Professional Documents
Culture Documents
General Hygiene
General Hygiene
EDUCATIONAL INSTITUTION
«GRODNO STATE MEDICAL UNIVERSITY»
I.A. Naumov
E.A. Moiseenok
S.P. Sivakova
T.I. Zimatkina
GENERAL HYGIENE
Training manual
for the Faculty of Foreign Students
(English medium)
Grodno 2013
3
PREFACE
The training manual «General Hygiene» is made with the purpose of
adaptation of the educational materials stated in textbooks on General
Hygiene to the program of teaching General Hygiene in the Republic of
Belarus and simplification of self-preparation of the foreign students for
forthcoming practical classes and more successful development of practical
skills. The present training manual includes basic questions of General
Hygiene as medical science and covers main topics of Nutritional Hygiene,
Hygiene of Healthcare Institutions, Occupational Hygiene and Hygiene of
children and adolescents.
The manual is intended for the foreign students of medical
educational institutions with the education in the English language.
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1. THE PLACE OF HYGIENE IN THE SYSTEM OF MEDICAL
SCIENCES AND PROTECTION OF THE POPULATION HEALTH
HYGIENE -
a branch of preventative medicine which studies the influence of the
environment (living, working, studying, etc.) on human health, working
performance and life expectancy and creates the measures of prevention of
the diseases and providing optimal environment, preserving health and
active longevity.
5
The relationship "biological-social"
social environment
Food
Clothes
Housing
Ecology
Technology
Nature Biology
Climate Physiology
6
Physical
development
communicative
competence
Health
7
Risk factors – potentially dangerous factors for health; behavioral,
genetic, ecological, social factors raising probability of the diseases, their
progress and unfavorable upshot.
Direct Indirect
Identification of harmful
1 (dangerous) factor 6
Rating (justification) of
acceptable risk
Identification of adverse events (including legal requirements)
associated with detection
2
of harmful factor
7
Assessment of risk associated
with hazardous
Estimation of the (dangerous) factor
probability (P) (is a risk assumed?)
3 of undesirable events
5
The calculation of risk
Assessment of potential
(Р * С)
losses (С), associated with
4
the onset of adverse events
8
Risk factors in the external medium.
Physical
Chemical
Biological
Psycho-
physiological
Social
9
Structure of hygiene.
10
Determining the contribution of the factors in health disorders of the
individuals, groups of people and hypersensitive subgroups.
11
Modern physico-chemical methods include: spectrophotometry,
radiometric, dosimetry, luminescent analysis, etc.
Biological methods – bacteriological and helminthological.
Epidemiological method – while studying the indices of the morbidity, it
relates to sanitary-statistic – use of official information from reports and
monitoring documents.
Clinical studies - in pre-nosological diagnostics, for studying the
professional pathology and developing adequate methods of treatment and
prevention.
Method of hygienic experiment allows to investigate the influence of
various factors on organisms of humans and experimental animals.
Laboratory modelling is used for experimental establishing of maximal
permitted concentrations and levels, guide safe levels of impact, and other
indices called hygienic standards.
12
Aims of hygiene
harmoniously
developed
socially adapted
Healthy
Culture Health protection social welfare
PREVENTION
is a complex of state, social and medical measures aiming to preserve and
strengthen population health, to grow up healthy young generation, and to
extend the active longevity.
13
Tertiary prevention (rehabilitation) aims to prevent the complications
and recurrence of already existing diseases, and their transformation into
chronic forms.
14
Sanitary supervision and sanitary control.
16
Hygiene, sanitary departments and subdivisions of the Ministry of
Defence, Ministry of Internal Affairs, railway and air fleet.
USA
Australia
UK
Canada
18
2. HYGIENIC PROBLEMS OF NUTRITION
It consists of 2 parts:
•Hygienic problems of nutrition in different groups of population;
•Hygienic problems of food resources protection and providing safety of
food and food products.
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TYPES OF NUTRITION:
•Rational nutrition (balanced, correct, scientifically justified, optimal,
adequate).
•Clinical nutrition.
•Preventive nutrition.
Rational nutrition –
is a nutrition of a healthy individual, aiming to prevent alimentary, cardio-
vascular, allergic, stomach, bowel and other diseases.
Energetic value of the daily ration should match the energy requirements
of the organism;
Physiological requirements of organism should be supplied with nutrients
in the most useful amounts and proportions;
Chemical structure of the food should correspond enzyme and digestive
systems of the organism;
Food consumption should be distributed correctly throughout the day;
Food should not possess risks for health.
Dietary sources
The optimum ratio of protein, fat and carbohydrate
(by weight) in a daily ration is 1:1:4
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Quality side of physiological requirements shows:
•How much of proteins, fats, carbohydrates, vitamins, mineral substances
should the ration contain;
•The ration of these components, as this may influence their digestion;
•What kinds of food products should supply the particular components of
food.
22
3. HYGIENIC CHARACTERISTICS OF MACRO- AND
MICRONUTRIENTS
23
Substances that provide energy
Carbohydrates are compounds made up of sugars. Carbohydrates
are classified by their number of sugar units: monosaccharides(such
as glucose and fructose), disaccharides (suchas sucrose and lactose), oligos
accharides, and polysaccharides (such as starch, glycogen, and cellulose).
Proteins are organic compounds that consist of the amino acids
joined by peptide bonds. The body cannot manufacture some of the amino
acids (termed essential amino acids); the diet must supply these.
In nutrition, proteins are broken down through digestion by proteases back
into free amino acids.
Fats consist of a glycerin molecule with three fatty acids attached.
Fatty acids are unbranched hydrocarbon chains, connected by single bonds
alone (saturated fatty acids) or by both double and single bonds
(unsaturated fatty acids). Fats are needed to keep cell
membranes functioning properly, to insulate body organs against shock, to
keep body temperature stable, and to maintain healthy skin and hair. The
body does not manufacture certain fatty acids (termed essential fatty acids)
and the diet must supply these.
Dietary
RDA Category Insufficiency Excess
element
25
is a systemic electrolyte and is
essential in coregulating ATP with
1500 potassium. Dietary sources include hyper
Sodium hyponatremia
mg table salt (sodium chloride, the natremia
main source), sea vegetables, milk,
and spinach.
2.3 manganese
Manganese is a cofactor in enzyme functions. manganism
mg deficiency
Other elements
Many elements have been suggested as essential, but such claims
have usually not been confirmed. Definitive evidence for efficacy comes
from the characterization of a biomolecule containing the element with an
identifiable and testable function. One problem with identifying efficacy is
that some elements are innocuous at low concentrations and are pervasive,
so proof of efficacy is lacking because deficiencies are difficult to
reproduce.
27
Vitamins
Recommended
Vitamin
dietary
generic Vitamer chemical Deficiency Overdose
allowances
descript name(s) disease disease
(male, age 19–
or name
70)
Retinol, retinal,
Night-blindness,
Vitamin four carotenoids Hypervitamino
900 µg Hyperkeratosis,
A including beta sis A
Keratomalacia
carotene
Drowsiness or
Beriberi, Wernick
Vitamin muscle
Thiamine 1.2 mg e-Korsakoff
B1 relaxation with
syndrome
large doses.
Vitamin
Riboflavin 1.3 mg Ariboflavinosis
B2
Liver damage
Vitamin Niacin, (doses >
16.0 mg Pellagra
B3 niacinamide 2g/day) and
other problems
29
Diarrhea;
Vitamin
Pantothenic acid 5.0 mg Paresthesia possibly nausea
B5
and heartburn.
Impairment of
Pyridoxine, proprioception,
Vitamin Anemia periphera
pyridoxamine, 1.3–1.7 mg nerve damage
B6 l neuropathy.
pyridoxal (doses >
100 mg/day)
Megaloblast and
Deficiency during
May mask
pregnancy is
Vitamin Folic acid, folinic symptoms of
400 µg associated with
B9 acid vitamin
birth defects, such
B12deficiency.
as neural
tube defects
Acne-like rash
Cyanocobalamin,
Vitamin Megaloblastic [causality is not
hydroxycobalamin, 2.4 µg
B12 anemia conclusively
methylcobalamin
established].
Vitamin Vitamin C
Ascorbic acid 90.0 mg Scurvy
C megadosage
30
E tocotrienols mild hemolytic heart failure
anemia in seen in one
newborn infants. large
randomized
study.
Increases
Vitamin phylloquinone, coagulation in
120 µg Bleeding diathesis
K menaquinones patients taking
warfarin.
31
4. NUTRITION REQUIREMENTS FOR DIFFERENT GROUPS OF
POPULATION AND THEIR PHYSIOLOGICAL BACKGROUND
33
2 group – workers of light physical load
•Engineering and technical work requiring some physical efforts, workers
of automated lines, radio-electronic industry, servicing personnel, traders,
workers of sewing industry, veterinary doctors, zootechnitians,
agronomists, medical nursing staff, physical training instructors and
trainers.
•CPA = 1.6
•Daily energy requirements vary from 2100 to 2200 kcal for women,
from 2500 to 2800 kcal for men.
34
Special features of nutrition for intellectual work employees and
students.
Food quality.
quality of food
Proteins The main building blocks of cells
Macroelements
Vitamins
Serve as body energy reserve
Fats
Microelements
Nutritional value.
37
Food safety.
Safety – a complex of raw food ingredients, food products and
prepared food properties, due to which they are harmless and do not
possess any danger to life and health of current and future generations
under usual conditions of use.
The following are determined to detect food safety :
Degree of harmless;
Signs if spoilage/ damage.
Certification of quality and safety
Critical control point – stage of manufacturing or trade, when laboratory
technological control can be used.
INFORMATION about the quality and safety of raw food and food
products can be placed on marking, label, pimple, etc. And should include:
Name of the product.
Reference to the legal document determining the requirements to quality
and safety.
Information about genetically modified ingredients / supplements.
Date of manufacture (expiry date, shelf life time).
Additional information about preventive properties of products is allowed
if relevant permission obtained from the Ministry of Healthcare of the
Republic of Belarus.
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5. HYGIENIC BASICS OF THE CLINICAL AND PREVENTIVE
NUTRITION
39
Main preventive nutritional factors – Vitamins and Minerals
•antioxidants (vitamins A, E, C) fight free radicals,
•increase body resistance,
•increase functional capacity of the organs (iron, calcium, magnesium).
40
Characteristics of the preventive diets:
Diet # 5
is administered in chemical industry - production of carbon disulfide,
acetaldehyde, and phosphoric poisonous chemicals. Contains eggs, PUFA
(seed oil), vitamin B1 and full value animal proteins for nervous system
and liver protection. Additionally – 150 mg of ascorbic acid, 4 mg of
vitamin B1.
Vitamin supplement
provided for individuals working in hot environment (smelt and
rolling metal, glass manufacture, bakery): Vit A 2 mg, Vit B1 3 mg, Vit
B2 3 mg , Vit PP 20 mg and Vit C 150 mg,
workers at tobacco and nicotine manufactures – Vit B1 2 mg and Vit
C 150 mg.
Milk
provided daily during the working days, 0.5 l per day,
may be replaced with soured milk, kefir or colibacter (in antibiotics
manufacturing).
42
Indications:
Diseases of the digestive system, requiring the appointment of a diet
with mechanical and chemical sparing. The period after the operations on
the internal organs.
Chemical content:
Protein - 85-90g (including animal - 40-45g).
Fat - 79-80g (including vegetable - 25-30g).
Carbohydrates - 300-350g, including mono-and disaccharides (50-
60g).
Energy value: 2170-2480 kcal.
A diet with high protein and calorie content - Diet T (High-protein and
high-calorie)
A diet with a high content of proteins, fats and carbohydrates. Meals
are cooked as boiled, stewed, baked form. Temperature of dishes - from 15
to 60-65 ° C. Free fluid - 1.5 l. Sodium chloride – 15g. Meals 4-6 times a
day.
Indications:
Tuberculosis of the lungs. Burn disease.
Chemical content:
Proteins - 110-130 g (including animal - 70-80 g).
Fat - 100-120 g (including plant - 20-30 g).
Carbohydrates - 400-450 g
Energy - 3000-3400 kcal.
Vitamin C - 70 mg.
44
6. NUTRITIONAL AND BIOLOGICAL VALUE OF THE PRINCIPAL
FOODS
Milk proteins:
•are easily absorbed,
•contain all essential amino acids,
•casein milk (75% and more of casein) – cow, goat,
•albumin milk (50% and less of casein) – mare milk.
Milk fats:
•triglycerides (98.2-99.5% of all fats),
•phospholipids,
•free fatty acids,
•sterols.
45
Nutritive value of cow milk:
Proteins 2.5-4.8 %
Fats 0-6 %
Carbohydrates 4-5,6 %
Water 83-89 %
46
Meat products are important as a source of:
•full-value proteins;
•easily absorbed Fe;
•Zn;
•Vitamins group B, including B12.
•Limitation: some meat products contain high amounts of the saturated
animal fats.
Composition of meat:
•muscle tissue (lysine, actin, globulin, myoglobin),
•fatty tissue (saturated fats),
•connective tissue (collagen, elastin),
•blood,
•bones.
47
Nutritive value of meat:
Proteins 11-21 %
Fats 8-19 %
Carbohydrates only in fresh meat,
about 1%
Vitamins and minerals about 2 %
Extractive substances about 1 %
Water 68-74 %
Energy value (beef) 218 kcal/ 100 g
Trichinosis
•results from eating raw or inadequately cooked or processed pork or pork
products (rarely, meat of wild animals, especially bears), containing
encysted larvae (trichinae).
Sanitary inspection
•includes microscopic analysis of the meat samples.
•The samples of diaphragm, tongue, pectoral and intercostal muscles are
taken for the analysis.
•The detection of 1 trichinae in 24 samples or > 3 cysts of Taenia in 40 sm2
results in the utilization of the meat.
48
Nutritional properties of poultry:
•it contains less connective tissue;
•muscle tissue does not contain much fat;
•proteins contain all the essential amino acids;
•fats contain unsaturated fatty acids;
•there are more extractive substances (up to 10%), especially in wild birds.
Fish
•Rich in proteins with good biological value.
•Satisfactory amino acid balance.
•Sea fish is a rich source of iodine and iron.
•The fat of fish is rich in unsaturated fatty acids, especially ω-3 group and
A and D vitamins.
49
Limitation: Fish has low appetite saturation and cannot be consumed
every day.
• The adult worm has several thousand proglottids and measures 4-9 m
in length.
• Eggs are released from the proglottid in the intestinal lumen. As the
egg hatches in fresh water, it releases the embryo, which is eaten by
small crustaceans. They may, in turn be ingested by fish.
• Humans are infected by eating raw or undercooked infected fish.
• Prevention: all freshwater fish should be thoroughly cooked or frozen
at -10 ˚C for 48 h.
Eggs
Water 74 %
Energy value 157 kcal/ 100 g
•There are almost no limitations for the cereals consumption if no fat and
sugar are added.
51
Nutritive value of wheat:
Proteins 6-10 % deficient for the
essential amino acids
Fats About 1 %
Carbohydrates 45-50 %
Vitamins and minerals About 1 %
Water 30-40 %
Energy value 330 kcal / 100 g
Proteins 2-3 %
Fats absent
Carbohydrates 20-30 %
Vitamins and minerals About 1 %
Water 70-95 %
Energy value 10-80 kcal/ 100 g
52
Fats and oils.
•vegetable oils,
•mayonnaise.
•Butter,
•animal fats.
53
7. HYGIENIC ASSESSMENT OF THE NUTRITIONAL STATUS
56
the contribution of "non-food" consumption (such as betel
nut, laundry starch, and vitamin and mineral supplements) to
total nutrient consumption.
59
The decreased status is characterized by fat quantity in a body 9-
12% or BMI from 18,5 up to 20,0 kg/m2. It can be caused by the
constitutional and adaptable features of the organism, an inadequate
nutrition, physical and nervous-and-emotional loadings. Preservation of
functional adaptable organism opportunities or their insignificant reduction
at inadequate nutrition take place.
People concern to the increased nutritional status with a fatty
component of body from 18 up to 21% (BMI - 25,0-27,5 kg/m2). Such
status is formed as a result of consumption of diets, at which energy
expenses of organism less then consumption. Essential changes of
functional and adaptable opportunities are not marked, though some
reduction takes place.
The insufficient nutritional status arises at quantitative or
qualitative inadequacy of nutrition, and also at reduction or full
impossibility of nutrients assimilation. Therefore the body structure,
functional both adaptable reserves and opportunities of organism can be
broken. Persons with such nutritional status (fat content in organism less
than 9%, BMI - not less than 18,5 kg/m2) are subject for medical inspection
and treatment. The insufficient nutritional status is subdivided on pre-
morbid (latent) and morbid.
Pre-morbid status is characterized by occurrence of microsymptoms
of nutrient’s insufficiency, deterioration of functions of the basic physical
systems, decrease of the general resistency and adaptable processes even in
usual conditions of vital activity. Morbid or the painful status is
characterized not only functional and structural infringements, but distinct
syndrome of nutrient insufficiency development.
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8. ALIMENTARY (NUTRITIONAL) DISEASES AND FOOD
POISONING
Alimentary anemia:
•Fe-deficient anemia.
•Other (vitamin B6, B12, folate-deficient).
Exogenous reasons:
•natural disasters,
•catastrophes,
•wars,
•voluntary starvation.
Endogenous reasons:
•Anorexia,
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•impaired digestion,
•disordered absorption,
•endocrine dysfunction,
•prolonged infections,
•surgical procedures,
•malignant tumors.
3 degrees of severity:
•Mild. Carbohydrates and fat are utilized. Hunger.
•Moderate. Body weight loss. Biochemical changes (protein catabolism,
electrolyte depletion, anemia).
•Severe. Total body fat loss. Anorexia. Muscular atrophy. Mental
disorders.
Prevention:
•Public – to provide with sufficient quantity of food.
•Individual – medical treatment.
A diet with excessive non protein calories from starch or sugar, but
deficient in total protein and essential amino acids results eventually in
Kwashiorkor. This is a disease of children aged 1-5 years in rural Africa.
Kwashiorkor is characterized by
•generalized edema,
•``flaky paint`` dermatosis,
•thinning and decoloration of the hair,
•enlarged fatty liver,
•retarded growth,
•generalized infections.
Etiology:
•imbalanced diet and low physical activity;
•genetic and developmental factors;
•social factors;
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•endocrine and metabolic factors;
•psychological factors and brain damage.
Toxic type
•bacterial (Staph. aureus, Cl. botulinum),
•Mycotoxicosis (toxin-producing moulds Aspergillius, Fusarium,
Penicillium, Claviceps purpurea).
Prophylactic measures:
•Prevention of food contamination.
•Prevention of bacterial reproduction in food.
•Sufficient thermal treatment of food to kill bacteria.
Prophylaxis
•Careful food preparation is essential to prevent these episodes. People
with Staphylococcal diseases should not prepare food.
•Prevention of bacterial reproduction in food.
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•Veterinary control of animals.
Prophylactic measures
•Proper home and commercial canning and adequate heating of home-
canned food before serving are essential.
•Canned foods showing any evidence of spoilage should be discarded.
•Anyone known or thought to have been exposed to contaminated food
must be carefully observed.
Mycotoxicosis
•gangrene and convulsions (ergotism),
•renal disease (Balkan nephropathy),
•liver cancer (aflatoxicosis).
Classification:
•Food poisoning of plant origin.
•Food poisoning of animal origin.
•Mushroom poisoning.
•Chemical poisoning.
64
Red kidney beans
•A number of toxic substances can be extracted from the beans, but current
evidence suggests that the haemagglutinin component is probably
responsible for diarrhea and vomiting. Much of this substance is leached
out by soaking beans for several hours, and thorough cooking will render
them safe.
Solanine
•Potatoes that are left to sprout or that are exposed to sunlight in such way
that the skin surface becomes green, will accumulate the alkaloid solanine
in skin and just below the surface. Peeling and washing will render them
safe, but jacket potatoes have caused some cases of poisoning.
Ciguatera poisoning
•can occur after ingestion 400 species of fish from the tropical reefs
where dinoflagellate supplies a toxin that accumulates in the marine
animals flesh. The fish flavor is unaffected and any processing procedures
are not protective.
Histamine poisoning
(scombroid fish)
•from tuna, skipjack and mackerel and, occasionally, herring and sardine
may become contaminated with spoilage organisms, which can convert the
amino acid histidine in the tissue to histamine.
Tetraodon poisoning
•from the puffer fish causes similar symptoms and signs, death may result
from respiratory paralysis.
Mushroom poisoning
•A. pantherina (false blusher)
65
•A. muscaria (fly agaric)
•A. phalloides (death cap)
•A. virosa (destroying angel)
Prophylactic measures:
•Collect only known mushrooms.
•Adults should control children in collecting mushrooms.
•Only sorted mushrooms can be sold.
•Products in which mushrooms are cut and mixed can`t be sold.
Chemical poisoning
•may follow ingestion of unwashed fruits and vegetables sprayed with
arsenic, lead, or organic insecticides; liquids served in lead-glazed pottery;
or food stored in cadmium-lined containers.
Pesticides
•These substances are used to control pests of various kinds on wheat
seeds, fruit trees and vegetables. If ingested they are absorbed and
particularly affect the CNS. Mortality is about 8%.
Metals
•Mercurials discharged into the sea may be taken up by fish and cause
nephritis and CNS damage in people who ate them. Zinc leached from
galvanized pans when acid materials, such as fruit, are boiled in them is
toxic and causes acute abdominal symptoms.
Stage 3:
•Decryption of the food poisoning mechanism.
Stage 4:
•Dangerous food utilization.
•Infection source isolation.
•Object disinfection.
•Bacteria reproduction prevention.
Stage 5:
Compilation of the food poisoning investigation Act.
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9. HYGIENIC REQUIREMENTS FOR THE NUTRITION PROVISION
UNITS AND CATERING IN HOSPITALS
Storage facilities:
•freezing chambers (to store meat, fish, milk),
•storerooms (to store vegetables, flour, sugar, cereals).
Working area:
•vegetable processing room,
•meat processing room,
•fish processing room,
•kitchen or cookroom.
Personnel facilities:
•checkroom,
•shower,
•lavatory,
•personnel`s dayroom,
•offices.
Service space:
•washing chamber,
•daily food storeroom.
69
Qualitative characteristics of the equipment materials fitness:
•should be harmless;
•taste property should not be worse;
•should have smooth surface;
•should provide with reliable protection against contamination;
•simple and effective treatment.
It is prohibited:
•to admit products with expired date of realization;
•to admit some kinds of the products (duck and goose eggs);
•to keep uncooked products together with cooked meal;
•to keep spoiled products;
•to keep inedible materials together with food.
70
Cooking process consists of:
•primary processing;
•intermediate food processing (cold processing);
•thermal processing;
•cooked meal realization.
Catering in hospitals.
Head physician, General supervision
deputy head physician
Division Nutrition control in the
superintendent hospital departments
Dietarian, dietary nurse Medical and scientific
basics, direct
manufacturing
inspection
Assistant manager Providing with
products, equipment,
direct personnel’s
control
Catering in hospitals.
Doctor Prescribes the patient
clinical diet
Head nurse Arranges nutrition
orders
Dietary nurse Arranges bill of fare
based on nutrition
orders
Nutrition unit personnel Cooks the meal
73
10. HYGIENIC REQUIREMENTS FOR HEALTHCARE
INSTITUTIONS (HCI) PLACEMENT.
SITUATION AND GENERAL CONSTRUCTION PROGRAMMES
74
Territories of HCI should be located away from:
railways, airports, motorways - sources of noise, vibration and other
physical factors;
industrial plants, sewage and hard waste treatment – sources of
atmospheric air pollution;
major sportive complexes – CROWDED PLACES (noise and biological
factors, risk of terrorism).
75
Nature and climate factors:
Following climate factors have to be considered:
•Air temperature,
•Humidity,
•Predominant winds,
•Solar radiation,
•Local relief.
Air temperature
•Long-term data on a year average temperature, absolute minimal and
maximal temperatures are to be taken into account.
•Temperature characteristics are necessary for making a decision on depth
of foundation, thickness of walls, planning of heating, etc.
Humidity
Humidity has to be assessed together with precipitations,
nebulosity and fogs, because all these factors sufficiently affect the
following:
diversion of storm rainfall,
possibility of flooding in some areas,
dispersion of pollutions, getting in atmospheric air.
Value of hydrological factors:
Hydrological factors - water sources and level of subsoil waters.
•Water sources are used for household, drinking and healthcare purposes.
•Level of subsoil waters shows the probability of flooding and water
logging of the territory.
Planting of greenery
Value of green plants:
•changes in microclimate,
•noise reducing effect,
•protection against wind,
•protection against dust,
76
•ability of some species to absorb gases, vapors and bacterial dredges,
•production of essential oils, wood resins.
Local relief:
•Influences conditions of insolation (solar irradiation of Earth surface).
All buildings, places on south side of a hill receive more solar radiation
than those in areas with a horizontal surface. Northern sides of hills receive
the least amount of heat.
•Calm relief providing conditions for drainage of atmospheric
precipitations is the most favourable. Incline should be within the limits of
1- 5 %. Incline up to 10 %, is permitted on short parts only.
•Treating, diagnostic, utility and auxiliary premises are located in the same
building.
•This system is the most compact and economical one.
77
•Although it is difficult to provide treating regimen and to prevent hospital
acquired infection.
Mixed system.
Most of wards and departments are located in the main building,
pediatric and obstetric wards, radiotherapy department and communicative
disease unit are located in the separate buildings.
78
General plan of HCI.
•General plan – is a plan of institution’s territory including zoning, location
of buildings construction of services and siting to the particular area.
•Zoning – is a conventional division of a territory according to functional
purpose.
79
11. GENERAL HYGIENIC REQUIREMENTS FOR BUILDINGS AND
PREMISES OF HEALTHCARE INSTITUTIONS
Wards area to treatment and auxiliary premises area ratio should be 1:1.
83
Hygienic requirements for working conditions of medical staff:
•Favourable microclimate and air conditions (temperature, humidity, speed
of air mobility, chemical and bacterial content) and sufficient air exchange
should be provided at the working places.
•Placement of equipment and its uses should be performed according to
the current safety requirements.
Cloakrooms
2
•Sizes of cloakroom for casual clothes: at least 0.08 m per 1 hanger
(hook);
•Number of lockers in cloakrooms for casual and hospital clothes should be
equal to the number of staff, i.e. every member of staff should have own
locker;
•Clothes should be stored in double-doors, lockable, ventilated lockers.
Locker construction must provide separate storage of casual and hospital
clothes and shoes.
84
Auxiliary premises for staff:
Staff toilets must be separate for male and female staff;
Number of shower cabins depends on the type of a department.
Infectious diseases and tuberculosis departments should have 1 shower
cabin per 10 people, other departments should have 1 shower cabin per 15
people; if the number of staff is less than 10, there should be 1 shower
cabin per department;
For female staff there should be available personal hygiene rooms
equipped with bidet.
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Hygienic requirements to internal design of premises
Wall and ceiling surfaces in the premises should:
be integral,
be smooth,
not have traces of leakages, mould, etc.
be easily accessible for wet cleaning and
disinfection.
Flooring should:
have no defects (gaps, crackles, holes, etc.);
be smooth;
match well the basement.
In the premises with “dry” regimen (wards, halls, doctor’s and
administration rooms, dining rooms, physiotherapy and other treatment and
diagnostic premises):
Walls are advised to be covered with water resistant paints. Areas of
basins, sinks, other similar equipment should be covered with tiles.
Ceilings can be painted with lime or water soluble emulsion. Use of
hanging ceilings allowed in premises not requiring aseptic and antiseptic
regimens only.
Floorings should be made of materials with higher thermo isolation
properties.
Floors in halls should be resistant to mechanical damage, so stronger
flooring should be used (tiles, marble, etc).
86
General hygienic requirements to furniture and equipment
Medical, technical, auxiliary and other furniture and equipment
used in the hospitals should:
•Be simple and convenient;
•Function properly;
•Be designed for frequent wet cleaning and disinfection.
Not permitted: use of malfunctioning equipment, furniture and
devices. Broken equipment, furniture and devices should be repaired or
replaced immediately.
Prohibited: placement and storage of unused equipment in functional
premises. Unused devices, furniture and equipment can be temporarily kept
in stockrooms.
88
12. HYGIENIC CHARACTERISTICS OF MICROCLIMATE,
HEATING AND VENTILATION IN HCI
Air TEMPERATURE:
•True air temperature is a temperature level not affected by influence of
heat radiation on thermometer.
•Climatic temperature is a total value of air temperature and influence оf
heat radiation on thermometer.
Air humidity:
•Absolute air humidity is the mass of water vapour in 1 m3 of air.
•Maximal humidity is the mass of water vapour required to saturate 1 m3
of air at a defined temperature.
90
•Physiological humidity deficit - difference between maximal humidity at
37о C (body temperature) and absolute humidity at the time of
observation.
Outdoor environment:
•most favourable wind speed – 1-4 m/s,
•irritating effect of wind can be seen at 6-7 m/s.
Atmospheric pressure
Its variations within 10-30 mm limits impair general health feeling in
people suffering from rheumatoid arthritis, angina, hypertension, chest
and neurological conditions.
Normal are atmospheric pressure variations within the limits of:
91
760 ± 20 mmHg, or
1013 ± 26.5 hPa
•Katathermometers:
ball and cylindrical for measuring speed of air mobility in indoor
premises (if speed is lesser than 1 m/s).
94
Physiological and hygienic value of microclimate factors is due to their
influence on:
•heat balance of organism and processes of heat exchange;
•metabolism rate;
•physiological condition of the main functional systems;
•more prominent effect on sick organism;
Heat comfort promotes good outcome.
Systems of heating:
•Local heating: •Central heating:
•stoves with big heat capacity heat transmission from one
(holland stoves, temperature of their centralised source (boiler, or heat
surface should not be more than and power plant). With central
80°C), heating fuel combustion takes place
•stoves with medium heat capacity in a boiler. Resulting heat is sent to
(hold heat poorly, premises should heat carrier, which is delivered to
be heated twice a day), the premises via a system of pipe-
•stoves with small heat capacity lines.
(made of cast-iron, iron, small
ceramics – maintain the temperature
for 1-2 hours, can be used in
premises, where people stay
temporarily).
•Disadvantages:
•Large temperature variations during •Types of central heating according
a day (4-6°C). to a kind of heat carrier:
•Risk of air pollution with products •water
of incomplete fuel combustion, so •steam
fire-chambers should be located at •air
corridor site. •radiant.
Radiant heating:
•Heating elements (pipes or electric heaters), mounted in ceiling, walls or
floor: panel, overhead, floor heating.
•Temperature of heat-carrier should provide the following surface
temperatures : floors – 24-27°C, ceilings – 28-30°C, walls – 35-40°C.
95
Advantages and disadvantages of radiant heating:
Advantages:
•Premises are heated more evenly.
•Almost absent dust raise, because of weak convectional flows.
•Due to higher temperature of barrier constructions heat losses from the
body surface are decreased, so good general feeling remains even at a
lower temperature (17-18°C).
•In summer time premises can be cooled by delivering cooling agent
through the pipes.
Disadvantages:
•Higher building expenses.
•Repair of heating elements is more complicated.
•Heating time of premises is prolonged.
96
Air conditioning should be installed in:
•Operation and obstetric theatres, anaesthetic rooms, postoperative, post
delivery and intensive care wards,
•One- and two-bed wards for burned patients,
•Neonatal wards.
97
13. HYGIENIC ASSESSMENT OF AIR PURITY, LIGHTING AND
INSOLATION OF HOSPITAL’S PREMISES
98
3. Vapours of disinfectants, medications and substances, secreted by
polymers.
HCI air may contain vapours of:
•Alcohol, aldehydes, phenols.
•Peroxides (hydrogen peroxide, peracetic acid).
•Halogens (chlorine and iodine containing substances).
•Quaternary ammonium compounds.
•Biguanidines.
•Polyhexanides.
•Antibiotics.
•Harmful chemicals produced by building materials, furniture, polymers.
О2 – 21 %, СО2 – 0.04 %,
Expiration air concentrations of
О2 drops to 16.4 %,
СО2 raises up to 4 %.
100
Assessment of air purity using microflora
is based on:
3
•general amount of microorganisms per 1m of air;
•presence of hygienically and clinically important microorganisms –
haemolytic
streptococci and staphylococci.
By mechanism:
Input ventilation – ventilation devices deliver the air to the premise,
Exhaust ventilation – ventilation devices remove air from premises,
Combined extract and input ventilation.
Air exchange:
input is marked (+),
exhaust is marked (-).
Types of ventilation:
By nature of driving forces:
Natural ventilation;
Artificial ventilation;
101
Natural ventilation is performed due to:
•temperature gradient between outside and inside air,
•impact of wind force.
Airing
•is performed through intrawall channels;
•one end of the channel is opened in wards, auxiliary premises, corridors,
etc., whereas another end is opened on the roof;
•exhaust outlets are placed in the upper part of the wall, because warmed
air rises up;
•for better draught in channel special deflectors (“chimney with a cap”) are
placed on the roof.
Aeration coefficient
A ratio of a glassed area of the window leaf or the transom to the floor
area.
Normal ratio = 1 : 50
Artificial ventilation
•General ventilation – air exchange takes place in a whole premise.
•Local ventilation – delivery or removal of air takes place within the
limited part of the premise (exhaust hood).
104
Orientation of windows
•Wards windows in south (45° n. l.) and mid (45-55° n. l.) latitudes
should be oriented in south, south east and east, as this provide enough
lighting and insolation without overheating.
It is undesirable to place wards with windows looking west in south
latitudes, as this results in continuous and deep exposure to sun shine.
•Wards windows in north latitudes (55° n. l.) should look south, south-east
or south-west direction.
•Windows in operational theatres, wound dressing change, procedure,
resuscitation rooms should look north, north-west or north-east, as this
prevents dazzle from sun shine.
106
14. WATER AS A FACTOR OF HEALTH. HYGIENIC
REQUIREMENTS TO WATER SUPPLY OF SETTLEMENTS
Epidemic diseases
Water becomes epidemiologically dangerous, if it gets contaminated
with secretions of carriers or sick people and animals.
Pathogenic microorganisms may contaminate open water sources
during:
burial of sewage from ships,
cattle watering,
washing of linen,
108
bathing,
washing away of garbage from soil surface by atmospheric sediments,
pollution with domestic and, particularly, hospital’s sewage water.
Viral infections:
Infectious hepatitis, polio, adenoviral, enteroviral.
Epidemically dangerous is infectious hepatitis, because a large number
of people may get infected through water before prevention measures are
taken.
Virus of polio remains viable for up to 100 days in tap water.
Enteroviruses retain pathogenicity in sewage water for months.
Pathogenic protozoa:
Water may be contaminated with protozoa (amoebas) and helminths
eggs (ascarids, threadworms).
109
Development cycle of biohelminths (tapeworms, opisthorchosis,
leishmania) takes place in water.
In unfavourable epidemic conditions there is a risk of infection,
particularly during use of local water sources (wells) and swimming pools.
Endemic diseases
Molybdenum possesses anti caries properties. Excessive intake
increases synthesis of uric acid leading to “molybdenic gout”.
Selenium. Deficit of selenium causes dystrophic changes in muscles,
including myocardium, and dystrophy of pancreas.
Beryllium – can cumulate. Its accumulation affects respiratory,
nervous and cardiovascular systems, suppresses erythropoesis.
Strontium. Concentrations over 2mg/dm3 cause changes in mineral
metabolism and enzymatic processes in bone tissue.
Water sources:
•For water supply purposes the following water sources can be used:
–Atmospheric water, ice, snow;
–Surface water (water of open sources – rivers, lakes, water reservoirs,
etc.);
–Groundwater.
110
Atmospheric water
Used for domestic and drinking needs in tropical regions with high
atmospheric precipitants levels and in aridity regions.
In some areas (polar regions, mountain areas) ice and snow are used.
111
They have constant chemical content, low bacterial contamination, often
highly mineralized.
113
Special methods:
–distillation or demineralization (removal of salts),
–degassing (removal of dissolved gases),
–deferrization,
–fluoridation.
114
Water precipitation
The 2 types of precipitation tanks are used:
horizontal and vertical;
sedimentation of the suspension occurs due to abrupt slowing of water
current while moving from a narrow entering tube to the tank space;
moving slowly in precipitation tank, in 2-3 hours water partially gets free
from the suspension, which is mostly mineral, and partially – from bigger
microorganisms and eggs of helminths;
water transparency increases, chromaticity, amount of microorganisms
and eggs of helminths decrease as a result of precipitation.
Filtration
Physical-biological method of water treatment, which is
performed during the second stage of water purification.
Silica sand is used as a filtering substance;
In two-layered filters the lower layer is silica sand, and the upper layer is
crushed anthracite.
Filter should get mature, i.e. an active biological film, consisting of
sediment, bacteria and plankton should form on it surface. Mature filter
stops up to 80 % of water microorganisms.
There are 2 types of filtration:
3
Filtration through slow filters (10-20 cm /h),
3
Filtration through fast filters (5-12 m /h) – of a lower quality.
Ultraviolet treatment.
Is performed with powerful high pressure mercury quartz lamps and
argon mercury lamps.
2 minute exposition is required. This is an effective and promising
method.
115
Ultraviolet radiation affects not only bacteria and eggs of helminths, but
also spore-forming microorganisms and viruses.
It does not change physical-chemical and organoleptic properties of
water.
Disadvantages: water should be very clear – of a low chromaticity and
should not contain suspended particles.
Boiling
Simple and reliable method of water decontamination.
Microorganisms which do not form spores, are killed after 20-30 seconds
of heating at a temperature of + 800С.
Water sterilization can be achieved after 30 minutes of boiling.
Disadvantages: gases evaporate, method can be used for decontamination
of a small amount of water, water can not be stored for more than 24 hours
at a room temperature, as it loses its ability to self-purification, and a fast
growth of microorganisms starts.
Chemical methods
Water chlorination with the help of:
Gaseous chlorine in a form of liquid;
Substances containing active chlorine:
– chloride of lime (active Cl – 25 - 36 %),
Ozone treatment
Ozone simultaneously provides water decontamination, decolouration
and improves its organoleptic properties. This method does not require
supply with any substances.
3
Dose of 0.8-4 mg/dm (depends on water chromaticity and turbidity) in 3-
5 minutes provides marked decontaminating effect.
Ozone destroys spore-forming bacteria 300 times more actively than
chlorine.
WATER CHLORINATION
Advantages: affordable reagents (chlorine containing chemicals;
inexpensive method, effective; allows to monitor the effectiveness
detecting residual chlorine).
116
Disadvantages: changes organoleptic properties of water, chemicals
are aggressive and unstable.
For water chlorination at waterworks gaseous chlorine is used.
Reaction of hydrolysis occurs after it is added to water:
Сl2 + H2O → HCl + HOCl (hypochloric acid),
HOCl → H+ + ОCl- (hypochlorite ion).
Hypochloric acid and hypochlorite ion are included in to a notion of
“active chlorine”.
Microelements:
3
•Aluminium – 0.5 mg/dm .
3
•Lead – 0.03 mg/dm ,
3
•Selenium – 0.01 mg/dm ,
•
Mercury – 0.0005 mg/dm3.
120
15. INFECTION CONTROL IN HOSPITALS. HYGIENE OF
PATIENTS AND STAFF. HOSPITAL LINEN REGIMEN
123
Hands microflora
Consists of two types of microorgaisms: Permanent and transitory.
•Permanent microflora resides in corneal skin layer, sweat and oil glands,
hair follicles and consists of epidermal staphylococci, diphtheroids,
propionic bacteria, etc forming barrier skin function.
In periungual area and interdigital spaces, apart from the above
mentioned microorganisms Staphylococcus aureus, Pseudomonas, E. coli
and Klebsiella can be found.
The mentioned skin areas are the natural habitats for these groups of
bacteria.
•Transitory microflora gets onto skin as a result of a contact with infected
patients or contaminated objects and remains on hands skin for up to 24
hours.
It consists of obligate and elective pathogenic microorganisms (E.
coli, Klebsiella, Pseudomonas, Salmonella, Candida, adeno- and
rotaviruses, etc.).
Species composition of transitory microflora is characteristic for
certain profile of healthcare institution.
Hands antiseptic
Requires use of chemicals with antibacterial properties and designed for
skin decontamination.
Hand antiseptics should be easily available.
Dispensers with skin antiseptics should be placed:
•By operational theatre entrance,
•In intensive care and resuscitation wards,
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•In procedure rooms,
•In wound dressing change rooms,
•In manipulation rooms,
•In wards for patients with pyoinflammatory and septic infections.
Medical staff, involved in treatment and looking after the patients
should be provided with personal, pocket-size dispensers with antiseptic
solutions.
Antiseptics which are used for surgical hands antiseptic treatment
should provide persisting (continuous) effect.
Responsibility
•Senior sisters (matrons) of the departments are responsible for
maintenance of hospital linen regimen.
•Senior sister and matron are responsible for collection, storage and
transportation of soiled linen.
127
General requirements to hospital
linen regimen:
•Departments should maintain the sufficient stock of clean linen.
•Clean hospital linen should be stored in special premises – linen rooms.
•Hospital linen should be marked, storage of unmarked linen is not
allowed.
•Clean linen is kept packed (wrapped in pillow-cases or bed sheets) in sets
of 30-50 pieces.
•Hospital linen is given by matron. Before unpackaging, counting and
distribution matron washes her hands and puts on special gown and mask.
•Disposable linen should be used in operational theatres block, intensive
care and resuscitation units and in postoperative wards.
•Sterile disposable linen and drapes should be used in obstetric wards
and other premises with aseptic regimen (neonatal wards) and
operational theatres.
•Modern hygienic remedies (wipes, nappies, etc.) can be used.
Special requirements:
Hygienic clothes and textile means of personal protection
arriving from:
Obstetric and neonatal,
Infectious diseases,
Skin and venereal diseases,
Surgical infections,
Tuberculosis
departments are treated as per regimen for IV degree soiled linen;
particularly badly soiled linen from these departments as per regimen for
IVa soiled linen.
129
wash the hands with a soap first and than to perform hygienic antiseptic
hands treatment.
hospital linen.
Separate technological pathway is required for washing linen for
newborns and infants up to 1 year old. Children linen is washed with
boiling only (as per regimen for IV-IVa degree of soiling).
Linen from infectious and obstetric departments should be washed in
special laundry. If special laundry can not be provided, then this linen is
washed separately from other departments linen.
To avoid “clotting” during washing linen from obstetric, surgical and
other departments soiled with high protein substances (blood, milk, pus),
few cycles of pre-washing in water are used.
Linen from infectious departments and that soiled with biological
excretions is disinfected and washed in through-put washing machines with
2 openings – loading (“dirty”) and unloading (“clean”).
Non-infected linen is washed in ordinary washing machines.
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added phenolphthalein shows red-violet discoloration, or if litmus paper
changes colour to blue.
Bacteriological investigations – linen treatment is effective, if there is no
hygienically important microflora growth.
Disinfection
All goods are needed to be disinfected after use
Disinfection is performed in order to kill vegetative forms of
microorganisms: viruses, vegetative bacteria and dermatophytes.
After disinfection goods are rinsed with tap water, dried up and either
used, or underwent pre-sterilization cleaning and sterilization.
Pre-sterilization cleaning and sterilization
Reusable goods require pre-sterilization cleaning in order to remove
protein, oily and mechanical soils, residues of drugs before sterilization.
Sterilization is performed in order to kill all kinds of microorganisms,
including spores.
Sterilization is required if goods contact with:
wound surface,
blood,
solutions for injections,
mucosa and if they can damage it.
133
Chief doctor of HCI is responsible for organization and maintenance of
effective epidemiological monitoring, he organises and provides
microbiological monitoring of hospital strains.
Chief doctor should be notified about all detected disturbances of
epidemiological regimen in HCI and assumes the measures on their
correction.
Chief doctor is responsible for reliability of all cases of HAI monitoring,
and for prompt reporting of HAI cases to the Centre of Hygiene and
Epidemiology.
Epidemiological monitoring
The following things should be sterile and should undergo epidemiological
checks:
Instruments, damaging the skin and mucosa integrity (lancets, syringes).
Objects contacting with solution for injections (package, needles), or with
wound surface (dressing materials, surgical instruments).
Medical goods designed for manipulations on sterile areas of patients
bodies (endoscope equipment).
Surgical gloves.
Suturing and wound dressing material.
Remedies for care after patient’s mucosa.
Medications for injections, blood, blood substitutes.
Linen in operational theatres and wound dressing change rooms.
Catheters, gastric tubes, endotracheal tubes, etc.
134
Backgrounds of epidemiological troubles:
Microorganisms are detected on those objects of the environment where
they should not be found (on medical instruments, in solutions for
injections, etc.).
Increased bacterial contamination of those objects where microflora is
normally detected (drinking water, air, etc.).
In the presence of the backgrounds which can affect hygienic and
epidemiological condition of the HCI, chief doctor implements measures to
reduce the use of the department until the detected defects are corrected.
135
In case of finding HAI
People being in contact with HAI patient in a ward stay in the same ward
until discharge.
Admission of new arrived patients to the quarantine ward is prohibited.
Current cleaning in wards with HAI patients is performed with
disinfectants.
Cleaning of wards and patients care in HAI wards are performed after
disinfection of wards.
In wards with HAI patients medical staff works in specially marked
gowns and caps which are changed daily and in gloves changed when
moving from one patient to another.
Bacteriological investigation
The following undergo bacteriological investigation:
Wound discharge (microbial contamination of the swab contacting with
wound and removed during the next dressing change is investigated).
Hands skin.
Nasal mucosa in medical staff and patients.
Faeces and other biological substrates of staff and patients organisms.
136
16. THE FUNDAMENTALS OF IONIZING RADIATION HYGIENE
Principle of substantiation
is used at the stage of making decision
•during planning of new radiation objects,
•during approval of regulating technical documentation regarding use of
the sources of radiation,
•if conditions of work have been changed.
Principle of optimization
provides keeping individual and collective radiation doses on the
lowest possible level.
Principle of regulation
•Requires control of the approved limits of radiation doses.
•Should be followed by all organizations and authorities responsible for the
level of radiation exposure.
137
Radiation risk
Radiation risk is described by the total cumulative reacting dose
from all radioactive sources.
The value of each radiation source is detected by its contribution into
the total reacting dose.
139
Monitoring over radiation safety
•Monitoring over radiation safety should be organised and performed on
the object.
•This monitoring is performed by a special service or a specially trained
person responsible for radiation safety.
•Plan of monitoring should be approved by local Centre of Hygiene and
Epidemiology.
Radiation monitoring
The purpose of radiation monitoring is to obtain the information about
individual and collective radiation exposure doses of the staff, patients and
population.
The objects of the radiation monitoring are:
•Staff undergoing the impact of SIR in working environment;
•Patients during performing of medical radiological procedures;
•Population under effects of natural and artificial SIRs;
•Environment.
140
Classification of the radiation objects according to their potential
danger
Potential danger of the radiation object is determined by its possible impact
on population.
According to the potential radiation danger there are 4 categories of
objects:
•I category are the objects where in a case of accident radiation impact on
population is possible.
•II category – radiation impact in a case of an accident is restricted to the
hygienic-protective zone.
•III category – radiation impact in a case of an accident is limited to the
territory of the object.
•IV category - radiation impact in a case of an accident is limited to the
premises where the work with sources of radiation is performed.
141
Planning of the radiation objects should provide:
•Minimal staff radiation exposure;
•Maximal automatic control of operations;
•Absence of toxic and harmful substances;
•Minimal levels of noise, vibration and other harmful factors;
•Minimal spikes and fault of radioactive substances;
•Minimal amount of radioactive waste and reliable ways of its temporary
storage and processing;
•Sound and/or light breach of technological process alarm.
Staff requirements:
•People allowed to work with sources of radioactivity should not be
younger than 18 years old and should not have medical contraindications.
•All workers should have training and knowledge testing about the rules of
safety before getting permission to work;
•Knowledge of the radiation safety rules should be tested before staff starts
to work and than regularly, no less than once a year, for managerial staff –
at least once in 3 years.
•Safety instruction should be performed at least twice per year.
142
•Staff should not be allowed to work if qualification requirements are not
satisfied.
Storage of SIR
Out of use SIR should be stored in special places or equipped depositories.
Dose rate on the external surface of depository should not exceed 1.0
mcGr/h.
•Depository should be equipped with 24-hour exhaust ventilation.
•Radioactive substances that produce radioactive gases during storage
should be stored in exhaust hoods with purifying filters on ventilation
systems.
•Cooling system should be provided for storage of high activity radioactive
substances.
•Nuclear safety measures should be provided for the storage of fissionable
species.
•Measures of explosion and fire safety should be organized during storage
of easy inflammable or explosive substances.
144
Work with open sources of radiation
Work with open SIR is divided into I, II and III classes depending on
radioactive danger of nuclides and it actual activity.
Measures of radiation safety during work with open SIR should:
•Provide staff protection from internal and external radiation;
•Limit pollution of air, working surfaces, skin and clothes;
•Minimize pollution of the environment – air, soil, green plants, etc.
Premises for work with open SIR are divided into three zones:
•1 zone – non-serviced premises, the main source of radioactive emanation
and radioactive pollution. Staff is not permitted to stay in non-serviced
premises when technological equipment is working;
•2 zone – periodically serviced premises used for equipment repair and
radioactive substances storage;
•3 zone – staff premises - for staff accommodation during the shift
(operator’s rooms, control panels, etc).
145
•Trays and pans made of low absorbing materials should be used to
diminish working surfaces pollution.
•Disposable materials should be used – plastic films, filtering paper, etc.
147
17. OCCUPATIONAL HYGIENE. HYGIENE, PHYSIOLOGY AND
PSYCHOLOGY OF WORK. WORKING ENVIRONMENT
Occupational Hygiene
is a part of hygiene studying:
working environment,
nature of work,
effects of working environment and nature of work on functional state
and health of human beings,
this field of hygiene creates scientific background and practical
prevention of adverse effects due to working environment and nature of
work.
149
Workload and tension of work
Workload – description of the working process reflecting its load on
muscular-skeletal system and systems, providing its performance
(cardiovascular, respiratory).
Tension of work – description of working process reflecting the load on
central nervous system, senses and emotional sphere.
Measurements and calculation of workload and tension of work are
performed according to the methods used in physiology and occupational
hygiene.
151
Effects of work and leisure on functional states of human organism
Adverse
change in the
functional Area of harmful working conditions
state of the
human
organism
Adverse
change in the
functional
state of the
human Area of harmful working conditions
organism
1 2 3 4 5 6 7 8 9 10 11 vac 1 2 3
Psychology of work
New chapter of occupational hygiene uses the achievements in
general psychology for professional orientation, professional training,
increase of working efficiency and improvement of working environment
and interpersonal relationships in a working group.
Includes the following:
Psychological expert examination.
Psychology of professional training.
Engineering psychology (ergonomics).
Psychological rationalization of the work (based on psychometric
results).
Psycho-physiological pre-nosological diagnostics.
152
Tiredness
– physiological process based on protective inhibition. It develops in
CNS and reflects the ratio of the processes of excitation and inhibition in
brain cortex (dominance of protective inhibition).
•Quickly developing tiredness is the result of either overload or load
inadequate to organism's functional capacity.
•Slowly developing tiredness is the result of a continuous or monotonous
work
Over fatigue – pathological condition resulting from widespread
inhibition or over excitation of the brain cortex.
Unlike the tiredness in over fatigue the rest period does not
restore the functions.
Over fatigue is a base of general and professional morbidity.
Working conditions
Working conditions is the sum of factors of the working environment,
affecting the efficiency of work.
Efficiency of work is a physical state of a human, which describes
ability to perform certain amount of work over a certain time interval.
Ability to work is a condition which considers a sum of physical,
intellectual and emotional abilities of a human to perform certain amount
of work over a time interval.
manufacturing process
Devices and
Equipment
instruments
Technology Industrial medium Management
Production risks
Professional risks
Qualification, Responsibility,
State of health
experience self-discipline
Worker
154
International risk assessment methodology
2. Exposure assessment:
dose, exposure and
intensity of factor, its frequency,
duration of
the impact in past, present and future are set
4. Risk profile:
data analysis and calculation of individual
and group risks, a comparison of risks
with tolerable levels.
The aim of a phase – identification of the risks
that must be eliminated
or reduced to the lowest possible level
Manufacturing factors
•The leading manufacturing factor is the factor which effect on organism
is the most prominent in a case of combined influence.
•Harmful manufacturing factor is the factor which effect on working
person may result in professional disease, decreased working efficiency or
affect negatively the descendants.
•Dangerous manufacturing factor is the factor which effect on working
person results in injury, acute poisoning other sudden abrupt health
deterioration or death.
Dependently on level concentration and duration of exposure,
harmful manufacturing factor may become dangerous.
156
Hygienic criteria – indices allowing to assess the degree of
deviation of certain parameters of working environment and
manufacturing process from the current hygienic standards.
Physical Chemical
moving machinery; By nature of the impact on the body
high or low temperature; Toxic Irritating Sensitizing
increased noise at the workplace;
Carcinogenic Mutagenic
increased level of vibration;
high voltage electrical circuit; Affecting the reproductive function
insufficient illumination of the working area; By way of penetration into the human body
sharp edges, burrs and roughness By Inhalation Through GIT
on the surface of workpieces, tools and equipment.
Through the skin and mucous membranes
Biological
pathogenic microorganisms (bacteria, viruses, ...) and their macroorganisms (animals and plants)
metabolic products
Psychophysiological
Physical overload Mental Overload
mental strain monotony of work
static
analyzers overstrain emotional overload
dynamic
157
•Biological factors;
•Ionising radiation.
The lower
Result of
confidence limit of
the measurement
result
Measurement or time
1 2 3 4 5 6 7
The uncertainty of the
Field of "actual" values
measurement result
158
By revelation of correlation between indices of toxicity found in short-
term researches and effects of chronic impact.
With the use of cell culture, isolated tissues and organs, biological objects
of various complexity.
Methodology of hygienic
regulation Unacceptable
harmful
Extremely
Very
Not Harmful harmful
harmful
harmful
6
3
1
The ratio of the factor to the MPL or MPC
Risk of
pathogenic
effects
healthy
1
Intoxication in 1-2
month 3-5
times
MPC Intoxication
in 2-4 weeks 10 times
Intoxication in 1-2
100 times
weeks
159
The main regulating documents in occupational hygiene in Belarus are
Hygienic Rules and Standards.
Normative documents must be used :
On all manufactures, irrespectively on the type of property;
For obtaining full and complete information about working
conditions at a time of staff recruitment;
By state supervising bodies;
By medical staff of occupational health departments, out-patient
clinics, surgeries, departments of professional diseases;
By national insurance staff.
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18. NOISE AS MANUFACTURING FACTOR
Sound
is a mechanical oscillation of a bumping (air) medium at
frequency from
20 Hz to 20 kHz.
Sonic wave carries:
sonic pressure, measured in Pa or N/m2;
sonic energy, measured in Wt/m2.
Noise
is a sum of a sounds of various rates and intensity, disorderly
combining and changing in time.
Noise is characterised by spectre (frequency content):
low frequency noise – up to 350 Hz;
medium frequency noise – 350-800 Hz;
high frequency noise – over 800 Hz.
Types of noise:
domestic – elevators, technical hygienic facilities (air conditioners,
water supply), objects of general use, trade, catering which are placed in
living buildings;
street – motor vehicles;
manufacturing.
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Noise regulations
Frequency characteristics: sound spectre is divided into 9 octave stripes
with the following medium geometric frequencies:
31.5 Hz; 63 Hz; 125 Hz; 250 Hz; 500 Hz; 1000 Hz; 2000 Hz; 4000
Hz;8000 Hz.
Manufacturing noise
Elevated noise levels are typical for many modern manufactures:
In manufacturing of reinforced concrete units noise levels reach 105-120
dB.
In woodworking industry - 85-105 dB.
In spinning and weaving manufacture - 92-110 dB.
162
Noise disease is complicated symptom complex of functional and
organic disorders in the organism developing simultaneously to hearing
disorders.
Hearing disorders.
1st stage – hearing adaptation: under influence of noise the hearing
threshold increases by 10-15 dB. Hearing threshold returns back to normal
in 3-5 minutes after noise is over.
2nd stage – hearing fatigue: adaptation time is prolonged.
3rd stage – cochlear neuritis or occupational deafness: persistent
decrease of sensitivity to different tones and whistling.
4th stage – occupational hearing loss: constant capillary spasm results in
acoustic papilla atrophy.
Noise disease:
General effects of noise on CNS:
Slowing of all neural responses;
Shortening of the active attention duration;
Decrease in working efficiency and performance.
Higher nervous activity disorders:
Changes in respirations and cardiac contractions rhythm;
Increase of systolic and diastolic blood pressure;
Hyper secretion of some endocrine glands;
Increase in sweating particularly of palms and feet.
Changes in motor and secretion activity of the digestive system.
Metabolism disorders, particularly in lipid metabolism, raise of
cholesterol levels due to endogenous hypercholesterolemia.
163
Prevention of noise disorders
With the help of the following:
Introduction and following hygienic standards for maximum
permissible noise levels with consideration of work intensity and workload.
Technical support.
Management measures.
Medical protection.
Categories
of work Categories of workload
intensity
light moderate hard 1st. hard 2nd. hard 3rd.
80 dB 80 dB 75 dB 75 dB 75 dB
light
moderate 70 dB 70 dB 65 dB 65 dB 65 dB
Intensive 60 dB 60 dB
1st.
Intensive 50 dB 50 dB
2nd.
Infrasound
acoustic vibrations in the range of up to 20 Hz frequency not
detectable my human ear.
Manufacturing infrasound varies in frequency from 1.6 to 20 Hz
and has four octave stripes with average geometric frequencies of 2, 4,
8 and 16 Hz.
According to the spectre infrasound noises can be:
tonal, when one of the frequency spectre compound overwhelm the
levels of the rest frequencies by 10 dB or more;
wideband, when frequency spectre consists of a number of octave
infrasound stripes.
Effects of infrasound:
Headache and dizziness,
Nausea,
Shakes and shivering,
Aches during swallowing, mouth dryness,
Numbness of palate and facial skin,
Nervous and psychic disorders (fear, anxiety, senestopathy),
Various vegetative reactions.
2 Hz 4 Hz 8 Hz 16 Hz
1 Manufacturing premises
for:
works of various
workload,
100 95 90 85
works of various intensity 95 90 85 80
2 Area of dwelling building
up 90 85 80 75
3 Dwellings and public
buildings premises 75 70 65 60
Ultrasound
Bumping oscillations and waves with a frequency of over 20 kHz,
non-detectable by human ear.
Use of low-frequency (up to 100 kHz) ultrasound waves, spreading by
contact and through air – for cleaning, purification, degreasing, welding,
soldering and thermal treatment of materials, in medicine – ultrasonic
surgical equipment, sterilization of instruments.
Use of high-frequency (100 kHz - 100 MHz and higher) ultrasound,
spreading only through direct contact, for non-invasive control and
measurements, also in medicine for diagnostics and treatment.
166
Biological effects of ultrasound
specialists in USG diagnostics, physiotherapists and surgeons are exposed
to effects of ultrasound with a frequency of 18 kHz - 20 MHz and intensity
of 50-160 dB.
Effects of ultrasound on hearing are less than those from high-
frequency noise, however, its effects on vestibular apparatus are more
prominent.
Low-intensity ultrasound promotes faster metabolism, light tissue heating
and micro massage.
Medium-frequency ultrasound causes reversible reactions of suppression,
first of all, in nerve tissue.
High-frequency ultrasound causes irreversible suppression, progressing
into complete tissue destruction.
Local effects:
Hand paraesthesia;
Increased cold sensitivity;
Hands weakness and aches at night;
Decrease in tactile sensation;
Palm sweating.
General effects:
Headaches;
Dizziness;
Tinnitus;
167
General fatigue;
Palpitations;
Chest pain.
168
Soilingof hands with contact lubricants,
Concomitant hands hypothermia or cooling microclimate in the premises,
Work in a forced posture or static load on fingers and wrists muscles.
Medical prevention
Clinical examination of the staff,
Regular health screening,
Physiotherapy: warming air procedures with massage and warming
hydromassage for hands, massage of upper extremities,
Physical exercises,
Balanced diet, vitamins,
Psycho-physiological relief.
Personal protection devices:
Use of two pairs of thick cotton gloves - to prevent the spread of
ultrasound through solid medium;
A pair of thick rubber gloves over a pair of cotton gloves – to prevent the
spread of ultrasound in liquid medium.
169
19. THE EFFECTS OF VIBRATION ON HUMAN HEALTH
Vibration is the mechanical oscillations of an object about an
equilibrium point.
The oscillations may be:
regular such as the motion of a pendulum or
random such as the movement of a tire on a gravel road.
The study of health effects of vibration require measures of the
overall "pressure waves" that are generated by vibrating equipment.
Vibration enters the body from the organ in contact with vibrating
equipment. When a worker operates hand-held equipment such as a chain
saw or jackhammer, vibration affects hands and arms. Such an exposure is
called hand-arm vibration exposure. When a worker sits or stands on a
vibrating floor or seat, the vibration exposure affects almost the entire body
and is called whole-body vibration exposure.
The risk of vibration induced injury depends on the average daily
exposure. An evaluation takes into account
the intensity and frequency of the vibration,
the duration (years) of exposure and
the part of the body which receives the vibration energy.
Characteristics of vibration
If we could watch a vibrating object in slow motion, you could see
movements in different directions. Any vibration has two measurable
quantities. How far (amplitude or intensity), and how fast (frequency)
the object moves helps determine its vibrational characteristics. The terms
used to describe this movement are frequency, amplitude and acceleration.
170
Frequency
A vibrating object moves back and forth from its normal stationary
position. A complete cycle of vibration occurs when the object moves from
one extreme position to the other extreme, and back again. The number of
cycles that a vibrating object completes in one second is called frequency.
The unit of frequency is hertz (Hz). One hertz equals one cycle per second.
Amplitude
A vibrating object moves to a certain maximum distance on either
side of its stationary position. Amplitude is the distance from the stationary
position to the extreme position on either side and is measured in metres
(m). The intensity of vibration depends on amplitude.
Resonance
Every object tends to vibrate at one particular frequency called the
natural frequency. The measure of natural frequency depends on the
composition of the object, its size, structure, weight and shape. If we apply
a vibrating force on the object with its frequency equal to the natural
frequency, it is a resonance condition. A vibrating machine transfers the
maximum amount of energy to an object when the machine vibrates at the
object's resonant frequency.
171
Vibration exposure
Contact with a vibrating machine transfers vibration energy to a
person's organ. We know that vibration affects the organ in contact such as
the hands. But we do not fully understand how vibration may affect other
parts of the worker's body or only a selected particular organ. The effect of
vibration exposure also depends on the frequency of vibration. Each organ
of the body has its own resonant frequency. If exposure occurs at or near
any of these resonant frequencies, the resulting effect is greatly increased.
Whole body vibration energy enters the body through a seat or the
floor, and it affects the entire body or a number of organs in the body.
Exposed groups include operators of trucks, buses, tractors and those who
work on vibrating floors.
172
Furniture manufacture Hand-arm Pneumatic chisels
Iron and steel Hand-arm Vibrating hand tools
Lumber Hand-arm Chain saws
Machine tools Hand-arm Vibrating hand tools
Mining Whole body Vehicle operation
174
Occasional attacks affecting finger tips and middle of the finger
2 Moderate
and rarely also the finger parts close to the palm
3 Severe Frequent attacks affecting most fingers
Very Same symptoms as in stage 3 with degenerate skin changes in the
4
Severe finger tips.
175
Years of employment Individual
Position of the hand and arm
involving vibration susceptibility to
relative to the body
exposure vibration
Smoking and use of
drugs.
Texture of handle-soft and
State of tool maintenance Exposure to other
compliant versus rigid material
physical and
chemical agents.
Protective practices and
Medical history of injury to Disease or prior
equipment including
fingers and hands, particularly injury to the fingers
gloves, boots, work-rest
frostbite or hands
periods.
The symptoms are similar to those that many people experience after
a long car or boat trip. After daily exposure over a number of years, whole-
body vibration can affect the entire body and result in a number of health
disorders. Sea, air or land vehicles cause motion sickness when the
vibration exposure occurs in the 0.1 to 0.6 Hz frequency range. Studies of
bus and truck drivers found that occupational exposure to whole-body
176
vibration could have contributed to a number of circulatory, bowel,
respiratory, muscular and back disorders. The combined effects of body
posture, postural fatigue, dietary habits and whole-body vibration are the
possible causes for these disorders.
Studies show that whole-body vibration can increase heart rate,
oxygen uptake and respiratory rate, and can produce changes in blood and
urine. East European researchers have noted that exposure to whole-body
vibration can produce an overall ill feeling which they call "vibration
sickness."
Many studies have reported decreased performance in workers
exposed to whole-body vibration.
178
those with vibration-induced white finger (VWF) had greater hearing loss
than those without VWF. The reason for this effect is not clear.
Studies of the effect of separate and simultaneous exposure to noise
and whole-body vibration have concluded that whole-body vibration alone
does not cause hearing loss. However, simultaneous exposure to noise and
vibration produces greater temporary hearing loss than noise alone.
179
MPL of whole-body vibration in accommodation,
hospital wards, schools and reading rooms of
libraries
Frequencies of octave dB
bands, Hz
2 76
4 71
8 67
16 67
31,5 67
63 67
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Prevention
Good practice in industrial health and safety management requires
that worker vibration exposure is assessed in terms of
acceleration amplitude and duration. Using a tool that vibrates slightly for a
long time can be as damaging as using a heavily vibrating tool for a short
time. The duration of use of the tool is measured as trigger time, the
period when the worker actually has their finger on the trigger to make the
tool run, and is typically quoted in hours per day. Vibration amplitude is
quoted in metres per second squared, and is measured by
an accelerometer on the tool or given by the manufacturer. Amplitudes can
vary significantly with tool design, condition and style of use, even for the
same type of tool.
181
20. HYGIENE OF CHILDREN AND ADOLESCENTS. PHYSICAL
DEVELOPMENT AND HEALTH STATUS OF CHILDREN AND
ADOLESCENTS
182
General directions of research
1. Assessment and analysis of health status and physical development.
2. Hygienic requirements, rules and standards for physical training.
3. Hygienic requirements, rules and standards for educational process.
4. Hygienic requirements, rules and standards for working activity.
5. Hygienic requirements and hygienic accomplishment of institutions.
184
They need a complex of health improving measures to increase the
organism resistance with non-specific remedies:
1) optimal motion activity;
2) tempering with native factors of nature;
3) rational daily regimen,
4) additional vitamin supplement, etc.
Schedule of health follow-up is set individually by the doctor with
considerations to trend of deviations in health status and the degree of
organism resistance.
185
Age period
Human maturing is divided into several age periods.
“Age period” includes period of time during which processes of
growth and development as well as physiological features of organism are
similar and responses to stimulus are more or less the same.
At the same time, age period is a time required for completion of a
certain stage of morpho-functional development of the organism and
achievement of a child’s preparedness for a certain type of activity.
Age standards
Reflect the level of physical development of certain groups of children
and adolescents which are formed according to age, gender, place of
residence, inheritance, ethnicity, social and economical state of the
population, ecological and other factors.
Local (regional) standards of physical development are used by doctors
for individual assessment of physical development.
187
•Disharmonic – body mass and chest circumference are out of standard
range for more than 1 sigma (М ± 1.1 – 2.0).
•Badly disharmonic - body mass and chest circumference are out of
standard range for more than 2 sigma (М ± 2.1 – 3.0).
189
21. FUNCTIONAL PREPAREDNESS FOR SYSTEMATIC
EDUCATION. HYGIENIC ASSESSMENT OF CLASSES AND DAILY
ROUTINE IN GENERAL SCHOOL
191
Tiredness usually is accompanied by a feeling of restlessness. However
tiredness and restlessness may not come at the same time. When work is
interesting and accompanied by positive emotions children do not feel
restlessness over a long period of time although objectively they are
already tired. And vice versa, in a case of monotonous, boring work
restlessness comes much earlier than decrease in functions.
Development of tiredness relates to a sophisticated mixing of processes in
the neural centres and peripheral viscera. In some cases the leading role
belongs to neural centres, in other cases – to peripheral organs. For
instance, in heavy motion load tiredness first develops in muscles as a
result of switching off fast tiring motion units whereas in activity with light
loads, performed by low-tiring motion units – in nervous centres. In a case
of medium load there is a sophisticated combination of the tiredness
events.
192
Overwork
Cumulating state of tiredness which signs do not disappear neither
with daily nor with weekly rest.
Signs of overwork are not reversed not only after a short rest but even
after normal duration night sleep.
More continuous rest is required for complete recovery of the efficiency,
elimination of neuro-psychic disturbances and regulatory processes
disorders, sometimes – complex treatment with the use of medicines,
physiotherapy and treating exercises.
Signs of overwork
Initial signs of overwork:
•Changes in pupils behaviour,
•Impaired progress in studying,
•Loss of appetite,
•Functional neuro-psychic disorders (irritability, etc.),
•Various vegetative disorders, particularly of cardio-vascular system.
Prominent signs of overwork:
•Sudden and continuous drop in mental and physical efficiency;
•Neuro-psychic disorders (sleeping disorders, feeling of fear, hysteria);
•Steady changes in regulation of vegetative functions (dysrhythmia, neuro-
vascular dystony);
•Decreased resistance against unfavourable factors and pathogenic
microorganisms.
193
Physiology of the decreased functional state recovery
Recovery period consists of 2 phases:
1 – restoration of functional level and
2 – strengthening of achieved recovered state.
If the rest is limited to the 1st phase only, i.e. restoration of efficiency
the expected results can not be achieved. Any new load, even
unremarkable, quickly brings the organism back to the state of impaired
efficiency.
That’s why the duration of rest depends on degree of functional
impairment, nature and intensity of the job performed.
195
of low efficiency control testing and control questioning must not held on
Friday, also there is no sense in starting new material on this day.
Hygienic requirements to timetable take into consideration dynamics of
changes of physiological functions and efficiency of pupils throughout
working day and week.
Most difficult and tiring subjects should be placed in a timetable on days
of high efficiency.
It is advised not to organize on the same day lessons on subjects requiring
lot of time for preparing home tasks.
Scales of subjects difficulty are used for hygienic assessment of the school
timetable (max - 10 points – mathematics, min – 1 point - singing). For this
purpose sum of points per day is calculated.
196
Principles of daily regimen planning
Regimen should first allow the required time for sleeping, feeding, being
in open air, activity games, and only after this time can be planned for
education.
Duration of certain types of rest should be determined by age.
Some types of activity, comprising the daily regimen, should cause some
tension of corresponding organs and systems as it would promote their
training and prepare organism for moving on the next level of the dynamic
stereotype.
197
o
By the end of the study day air temperature is 3-5 C higher, CO2
concentration, content of organic substances and microorganisms may
increase 3 times and more.
198
for street and change clothes, bed with linen, chamber pot in the toilet,
towel, tooth brush and a comb in a personal cell.
199
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