CHAPTER 13

ENVIRONMENTAL HEALTH

CHAPTER CONTENTS

INTRODUCTION
ENVIRONMENTAL HEALTH RECORDS
MANAGEMENT
SOLID WASTE MANAGEMENT
WATER SANITATION
EMERGENCY WATER TREATMENT
AIR PURITY
TOXIC AND HAZARDOUS WASTE CONTROL
FOOD SAFETY
SANITATION
VERMIN AND VECTOR CONTROL
BUILT ENVIRONMENT
SUMMARY

SERRANO, JOVELYN A.
BSN-2
 INTRODUCTION
“No amount of medical knowledge will lessen the accountability for nurses to do what
nurses do; that is, to manage the environment to promote positive life process.”

Sister Calista Roy, Commentary

on notes on Nursing 1992

 (DOH) DEPARTMENT OF HEALTH, 1998

In its implementing Rules and Regulations of Chapter XX (Pollution of the Environment) of
the Code of Sanitation of the Philippines (P.D. 856), defined environmental health as:
The characteristics of environmental conditions that affect the quality of health. It is the
aspect of public health that is concerned with those forms of life, substances, forces and
conditions in the surroundings or person that may exert an influence on human health and
wellbeing.

 (WHO) World Health Organization, 1993

Described environmental health through a consultation in Sofia, Bulgaria:
Environmental Health comprises of theses aspects of human health, including quality of
life, that are determined by physical, chemical, biological, social, and psychological
factors in the environment. It also refers to the theory and practice of assessing,
correcting, controlling and preventing those factors in the environment that can
potentially affect adversely the health of present and future generations.

 (IACEH) Inter-Agency Committee on Environmental Health

The Philippine government takes this course of action through Executive Order No. 489,
institutionalizing the IACEH. The member agencies are represented by the various
secretaries and directors of the executive branch of the government, headed by the Secretary
of the DOH as chairperson, and the Secretary of the Department of Environment and Natural
Resources (DENR) as vice chairperson. The various roles of IACEH specified by law
include the task of coordinating, monitoring, evaluating environmental health program
initiated by the government and private agencies to achieve environmental protection for
health promotion.

 (NEHAP) National Environmental Health Action Plan

Has been developed, identified seven components of environmental health that will be
assigned to the leadership of the members of the IACEH namely;

1. Solid waste 3. Air 5. Occupational health 7. Sanitation

2. Water 4. Toxic and hazardous waste 6. Food safety

(SWATOFS)
 ENVIRONMENTAL HEALTH RECORDS MANAGEMENT

In the Philippines, the maintenance of environmental health records is one of the

responsibilities given to the city, municipal, and provincial health nurses. The current data
management system being used by the DOH is the Field Health Services Information System
(FHSIS). Data collection begins with the midwife and the barangay health workers.
The eight environmental health indicators that need to be monitored are as follows:

1. Households with the access to improved or safe water – stratified to level I, II, and III
2. Households with Sanitary toilets
3. Households with satisfactory disposed of solid waste
4. Households with complete basic sanitation facilities
5. Food establishments
6. Food establishments with sanitary permits
7. Food handlers
8. Food handlers with health certificates

The public health nurse must therefore be abreast with the definition of these records that must
be maintained. The 2008 version of the FHSIS presents the following definitions:
Households with access to improved or safe water supply – refers to those covered by or
have access to any of the three levels of safe water sources that conforms to the national
standards for drinking water.
Level I (point source) – refers to a protected well (shallow or deep well), improved dug well,
developed spring, or rainwater cistern with an outlet but without a distribution system. A level I
facility is generally adaptable for rural areas where the houses are thinly scattered. It would
normally serve 15-25 households and its outreach must not ne more than 250 meters from the
farthest user. The yield or discharge is generally from 40-140 liters/minute.
The point of consumption of level I system is at the source itself, placing the water
reservoir at higher risk of contamination. In the FHSIS, if the level I reservoir (ex: a protected
rainwater cistern) is piped into the tap of households, they are then considered to have a level III
access as the risk of reservoir contamination is minimized.
Level II (communal faucet system or stand post) – refers to a system composed of a sound, a
reservoir, a piped distribution network, and a communal faucet located not more than 25 meters
from the farthest house. Level II system may also include a communal faucet where a group of
households get their water supply even if the said faucet is connected to a level III source. The
typical level II system is designed to deliver 40-80 liter per capita per day to an average of 100
households, with one faucet per 4-6 households.
Level III (waterworks system) – refers to a system with a source, transmission pipes, a reservoir,
and a piped distribution network for household taps. It is generally suited for densely populated
areas. This level of facility requires minimum treatment of disinfection. Examples of this include
water districts with individual household connections. For reporting purposes, a level III system
may also include a Level I system with piped distribution for household taps, serving a group of
housing dwellings such as apartments or condominiums.
 Households with sanitary toilets – refer to household with their own flush toilets connected to
septic tanks and/or sewerage system or any other approved treatment system sanitary pit
latrine or ventilated improved pit latrine.
 Households with complete basic sanitation facilities – refers to these that satisfy the presence
of the following basic sanitation elements, namely:
1. Access to safe water
2. Availability of a sanitary toilet
3. Satisfactory system of garbage disposal
 Food establishments – refer to those where food or drinks are manufactured, processed,
stored, solid, or severed, including those that are located in vessels.
 Sanitary permit – the written certification of the city or municipal health officer or sanitary
engineer that the establishment complies with the existing minimum sanitation requirements
upon inspection conducted in accordance with Presidential Decree Nos. 522 and 856 and local
ordinances.
 Food handlers – refer to persons who handle, store, prepare, or serve any food item, drink, or
ice, or who come in contact with any eating or cooking utensil or food vending machine.
 Health certificate – a written certification, using the prescribed form, and issued by the
municipal or city health officer to a person after passing the required physical and medical
examinations and immunizations.

SOLID WASTE MANAGEMENT

SWD – Solid Waste Diversion refers to activities that reduce, and possibly eliminate, the
potentially recyclable materials in the waste stream before they end up as added undesirable
matter on the land known as land pollution. This act to reduce the contamination of land supports
the work of the public health nurse in enabling the community to increase its level of wellness, as
it necessarily protects some of the health – supporting functions of land such as:
1. Platform for human activities: Polluted soil may be contaminated with disease causing
parasites and microbes.
2. Agricultural production: Alteration of soil composition can make the land unsuitable for
growing crops and threaten food security. Hazardous materials such as cadmium, lead and
mercury from disposed batteries and mine tailings can accumulate in the land and be
present in the harvested products.
3. Habitat of members of the food chain: As hazardous materials accumulate in the soil; they
affect the lower life-forms in a process called “bioaccumulation”. As these creatures in the
bottom of the food chain consumed by the more superior creatures, hazardous chemicals
increase in concentrations in the food chain in a process called “biomagnifications.” At
the top of the food chain, the human is at risk of consuming the hazardous materials.
4. Filter for surface water: Natural bodies of water and storm water percolate through the
layers of the soil until it finds its way to the ground water. Soil saturated with pollution
not only acts as a poor filter but may also contaminate the sleeping water.
Through the definitions used by Republic Act 9003 otherwise known as the “Ecological
Solid Waste Management Act of 2000” and the DOH Manual on Healthcare Waste
Management of 2011 a way by which solid wastes may be classified is a follow:

Municipal waste refers to all discarded non-hazardous household commercial and

institutional waste, street sweepings, and construction debris.
Health care waste (or biomedical wastes) refers to the refuse that is generated in the
diagnosis, treatment, or immunization of human beings or animals together with those
related to the production or research of the same. This can be classified as follows:
1. “Infectious wastes” refer to those suspected to contain bacterial, viral, parasitic, or
fungal pathogens in sufficient concentration so as to cause a disease in susceptible
hosts: These include, but are not limited to laboratory cultures, contaminated
wastes from clients with infectious disease and any other dressing, swabs,
instruments or materials that have been in contact with infected persons or
animals.
2. “Pathological wastes” refer to tissues, organs, body parts, human fetuses, animal
carcasses, and blood and body fluids. Within this category, recognizable human
aid animal body parts are also called anatomical waste.
3. “Pharmaceutical wastes” include pharmaceutical products such as drugs, vaccines,
and sera that are no longer required and need to be disposed of for any reason. This
category also includes disordered items used in handling of pharmaceuticals such
as bottles or boxes with residues, gloves, masks, connecting tubing and drug vials.
4. “Chemical wastes” include the varied states of chemical matter from clinical or
laboratory activities, environmental work, housekeeping and disinfecting
procedures. This subcategory has any of the five properties of hazardous wastes
and is therefore termed as “hazardous chemical wastes.”
5. “Sharps” include biomedical wastes that could cause cuts or puncture wounds.
Theses include, but are not limited to needles, broken glass and scalpels blades.
6. “Radioactive wastes” include sealed radiation sources typically used in cancer
treatments, liquid and gaseous materials contaminated with radioactivity and
excreta of patients who underwent radionuclide diagnostic and therapeutic
applications, together with the related paraphernalia and tap water washings.

Industrial waste refers to the refuse that arise from production and from agricultural and
mining industries. Aside from rubbish, industrial wastes can be mixed with contaminated
soil, ashes, and hazardous wastes.

Hazardous wastes are substances that pose either an immediate or long-term substantial
danger to human because of possessing any of the following properties:
1. Toxic
2. Corrosive such as acids of pH<2 and bases of pH>12
3. Flammable
4. Reactive such as those can cause explosions
 5. Genotoxic such as cytostatic drugs

The pathway of municipal solid waste (solid waste stream) begins with waste generation.
At this stage, waste reduction can be done though the reuse of materials. Materials that
cannot be used should be segregated in trash bins with color-coded and labeled linings so
that form of waste item could be managed accordingly.
 Black or colorless: Nonhazardous and nonbiodegradable wastes
 Green: nonhazardous biodegradable wastes
 Yellow with biohazard symbol: pathological/anatomical wastes
 Yellow with black band: Pharmaceutical, cytotoxic or chemical wastes (labeled
separately)
 Yellow bag that can be autoclaved: Infectious wastes
 Orange with radioactive symbol: Radioactive wastes
Public health officer should also keep in mind that the implementing Rules and
Regulations of Republic Act 9003 has declared the following as some of the prohibited
acts:
 Open burning solid wastes
 Open dumping
 Burying in flood – prone areas
 Squatting in landfills
 Operation of landfills on any aquifer, groundwater reservoir or watershed
 Construction of any establishment within 200 meters from a dump or landfill.

WATER SANITATION
The DOH had identified three levels of access to safe water supply and had set the
standards of the
Quality of drinking water through the DOH Administrative Order No. 2007-0012, otherwise
known as the Philippine National Standards for Drinking Water of 2007.
The general requirements of safe drinking water cover the following:
1. Microbial quality tested through the parameters of total coliform, fecal coliform, and
heterotrophic plate count.
2. Chemical and physical quality tested through the parameters of pH, chemical-specific
levels, color, odor, turbidity, hardness, and total dissolved solids.
3. Radiological quality tested through the parameters of gross alpha activity, gross beta and
radon.

DOH AO 2007 – 0012 directs all drinking water processors from large water systems to water
refilling stations to create a water safety plan. The three key components of water safety plans
include:
1. System assessment – to determine if the drinking water supply chain as a whole can
deliver water of quality that meets health-based targets.
 2. Operational monitoring – to identify control measures in a drinking water system that
will collectively control identified risks and ensure that the health-based targets are met
and to rapidly detect any duration from the required performance.
3. Management plans – to describe actions to be taken during normal operations or incident
conditions.

Other than the concern on the standards of the quality of drinking water. DOH has also produced
the Implementing Rules and Regulation of the Code Sanitation of the Philippines (P.D. 856)
Chapter II: Water Supply. Some of the provisions include:
1. Washing and bathing within a radius of 25 meters from any well or other sound of
drinking water is prohibited.
2. No artesians, deep, or shallow well shall be constructed within 25 meters from any source
of pollution (including septic tank and severe age systems). Drilling a well within 50
meters distance from a cemetery is also prohibited.
3. No radioactive source or material shall be stored within a radius of 25 meters from any
well or source of drinking water unless the radioactive source is adequately and safely
enclosed by proper shielding.
4. No dwellings shall be constructed within the catchment area of a protected spring water
source, and it shall be off limits to people and animals.

EMERGENCY WATER TREATMENT

Water that needs treatment during emergencies is the one that is used for drinking and
preparing foods. This
Is estimated to amount to about 5 liters per person per day. In 2011, the WHO published the
Technical Notes on Drinking Water, Sanitation, and Hygiene in Emergencies created by the
Water, Engineering, and Development Center (WEDC). It provides the following prescriptions
for emergency treatment of drinking water.

Pretreatment Processes:
 Aeration is done to remove volatile substances and oxidize dissolved minerals in
preparation for sedimentation and filtration. A method for aeration is to rapidly shake a
container that is partially full of water for about 5 minutes.
 Settlement is done by allowing water stand undisturbed in the dark for a day. This
process causes death to more than 50% of most harmful bacteria and settling of
suspended solids. Repetition of settlement in another container or pot increases the
effectiveness of the process, as water is made to settle for longer periods.
 Filtration is done by utilizing filters to block particles while allowing water to pass
through. Filters include clean cloth, sand and ceramics.

Disinfection Processes:
 Boiling, despite being energy consuming, is considered as a very effective method for
water disinfection. The water should be brought to a “rolling boil” and kept in that state
 for at least 1 minute at sea level. At higher altitudes, the water should be kept in a rolling
boil state for at least 3 minutes. This process causes the water to change taste.
 Chemical disinfection can be done using various chemicals but the most widely used
remains to be chlorine as it can kill all viruses and bacteria. However, some species is
available in various size and strength.
 Solar disinfection (SODIS) follows the principle that ultraviolet rays from the sun
destroy harmful organisms in water. This can be done by felling transparent plastic
containers 1 to 2 liters in size with clear water and exposing them to direct sunlight for
about 5 hours. If the skies are cloudy, the bottles are exposed for two consecutive days.

AIR PURITY

The first 11 kilometers of the atmosphere from the earth is the troposphere where we live in.
In this layer, the temperature profile is warmest at sea level and coolest at higher altitudes. Public
health nurses serving mountainous communities should keep in mind that these communities are
generally exposed to cooler weather. As the air gets cooler, the less water vapor it is able to
carry, the public health nurse should be sensitive to the rise of respiratory infections in these
communities as the moist “mucociliary blanket” protection of the airways could be interrupted
by the dry air.
The DENR AO 2000-81: Implementing Rules and Regulations for RA 8746 identified some
of the pollutants that should concern communities such as ozone-depleting substances,
chlorofluorocarbons, particulate matter that refer to any material that exists in a finely divided
form as a liquid or solid other than water and greenhouse gases that can induce global warming
such as carbon, dioxide, methane, and oxides of nitrogen, chlorofluorocarbons and fuel
components such as aromatics, benzene and sulfur.

 Stratosphere where the ozone layer is found. The stratosphere has an inverted vertical –
temperature profile, that is, it gets warmer as you increase altitude. As public health
nurses identify possible sources of air pollution, they should be aware of the two major
sources identified by the Clean Air Act, namely mobile and stationary sources.
 Mobile source refers to any vehicle/machine propelled by or through oxidation or
reduction reactions, including combustion of carbon-based or other fuel, constructed and
operated principally for the conveyance of persons or transportation of property or goods
that emit air pollutants as a reaction product.
 Stationary source refers to any building or fixed structure, facility or installation that
emit or may emit any air pollutant.

In the Philippines, the Air Quality Management Section of the DENR Environmental
Management Bureau (DENR-EMB) monitors air quality. It maintains 42 air quality – monitoring
stations nationwide, which measure the total suspended particulates (TSP). DENR-EMB acts as
the chairperson of the air management, whereas the Department of Transportation and
Communication (DOTC) acts as the vice chairperson.
 Several programs have been initiated to address air pollution:
Bantay Tsimineya Program that monitors point-source air pollution from industries.
Bantay Tambutso Program and Standard Setting that adopted Euro-II emission standards for
motorized vehicles. This program penalizes vehicles owners who fail to meet the set-standards.
Improved fuel Quality Program that phased out leaded gasoline and regulated the sulfur,
benzene and aromatic contents of fuels.
National Research and Development Program for the Prevention and Control of Air Pollution
whose development was directed by DENR Administrative Order 2000-81 to the DENR-EMB,
in coordination with the Development of Science and Technology (DOST)

The public health nurse is tasked to be both a nurse who advocates for the client
community, and a government officer who must assure that the rights of the people are protected.
People’s right to clean air has been clearly defined by the Republic Act 8749 also known as the
“Philippine Air Act of 1999.” Pursuant to the principles of the said law, following rights of
citizens are sought to be recognized:
1. The right to breath clean air
2. The right to utilize and enjoy all-natural resources according to the principle of
sustainable development.
3. The right to participate in the formulation, planning, implementation, and monitoring of
environmental policies and programs and in the decision-making process.
4. The right to participate in the decision-making process concerning development policies,
plans, and programs projects or activities that may have adverse impact on the
environment and public health.
5. The right to be informed of the nature and extent of the potential hazed of any activity,
undertaking or project and to be served timely notice of any significant rise in the level of
pollution and the accidental or deliberate release into the atmosphere of harmful or
hazardous substances.
6. The right of access to public records which a citizen may need to exercise his or her
rights effectively under this Act.
7. The right to bring action in court or quasi-judicial bodies to enjoin all activities in
violation of environmental laws and regulations, to compel the rehabilitation and clean-
up of affected area and to seek the imposition of penal sanctions against violators of
environmental laws.
8. The right to bring action in court for compensation of personal damages resulting from
the adverse environmental and public health impact of a project or activity.

TOXIC AND HAZARDOUS WASTE CONTROL

The country has several poison control centers nationwide, headed by the National
Poison Management and Control Center (NPMCC) based in the Philippine General Hospital
(PGH). The top causes of poisons are the following: jewelry cleaners (high in cyanide),
pesticides, button batteries, watusi firecracker, jatropha seeds, multivitamins, malathion and
xylene, camphor with methyl ASA and turpentine.
 Primary health care facilities should be capable of following the WHO recommendations
on essential symptomatic and supportive treatment of acute poisoning. Health care workers and
trained volunteers should wear personal protective equipment (PPE) to evacuate victims from the
contaminated environment. In the event of skin contamination, the clothing is removed, and the
skin is washed with the appropriate fluid. Interventions that may be considered thereafter include
gastric aspiration and lavage of adults, induced emesis of children, administration of high dose of
activated charcoal into the stomach, and administration of protective agents such as:
 Atropine for carbonate and organophosphate pesticides
 Methylene blue for chlorates and nitrates
 Acetylcysteine or methionine for paracetamol overdose
 Hydroxocobalamin or sodium thiosulfate for cyanide in silver cleaners.

FOOD SAFETY

The NEHAP defined food safety as the assurance that food will not cause any harm to the
consumer when it is prepared and eaten according to its intended use. To gear toward the food
safety, the DOH formed an interagency committee that is led by the Food and Drug
Administration (FDA). In 2009, Republic Act 9722 was enacted and is now known as the Food
and Drug FDA in safeguarding the safety and quality of processed foods, drugs, diagnostic
reagents, medical devices, cosmetics, and household substances.
The DOH has published the implementing Rules and Regulations of Chapter III of P.D.
856 to define the sanitation requirements for the operation of a food establishments.
The food establishment must have a sanitary permit from the city or municipality that has
justification over the business. The permit must be posted in a conspicuous place in the
establishment, available for inspection by health and other regulatory personnel.
The implementing rules state that no person shall be employed in any food establishment
without a health certificate properly issued by the city/municipality health officer. This must be
clipped on the upper left front portion of the garment of the employee while working. No person
shall be allowed to work on food handling if inflicted with a communicable disease, including
boils, infected wounds, respiratory infections, diarrhea and gastrointestinal upset.
The food preparation and storage rooms should never be used or be directly connected to
a sleeping apartment or a toilet. No animals can be kept in the food areas. The display of any live
animal in the food area is strictly prohibited. Floor, walls, and ceilings must be made of materials
that can be cleansed. The rules have set standards for the adequacy of lighting, sufficiency of
ventilation, and minimum space requirements. It requires hand washing basins, appropriate toilet
facilities, water supply, and refuse management systems.
Utensils must be scrapped from all food particles and be washed in warm water (49℃)
with soap. If running water is not available, the wash water shall be changed frequently, the
utensils are then subjected to one of the following bactericidal treatments.
1. Immersion for at least 30 seconds in clean hot water (77℃)
2. Immersion for at least 1 minute in lukewarm water containing 55-100 ppm of chlorine
solution
 3. Exposure to steam for at least 15 minutes to 77℃, or for 5 minutes to at least 200℃

It shall be the duty of the Sanitation Inspector of the city, municipality, or province to
perform an inspection and evaluation of the compliance of food establishments to the set
standards at a frequency specified by the implementing rules and regulations.

SANITATION

The Philippines Sanitation Sourcebook and Decision Aid developed by the DENR, the
DOH, and the Local Water Utilities Administration (LWUA) in 2005 limited the definition of
sanitation to the “hygienic and proper management, collection, disposal, or reuse of human
excreta (feces and urine) and community liquid wastes to safe guard the health of individuals and
communities.” This is proof of the development of the arts and sciences involved in the various
fields of sanitation, that is, a singular code on sanitation such as the Presidential Decree 856: The
Code on Sanitation of The Philippines of 1976 may need to be revisited and updated to provide a
more comprehensive coverage to this growing discipline.
In 2006, the Sanitation and Hygiene Programming Guidelines developed the F-Diagram
that proposed the 6 Fs that from part of the means to transmit microorganisms in fecal materials
to a new host, namely, feces, fingers, fluids, flies, fields/floors, and food. It featured the primary
and secondary barriers that public health practice could implement to prevent the transmission of
the pathogens.
 Primary barriers are the structures and facilities that prevent the fecal contamination of
finger, fluid, flies and fields/floors.
 Secondary barriers are practices that prevent contaminated fingers, fluids, flies,
fields/floors from coming in contact with food or the new host. Secondary barriers
include, but are not limited to handwashing practices, insect and vermin control, water
treatment, and proper food handling.
Sanitation facilities generally have four components, namely, toilet, collection, treatment and
disposal/reuse. The toilet could either be a receptacle (bowl) where the user sits down or a
squatting plate. Collection systems, also known as sewerage systems, transport the
wastewater for treatment or disposal.
The implementing Rules and Regulations of the Sanitation Code of the Philippines
developed by the DOH describes three components of a sanitary privy, namely:
- Earthen pit (1m² wide)
- A floor covering the pit
- Water-sealed bowl

The following are some of the sanitation facilities that a nurse or sanitation officer may
encounter in the community:
 Box-and-can privy (or bucket latrine): Fecal matter is collected in a can or bucket,
which is periodically removed for emptying and cleaning.
 Pit Latrine (or pit privy): Fecal matter is eliminated into a hole in the ground that
leads a dug pit. Generally, a latrine refers to toilet facilities without a bowl.
 Antipolo toilet: It is made up of an elevated pit privy that has a covered latrine. The
elevation ensures that the bottom of the pit is at least 1.5 meters above the water table.
 Septic privy: Fecal matter is collected in a built septic tank that is not connected to a
sewerage system. The septic tank contains water but there is no drip pipe from the
latrine that is dipped into the water.
 Aqua privy: Fecal matter is eliminated into a water-sealed drop pipe that leads from
the latrine to a small water-filled septic tank located directly below the squatting
plate.
 Overhung latrine /: Fecal material is directly eliminated into a body of water such as
a flowing river that is underneath the facility.
 Ventilated-improved pit (VIP) latrine: It is a pit latrine with a screened air vent
installed directly over the pit. The ambient air that enters the pit hole pushes the foul
air onto the air vent. The screen on top of the vent prevents entry of insects attracted
by the smell. Filled pits are then covered with soil for composting, and the facility is
redirected or relocated to another pit.
 Concrete vault privy: Fecal matter is collected in a pit privy live with concrete in
such a manner to make it watertight.
 Chemical privy: Fecal matter is collected into a tank that contains a caustic chemical
solution, which in town controls and facilitated the waste decomposition.
 Compost privy: Fecal matter is collected into a pit with urine and anal cleansing
materials with the addition of organic garbage such as leaves and grass to allow
biological decomposition and production of agricultural or fishpond compost (or
night soil)
 Por-flush latrine: It has a bowl with a water-seal trap similar to the conventional
tank-flush toilet except that it requires only a small volume of water for flushing.
Feces at the water-sealed trap are washed-off by small quantities of water hand-
poured from a container.
 Tank-flush toilet: Feces are excreted into a bowl with a water-sealed trap. The water
tank that receives a limited amount of water empties into the bowl for flushing of
fecal materials through the water-sealed trap and into the sewerage system. The trap
retains an amount of the flush to maintain the water seal.’
 Urine diversion dehydration toilet (UDDT): It is a waterless toilet system that allows
the separate collection and in-site storage or treatment of urine and feces. The site
could be made up of a urine separation toilet with the urine side leading to a
collecting container for agricultural use and the fecal side leading to a ventilated
vault. The fecal vault is kept “dry” and the feces are left to dehydrate for agricultural
use.

In 2010, the DOH published the Philippine Sustainable Sanitation Roadmap and defined
the three sanitation facilities that are considered sanitary under the DOH and National
Statistics Office (NSO) definitions:
 1. Water-sealed toilet connected to a sewer or septic tank, used exclusively by the
household.
2. Water-sealed toilet connected to other depository type, used exclusively by the
household.
3. Closed pit used exclusively by the household.

Unsanitary facilities:
1. Water-sealed toilet connected to a sewer or septic tank, shared with other households.
2. Water-sealed toilet connected to other depository type, shared with other households.
3. Closed pit shared with other households.
4. Open pit
5. Hanging toilet
6. Other unsanitary types of practice
7. Open defecation

VERMIN AND VECTOR CONTROL

Vermin Control of the Code Sanitation of the Philippines (P.D. 856).

 Vermin: A group of insects or small animals such as flies, mosquitoes, cockroaches, fleas,
lice, bedbugs, mice, and rats, which are vectors of diseases.
 Insects: Flies, mosquitoes, cockroaches, bedbugs, fleas, lice, ticks, ants, and other arthropods.
 Pest: Any destructive or unwanted insect or other small animals (rats, mice, etc.) That causes
annoyance, discomfort, nuisance, or transmission of disease to humans and damage to
structures.
 Rodent: Small mammals such as rats and mice, characterized by constantly growing incisor
teeth used for growing or nibbling.
 Vector: Any organism that transmits infection by inoculation into the skin or mucous
membrane by biting or by deposit of infective materials on skin, food, or other objects or by
biological reproduction within the organism.

The DOH outlined the various vermin control and disinfestation methods, which include:
 Environmental sanitation control: The maintenance of cleanliness of the immediate
premises and proper building construction and maintenance so as to prevent access of pets
into human dwellings.
 Naturalistic control: A pest control method that utilizes nature and nature’s systems without
disturbing the balance of nature.
 Biological and genetic control: A method that utilizes living predators, parasites and other
natural enemies of the pest species to reduce or eliminate the pest populations. It is aimed at
killing the larvae without polluting the environment.
 Mechanical and physical control: A method that utilizes mechanical devices such as rodent
traps, fly traps, mosquito traps, air curtain, and ultraviolet light.
 Chemical control: A method that utilizes rodenticides, insecticides, larvicides, and
pesticides.
  Integrated control: A method that control pests through the use of different methods and
procedures that are used to complement each other. Those procedures may include the use of
pesticides, environmental sanitation measures, and natural, as well as mechanical and
biological control methods.

BUILT ENVIRONMENTS

Built environment refers to the man-made structures that provide a setting for human
activities. In the Philippines Presidential Decree Number 1096 (P.D. 1096) also known as the
Natural Building Code of the Philippines governs the design of built environments. Some of the
provisions enacted to protect public health are as follows:
 Minimum air space shall be provided as follows:
 School rooms – 3.00 m³ with 1.00 m² of floor area per person.
 Workshops, factories, and offices – 12.00 m³ of air space per person.
 Habitable rooms – 14.00 m³ of air space per person.
 Minimum sizes of rooms and their least horizontal dimensions shall be as follows:
 Room for human habitations – 6.00 m² with a least horizontal dimension of 2.00
m.
 Kitchen – 3.00 m² with a least horizontal dimension of 900 mm.
 Ceiling height of habitable rooms:
 Rooms provided with artificial ventilation shall have ceiling heights not less than
2.70 m (9ft)
 Mezzanine floors shall have a clear ceiling height not less than 1.80 m above and
below it.
 Minimum window sizes:
 Rooms intended for any use, not provided with artificial ventilation system, shall
be provided with a window or windows with a total area of openings equal to at
least 10% of the floor area of the room.
 Toilet and bathrooms, laundry rooms, and similar rooms shall be provided with
window or windows with an area not less than ½ of the floor area of such rooms,
provided that such opening shall not be less than 240 mm²
 Such window or windows shall open directly to a court, yard, public street, or
alley, or open water course.

SUMMARY

Public health nurses in the Philippines maintain a record of indicators of environmental

health in the country, particularly that of sanitation, safe water access, solid waste management,
and food safety. It is necessary that the nurse becomes aware of the various effects of solid
waste, water, air, toxic and hazardous wastes, food safety, sanitation and vermin control on
human health. In the management of these, the nurse must be guided by the various laws,
standards, and implementing rules and regulations that govern each.