Introdution To Env. Health
Introdution To Env. Health
Introdution To Env. Health
Determinants of Health
Instructor: Tsegaluel Abay.(MSc. In Water and Public Health)
Week Two
Lecture Note
Ecology and Environmental health:
A. Introduction to environmental health
• Environmental health: definition, concept and history
• Components of environmental health
• Occupational health and safety
• Infection prevention
B. Introduction to Human ecology
• Human – environment interaction
• Ecology of health and disease
• Biosphere and pollution
objectives
At the end of the course the students will be able to:
• To make students familiar with the concept, terms and theories that
helps them to identify and intervene environmental and ecological
factors to human health.
• Identify and explain components of environmental health
• Realize the practical techniques in planning, development and
maintenance of safe water supplies and waste disposal facilities.
• Identify vectors of health importance and introduce appropriate control
measures.
• Know the basic requirements of healthful housing and institutions.
• Solve the health and safety problems encountered in industries, various
occupational and recreational areas.
Introduction to Environmental health
What is the environment?
• is the physical, chemical and biological entities, conditions and dynamics that surrounds us
• The complex of physical, chemical and biological factors that act upon an organism or an
ecological community and ultimately determine its form and surrounding.
• Environment is divided into four traditionally: Atmosphere, biosphere, lithosphere and
hydrosphere. Adding the anthrosphere: technologically effect
• Contributors to the “Environment/health”
• Chemical − Air pollutants, toxic wastes, pesticides, VOCs
• Biological − Disease organisms present in food and water
− Insect and animal allergens
• Physical − Noise, ionizing and non-ionizing radiation
• Socio-economic − Access to safe and sufficient health care
Public Health Definition of “The Environment”
• All that which is external to the individual host. It can be divided into physical, biological,
social, and cultural factors, any or all of which can influence health status in populations
Definitions and concepts of environment
Ecology
• Is the study of the interaction of organisms and their environment and how organisms interact with
each other in which they live.
• Is the scientific study of the environmental factors that effect organisms and how organisms
interact with these factors and with each other.
Environmental science
• Is the scientific study of human (organisms) interactions with the environment environmental
indicators).
• Is the study of the earth, air, water, and living environments, and the effects of technology thereon
(anthrosphere).
Environmental studies
• Is the discipline dealing with the social, political, economical, philosophical and ethical issues
concerning man's interactions with the environment.
Environmentalist
• A person working to solve environmental problems, such as air, water pollution and soil
contaminations, the exhaustion of natural resources, uncontrolled population growth, etc.
Definition: health
• The condition of being sound in body, mind, or spirit
• A flourishing condition or well-being—not just the absence of
disease
or
• A state of complete physical, mental, and social well-being
and not merely the absence of disease or infirmity
- WHO (1948)
Definition: Disease
• Trouble or a condition of the living animal or plant body or one of its parts
that impairs or damages the performance of a vital function
What is Environmental Health?
Environmental health is
• broader than hygiene and sanitation; it includes hygiene, sanitation and
many other aspects of the global environmental challenges such as global
warming, climate change, radiation, gene technology, flooding and
natural disasters.
• It also involves studying the environmental factors that affect health.
• The World Health Organization (WHO) estimates that over 90–95% of all
Environmental pollution
Role of environmental health in public health
Hygiene is generally:
• refers to the set of practices associated with the preservation of health and
healthy living.
• The focus is mainly on personal hygiene that looks at cleanliness of the hair,
body, hands, fingers, feet and clothing, and menstrual hygiene.
• 25% of world’s population and 60% population in developing countries lack basic housing
sanitation.
• 80% of health problems in developing countries is due to lack of safe water and basic
sanitation.
• About 45% of all deaths in under five children (U5) is due to diarrhea etc.
CONT…
• Global climate change has become a concern in the world:
Ethiopian Situation
• About 75% registered OPD cases are associated to lack of basic hygiene and
sanitation:
• A number of discoveries in the 19th century were important events for the
understanding of communicable diseases.
• For example, the link between contaminated water and cholera was
discovered by John Snow in 1854;
• The importance of hygienic handwashing before attending delivery of a
baby was noted by Dr. Semmelweis in 1845; and
• the discovery that microorganisms (very small organisms only visible under
a microscope) cause disease was made by Louis Pasteur around this time.
• The period following the industrial revolution in Europe in the 19th century
showed that improvements in sanitation, water supply and housing
significantly reduced the occurrence of communicable diseases.
Hygiene and Sanitation development in Ethiopia
2. COMMUNITY WATER SUPPLY AND HEALTH
2.1. Introduction to water supply
Physiological needs:
• 70% of our body by weight: Body needs about 2.0-2.5 liters per day
• Survival with out water is very hard
• Most food contains rich in water such as milk about 90%, fish about 80%.
• Water is the most widely occurring substance in the world.
• The problem is that the distribution, quality, quantity and mode of occurrence is highly
variable from one locality to another.
• The tiny usable portion is about 0.8% of the total, which is neither evenly distributed nor
properly used.
• Globally: 23% urban and 64% of rural population in developing countries lack safe water
• More than 80% of diseases in developing countries is due to lack of safe water supply and
sanitation.
2.1. Introduction to water supply
• Polluted water: water that has contact with substances that alter its physical
qualities so that it changes in color, turbidity, taste or smell and causes
detrimental health problems. Polluted water can be detected by the sense
organs.
• Sedimentation: the action of settling down or depositing matter in a liquid.
• Turbidity: disturbed, muddy appearance of water.
Sources of water - Global Total Water and
Freshwater Reserves
The Hydrologic Cycle
2.2. Sources of water
Groundwater
- Available at point of need at little cost
- Until recently was not polluted
Surface water
- Usually requires extensive purification
Protected runoff (Rain water)
- Rain water is the purest of all natural water, it is relatively free of
dissolved minerals
Ocean and brackish (saline) waters
- Costly to desalinate
Water System Facts
2.3. The Importance of Water
1. Point source pollution: the discharge of pollutants arise from specific locations
such as factories, sewage treatment plants and latrines that are directly connected
• Sources include runoff from farm fields, roads, and parking lots, etc.
Surface Water Contamination
Point and
nonpoint sources of
surface water
contamination
Classes/types of Water Pollutants
Major Causes of Stream and River Pollution
Goals of water
purification:
- Provides safe
source of water
that meets quality
objectives
- Reasonable cost
2.5. Water Associated Diseases
• Ethiopia's water and sanitation crisis
• 62 million Ethiopians lack access to safe water and 97 million lack access to improved
sanitation.
• Of those who lack access to improved sanitation, a staggering 23 million practice open
defecation.(WHO, 2016)
• many women and children walk more than three hours to collect water, often from shallow
wells or unprotected ponds they share with animals.
• Recurring droughts result in famine, food shortages, and water-related diseases, as people are
forced to rely heavily on contaminated or stagnant water sources.(water.org, 2018)
• Safe, adequate and accessible supplies of water, combined with proper sanitation, are basic
human needs.
• Therefore, water supply is taken as an essential component of community health.
2.5. Water Associated Diseases
• Most disease associated with water are caused by pathogens.
2. Water-washed disease:
• Due to lack of adequate supply of water & poor sanitation (personal
hygiene)
Eye infections : trachoma, conjunctivitis
Skin infections: scabies & ring worm,
Body louse : typhus, & RF
Other flea, & tick-borne diseases.
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4. Chlorination
• Ex. Chlorine
tablet and weha-
agar
5. Storage
When household storage is well practiced in the community, turbidity will
be reduced, bacteria and eggs of parasites will be killed.
Use a clean water source or treat the water, either at home or in a storage
tank.
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6. SODIS (Solar Disinfection )
Sunlight kills
microorganisms and could
be used for water
disinfection.
Plastic bottles are often
available as a waste
product and could be used
for a new water treatment
method.
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B. Municipality (large scale) water treatment:
1. Ground water:
Aeration (The process of exposing to air) to remove
chemicals.
Disinfection (chlorination).
2. Surface water:
Screening (the large particles)
Pre-chlorination
Coagulation (The process of forming semisolid lumps
in a liquid)
Mixing
Sedimentation
Filtration (slow and rapid sand filtration)
Post chlorination
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(disinfection)
Large scale water treatment:
Simplified Flowchart of Drinking Water Treatment
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Water disinfection:
Disinfection means the destruction, or at least the complete
Pre-treatments of water can not assure that the water they produce
is bacteriological safe, i.e. Final disinfection will be needed. 61
Factors that influence the disinfection of
water:
1. The nature of water to be disinfected.
2. The type and concentration of the disinfectants used.
3. The temperature of water to be disinfected
4. The time of contact
5. The nature and number of the micro-organisms to be
pH of water
6. Mixing
• Good mixing ensures proper dispersal of the disinfectant
through out the water.
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Chlorine and its compounds:
Methods of calculating chlorine dosage:
– Too much chlorine is poisonous and too little is unreliable in disinfecting
water.
– An exact dose must therefore be determined for chlorinating a given
water supply.
• The effectiveness of chlorine is dependent on the water pH,
temperature, contact time, water clarity, and absence of
interfering substances.
63
Water disinfection by chlorination:
was perhaps the most important technological
century,
Even though chlorine and chlorine related substances
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Chemical agents used for disinfection of
water:
66
Tests of water:
67
Adequacy of supply:
• In understanding an assessment of the adequacy of the
Accessibility
Affordability(Cost)
Continuity 68
Service level &quantity of water collected:
69
Water consumption at home:
Purpose Consumption L/c/d
• Drinking 2.3
• Cooking 4.5
• Ablution 18.2
• Washing of utensils and houses 13.6
• Flushing of toilet 13.6
• Bathing 27.3
• Total 106.8
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Use of water by different establishments:
Type of building consumption L/c/d
• Factories with bathroom 45
• Factories with no bathroom 30
• Hospitals with laundry/bed 340
• Nursing room 135
• Hostels 135
• Hotels/bed 130
• Offices 45
• Restaurant 70
• Day school 3-5
• Boarding school 40
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3. Introduction to Solid Waste Management
Definition of terms
• Waste: Any substance or object which the holder discards or intends to discard.
• A holder means the producer of the waste or the person who is in possession of it.
• Solid wastes: comprise all the wastes arising from human and animal
activities that are normally solid and that are discarded/useless/unwanted.
• Waste water/liquid wastes all the wastes arising from human and animal
activities that are normally liquid.
• Bioaccumulation: is an increase in concentration of a pollutant from the
environment to the first organism in a food chain.
• Biomagnifications: is an increase in concentration of a pollutant from one
link to another in a food chain
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Hazardous wastes:
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Household waste: Waste from private domestic accommodations, residential homes,
universities/schools, hospital premises, private garages, camp sites, prisons, meeting halls and
royal palaces.
Industrial waste: Waste from any organization
• Ex. waste producers from the manufacturer of food products, textiles, wood products, plastic
products, motor vehicles, chemicals etc.
Commercial waste: Waste from premises used wholly or mainly for the purpose of trade or
business or the purpose of sport, recreation or entertainment.
• Ex. waste from offices, hotels, shops, local authorities, market, fairs etc.
Clinical waste: waste which consists wholly or partly of human or animal origin tissue, blood
or other body fluids, excretions, drugs or other pharmaceutical products, dressings, syringes,
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Municipal wastes: Waste collected and disposed by or on behalf of a local authority.
Biochemical oxygen demand (BOD):
• A laboratory measurement of wastewater that is one of the main indicators of the quantity
of pollutants present.
• A parameter used to measure the amount of oxygen that will be consumed by
microorganisms during the biological reaction of oxygen with organic material.
Classification of wastes according to their Properties:
Bio-degradable: can be degraded (paper, wood, fruits and others).
Non-biodegradable: cannot be degraded (plastics, bottles, old machines and others).
Classification of wastes according to their effects on human health and the
environment:
hazardous wastes
Nonhazardous wastes
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Solid waste management:
– A systematic administration of activities that provide for the collection,
source separation, storage, transportation, transfer, processing, treatment
and disposal of solid waste.
• Solid Waste: comprise all the wastes arising from human and animal
activities that are normally solid and that are
discarded/useless/unwanted.
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Solid waste management:
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Main sources of solid waste (waste generation):
1. Residential( domestic )
2. Commercial
3. Institutional
4. Construction Demolition
5. Municipal services
6. Treatment plant sites
7. Industrial
8. Agricultural
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CLASSIFICATION OF SOLID WASTES:
1. Residential: Generated from living households (domestic), generally contain non-hazardous
solid wastes; kitchen waste, ‘‘Ketema”, and ash are common in Ethiopia.
2. Agricultural: Solid wastes due to agricultural activities: food residues, animal dung, crop
residues, etc. Such wastes are usually non-hazardous and negligible in rural Ethiopia.
3. Commercial: Wastes generated from business establishments, food establishments, shops, etc.
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Waste Management Hierarchy
Most Preferable
Least Preferable
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CLASSIFICATION OF SOLID WASTES:
84
Recycling
1. Resource conservation
Recycling reduces pressure on renewable & non-renewable resources
2. Energy conservation
Recycling consumes 50–90% less energy than manufacturing the same item
from the previous material
3. Pollution abatement
Reduces level of pollutant emissions
Recover:
using solid materials as source of energy
Treatment(Incineration)
• Reduces waste volume by 80–90% by incineration for solid wastes
• but odor and smoke are negative effects.
85
Functional elements of solid waste management system:
• There are six elements of a waste management system.
1. Waste generation:
• Includes activities in which materials are identified as no longer value and are
either thrown away or gathered together for disposal.
2.Waste handling, separation, Storage and processing at the source:
Waste handling and separation involves the activities associated with management
of wastes until they are placed in storage container for collection.
• Handling also encompasses the movement of loaded containers to the point of
collection.
Separation of waste components is an important step in the handling and storage
of waste at source.
To recover sale materials, best separate at source). 86
Functional elements of solid waste management system:
3. Collection:
• It involves not only the gathering of wastes and recyclable materials,
• but also the transport of these materials, after collection, to the location
where the collection vehicles emptied.
This location may be material processing facility, a transfer station or a
landfill disposal site.
4. Separation, processing and transformation of waste:
• It all occurs primarily in locations away from the source of waste generation.
• The separation and processing of wastes that have been separated at the
source and the separation of commingles wastes usually occurs at materials
recovery facilities, transfer stations, combustion facilities and disposal sites.
87
Functional elements of solid waste management system:
5. Transfer and transport:
It involves two steps:
• The transfer of wastes from the smaller collection vehicle to the larger
transport equipment.
• The subsequent transport of the wastes, usually over long distances, to a
processing or disposal site.
• Although motor vehicle transport is most common, rail cars and barges (flat
bottom large boats) are also used to transport wastes.
88
Functional elements of solid waste management system:
6. Disposal:
• The final functional element in the waste management System is disposal.
• In many parts of the world, even today, land-filling or land spreading is the ultimate
fate of all solid wastes.
Methods of solid waste treatment and disposal system:
1. Ordinary open dumping
2. Controlled tipping/burial
3. Hog feeding
4. Incineration
5. Sanitary landfill
6. Compositing
7. Grinding and discharge into sewers 89
Methods of solid waste treatment and disposal system:
1. Open Dumping
• Some components of solid waste such as street sweepings, ashes and non combustible rubbish are
suitable for open dumping.
• Garbage and any other mixed solid wastes are not fit or suitable because of nuisance and health
hazard creation.
2. Controlled tipping/burial
• Indiscriminate dumping of garbage and rubbish creates favorable conditions for fly-breeding,
shelter and food for rodents, nuisances etc.
• In order to avoid such problems, garbage and rubbish should be disposed of under sanitary
conditions.
• This can be done by digging shallow trenches, laying down the waste manually or mechanically
and covering by ash at the end of each days work.
3. Hog Feeding
• The feeding of garbage to hogs has been practiced for many years in different parts of the world.
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Methods of solid waste treatment and disposal system
4. Incineration
• Incineration is a process of burning the combustible components of
garbage and refuse.
• Can be effectively carried out on a small scale in food service
establishments as well as in institutions such as hospitals, schools etc.
5. Sanitary Landfill:
• Is an engineered facility used for disposing of solid wastes on land or
within the earth’s mantle-
• without creating nuisances or hazards to public health or safety, such as
breeding of rats , insects and the contamination of groundwater.
• It is one of the most widely used means of solid waste disposal system .
91
Methods of solid waste treatment and disposal system
92
Main features of a modern landfill
93
Methods of solid waste treatment and disposal system
6. Composting
• Composting is an effective method of solid waste disposal.
• Biodegradable materials break down through natural processes and
produce humus.
• The metabolism of micro-organisms breaks down the waste aerobically
or an aerobically.
• Aerobic respiration, typical of composting, results in the formation of
Carbon dioxide and water.
• While the anaerobic respiration results in the formation of Carbon
Dioxide and methane.
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Methods of solid waste treatment and disposal system
95
Hazardous and infectious waste management:
• Hazardous waste(HW): is a term used all over the world for waste
which is dangerous or difficult to keep, treat or dispose of.
• May contain substances which are corrosive, toxic, reactive,
carcinogenic, infectious, irritant or harmful to human health and which
may also be toxic to the environment.
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Hazardous wastes…..
Wastes that require special handling due to serious threat to human health & the
env’t if mismanaged.
Ignitability- Catch fire (Flash point of 140F0 or more).
Corrosively-Substances that corrode (pH <2 or >12.5).
Reactivity- Chemically unstable & may explode (cyanide).
Toxicity- Injurious to health when ingested or inhaled (e.g., chlorine, pesticides).
Infective- suspected or containing infectious agents.
• Pose a substantial present or potential hazard to human or other living organisms.
• Because: Such wastes are non-degradable or persistent in nature.
• Can be biologically magnified.
• Can be lethal.
• May otherwise cause or tend to cause detrimental cumulative effects. 97
Sources of Hazardous Waste:
• The sources of hazardous wastes can be seen from two types of perspectives.
• Specific Vs nonspecific Sources
Non Specific sources of wastes:
• Produced in a variety of manufacturing/industrial processes.
Specific sources of wastes:
• Which are produced by specific industries.
SOURCEs:
They can be from:
• Households
• Institutions
• Agriculture
• Industries
• Health care facilities and,
• From Nature 98
4. Liquid Wastewater management
INTRODUCTION
• Sewage and other liquid wastes: water borne waste derived from
homes(toilets, bathrooms, laundry, lavatory, kitchen-sink wastes etc. i.e.
domestic wastes)and animal or Food processing plants.
• The waste matter eliminated from body is known as excreta and is about
27grams/capita/day (dry basis) and 100-200 grams/capita/day wet basis.
99
Sanitary sewage also called domestic sewage contains:
• human wastes and wash water from homes, public buildings or commercial
and industrial establishments.
• Excreta is associated with the spread of the following diseases:
• Bacterial: Cholera( Vibrio cholera); Bacillary dysentery /Shigellosis;
Typhoid/paratyphoid fever(Salmonella typhi).
• Viral- Polio/poliomyelitis(poliovirus); Viral diarrhea (rotavirus); hepatitis.
• Protozoa- Amoebiasis (Entamobea histolitica); Giardia lambiasis(Giardia
lambila).
• Schistosomiasis is a water contact disease caused by helminthes(parasite).
• Hook worm, Ascaris, Tape worm are common parasites associated with
water.
100
Mode of transmission of excreta associated disease:
• The four “F’s” i.e. fingers, flies, fields, and fluids are responsible for contacting
the feces and transmitting the pathogens to foods.
• However proper hand washing and water protection are effective means to
control their transmission.
1. Non water carriage: traditional pit latrine, VIP latrines, pour-flush latrine,
bore hole latrine.
2. Water carriage system: municipal sewerage system and local small scale
system.
General considerations of excreta disposal system
1. Proper sitting: in relation to housing unit, kitchen, ground and
source of water, direction of wind, available site;
2. Size of the underground structure: depends on users number and
minimum service years;
3. Construction material: availability of wood, cement, nails, stones,
gravel, sand, etc. 102
General considerations of excreta disposal system
4. Technology feasibility and sustainability: simplicity, acceptability,
affordability, community concern for participation in planning,
construction, financing, maintenance, and use;
5. Final disposal options: Burial? Vacuum truck? Seepage? Sewerage?
6. Users type: house hold, community, camps, etc. that will determine the
latrine technology
Types of treatment schemes
• There are two treatment schemes: small scale and municipal
sewage system:
1. Small scale treatment system:
This is a low cost type used at individual and community level.
103
Types of treatment schemes
2. Municipal sewage system:
Purpose: to remove the organic, inorganic, and bacterial load of the
sewage to an extent it is safe for final discharge or reuse
Requirements (infrastructure based):
• Installation of piped water in liquid waste generating sites (residential
houses, etc);
• Installation of sanitary fittings inside houses (latrine, bath, shower,
kitchen sinks, septic tanks);
• The construction of sewerage lines and treatment plants.
• Limitations: Operational and operating costs, land and water
availability, level of operators performance, sewer management
capacity (blockage, maintenance, etc.); final disposal site conditions104
Processes involved:
• Mechanical separation of solid components;
• Aeration/ oxygenation for aerobic bacteria;
• Organic matter decomposition;
• Sludge processing and drying;
• Neutralization;
• Destruction of pathogens (usually chlorination).
• The above process can be classified into physical, biological, and
chemical process that makes the waste safe for final disposal.
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Treatment strategies:
Collection,
Treatment and,
Reuse.
• Collection includes water carriage system or other methods of night soil
collection.
• The principle behind treatment step is to destroy pathogenic agents.
• Re-use in agriculture and aquaculture.
Performance criteria for waste water management system:
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• Activated Sludge (aerated sewage containing aerobic micro-organisms which help
to break it down).
• The most common option uses microorganisms in the treatment process to break
down organic material with aeration and agitation, then allows solids to settle out.
• Bacteria-containing “activated sludge” is continually re circulated back to the
aeration basin to increase the rate of organic decomposition.
• . Trickling Filters- These are beds of coarse media (often stones or plastic).
• Wastewater is sprayed into the air (aeration), then allowed to trickle through the media.
• Microorganisms, attached to and growing on the media, break down organic material in
the wastewater.
• Trickling filters drain at the bottom; the wastewater is collected and then undergoes
sedimentation.
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Lagoon Systems
• Lagoons(oxidation ponds or
– hold the waste-water for several months
stabilization ponds): – natural degradation of sewage
• A wastewater treatment method that – Usually reeds are preferred
uses ponds to treat wastewater.
• Algae grow within the lagoons and
utilize sunlight to produce oxygen,
which is in turn used by
microorganisms in the lagoon to break
down organic material in the
wastewater.
• Wastewater solids settle in the lagoon,
resulting in liquid waste that is
relatively well treated, although it
does contain algae.
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Tertiary or Advanced wastewater treatment:
• The sewage from the secondary settling tank is chlorinated for final disposal.
• Any thing that follows conventional primary and biological treatment is
considered to be advanced treatment.
• The main purpose is to remove nitrogen and phosphorus (to avoid eutrophication
in water bodies) and to further decrease the BOD of partially treated waste
water.
• The removal of organics (BOD) and nutrients helps to protect the quality of
aquatic ecosystems.
• Tertiary treatment is any level of treatment beyond secondary treatment.
112
• Could include filtration, nutrient removal (removal of N and P) and removal
of toxic chemicals or metals.
• Also called “advanced treatment” when nutrient removal is included.
• Not all sewage treatment plant requires tertiary (advanced) treatment.
• One approach to nitrogen control, utilizes aerobic bacteria to convert
ammonium ions (NH4+) to NO3- , which is nitrification, followed by
anaerobic stage in which different bacteria convert nitrates to nitrogen gas
(N2), which is de-nitrification( remove nitrogen).
• Second approach to control nitrogen is known as ammonia
stripping/removing method.
• On the average, raw sanitary sewage contains about 35 mg/L of N and 10
mg/L of P.
113
•phosphates: Removing phosphates is most often accomplished by adding a
coagulant to the aeration tank when the activated sludge process is being
used, usually alum [Al2(SO4)3] or lime [Ca(OH)2]:
• Finally, the amount of pathogens in the wastewater is expected to be
proportional to the concentration of fecal coli-form bacteria.
• The coli-form concentration in raw sanitary sewage is roughly 1 billion
per liter.
114
Characteristics of Hazardous Waste:
1. Flammability and Ignitability : The waste burns or
explodes with the application of fire, friction,
electricity spark, or any source of heat.
• wastes with high ignitable potential and/or which
burn vigorously and persistently.
2. Corrosively: It is the ability of the waste to cause skin
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4. Toxicity: A waste that is likely to produce mass acute
and chronic poisoning; long-term health effects.
5. Infectivity: A waste is a potential cause for infectious
diseases, such as hepatitis B.
6. Radioactivity: Wastes containing radioactive elements.
• Such wastes are mainly from biomedical training and
research institutes.
7. Bioaccumulation effect: Wastes that are not easily
degraded when exposed with the environment.
116
Treatment technologies:
118
Disposal methods of hazardous wastes:
1. Secure landfills
2. Incineration
3. Recycling
4. Deep well injection
5. Biological methods
Infectious waste: is a waste which is suspected to
contain pathogens ( bacteria, virus, parasites or fungus)
in sufficient condition to cause disease on susceptible
host.
119
• Infectious waste includes human blood and blood
products, cultures, stocks of infectious agents.
• pathological wastes, contaminated sharps (hypodermic
needles, scalpel blades, capillary tubes), contaminated
laboratory wastes.
• contaminated wastes from patient care, discarded
biological, contaminated animal carcasses and body
parts infected with human pathogens.
120
Health hazards:
122
• The final choice of treatment system should be made
carefully, on the basis of various factors, many of
which depend on local conditions:
1. Incineration Technology
2. Open dumps
3. Sanitary landfills
4. Safe burial on health-care premises
5. Sterilization
123
• Health care waste: is the total waste generated by
hospitals, healthcare establishments & research facilities
in the diagnosis, treatment, or immunization of human
beings or animals, & other associated research & services
(WHO).
Healthcare waste categories:
a. Low risk waste- communal wastes.
• Approximately 85% of the general waste produced by
hospitals & clinics is non-contaminated waste & poses no
infection risk to persons who handle it.
b. High Risk Wastes 124
Health effects of Healthcare Wastes
Needle stick injuries
Transmission of infection example from re-use of
some type of waste -e.g., syringe
Environmental pollution e.g., air, water
Exposure to radiation
Fires
Public nuisance (offensive smells, unsightly)
125
Health Care Waste Management
HCWM is defined as actions associated with the control
of generation, storage, collection, transport & disposal of
HCWs in accordance with the best principles of public
health.
Importance of proper HCWM
128
a. Waste Minimization
Waste minimization is the first & best way to:
Reduce HCW quantities & costs
Reduce env’tal impact on air pollution & landfill
capacity
All purchases of material & supplies should be made
with waste reduction in mind
Improving reuse & recycling practice
Administrative controls
129
b. Waste Segregation/ Separation
Is separating waste by type at the place where it is
generated.
Waste should be separated immediately by the person
generating the waste.
Waste handlers should never sort through waste after it
has been placed in the bin.
Segregation must be maintained throughout until final
disposal
Segregation will result in a clear solid waste stream. 130
131
c. Handling, i.e. collecting, storing…
Protective clothing should be worn by waste handlers.
Aprons, Heavy duty gloves, Footwear, Goggles/glasses and
masks, Hands should be washed.
• Waste collection : Collect, quantifying by volume, labeling as to
its source & recording.
• Storage: Placing waste in a secure place until it can be disposed
Ideal storage area should be:-
133
Types of Recommended Recommended
Waste treatment procedures
137
5. FOOD HYGIENE
139
Five keys to safe food:
• keep clean
• Separate raw food from cooked
• Cook carefully
• Use safe water
• Use safe raw materials
Foods of Concern:
Any food can be a vehicle for food borne illness.
High protein foods are most often responsible for food
borne illness
Milk & milk products
Egg, Meat, Seafood, Cooked potatoes, etc.
140
Public Health significance of food:
1. Food borne diseases: Infection, intoxication
2. Chemical poisoning
3. Adulteration and misbranding
4. Food spoilage
Factors of food borne diseases:
1. Raw foods: perishable foods
2. The environment: flies, rats, contaminated water and
equipments
3. Food handlers: skin lesions, spitting, coughing
4. From sick animals
141
1 .Food borne diseases
• Either infectious or toxic in nature,
• caused by agents that enter the body through the
ingestion of food.
Classification of food borne diseases:
depending on the causative agent.
1. food-borne poisonings/intoxications
2. food-borne infections
Food borne infections: are diseases whose
etiologic agents are viable pathogenic
organisms ingested with foods.
142
• Is caused not because of toxins produced in the food,
• Thus referred as infection type.
Ex. bacterial infection- salmonella
viral infections- hepatitis
parasitic infection- tape worm
Food borne poisonings/ intoxications:
• Ingestion of toxins released by microorganisms,
• Intoxications from poisonous plants or toxic animal
tissues;
• Consumption of food contaminated by chemical poisons.
Ex. Staphylococcal enterotoxin
clostridium botulinum
clostridium perfringes 143
2. Chemical poisoning:
• Certain chemicals or poisonous substances are
introduced into the food, directly or indirectly and
consumed.
• They may cause poisoning immediately, depending on
the type and dose of the chemical substance.
Example:
• Fertilizers
• Insecticides, herbicides, weedicides
144
Poisonous plants and animals:
145
Eating and drinking establishment sanitation:
Control measures:
146
Cleanliness:
• Keeping hands and fingers away from hair, nose and
mouth parts.
150
Food protection measures:-
1. Strict observation of food handlers’ personal hygiene
2. Keeping potentially hazardous foods refrigerated at all
times to their proper T0
3. Application of good sanitation practices in storage,
preparation, display & service of food.
4. Adequate cooking of foods
5. Through washing & proper storage of
fruits/vegetables.
6. Provision of adequate equipment & facilities.
151
• Factors that affect bacterial growth:
1. Temperature
2. Time
3. Water activity/ Relative humidity
4. Oxygen
5. pH
6. Light
7. Physical structure
152
3. Food spoilage:
• Alteration of food in color, odor, taste, texture, consistency due to
food decomposition, decaying, rotating & fermentation.
Courses of spoilage:
growth and activity of micro organisms in food
Chemical reactions
Eg. meat , fish , egg ,milk ,most fruits and vegetables, etc.
• Semi-perishable- have medium moisture content and
protective covering .E.g. potatoes, apples ,nuts etc.
• Non –perishable or stable foods- dry and can be kept
long period .E.g. sugar, flour, and other cereals etc.
154
Milk borne diseases:
• Milk is a medium (hot bed) for bacterial growth.
• Common milk borne diseases
» Due to contamination of milk from:-
milk handlers like Diphtheria.
bacillary dysentery.
the cow like bovine TB and Brucellosis
155
Health importance of milk sanitation?
1. Good bacterial growth media
2. Easy for contamination during production and
processing;
3. High risk of spoilage under favorable condition;
4. High probability to be consumed as raw;
5. Milk usually used by vulnerable groups: infants,
elderly, the sick.
6. High risk of adulteration
156
Control measures for milk safety and its preservation
157
Cont….d
• Preserve milk as dry milk powder made at high
temperature;
• Sterilization: 100C0 for 15 minutes in a closed
sterilizer;
• Condensed milk to 1/4th original volume by
heat and packing as creamed or skimmed milk
158
Meat borne diseases:
Some common meat related diseases are:
161
4. Fermentation & pickling/ ex. Adding vinegar
5. Acid preservatives
Benzoates, Sorbets, Propionates, Acetic &
lactic acids
6. Chemical preservation
Salting , Sugaring, Spices, Smoking,
Fumigation
162
• Transmission of disease from excreta
Water
Hands
EXCRETA
Death
Food/milk, New
Vector Vegetables Host
Debility
Soil
163
Ten golden rules for safe food preparation
and consumption (WHO)
• Choose food processed for safety
• Cook food thoroughly
• Eat cooked food immediately
• Store cooked food immediately
• Reheat Cooked foods thoroughly
• Avoid contact between raw and cooked foods
• Wash hands repeatedly
• Keep all kitchen surfaces accurately clean
• Protect foods from insects, rodents, and other animals
• Use pure water
164
6. VECTOR CONTROL
Vector
Arthropods/other invertebrates which
168
Factors that affect vector effectiveness in diseases
transmission:
1. Receptivity: Ability to support the pathogen to develop
2. Specificity: Exclusive to a specific vertebrate host
3. Longevity: Live a sufficient period of time
4. Frequency of feeding: Nature of vector- host contact
frequency.
5. Mobility: Superior mobility aids in the rapid
dissemination of pathogens over a wide area.
6. Number: Large number increases the chance of feeding
& infecting the host.
7. Physiological & behavioral plasticity: Ability to
develop resistant mechanism by physiological &
behavioral means. 169
Impacts of insects on public health:
1. Economical problems
2. Injure sense organs
3. Allergic reactions
4. Dermatitis, fever, blisters
5. Disease transmission/ vectors
6. Nuisance/irritating
7. Entomophobia
170
Most public health important vectors:
• HOUSE FLY
• the closest associates of man.
• One pair of wings characterizes them, most prevalent found inside
buildings.
• mechanical disease transmission:– leg hairs, wings, body, vomitus,
defecting on food;
• Disease transmitted: faeco-orale borne diseases; eye infections:
typhoid fever, amoebiasis, bacillary dysentery, helminthic diseases,
conjunctivitis;
Fly control measures
• Environmental sanitation
• Mechanical and Physical methods
• Chemical use 171
1. MOSQUITOES:
• family Culicidae
notorious as proven
vectors of some of the
most devastating human
diseases.
also cause diseases like
Rift Valley fever (RVF)
and the equine
encephalitis in live stocks. 172
External morphology
• Dipterans/two winged insect
• Three pairs of long thin legs
• Long slender body
• Long needle shaped piercing mouth parts.
• Scales on the thorax, legs, abdomen, and wings.
• they can be sexed by examining their antennae (male-feathery,
female-short, invisible).
• The most important man biting belongs to the genera Anopheles.
Larvae of culex
175
pupae of mosquito
Adult behavior
Parasite component
• Anti-malarial drug resistance eg. Plasmodium species
179
• Black flies:
• commonly called "buffalo gnats“,
• because of their humped back appearance.
• dark in color
• appear in a variety of neutral shades from light gray to
black.
• They belong to the order Diptera (Flies) and the family
Simuliidae.
Onchocerciasis was first reported in southwestern
Ethiopia in 1939 by Italian investigators.
Transmitted by the bites of black flies found near the
fast-flowing rivers.
• Endemic areas extend from the northwest to southwest
of the country that borders the Sudan. 180
Habitats & Life Cycles:
• Ocular onchocerciasis
183
Prevention and control:
184
3.SAND FLIES (PHLEBOTOMINAE)
• Sand flies are small blood sucking flies
that are important as vectors of
leshmaniasis and
• can cause a serious but localized biting
nuisance.
• Species that occur in the Mediterranean
region can transmit sand fly fever, a viral
disease also known as Pappataci fever or
three-day fever. trans-ovarious
185
• Species in three genera
-Phlebotomus,
-Lutzomia and
-Sargentomia suck blood from vertebrates.
• The first two genera are more important medically as
they contain disease vectors.
188
LARVAE: Are mainly scavengers (feed on organic matter
such as fungi, decaying forest leaves, etc.
PUPA: the skin then splits open and the pupa wriggles out.
Adult
• They are minute in size (1.3-3.5 mm in length).
• Limited home range- Horizontal flight: maximum 200
meters.
• Vertical flight: about 6 meters.
• Sand flies usually rest in the day in dark and humid sites.
Medical importance
• Transmission of Leishmaniasis
• Obligate intracellular protozoa of the genus Leishmania
189
• Leishmania: Named after Leishman, who first
described it in London in May 1901.
• Leishmaniasis can easily classified clinically as
• Visceral leishmaniasis
• Cutaneous leishmaniasis
• Mucocutaneous leishmaniasis
• Diffuse cutaneous leishmaniasis
• These different forms of the disease is caused by the
different species of Leishmania
190
• Cutaneous Visceral
leishmaniasis(CL) leishmaniasis(VL)
– L. tropica L. donovani
– L. major
L. infantum
L. Chagasi
– L. aethiopica
– L. panamensis
– L. guyanensis
– L. peruviana Diffuse cutaneous
Mucocutaneous leishmaniasis(DCL)
leishmaniasis(MCL) • L. amzonensis
L. panamensis • L. aethiopica
L. guyanensis
L. Brazilliensis 191
• In Ethiopia
– Four species of Leishmania are found, namely,
▪ L. aethiopica,
▪ L. major
▪ L. tropica
▪ L. donovani
192
Cutaneous Leishmaniasis
(Oriental sore)
• chronic ulcerated,
papular, or nodular
lesion
• lesion is painless, non-
tender, non- pruritic
and usually clean
193
Muco-cutaneous Leishmaniasis
(espundia):
194
Visceral leshmaniasis
(kala-azar)
• incubation period
• generally 2-6 months
• can range 10 days to years
• fever, malaise, weakness
• wasting despite good appetite
• spleeno- and hepatomegaly,
enlarged lymph nodes
• depressed hematopoiesis
• severe anemia
• leucopenia
• thrombopenia petechial
hemorrhages in mucosa
195
Adult behavior
• females suck blood from a variety of vertebrates.
• Biting is usually restricted to crepuscular and
nocturnal periods
• but people may be bitten during the day in
darkened rooms, or in forests during overcast
days.
• Most species feed out of doors (exophagic) but a
few also feed indoors (endophagic).
196
Cont…
• biting may be localized to a few areas.
• However, it is known that adults of at least some species can
fly up to 2.2 km over a few days.
• several short flights and landings before females settle on their
hosts.
• Windy weather inhibits their flight activities and biting.
• Because of their very short mouthparts, they are unable to bite
through clothing.
197
Prevention and control of Leishmaniasis
• Most cases of CL heal without treatment, leaving
the person immune to further infection.
• In many parts of South-west Asia, infections were
deliberately encouraged on the buttocks of
babies in order to immunize them (avoiding
disfiguring scars on the face or elsewhere).
• Prevent sand fly bites through the repellents and
Insecticides.
• residual sprays applied to walls, screens, fences,
etc.
198
4.Tsetse flies:
• Vectors of animal and human
trypanosomiasis.
• Male and females feed exclusively on
blood.
• Adults mate only once and lay one larva
every 9 days.
• Females are larviparous.
200
Control Measures: -
• Animal culling and clearing of wooded vegetation.
• Clearing forest and bushy habitat of tsetse fly
• Clear 10-12 meters on both sides of forest crossing
roads.
• Close highway of tsetse infested areas.
• Trapping adults, killing pupa using nets or / odor
attracted traps.
• Aircraft pesticide applications can be effective in
areas where it is not practical to eliminate or reduce
thick bush.
201
Cont…
• Use animals as bait / visual targets to trap.
• Inspection of people and treating cases.
• Genetic control: sterile males by radiation.
• Insecticide application / with care (Aerial spraying,
Ground spraying, and Fumigation).
• Use of repellents: Oils, lotions or creams applied to
exposed body parts or applied lightly on clothing.
202
5. Flea and lice:
• ORDER: Siphonaptera (Fleas)
• Small, wingless and laterally flattened.
• Possess piercing & sucking mouthpart which is
distinctly pointed down wards.
• Both sexes are exclusively blood suckers.
• Legs are specialized for jumping.
• Combs & compressions facilitate movement.
203
• Only the body louse has been implicated as a vector
of disease, i.e. of epidemic typhus (R.prowazeki),
endemic relapsing fever, flea-borne endemic typhus
(Rickettsia typhi), plague (yersinia pestis) and trench
(Quintana) fever.
• Epidemics of these diseases are often associated with
wars or natural disasters.
– When standards of hygiene are low and people are
living in crowded conditions.
204
Control measures of fleas
• Insecticide application
• Insect growth regulators: such as methoprene have been incorporated
in to sprays often combined with a pyrethroid such as permethrin for
treating household infestations.
Such sprays may remain effective for 10 week.
205
6. Medical importance of ticks:
212
Removal and destruction of snails
• Snails can be removed from canals and watercourses with
dredges and crushed or left to die of desiccation.
• This happens in irrigated areas of Egypt and Sudan as a
beneficial side-effect of efforts to improve the flow of
water by removing mud from canal bottoms .
213
Plants with molluscicidal activities
• Endod is the Ethiopian name for the soap berry
plant Phytolacca dodecandra (Synonyms: P.
abyssinica, Pircunia abyssinica), a member of the
Phytolaccaceae family.
• The distribution in east, west, central, and southern
Africa and parts of South America and Asia.
214
Vector control tools
215
Vector Control tools…
Personal Protection methods
• They are usually simple to use
• Includes:- 1) Repellents
2) Insect vaporizers
3) Mosquito nets
Vector Disease
Sand fly Leishmaniasis
Black fly Onchocerciasis (Eye blindness)
219
7. HOUSING AND INSTITUTIONAL HEALTH
222
1. Fundamental physiological needs:
Adequate living space
Adequate & clean air
Adequate ventilation
Protection against excessive noise
Maintenance of thermal comfort
Adequate indoor lighting
223
2. Protection against diseases (infection):
Safe water supply
Safe waste management
Personal & domestic hygiene
Safe food hygiene
Vector control
224
3. Protection against accidents:
Structural features provide safety protection
against falls, collapse, & other mechanical
injuries.
Indoor air pollution
Chemical safety
Electrical control & safety provisions
Fire control & safety provisions
Protection against gas poisoning
Traffic accidents
225
Causes of accidents:-
Structural faults during design & construction
Lack of maintenance
Human activities
• Slippery floor
• Improper electric wires protection
• Improper chemical use & storage
• Cooking with biomass fuels, etc
226
4. Reducing psychological & social stresses:
Reinforcement of personal/family security
1 1 2
2 2 3
3 3 5
228
8. Institutional health:
229
1. School Health Service:
A school health program should generally include the
following important services:
Communicable diseases control
Accident prevention
230
2. Health institution/hospital:
HIs have many potential hazards that can pose a
threat to employees, patients and visitors.
Main health hazards in the hospital setting are
bacterial infections (streptococcus & staphylococcus)
& viral infections (Hepatitis B & C)
Objectives of sanitation in HI are aimed at
maintaining a high degree of cleanliness & effective
sterilization techniques in order to prevent
nosocomial infections.
231
Control procedures of nosocomial infections:
a. Laundry
Clothes of the patients to be admitted should be
disinfected & washed as soon as possible.
b. Proper wastes disposal
Best methods of disposal of infectious wastes are,
incineration & burying (non-combustible wastes).
c. House keeping
All wastes should be properly stored in a watertight
covered, corrosion & wet resistant containers (bins)
until properly disposed.
Wet mopping specially with disinfectant chemicals is
best to minimize the risk of infection.
232
d. Health care staff
PPEs such as gowns, masks, gloves, & caps must
be worn &
removed before entering clean areas such as lunch
236
III. Prison health:
Prison is an institution where prisoners are kept under
custody for a certain period of time.
Source of disease in the prison
Some prisoners may join the prison with apparent or
unapparent infection from outside and infect other
prisoners;
Infection that originate in the prison it self because
of poor environment (Poor housing, inadequate
ventilation, overcrowding, malnutrition, poor
hygiene, due to lack of facilities, inadequate water
supply, etc).
237
Aims of prison health service:
1. To solve the immediate physical & mental health
problems.
2. To prevent the infectious disease especially the
chronic ones such as TB.
3. To teach prisoners the basic principles of healthy
living
• so that when they are released from the prison to join
their community once again, they can convey
whatever health messages they gate in the prison.
4. To advise prison administration on health and
environmental conditions of the prison.
238
Prevention & control methods of CDs in prison:
a. Buildings
Should be structurally sound, secure and fire
resistance
Cells should be designed to provide at least 5m2 of
floor area for each prison inmate.
Cells should be provided with a minimum of 30 ft-c
illumination.
A minimum of 4m2 sleeping area per person is
required to avoid overcrowding.
Height of the ceiling should not be less than 2.35m.
Beds should be raised by 30cm from the floor.
Minimum space of 90 cm b/n two beds and 120 cm if
double beds are used. 239
b. Physical examination of inmates & inspection of
the basic necessities.
c. Lighting & ventilation
All rooms should receive natural and artificial
light as well as adequate ventilation.
d. Water supply & sewage disposal system:
At least one drinking tap should be provided
prisoners.
At least one seat hole of pit latrine per 50
prisoners.
240
e. Control of vectors such as rodents & insects
f. Food hygiene
Regular inspection of food preparation
Proper training to food handlers
Regular medical check up of food handlers
g. Appropriate refuse disposal facilities provision
h. Temperature regulation
The prison is recommended to have a day
temperature of 20-22.2OC & a night temperature
of 15.5 OC in cells, offices, & similar areas.
241
9. OCCUPATIONAL HEALTH
7.1. Definitions
Occupational health & safety service:
Science & art devoted to the anticipation,
243
Ergonomics:
Work place design
Study of human characteristic for the appropriate design
of work env’t.
Application of human biological science in
his work
244
7.2. Scope of occupational health:
Occupational health encompasses prevention ,
control, curative & rehabilitative programs.
Health promotion in the work env’t
Establishment of sound env’tal conditions
Organization of health services including first aid
Diagnosis & treatment of occupation related
diseases & accidents
Rehabilitation of those that have been injured
245
7.3.Elements of the work environment:
Associated with different hazards
1. Worker: Differ in susceptibility to disease
2. Tool: Range from very primitive like a hammer/needle
to automated equipments & associated with d/t hazards
3. Process: Raw material used may be toxic or the process
may release toxic substances.
4. Work environment: Associated with d/t types of hazards
246
7.4. Classification of occupational hazards:
1. Chemical hazard: Particulates, solvents, gases.
2. Physical hazard: Noise, extreme To, humidity &
dust.
3. Biological hazard: Insects, rodents, M/Os,
poisonous plants & animals
4. Ergonomic hazards: Poor work place design
5. Mechanical hazards: Vibrating & rotating tools,
repetitive movement of hands etc.
6. Psychosocial hazard: Work over load, work under
load, poor job management, work shift, career
development, & lack of job security
247
7.5. Occupational Diseases
1. Disease of respiratory system
2. Musculoskeletal disease
3. Skin disease
4. Eye diseases
6. Reproductive disorders
7. Cardiovascular disease
9. Hematological disorders
248
1. Disease of the respiratory system:
Occupational asthma
Hypersensitivity pneumonites
Bagassosis= inhalation of sugarcane dust
Pneumoconiosis
Silicosis: silica (SiO ) dust
2
Asbestosis: asbestos dust
Bronchitis
Emphysema:- Destruction of alveolar walls
249
2. Musculoskeletal disease: Tendonitis, Neck tension
syndrome, Back pain
3. Skin disease: Dermatitis, Frostbite, Skin cancer
4. Eye diseases: Cataract, Conjunctivitis
5. Disease of the nervous system:
Neuralgic disorders
Central Nervous system
Behavioral disorders
Occupational stress
250
6. Reproductive disorders
Male: Spermato-toxicity and Hormonal alteration.
8. Hematological disorders
Hemolysis
Benzene
Suffocation
CO
251
9. Liver diseases (hepatic disorders)
Liver cirrhosis
Alcohol whiskey producer
Viral diseases
Hepatitis B virus
Liver cancer
CCl
4
2. Administrative Control
253
1. Engineering controls
First line of defense against work place hazards
i. Ventilation to minimize dispersion of air borne
contaminants
ii. Isolation of a hazardous operation or substance by
means of barriers
iii. Substitution of material, equipment, or process
2. Administrative control
Work period reduction
Job rotation
Appropriate work practices
Bonus
Proper management
254
3. Personal protective equipments (PPE)
Least effective method
255
End
Thank you
256
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