important tool for them to help the individual, family and community and as well as for their own purpose, so that they may easily recognize and could implement a help to the client. This three prevention is very important. This three levels of prevention is very cost effective , first the primary prevention, it is cost effective because your preventing any disease or illness that might occur or develop, could one afford not to have this , if ever he/she neglect this like having immunization he will take the risk, and he could have develop a lot of diseases to manifest, thus leading to problem that way may secondary prevention be implemented or applied. So as caring for your own health, why take this level of prevention, if you re really care for your health then an individual must do and have this. Although the secondary and tertiary is difficult to achieve its success but it is more costly.

Q.2) What do you understand by the term Epidemiology? How the study of Epidemiology helps us to know the Health status of the Community? Discuss the importance of surveillance in the Community Health. Ans:

An apocryphal story is told around CDC that illustrates the confusion sometimes accompanying the term "epidemiology." It seems that one of our scientists, on first arriving at CDC from a clinical practice, found himself somewhat unsure of what epidemiology was all about, so he sought an answer down the street at Emory University. The first person he asked was a medical student, who told him that epidemiology was "the worst taught course in medical school." The second, a clinical faculty member, told him epidemiology was "the science of making the obvious obscure." Finally, knowing that statistics are important to epidemiology, he asked a statistician, who told him that epidemiology is "the science of long division" and provided him with a summary equation. Giving up on finding a real answer, he returned to CDC. On the way, however, he decided to try one more time. He stopped a native Atlantan who told him that epidemiology was "the study of skin diseases." A less entertaining, but more conventional, definition of epidemiology is "the study of the distribution and determinants of health-related states in specified populations, and the application of this study to control health problems." A look at the key words will help illuminate the meaning:
y

Study Epidemiology is the basic science of public health. It's a highly quantitative discipline based on principles of statistics and research methodologies. Distribution Epidemiologists study the distribution of frequencies and patterns of health events within groups in a population. To do this, they use descriptive epidemiology, which characterizes health events in terms of time, place, and person. Determinants Epidemiologists also attempt to search for causes or factors that are associated with increased risk or probability of disease. This type of epidemiology, where we move from questions of "who," "what," "where,"
8

and "when" and start trying to answer "how" and "why," is referred to as analytical epidemiology.
y

Health-related states Although infectious diseases were clearly the focus of much of the early epidemiological work, this is no longer true. Epidemiology as it is practiced today is applied to the whole spectrum of health-related events, which includes chronic disease, environmental problems, behavioral problems, and injuries in addition to infectious disease. Populations One of the most important distinguishing characteristics of epidemiology is that it deals with groups of people rather than with individual patients. Control Finally, although epidemiology can be used simply as an analytical tool for studying diseases and their determinants, it serves a more active role. Epidemiological data steers public health decision making and aids in developing and evaluating interventions to control and prevent health problems. This is the primary function of applied, or field, epidemiology.

A comparison between the practice of public health and the more familiar practice of health care helps in describing epidemiology. First, where health care practitioners collect data on an individual patient by taking a medical history and conducting a physical exam, epidemiologists collect data about an entire population through surveillance systems or descriptive epidemiological studies. The health care practitioner uses his or her data to make a differential diagnosis. The epidemiologist's data is used to generate hypotheses about the relationships between exposure and disease. Both disciplines then test the hypotheses, the health care practitioner by conducting additional diagnostic studies or tests, the epidemiologist by conducting analytical studies such as cohort or case-control studies. The final step is to take action. The health care practitioner prescribes medical treatment, and the epidemiologist, some form of community intervention to end the health problem and prevent its recurrence. One succinct way to sum up the task of epidemiologists is to say that they "count things." Basically, epidemiologists count cases of disease or injury, define the affected population, and then compute rates of disease or injury in that population. Then they compare these rates with those found in other populations
9

and make inferences regarding the patterns of disease to determine whether a problem exists,. For example, in the hepatitis B example earlier, you might ask: Is the rate of disease among people with no know risk factors greater than we would expect? Is the pattern or distribution of the cases suspicious? Once a problem has been identified, the data are used to determine the cause of the health problem; the modes of transmission; any factors that are related to susceptibility, exposure, or risk; and any potential environmental determinants. Field epidemiology is, in the most general terms, the practice or application of epidemiology to control and prevent health problems. Epidemiologists are mobilized under a variety of circumstances, prime ones being when a problem is acute and unexpected and when quick action is required. The Legionnaires' disease outbreak in Philadelphia, mentioned at the beginning of this discussion, is an excellent example. These criteria are also met when a commercial product presents an imminent threat to public health and safety, as was the case with Ltryptophan and EMS. High levels of community concern often mandate a quick response. Involvement of the press is occasionally the driving force behind an investigation, and political pressure is also often part of the equation. Field investigations are action oriented, with the main goal being to solve a pressing public health problem. Uppermost in investigators minds is the need to institute the controls necessary to safeguard health as soon as possible, and often, as in the example of L-tryptophan and EMS, this step is taken before the entire investigation is complete. Limited control over the situation, little time for planning a study, and limited data sources and laboratory samples challenge investigators. However, the obligation remains to do the best science possible under the circumstances.

The surveillance and their importance in the Community Health:

Active surveillance: a system employing staff members to regularly contact heath care providers or the population to seek information about health conditions. Active surveillance provides the most accurate and timely information, but it is also expensive.

10

Passive surveillance: a system by which a health jurisdiction receives reports submitted from hospitals, clinics, public health units, or other sources. Passive surveillance is a relatively inexpensive strategy to cover large areas, and it provides critical information for monitoring a community's health. However, because passive surveillance depends on people in different institutions to provide data, data quality and timeliness are difficult to control. Routine health information system: a passive system in which regular reports about diseases and programs are completed by public health staff members, hospitals, and clinics. Health information and management system: a passive system by which routine reports about financial, logistic, and other processes involved in the administration of the public health and clinical systems can be used for surveillance. Categorical surveillance: an active or passive system that focuses on one or more diseases or behaviors of interest to an intervention program. These systems are useful for program managers. However, they may be inefficient at the district or local level, at which staff may need to fill out multiple forms on the same patient (that is, the HIV program, the tuberculosis program, the sexually transmitted infections program, and the Routine Health Information System). At higher levels, allocating the few competent surveillance experts to one program may leave other programs under-served, and reconciling the results of different systems to establish the nation's official estimates may be difficult. Integrated surveillance: a combination of active and passive systems using a single infrastructure that gathers information about multiple diseases or behaviors of interest to several intervention programs (for example, a health facility based system may gather information on multiple infectious diseases and injuries). Managers of disease-specific programs may be evaluated on the results of the integrated system and should be stakeholders. Even when an integrated system is functioning well, program managers may continue to maintain categorical systems to collect additional disease-specific data and control the quality of the information on which they are evaluated. This practice may lead to duplication and inefficiency.

11

Syndromic surveillance: an active or passive system that uses case definitions that are based entirely on clinical features without any clinical or laboratory diagnosis (for example, collecting the number of cases of diarrhea rather than cases of cholera, or "rash illness" rather than measles). Because syndromic surveillance is inexpensive and is faster than systems that require laboratory confirmation, it is often the first kind of surveillance begun in a developing country. However, because of the lack of specificity (for example, a "rash illness" could be anything from the relatively minor rubella to devastating hemorrhagic fevers), reports require more investigation from higher levels. Also an increase in one disease causing a syndrome may mask an epidemic of another (for example, rotavirus diarrhea decreases at the same time cholera increases). Behavioral risk factor surveillance system (BRFSS): an active system of repeated surveys that measure behaviors that are known to cause disease or injury (for example, tobacco or alcohol use, unprotected sex, or lack of physical exercise). Because the aim of many intervention program strategies is to prevent disease by preventing unhealthy behavior, these surveys provide a direct measure of their effect in the population, often long before the anticipated health effects are expected. These surveys are useful for providing timely measures of program effectiveness for both communicable and noncommunicable disease interventions.

Q.3 Providing pure drinking water to the population is a major concern of the Administration. Discuss various methods of water purification and problems in supplying pure drinking water.

Ans:

Of all the necessities of life, few are so fundamental as water. Yet on a thirsty planet with a fast-growing population, clean water is often in short supply. According to a World Health Organization study from 2005, some
12

1.1 billion people --- roughly a sixth of the human population --- lack access to safe clean drinking water. This problem stems from several root causes. Global Availability
o

About 97.5 percent of the water on the earth's surface is in the oceans, according to "Essential Environment" authors Jay Withgott and Scott Brennan. That leaves only 2.5 percent of fresh water. Of that 2.5 percent, 79 percent is frozen in ice caps and glaciers, and 20 percent is groundwater. A mere 1 percent is surface fresh water (e.g., rivers and lakes).

Climate Variation
o

Variations in climate mean that available fresh water is unevenly distributed across the earth's surface. For instance, Canada has roughly 20 times more fresh water per capita than China, while Iceland has 100 times more fresh water per capita than Somalia or Pakistan. These disparities mean that some of the world's most populous nations lack water, while others have more than they need. Furthermore, local droughts can exacerbate shortages in regions already cursed with a limited supply of fresh water. In wealthier areas like California, a drought may entail water rationing, and damage local economies by increasing the cost of doing business. In poorer nations like Ethiopia, however, drought can wreak havoc with crop yields and cause famine, illness and death.

Wealth Disparities
o

Poor nations usually cannot afford expensive options like desalination, which may be available to wealthy first-world nations. Also, environmental regulations in poorer countries are often lax or loosely enforced, because governments lack the resources to impose and enforce stronger regulations. According to a 2007 article in Smithsonian magazine, for example, the amount of domestic sewage released into India's Ganges River has doubled since the 1990s, and the regulatory status of industrial polluters has changed little over the past two decades. Water polluted with sewage and industrial chemicals is unfit to drink unless municipalities treat it to remove
13

contaminants; however, water-treatment facilities may be inadequate in many poorer countries, or absent altogether. Unsustainable Extraction
o

Humans are depleting freshwater resources at an unsustainable rate. As populations in dry and arid regions increase, the demand for water increases while the supply remains constant. For example, the demand for Colorado River water is so great that only a trickle of the water currently reaches the sea. Regardless, demand for Colorado River water is increasing. Similarly, the Aral Sea has lost about four-fifths of its volume in 40 years, largely due to the increasing demands of agriculture. Alternatives like seawater desalination and indirect potable reuse are expensive, and may be politically unpopular.

Water Purification Technologies :

y y y y y y y y

Distillation Ion Exchange Carbon Adsorption Filtration Ultrafiltration Reverse Osmosis Ultraviolet (UV) Radiation Pulling It All Together

14

Distillation Distillation is probably the oldest method of water purification. Water is first heated to boiling. Then the water vapor rises to a condenser where cooling water lowers the temperature so the vapor is condensed, collected and stored. Most contaminants stay behind in the liquid phase vessel. However there can sometimes be what is called carry-overs found in the distilled water. Organics such as herbicides and pesticides, with boiling points lower than 100C, cannot be removed efficiently and can actually become concentrated in the product water. Another disadvantage of distillation is cost. Distillation requires large amounts of energy and water and is very slow to produce clean water. Distilled water can also be very acidic (low pH), thus it should be contained in glass. Since there is not much left after distillation, distilled water is often called "hungry" water. It lacks oxygen and minerals and has a flat taste, which is why it is mostly used in industrial processes.

15

Table 1. Distillation Advantages Removes a broad range of contaminants Reusable Disadvantages

y y

y y

Some contaminants can be carried into the condensate Requires careful maintenance to ensure purity Consumes large amounts of energy System usually takes a large space on counter

Ion Exchange The ion exchange process percolates water through bead-like spherical resin materials (ion-exchange resins). Ions in the water are exchanged for other ions fixed to the beads. The two most common ion-exchange methods are softening and deionization. Softening is used primarily as a pretreatment method to reduce water hardness prior to reverse osmosis (RO) processing. The softeners contain beads that exchange two sodium ions for every calcium or magnesium ion removed from the "softened" water.

16

Deionization (DI) beads exchange either hydrogen ions for cations or hydroxyl ions for anions. The cation exchange resins, made of styrene and divinylbenzene containing sulfonic acid groups, will exchange a hydrogen ion for any cations they encounter (e.g., Na+, Ca++, Al+++). Similarly, the anion exchange resins, made of styrene and containing quaternary ammonium groups, will exchange a hydroxyl ion for any anions (e.g., Cl-). The hydrogen ion from the cation exchanger unites with the hydroxyl ion of the anion exchanger to form pure water. These resins may be packaged in separate bed exchangers with separate units for the cation and anion exchange beds. Or, they may be packed in mixed bed exchangers containing a mixture of both types of resins. In either case, the resin must be "regenerated" once it has exchanged all its hydrogen and/or hydroxyl ions for charged contaminants in the water. This regeneration reverses the purification process, replacing the contaminants bound to the DI resins with hydrogen and hydroxyl ions. Deionization can be an important component of a total water purification system when used in combination with other methods discussed in this primer such as RO filtration and carbon adsorption. DI systems effectively remove ions, but they do not effectively remove most organics or microorganisms. Microorganisms can attach to the resins, providing a culture media for rapid bacterial growth and subsequent pyrogen generation. The advantages and disadvantages of this technology are summarized below. Table 2. Deionization
17

Advantages
y

Disadvantages
y

y y

Removes dissolved inorganics effectively. Regenerable (service deionization). Relatively inexpensive initial capital investment

Does not effectively remove particles, pyr or bacteria. DI beds can generate resin particles and cu bacteria. High operating costs over long-term.

Carbon Adsorption Carbon absorption is a widely used method of home water filter treatment because of its ability to improve water by removing disagreeable tastes and odors, including objectionable chlorine. Activated carbon effectively removes many chemicals and gases, and in some cases it can be effective against microorganisms. However, generally it will not affect total dissolved solids, hardness, or heavy metals. Only a few carbon filter systems have been certified for the removal of lead, asbestos, cysts, and coliform. There are two types of carbon filter systems, each with advantages and disadvantages: granular activated carbon, and solid block carbon. These two methods can also work along with a reverse osmosis system, which can be read about below. Activated carbon is created from a variety of carbon-based materials in a hightemperature process that creates a matrix of millions of microscopic pores and crevices. One pound of activated carbon provides anywhere from 60 to 150 acres of surface area. The pores trap microscopic particles and large organic molecules, while the activated surface areas cling to, or adsorb, small organic molecules. The ability of an activated carbon filter to remove certain microorganisms and certain organic chemicals, especially pesticides, THMs (the chlorine by-product), trichloroethylene (TCE), and PCBs, depends upon several factors, such as the type of carbon and the amount used, the design of the filter and the rate of water flow, how long the filter has been in use, and the types of impurities the filter has previously removed.

18

The carbon adsorption process is controlled by the diameter of the pores in the carbon filter and by the diffusion rate of organic molecules through the pores. The rate of adsorption is a function of the molecular weight and the molecular size of the organics. Certain granular carbons effectively remove chloramines. Carbon also removes free chlorine and protects other purification media in the system that may be sensitive to an oxidant such as chlorine. Carbon is usually used in combination with other treatment processes. The placement of carbon in relation to other components is an important consideration in the design of a water purification system. Table 3. Carbon Adsorption Advantages
y

Disadvantages
y

Removes dissolved organics and chlorine effectively. Long life (high capacity).

Can generate carbon fines.

Microporous Basic Filtration There are three types of microporous filtration: depth, screen and surface. Depth filters are matted fibers or materials compressed to form a matrix that retains particles by random adsorption or entrapment. Screen filters are inherently
19

uniform structures which, like a sieve, retain all particles larger than the precisely controlled pore size on their surface. Surface filters are made from multiple layers of media. When fluid passes through the filter, particles larger than the spaces within the filter matrix are retained, accumulating primarily on the surface of the filter.

The distinction between filters is important because the three serve very different functions. Depth filters are usually used as prefilters because they are an economical way to remove 98% of suspended solids and protect elements downstream from fouling or clogging.

Ultrafilters are available in several selective ranges. In all cases, the membranes will retain most, but not necessarily all, molecules above their rated size Table 5. Ultrafiltration Advantages
y

Disadvantages
y

y y

Effectively removes most particles, pyrogens, microorganisms, and colloids above their rated size. Produces highest quality water for least amount of energy. Regenerable.

Will not remove dissolved inorganics.

Reverse Osmosis Reverse osmosis (RO) is the most economical method of removing 90% to 99% of all contaminants. The pore structure of RO membranes is much tighter than UF membranes. RO membranes are capable of rejecting practically all particles, bacteria and organics >300 daltons molecular weight (including pyrogens). In fact,
20

reverse osmosis technology is used by most leading water bottling plants. Natural osmosis occurs when solutions with two different concentrations are separated by a semi-permeable membrane. Osmotic pressure drives water through the membrane; the water dilutes the more concentrated solution; and the end result is an equilibrium. In water purification systems, hydraulic pressure is applied to the concentrated solution to counteract the osmotic pressure. Pure water is driven from the concentrated solution and collected downstream of the membrane. Because RO membranes are very restrictive, they yield slow flow rates. Storage tanks are required to produce an adequate volume in a reasonable amount of time.

RO also involves an ionic exclusion process. Only solvent is allowed to pass through the semi-permeable RO membrane, while virtually all ions and dissolved molecules are retained (including salts and sugars). The semi-permeable membrane rejects salts (ions) by a charge phenomena action: the greater the charge, the greater the rejection. Therefore, the membrane rejects nearly all (>99%) strongly ionized polyvalent ions but only 95% of the weakly ionized monovalent ions like sodium. Reverse osmosis is highly effective in removing several impurities from water such as total dissolved solids (TDS), turbidity, asbestos, lead and other toxic heavy metals, radium, and many dissolved organics. The process will also remove chlorinated pesticides and most heavier-weight VOCs. Reverse osmosis and activated carbon filtration are complementary processes. Combining them results

21

in the most effective treatment against the broadest range of water impurities and contaminants. RO is the most economical and efficient method for purifying tap water if the system is properly designed for the feed water conditions and the intended use of the product water. RO is also the optimum pretreatment for reagent-grade water polishing systems. In addition, Reverse osmosis treatment is an insurance policy against nuclear radiation such as radioactive plutonium or strontium in the drinking water. If one lives near a nuclear power plant, this is a key way to ensure the household is drinking the best water for their health. Table 6. Reverse Osmosis Advantages
y

Disadvantages
y

Effectively removes all types of contaminants to some extent (particles, pyrogens, microorganisms, colloids and dissolved inorganics) Requires minimal maintenance.

Flow rates are usually limited to a certain gallons/day rating.

Ultraviolet (UV) Radiation Ultraviolet radiation has widely been used as a germicidal treatment for water. Mercury low pressure lamps generating 254 nm UV light are an effective means of sanitizing water. The adsorption of UV light by the DNA and proteins in the microbial cell results in the inactivation of the microorganism. Recent advances in UV lamp technology have resulted in the production of special lamps which generate both 185 nm and 254 nm UV light. This combination of wavelengths is necessary for the photooxidation of organic compounds. With these special lamps, Total Organic Carbon (TOC) levels in high purity water can be reduced to 5 ppb.

22

Table 7. Ultraviolet Radiation Advantages

y y

Disadvantages
y y

Effective sanitizing treatment Oxidation of organic compounds (185 nm and 254 nm) to < 5 ppb TOC

Decreases resistivity. Will not remove particles, co or ions

Pulling It All Together

23

Water Purification Systems Because each purification technology removes a specific type of contaminant, none can be relied upon to remove all contaminants to the levels required for critical applications. A well-designed water purification system uses a combination of purification technologies to achieve final water quality. Each of the purification technologies must be used in an appropriate sequence to optimize their particular removal capabilities. The schematic below shows a central laboratory water purification system designed to produce water for critical applications. The first step is pretreatment equipment specifically designed to remove contaminants in the feed water. Pretreatment removes contaminants that may affect purification equipment located downstream, especially reverse osmosis
24

(RO) systems. Examples of pretreatment are: carbon filters (or tanks) for chlorine removal, particulate filters for sediment/silt/particulate removal, and softening agents to remove minerals that cause "hard" water. The next purification step is Reverse Osmosis (RO). RO removes 90 to 99% of all the contaminants found in water. It is the heart of any well designed water purification system because it effectively removes a broad range of contaminants. However, the tight porosity of the RO membrane limits its flow rate. Therefore, a storage container is used to collect water from the system and distribute it to other points-of-use such as polishing systems. Polishing systems purify pretreated water, such as RO water, by removing trace levels of any residual contaminants. Polishing elevates the quality of pretreated water to "Type I" or "ultrapure" water. A polishing system is designed to remove residual traces of impurities from water already pretreated by some other means (such as reverse osmosis or deionization). Treating raw tap water using such a system would quickly exhaust its capacity and affect final quality. A typical polishing system may consist of activated carbon, mixed-bed deionization, organic scavenging mixtures and 0.22 m final filtration. Systems can also be enhanced with ultrafiltration, ultraviolet oxidation or other features for use in specific applications. This combination of purification technologies, combined with proper pretreatment, will produce water that is virtually free of ionic, organic and microbial contamination.

Q.5 Enumerate the concept of Bio-medical Waste. Ans:

25

Medical care is vital for our life, health and well being. But the waste generated from medical activities can be hazardous, toxic and even lethal because of their high potential for diseases transmission. The hazardous and toxic parts of waste from health care establishments comprising infectious, bio-medical and radio-active material as well as sharps (hypodermic needles, knives, scalpels etc.) constitute a grave risk, if these are not properly treated/disposed or is allowed to get mixed with other municipal waste. Its propensity to encourage growth of various pathogen and vectors and its ability to contaminate other nonhazardous/ non-toxic municipal waste jeopardises the efforts undertaken for overall municipal waste management. The rag pickers and waste workers are often worst affected, because unknowingly or unwittingly, they rummage through all kinds of poisonous material while trying to salvage items which they can sell for reuse. At the same time, this kind of illegal and unethical reuse can be extremely dangerous and even fatal. Diseases like cholera, plague, tuberculosis, hepatitis (especially HBV), AIDS (HIV), diphtheria etc. in either epidemic or even endemic form, pose grave public health risks. Unfortunately, in the absence of reliable and extensive data, it is difficult to quantify the dimension of the problem or even the extent and variety of the risk involved. With a judicious planning and management, however, the risk can be considerably reduced. Studies have shown that about three fourth of the total waste generated in health care establishments is non-hazardous and non-toxic. Some estimates put the infectious waste at 15% and other hazardous waste at 5%. Therefore with a rigorous regime of segregation at source, the problem can be reduced proportionately. Similarly, with better planning and management, not only the waste generation is reduced, but overall expenditure on waste management can be controlled. Institutional/Organisational set up, training and motivation are given great importance these days. Proper training of health care establishment personnel at all levels coupled with sustained motivation can improve the situation considerably. The rules framed by the Ministry of Environment and Forests (MoEF), Govt. of India, known as Bio-medical Waste (Management and Handling) Rules, 1998, notified on 20th July 1998, provides uniform guidelines and code of practice for the whole nation. It is clearly mentioned in this rule that the occupier (a person who has control over the concerned institution / premises) of an institution generating bio-medical waste (e.g., hospital, nursing home, clinic, dispensary, veterinary institution, animal house, pathological laboratory, blood
26

bank etc.) shall be responsible for taking necessary steps to ensure that such waste is handled without any adverse effect to human health and the environment. Definition : Bio-medical waste means any solid and/or liquid waste including its container and any intermediate product, which is generated during the diagnosis, treatment or immunisation of human beings or animals or in research pertaining thereto or in the production or testing thereof. The physico-chemical and biological nature of these components, their toxicity and potential hazard are different, necessitating different methods / options for their treatment / disposal. In Schedule I of the Bio-medical Waste (Management and Handling) Rules, 1998 (Annexure II), therefore, the waste originating from different kinds of such establishments, has been categorised into 10 different categories (as mentioned in the box below) and their treatment and disposal options have been indicated. Components of Bio-medical waste (i) human anatomical waste (tissues, organs, body parts etc.), (ii) animal waste (as above, generated during research/experimentation, from veterinary hospitals etc.), (iii) microbiology and biotechnology waste, such as, laboratory cultures, microorganisms, human and animal cell cultures, toxins etc., (iv) waste sharps, such as, hypodermic needles, syringes, scalpels, broken glass etc., (v) discarded medicines and cyto-toxic drugs (vi) soiled waste, such as dressing, bandages, plaster casts, material contaminated with blood etc., (vii) solid waste (disposable items like tubes, catheters etc. excluding sharps), (viii) liquid waste generated from any of the infected areas, (ix) incineration ash, (x) chemical waste. Health hazards associated with poor management of Bio-medical waste (i) Injury from sharps to staff and waste handlers associated with the health care establishment.
27

(ii) Hospital Acquired Infection(HAI)(Nosocomial) of patients due to spread of infection. (iii) Risk of infection outside the hospital for waste handlers/scavengers and eventually general public. (iv) Occupational risk associated with hazardous chemicals, drugs etc. (v) Unauthorised repackaging and sale of disposable items and unused / date expired drugs

Management Issues of Bio-medical Waste Management The management principles are based on the followi ng aspects : Reduction/control of waste (by controlling inventory, wastage of consumable items, reagents, breakage etc.). Segregation of the different types of wastes into different categories according to their treatment/disposal options given in Schedule I of the Rules mentioned above. Segregated collection and transportation to final treatment/disposal facility so that they do not get mixed. Proper treatment and final disposal as indicated in the rules. Safety of handling, full care/protection against operational hazard for personnel at each level. Proper organisation and management.

Current Issues in Management of Health Care Waste There are two main issues at present : the recent legislation by the Govt. of India and implementation of the same at individual health care establishments level as well as whole town / city level.

LEGAL ASPECTS AND ENVIRONMENTAL CONCERN Indiscriminate disposal of infected and hazardous waste from hospitals, nursing homes and pathological laboratories has led to significant degradation of
28

the environment, leading to spread of diseases and putting the people to great risk from certain highly contagious and transmission prone disease vectors. This has given rise to considerable environmental concern. The first standard on the subject to be brought out in India was by the Bureau of Indian Standards (BIS), IS 12625 : 1989, entitled Solid Wastes- Hospitalsguidelines for Management (Annexure 7.1) but it was unable to bring any improvement in the situation. In this scenario, the notification of the Biomedical waste (Management & Handling) Rules, 1998 assumes great significance.. Bio-medical Waste (Management and Handling) Rules, 1998 The Central Govt. has notified these rules on 20th July, 1998 in exercise of section 6, 8 and 25 of the Environment (Protection) Act, 1986. Prior to that, the draft rules were gazetted on 16th October, 1997 and Public suggestion/comments were invited within 60 days. These suggestion were considered before finalising the rules. Scope and application of the Rules These rules apply to all those who generate, collect, receive, store, transport, treat, dispose or handle bio-medical waste in any form. According to these rules, it shall be the duty of every occupier of an institution generating bio-medical waste, which includes hospitals, nursing homes, clinics, dispensaries, veterinary institution, animal houses, pathology laboratories, blood banks etc., to take all steps to ensure that such wastes are handled without any adverse effect to human health and the environment. They have to either set up their own facility within the time frame (schedule VI) or ensure requisite treatment at a common waste treatment facility or any other waste treatment facility. Every occupier of an institution, which is generating, collecting, receiving, storing, transporting, treating, disposing and/or handling bio-medical waste in any other manner, except such occupier of clinics, dispensaries, pathological laboratories, blood banks etc., which provide treatment/service to less than 1000 (one thousand) patients per month shall make an application in prescribed form to the prescribed authority for grant of authorisation to carry on the work.
29

Whenever an accident occurs concerning bio-medical waste, it has to be reported to this authority. Each State and Union Territory (UT) Government shall be required to establish a prescribed authority for this purpose. The respective governments would also constitute advisory committees to advise the Govts with respect to implementation of these rules. The occupier or operator can also appeal against any order of the authority if they feel aggrieved to such other authority as the Govt. of the State/UT may think fit to constitute. Prescribed Authorities, so far established by various State Governments are listed at Annexure 7.3 and the time limit as per schedule VI of the Bio-Medical(Management & Handling) Rules,1998. Environmental Concern The following are the main environmental concerns with respect to improper disposal of bio-medical waste management: Spread of infection and disease through vectors (fly, mosquito, insects etc.) which affect the in -house as well as surrounding population. Spread of infection through contact/injury among medical/non-medical personnel and sweepers/rag pickers, especially from the sharps (needles, blades etc.). Spread of infection through unauthorised recycling of disposable items such as hypodermic needles, tubes, blades, bottles etc. Reaction due to use of discarded medicines. Toxic emissions from defective/inefficient incinerators. Indiscriminate disposal of incinerator ash / residues.

Q.6 Enumerate the occupational hazards and preventing measure. Ans: Except for infectious diseases all the main occupational hazards affecting health workers are reviewed: accidents (explosions, fires, electrical accidents, and other
30

sources of injury); radiation (stochastic and non-stochastic effects, protective measures, and personnel most at risk); exposure to noxious chemicals, whose effects may be either local (allergic eczema) or generalised (cancer, mutations), particular attention being paid to the hazards presented by formol, ethylene oxide, cytostatics, and anaesthetic gases; drug addiction (which is more common among health workers than the general population) and psychic problems associated with promotion, shift work, and emotional stress; and assault (various types of assault suffered by health workers, its causes, and the characterisation of the most aggressive patients). Finally, an occupational risk factor is any physical, chemical or biological agent present in the workplace that is able to harm the worker. Hazards Indoor air quality Air conditioning systems Photocopying machine Shavings furniture Insulating materials Videoterminals Illumination Medications Special waste assimilable to urban waste Hospital treated waste
31

Sharp hospital tools Electricity Photocomposition Wood dust

Risk Factors

Physicals Laser Microclimate Ionizing radiations Ultraviolet rays Radio frequencies and microwave radiations Noise Ultrasounds

Chemicals Strong acids and bases

32

Organic acids Alcohols, ethers, esters, halogen hydrocarbons Aldehydes, ketones Anaesthetics Chemotherapic drugs Radionuclides Detergents Formaldehyde Welding fumes Glutaraldehyde Radiological contrast agents Ethylene oxide Organic and inorganic salts

Biologicals Mycobacterium tuberculosis Laboratory and biological risks Hepatitis B virus

33

Hepatitis C virus Human Immunodeficiency Virus

Others Allergy-inducing agents Allergy-inducing agents Manual weight lifting Stress

Accident hazards

Slips, trips, and falls, especially in cluttered passages, on surfaces made slippery by spilled liquids, under conditions of poor illumination, or when carrying heavy and bulky photographic or illumination equipment. Falls from ladders when setting up overhead illumination or cameras, when mounting ladders while carrying heavy objects, or when using damaged or unstable ladders. Damage to legs and toes caused by falling objects, e.g., from overturned tripods. Hand cuts when handling photographic film and paper, especially in the dark. Cuts, burns, or damage to the eyes from burst
34

lamps or from direct contact with strong light sources; this may also cause ignition of flammable materials.
y

Bites, stings, and scratches from laboratory animals while setting them up for photographing. Electric shock caused by contact with defective electrical equipment (especially portable illumination equipment), cables, etc. Injury as a result of accidental contact, spillage, or inhalation of darkroom chemicals. Exposure to heat from illumination equipment or from drying equipment in the darkroom. Lack of proper ventilation in the darkroom. Cold temperatures in the storage rooms. Exposure to ultraviolet light. Exposure to a wide variety of photographic chemicals and their vapors and fumes may cause skin rashes, dermatitis, irritation of the eyes and mucous membranes, acute or chronic irritation of the respiratory system, various kinds of allergies, etc. [See Note 1]. Medical photographers are exposed to all of the chemical hazards of a hospital/medical care/medical research setup [See Note 2].

Physical hazards

Chemical hazards

35

Biological hazards

Infections due to the exposure to blood, body fluids or tissue specimens possibly leading to blood-borne diseases such as HIV, Hepatitis B and Hepatitis C. Medical photographers are exposed to all of the biological hazards of a hospital/medical care/medical research setup [See Note 2]. Eye strain as a result of moving frequently from the dark or semi-dark into strong light; handling small objects or photographic films or slides; etc. Musculoskeletal problems and fatigue as a result of long periods of standing, bending, etc. Overexertion and strains as a result of carrying or moving heavy and/or bulky objects, such as cameras, tripods, illumination equipment, transformers etc. Exposure to severely traumatized patients, multiple victims of a disaster or catastrophic event or severely violent patients may lead to post-traumatic stress syndrome.

Ergonomic, psychosocial and organizational factors

Preventive measures

Use safety shoes with non-slip soles.

36

Inspect ladders before climbing; never climb on a shaky ladder or a ladder with slippery rungs. Check electrical equipment for safety before use; take faulty or suspect electrical equipment to a qualified electrician for testing and repair. Install and use effective exhaust ventilation in the darkroom. Wear an appropriate respirator when exposed to solvent fumes. Wear protective goggles when handling, mixing, or diluting concentrated or corrosive solutions such as glacial acetic acid; provide eyewash bottles or fountains for use if needed. Seek proper medical attention if a skin rash develops; stop working in the darkroom until the rash heals. Avoid skin contact with photographic solutions; use neoprene gloves to protect the hands, and tongs to handle films or papers in processing tanks. Do not smoke, eat, or drink in the darkroom. Follow established appropriate infection control precautions assuming blood, body fluids and tissue are infectious Routinely use barriers (such as gloves, eye protection (goggles or face shields) and gowns) Wash hands and other exposed skin surfaces after coming into contact with blood or body fluids Follow appropriate procedures in handling and disposing of sharp instruments or needles Learn and use safe lifting and moving techniques for heavy or awkward loads; use mechanical aids to assist in lifting. Procedures and counselling services should be available to workers exposed to post-traumatic stress syndrome
37

38