Hygiene Book 6th Year

Rublevska N.I., Shevshenko O.A., Kramarova Y.S.
, Shchudro
S.A., Hryhorenko L.V., Dziak M.V., Zaitsev V.V.
Guideline
"Hygiene and Ecology"
Dnipro
2017
2
Rublevska N.I., Shevshenko O.A., Kramarova Y.S.,
Shchudro S.A., Hryhorenko L.V., Dziak M.V., Zaitsev V.V.
Guideline
"Hygiene and Ecology"
Recommended by the Academic Council of State Establishment “Dnipropetrovsk

Medical Academy of Health Ministry of Ukraine” as a study guide for students of
higher medical education establishment of the 4 th level of accreditation (Protocol №
3 November, 23 2017)
Dnipro
2017
3
Authors: MD, Prof. Rublevska N.I., MD, Prof. Shevshenko O.A., PhD Assoc.
Prof. Kramarova Y.S., MD, Assoc. Prof. Shchudro S.A., PhD, Assoc. Prof .
Hryhorenko L.V., PhD, assistant Dziak M.V., assistant Zaitsev V.V.
Reviewed by: I.V. Zavgorodniy, Doctor of Medical Sciences, Professor, Director of

the Educational and Scientific Institute of Education Quality of Kharkiv National
Medical University.
L.I. Buryak, Doctor of Medical Sciences, Professor of Dnipro Medical Institute of
Conventional and Alternative Medicine
Adapted and translated by Bachelor of Arts (Philology), PhD Hrygorenko L.V.,

PhD Kramarova Y.S.
Responsible-Editor: Head of Hygiene and ecology Department, MD, professor

Rublevska N.I.
Instructional book is carried out to the program „ Hygiene and Ecology” for students
of higher medical institutions ІV level of accreditation and working program on the
discipline. This guide reflect typical curriculum requirements in Hygiene and
Ecology.
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Content Page
№
1. Substantial module 1. Municipal hygiene. 5
2. Тheme № 1. Hygiene of water and water supply of settlements. Sanitary 5
protection of water objects.
3. Theme № 2.Sanitary protection of atmospheric air. Hygiene of planning in 17
the urbanized territories.
4. Тheme № 3. Sanitary protection of soil and clearing of the settlements. 21
5. Тheme № 4. Hygiene of the residential and public buildings and facilities. 27
6. Тheme № 5. Features of hygienic requirements towards planning, 33
functioning of health care facilities, and conditions carried out for
ambulatory patients. Complex of hygienic measures in order to prevent
nosocomial infections.
7. Тheme of independent out-of-class work №1. Hygienic meaning of 45
physical factors anthropogenic origin in the settlements.
8. Substantial module 2. Hygiene of nutrition. 53
9. Тheme № 6. Nutrition in the preventive medicine. Organization of the 53
treatment-and-prophylactic nutrition on the industrial enterprises.
10. Тheme №7. Medical control over organization of the treatment (dietary) 66
nutrition at the treatment and-prophylactic establishments in the public care
system.
11. Тheme of independent out-of-class work №2. Food poisonings as the 80
hygienic problem. Technique of investigation cases of food poisonings.
12. Substantial module 3. Occupational hygiene. 86
13. Тheme № 8. Legislative basis of sanitary surveillance over organization 87
and implementation of preventive medical examinations & investigation
occupational diseases in the industrial enterprises.
14. Тheme №9. Hygienic estimation occupational factors of an industrial 102
environment, in accordance with "Hygienic classification of work".
15. Theme of independent out-of-class work № 3. Hygiene of labor protection 115
medical staff in the treatment-and-prophylactic establishments.
16. Substantial module 4. Hygiene of children and adolescents. 118
17. Тheme № 10. Analyses state of health children and adolescents. 119
18. Тheme № 11. Hygienic estimation organization teaching &educational 126
training in the preschool institutions and comprehensive schools.
19. Theme of independent out-of-class work № 4. Hygienic principles of 140
rational organisation physical education and labour training at the children
and adolescents. Scientific bases carrying out of medical-professional
consultation.
20. Substantial module 5. Radiation hygiene. 145
21. Тheme №12. Laws of formation irradiation loading of a person in the 145
residential apartments, its hygienic estimation and issues to decrease.
Radiation danger and antiradiation protection on the objects with radiation-
nuclear technologies.
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22. Тheme № 13. Hygienic estimation of antiradiation protection medical staff 150
and radiating safety of patients at the radioactive substances application and
other sources of ionizing radiation in the health care facilities.
23. Theme of independent out-of-class work 5. Hygienic aspects of residing 155
population in the territories with high radioactive pollution levels as a
result of Chernobyl accident.
24. Substantial module 6. General questions of hygiene and ecology. 158
25. Theme № 14. Influence anthropogenesis components of biosphere on the 158
population and individual health. Hygienic estimation potential risk of
environmental factors impact on a human body and population health.
26. Theme of independent out-of-class work № 6. Hygienic estimation 167
influence natural components of biosphere on the person and population
health.
27. Theme of independent out-of-class work № 7. Hygienic value of solar 168
radiation and use its components for preventive diseases of the person and
sanitation of air, water and subjects.
28. Theme of independent out-of-class work № 8. Scientifical basis of medical 169
biorhythmology and chronohygiene.
29. Substantial module 7. Hygiene of extreme situations. 170
30. Theme of independent out-of-class work № 9. Sanitary inspection for 170
organization of nutrition and water supply in the conditions of accidents.
31. Theme of independent out-of-class work № 10. Organization and sanitary 178
inspection of working conditions liquidators of accidents consequences.
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Module: Estimation of environmental state and influence of environment on
the public health (hygiene and ecology)
Substantial module 1. Municipal hygiene.

Concrete purposes:
 Analises hygienic, physiological and epidemiological properties of water, role
of water at the epidemiology of infections desiases and helmintoses with water
mechanism of transfer.
 Give hygienic estimation of organoleptic, chemical and bacteriological
indicators of water from different water sources.
 Describe systems of water supply in the urbanic territories. Estimate methods
of improvement water quality – organoleptic properties (sedimantation,
filtration, coagulation), microbiological properties (desinfection), toxicological
properties (detoxification), deactivation.
 Estimate degree of atmospheric air pollution and its dangerous for public
health.
 Propose system of hygienic actions for sanitary protection of atmospheric air
pollution (technological, planning, sanitary-technical, legislative).
 Give hygienic estimation of soil quality on the data of laboratory research.
 Propose plan of hygienic actions on the sanitary protection of soil to prevent
diseases.
 Describe and explain priority of accumulation, transportation and utilization of
medical-preventive establishment waste (sewage, garbige from sergical,
infections departments).
 Planning, research and hygienic estimation of air quality in the premises of
public and medical-preventive establishments. Propose preventive measures to
protect negative influence of internal environmental factors in the premises to
the public health.
Тheme № 1: Hygiene of water and water supply of settlements. Sanitary

protection of water objects.
1. PURPOSE: estimate quality of potable water, water supply sources
(centralized and decentralized); estimate schemes of clearing city sewage, according
to standard norms.
2.1. Student should know:
2.1.1. Hygienic, physiological and epidemiological value of water and its role in
widespread of infectious and non- infectious diseases with water way of transfer.
2.1.2. Water supply systems at the settlements. Methods carried out improvement
quality of potable water, as well as organoleptic characteristics (sedimentation,
filtration, coagulation), microbiological indicators (disinfection), toxicological
parameters (neutralization).
2.1.3. Hygienic requirements to superficial water sources, basic requirements for
wastewater treatment and hygienic substantiation of their discharges into water
objects.
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2.2. Student should have professional skills:
2.2.1. Estimate laboratory analysis water samples, which have been taken from
centralized drinking water supply distribution network and carry out hygienic
conclusion.
2.2.2. Estimate laboratory analysis water samples, which have been taken from
underground water supply (wells) and carry out hygienic conclusion.
2.2.3. Estimate quality of potable water and propose water treatment schemes.
2.2.4. Carry out hygienic assessment of water quality in the reservoir after wastewater
descent, according to the water reservoir category.
3. Self-StudyMaterial Programm to practical training:
3.1. Hygienic, epidemic and endemic value of water.
3.2. Basic hygiene requirements to drinking water quality according to State Sanitary
Rules and Norms "Hygienic requirements to drinking water, intended for human
consumption" SSanR&N 2.2.4-171-10:
a) physiological value mineral composition of drinking water
b) organoleptic properties of drinking water
c) epidemiological safety indicators: microbiological and parasitological indicators
d) toxicological safety indicators
e) radiological safety indicators
3.3. Hygienic characteristics of surface and underground water sources according to
water quality principles in order to determine water source classes, carried out by ISO
4808:2007.
3.4. Methods of water sources treatment, according to their class. Basic water supply
schemes. Carring out comparison estimation of water treatment methods.
3.5. Hygienic requirements to sanitary protection zones (SPZ) organization, applied
for the centralized water supply sources.
3.6. Hygienic requirements to different water reservoir category (SanR&N 4630-88).
3.7. Sewage system at the settlements, its importance in order to prevent infectious
diseases. Disinfecting of sewage from medical establishments.
4. Practical Assignments
1. Standard legislative regulations using in order to carry out drinking water hygienic
estimation by the data of the scenario – based tasks.
2. Standard legislative regulations using in order to carry out hygienic estimation of
the superficial water reservoir.
5. QUESTIONS FOR SELF-PREPARATION:
5.1. What is the physiological value of water for human purposes (daily consumption,
liters per day) and minimum mineral salts content in the water? Which health
disorders can cause low content of mineral salts in the water?
5.2. Which indicators of epidemic safety of drinking water, regulated by SSanR&N
2.2.4-171-10 "Hygienic requirements to drinking water, intended for human
consumption"?
5.3. Specify presence of coliphage in water and measures, which should be taken in
this case?
5.4. Waterborne infectious diseases. Peculiarities of waterborne epidemics, their
prophylaxis.
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5.2. Which indices determined water radiation safety, regulated by SSanR&N 2.2.4-
171-10? Specify measures in order to normalize radiation safety indicators of
drinking water?
5.3. Which types of drinking water indicators are standardized by SSanR&N 2.2.4-
171-10?
5.4. Which disease (poisoning) can cause consumption of drinking water with
overnormal concentration of nitrates? Specify clinical symptoms. Which population
group has predisposition to this disease?
5.5. Which disease can cause consumption of drinking water with overnormal
concentration of fluorine in the drinking water? What are the clinical symptoms and
preventive measures?
5.6. Specify evidence of overnormal concentration of ammonia and coliforms in the
drinking water? What preventive measures should be taken?
5.7. What are the basic technological methods, carried out for centralized water
supply?
5.8. Which indicators of drinking water provide effectiveness of coagulation?
5.9. Which indicators of drinking water provide effectiveness of disinfection?
5.10. What types of laboratory monitoring of drinking water quality provide by
SSanR&N 2.2.4-171-10? Which sources are most suitable for the organization of
drinking water, explain why?
5.11. How many classes of water sources were established by ISO 4808? Which of
these classes can be used for drinking purposes?
5.12. What is the most important condition in order to use source of water supply for
drinking purposes?
5.13. Carry out procedure of drinking water source choosing, according to ISO 4808?
5.14. What hygienic standards and regulations provide requirements for water objects
sanitary protection zones?
5.15. Enumerate and determined quantity of sanitary protection zones for
underground water sources?
5.16. What measures should be implemented in the first sanitary protection zone for
surface water sources?
5.17 Which types of antropogenic activities are prohibited in the second sanitary
protection zone of underground water sources?
5.18. Which types of antropogenic activities are prohibited in the third sanitary
protection zone of underground water sources?
5.19. Enumerate and determined categories of superficial water objects by SSanR&N
4639-88? What water reservoir category should have the best quality, specify why?
5.20. Total coliforms have been found at the laboratory sample of water, which was
taken from public well. Specify, what means presence of these substances? Which
measures should be taken?
5.21. Which hygienic requirements carried out for wastewater descent, taken from
infectious departments towards public canalization system?
6. STRUCTURE AND OCCUPATION MAINTENANCE.
After carrying out of the test control of students on a theme, discussion of control
questions is spent. The attention to hygienic requirements of potable water quality,
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and water from mine wells carried out by "Hygienic requirements to drinking water,
intended for human consumption" SSanR&N 2.2.4-171-10 and ISO 4808. Show
sampling of water for bacteriological and chemical analyses. Hereafter students solve
scenario-based tasks, according to the potable water quality (appendix 1, 2), students
should carry out hygienic conclusion.
Each student receives a situational problem and estimates conditions of release
of sewage in a reservoir, according to hygienic requirements. At the end of
occupation students make out the hygienic conclusion, sign reports.
7. Theoretical Assignments
Appendix 1
CLASSIFICATION OF THE INFECTIOUS DISEASES
WITH WATER FACTOR OF TRANSFER (WHO)
І. Diseases which arise in order to the use polluted water for drinking purposes
1. Intestinal infection (transfer - mechanism fecal-oral):
a) bacterial nature: cholera, typhus, paratyphus A and B, dysenteria, coli enteritis,
salmonellas;
b) virus etiology: (virus hepatitis A, poliomyelitis, infections Koksaki, ECHO); epidemic
myalgia, angina, flu and dyspepsia, serous meningoencephalitis, virus disease of oral
cavity (gastroenteritis, infectious diarrhea);
c) protozoan illnesses: ameba dysentery, lambliosis;
2. Infections of respiratory ways (the fecal-oral mechanism of transfer):
a) bacterial nature: tuberculosis
b) virus etiology: adenovirus infections, i.e. adenoviral infections, nasopharyngitis,
conjunctivitis, rhinitis
3. Infections of the skin and mucous membranes (fecal-oral mechanism of transfer):
Siberian ulcer
4. Transmissive infections (fecal-oral mechanism of transfer): Ku-fever.
5. Zooantroponozis with fecal-oral mechanism of transmission (tularemia,
leptospirosis and brucellosis)
6. Helminths diseases, which are caused by worms, transfer from water:
a) heohelminthoses (tryhotsefaloz, ascariasis, ankilostomidoz);
b) biohelminthoses (echinococcosis, hymenolepiasis).
II. Diseases of the skin and mucous membranes that result from contact with
contaminated water: trachoma, leprosy, anthrax, fungal infections (athlete, etc.).
III. Diseases that cause worms transfer from water: schistosomiasis, drakunkulozis
IV. Transmissive infections, insects-carriers breeding in water (malaria, yellow fever).
Some infections are common the world over and include
• Salmonella infections.
• Pneumococcal pneumonia.
• Gonorrhoea.
• Thrush (candidiasis).
• Tuberculosis.
• Influenza.
• Epstein-Barr virus.
• HIV.
• Hepatitis C.
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• Herpes simplex.
• Threadworm (Enterobius).
Some infectious diseases are only common in the developing world, e.g.
• Malaria.
• Diphtheria.
• Rheumatic fever.
• Enteric fever (typhoid and paratyphoid).
• Hepatitis E.
• Poliomyelitis.
• Rabies (although Eastern Europe has significant disease).
• Viral haemorrhagic fever (aka VHF, e.g. Lassa fever).
• Onchocerciasis (river blindness).
• Schistosomiasis.
• Leishmaniasis.
• Ascariasis.
• Cutaneous myiasis (e.g. tumbu fly).
Some infectious diseases are common in some parts of the developed world but not in
other parts of the developed world, and include
• Lyme disease.
• Babesiosis.
• Histoplasmosis.
• Hydatid disease.
• Anisakiasis.
Indeed, only certain areas of the USA, for example, are endemic for
• Lyme disease.
• Coccidioidomycosis.
• Babesiosis.
• Histoplasmosis.
When considering the possibility of an infective process, one should always consider the
basic infection groups
• Bacteria (including primitive forms).
• Mycobacteria.
• Fungi.
• Viruses.
• Protozoa.
• Helminths.
• Prions.
• Myiasis.
Epidemic - intensity of epidemic process which is characterized by level of disease of
infectious diseases which exceeds similar disease in the given region for the analyzed period of
supervision.
Water epidemic - epidemic at which activators of infectious diseases extend through water.
TRIAD OF FACTORS OF WATER EPIDEMIC:
1. The activator allocated from the infected organism, should get to water.
2. The activator long time keeps the ability to live and pathogenicity in water.
3. The activator through water gets to a susceptible human body.
Pathogenicity - ability to cause infectious process in an organism.
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ENDEMIC VALUE OF WATER
Endemic illnesses - connected with the natural low or high maintenance of microcells in objects of environment, including in
water. They are extended in separate regions - geochemical provinces.
Geochemical endemic Reasons Geochemical provinces Clinical symptoms
Endemic fluorosis The fluorine maintenance in water In mountain areas of left-bank Fluorosis of teeth
more than 1.5 mg/l. Daily Ukraine ( the Buchaksky (porcelain stains, enamel
requirement is 3.2-4.2 mg. chink), about 57 % of all erosion), fluorosis of the
chinks of the Poltava area skeleton
receive water from the (osteosclerosis, etc.).
Buchaksky watershed.
Endemic dental caries The fluorine maintenance in water The most part of Ukraine (river Destructive defeats of teeth
less than 0.7 mg/l basin Dnepr) enamel in the stage of caries
cavities
Geochemical endemic Reasons Geochemical provinces Clinical symptoms

Endemic craw Iodine lack. Daily requirement is Carpathians, the Poltava area, Hyperplasia of thyroid gland,
0.2-0.3 mg. Central Asia, Caucasus, Altai. hypothyroidism, at children -
developmental anomalies,
intellectual backwardness.
Urovskaya disease Raised maintenance of Fe, Sr, Mn, Transbaikalia, Eastern Siberia Osteodeforming artroses of
(polyhypermicroelementosis) Zn, Pb, Ag, F against low (Amur, Irkutsk area), Korea, interphalanx joints, backbone -
maintenance of Ca China. «the bear paw», «duck gait».
Molyndenum podagra Concentration of Mo Armenia The strengthened formation of
> 0.1-0.3 mg/dm3 uric acid.
NONINFECTION DISEASES OF WATER ETIOLOGY
(WATER POLLUTION BY THE TOXIC CHEMICAL SUBSTANCES EXCEEDING MAXIMUM CONCENTRATION LIMIT)
Substance The maintenance in water, MAC The illness name Clinical symptoms
Polychlorinated Natural waters: Usho (oil illness) Nausea, vomiting, bronchitis,

byphenyles Pure <0.5 mg/l hepatitis, neurologic
Mind. Polluted 0.5-50 mg/l, infringements. Cancerogenic
Polluted> 50 mg/l action. Passes through the
transplacentary barrier.
Lead Undeg. waters-0.001-0.1mkg/l Saturnism Paralyses, infringements of

Open waters-0.01-0.5mkg/l hemopoesis, encephalopathies,
MAC-0.03 mkg/l gepatotoxic action
Cadmium Natural waters: Itaj-itaj Antagonist of Ca, Se, Fe, Zn, Co.
0.05-1 mkg/l; The osteoporosis, dysfunction of
MAC - 0.03 mg/l kidneys, anaemia.
Mercury Undeg. waters-0.001-0.1mkg/l (Methyl-mercury) Frustration of mentality,

Open waters-0.01-0.5mkg/l coordination of movements,
MAC -0.0005 mkg/l sensitivity, hearing, sight, speech,
spasm, clod.
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General hygienic requirements to drinking water according to SSanR&N 2.2.4-171-10
"Hygienic requirements to drinking water, intended for human consumption"
- organoleptic properties (transparency, comparatively low temperature, good refreshing
taste, absence of odours, unpleasant aftertastes, colour, apparent to the naked eye inclusions and so
on);
- optimal natural mineral composition, which guarantees good taste properties of water,
the receiving of some necessary for organism macro- and microelements;
- toxicological safety (absence of toxic substances in hazardous to organism
concentrations);
- epidemiologic safety (absence of agents of infectious diseases, of helminthiasis etc.);
- water radioactivity – within the limits of set levels.
Organoleptic properties of water are divided into 2 subgroups: 1) physical and organoleptic
– combination of organoleptic characteristics that are perceived by sense organs and are evaluated
according to the strength of perception and 2) chemical and organoleptic – content of particular
chemical substances, which can irritate receptors of corresponding analyzers and cause one sense or
another.
Odour – is the ability of chemical substances to evaporate and, producing sensible steam
pressure over water surface, to irritate receptors of mucous membranes of nose and paranasal
sinuses, and in such a way to cause corresponding sense. There is the following differentiation of
odours: natural (aromatic, marshy, putrefactive, fishy, grassy and etc.), specific (pharmaceutical)
and indeterminate odours.
Taste and aftertaste — is the ability of chemical substances, existing in water, to irritate
taste buds, which are placed on the surface of tongue/tongue surface, and to cause corresponding
sense. One can differentiate salty, bitter, sour and sweet tastes. The rest are aftertastes: alkaline,
marshy, metallic, aftertaste of mineral oil and etc.
Colour — is natural property of water, depends on humic substances, which are washed out
from the soil during formation of surface and ground water reservoirs and give water yellow-brown
tint.
Suspended materials concentration (turbidity) — is natural property of water that depends
on the content of suspended substances of organic and nonorganic origin (clay, sludge, organic
colloids, plankton and etc.). Suspended materials concentration of water is evaluated in mg/l by
comparison of optical water density with the density of standard suspensions of kaolin, according to
State standards (SSRandN) 383 – in nephelometric turbidity units (NTU).
Temperature influences greatly on: 1) organoleptic properties of water (odour, taste and
aftertastes); water with temperature more than 25°C provokes vomiting reflex; according to the
international standard the temperature should not exceed 25°C, cool water with temperature (12–
15°С) is considered to be the best water.
Solid residue (total salinity) — is the quantity of solutes, mainly mineral salts (90 %), in 1
litre of water. Water with solid residue up to 1000 mg/l is called fresh water, one with solid residue
from 1000 to 3000 mg/l – saltish water, one with solid residue more than 3000 mg/l – salt water.
Salinity of 300—500 mg/l is considered to be optimal.
Hydrogen index (pH value) — is natural property of water that depends on the presence of
free hydrogen ions.
Total hardness — is the natural property of water that depends upon the presence of so-
called salts of hardness, namely: calcium and magnesium (of sulphates, chlorides, carbonates,
hydrocarbonates and others).
Chlorides and sulphates are widely spread in nature and constitute the greater part of solid
residue of fresh water.
Natural chloride content in surface water reservoirs is small and varies within the limits of
several dozens of mg/l. They influence organoleptic properties of water – impart it salty (chlorides)
or bitter (sulphates) taste.
Criteria that characterize epidemic safety of water are subdivided into 2 subgroups: the sanitary
and microbiological criteria and the sanitary and chemical criteria.
Sanitary and microbiological criteria of epidemic safety of water. Absence of pathogenic
microorganisms – agents of infectious diseases – is a criterion of epidemic safety of water.
Permanganate oxidizability — is quantity of oxygen (in mg) that is necessary for chemical
oxidization of easily oxidable organic and nonorganic (Fe (II) salt, H2S salt, ammonium salts,
nitrites) substances, which are available in 1 litre of water. Here KMnO4 is oxidizing agent.
Biochemical oxygen demand (BOD) — is quantity of oxygen (in milligrammes) that is
necessary for biochemical oxidization (due to activity of microorganisms) of organic substances,
which are available in 1 litre of water, at temperature equal to 20 °С during either 5 days (BOD5) or
20 days (BOD20).
Sanitary inspection of centralized water supply
Centralized water supply sources are subdivided into preventive one and regular. Preventive
inspection includes sanitary examination of the design of water pipeline and all the components of
water pipeline, supervision of the process of its construction and putting into operation.
Before the constructed water pipeline is put into operation, the following sanitary
protection zones are to be designated:
- sanitary &regime zone, which includes the defined part of water area in the place of
water intake and upstream, territory around the water-purifying facilities;
- restriction zone – the territory, where any construction and operation of facilities, which
can pollute this territory and the water reservoir, is prohibited;
- zone of observation, which includes the whole water supply network.
Hygienic requirements to the quality of the surface water
Hygienic requirements for water quality in surface waters, depending on the types of water
use regulated SR&N № 4630-88, which regulates various types of economic activity that could lead
to contamination of surface water, determine the conditions under which body of water is
considered polluted and not suitable for fully or partially centralized domestic water supply or mass
recreation. According to the rules, standards of water quality in water bodies set depending on the
nature of water bodies for different types of water. Water bodies or areas are divided into two
categories of water use.
Category I - surface waters that are used for centralized or decentralized systems of water
suply and water for food businesses.
Category II - surface water, performing the role of recreation, aquatics and ponds located
within the settlement.
Calculation of additive action for chemical substances
Toxic chemical substances at simultaneous presence in water are capable to have on a
human body the combined effect which consequence to negative effects more often, i.e. additive
action. To guarantee preservation of health in the conditions of such combined action it is necessary
to adhere to the rule (Averyanov) additive toxicity: the sum of parities of actual concentration of
substances of water to their maximum concentration limit should not exceed 1:
where С1, С2, Сn — actual concentration of chemical substances in water, mg/l;

MAC1……n – maximum admissible concentration.
Water purification for human consumption purposes consists in the

removal of different contaminants as chemicals (i.e., pollutants, toxic
metals), biological contaminants (algae, bacteria, fungi, parasites,
viruses), suspended solids, and gases.
There are several methods used in the water purification process,
which include:
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(1) physical processes, such as filtration, sedimentation, or distillation;
(2) biological processes, such as sand filters, active carbon;
(3) chemical processes, such as flocculation, chlorination, the use of
ultraviolet light.
Regarding the physical approaches used in water purification, these
differ in the phenomenon on which the processes are based. For
instance, filtration is based on the separation of solids from fluids, by
interposing a porous medium (filter) which retains the solid particles and
allows the fluid to pass on the other side. On the other hand, the
sedimentation approach uses the gravitational force which determines
the solids to form a deposit at the bottom of the tube containing
contaminated water, while distillation involves the transformation of the
liquid (water) into a vapor phase, process which is based on the
difference in the volatility of the compounds.
Slow sand filters represent one example of biological approaches
used in water purification, which implies using 1–2 m deep tubes filled
with sand, which retain the impurities present in the filtered water.
Activated carbon (charcoal), another utilized approach, is a microporous
carbon with high surface area and enhanced adsorption properties.
In scientific terms, flocculation is a process in which colloids in
suspension become destabilized after the addition of a clarifying agent;
regarding the water purification process, the flocculation phenomenon
can refer to the destabilization and coagulation of contaminants present
in the water.
The use of electromagnetic light, especially with short wavelength
(in ultraviolet range) is commonly used in disinfection, due to the fact
that it produces gaps in the structure of nucleic acids of microorganisms
disabling their cellular functions. This method is often used in water
decontamination.
Water chlorination is commonly encountered in the treatment of
water supply and consists in the addition of chlorine or hypochlorite to
kill microbes and to prevent the spreading of waterborne diseases.
Chlorine inactivates a microorganism by damaging its cell membrane.
Once the cell membrane is weakened, the chlorine can enter the cell
and disrupt cell respiration and DNA activity (two processes that are
necessary for cell survival).
The benefits of chlorination are:
 Proven reduction of most bacteria and viruses in water
 Residual protection against recontamination
 Ease-of-use and acceptability
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 Proven reduction of diarrheal disease incidence
 Scalability and low cost
The drawbacks of chlorination are:

 Relatively low protection against protozoa
 Lower disinfection effectiveness in turbid waters
 Potential taste and odor objections
 Must ensure quality control of solution
 Potential long-term effects of chlorination by-products
CHLORINATION BY-PRODUCTS
A number of different by-products can be produced from the reactions in the disinfection
process. By-products created from the reactions between inorganic compounds and
chlorine are harmless and can be easily removed from the water by filtration. Other by-
products, such as chloramines, are beneficial to the disinfection process because they
also have disinfecting properties. However, there are undesired compounds that may be
produced from chlorine reacting with organic matter. The compounds of most concern
right now are trihalomethanes (THMs) and haloacetic acids (HAAs). THMs and HAAs
are formed by reactions between chlorine and organic material such as humic acids and
fulvic acids (both generated from the decay of organic matter) to create halogenated
organics. A greater level of THM formation has been found in surface water or
groundwater influenced by surface water.
Trihalomethanes are associated with several types of cancer and are considered
carcinogenic. The trihalomethane of most concern is chloroform, also called
trichloromethane. It was once used as an anaesthetic during surgery, but is now used in
the process of making other chemicals. About 900 ppm of chloroform can cause
dizziness, fatigue, and headaches. Chronic exposure may cause damage to the liver and
kidneys. Other harmful disinfection by-products are: trichloracetic acid, dichloroacetic
acid, some haloacetonitriles, and chlorophenols.
Trichloracetic acid is produced commercially for use as a herbicide and is also produced
in drinking water. This chemical is not classified as a carcinogen for humans, and there
is limited information for animals. Dichloroacetic acid is an irritant, corrosive, and
destructive against mucous membranes. This is also not currently classified as a human
carcinogen. Haloacetonitriles were used as pesticides in the past, but are no longer
manufactured. They are produced as a result of a reaction between chlorine, natural
organic matter, and bromide. Chlorophenols cause taste and odour problems. They are
toxic, and when present in higher concentrations, affect the respiration and energy
storage process in the body.
Ozonation (also referred to as ozonisation) is a chemical water treatment technique based on the infusion of ozone
into water. Ozone is a gas composed of three oxygen atoms (O3), which is one of the most powerful
oxidants. Ozonation is a type of advanced oxidation process, involving the production of very reactive oxygen
16
species able to attack a wide range of organic compounds and all microorganisms. The treatment of water with
ozone has a wide range of applications, as it is efficient for disinfection as well as for the degradation of organic
and inorganic pollutants. Ozone is produced with the use of energy by subjecting oxygen (O2) to high electric
voltage or to UV radiation. The required amounts of ozone can be produced at the point of use but the production
requires a lot of energy and is therefore costly.
Advantages
Rapidly reacts with bacteria, viruses and protozoa over a wide pH range
Stronger germicidal properties than chlorination
No chemicals are added to water
Also efficient for organics degradation and inorganics removal
Removes colour, taste and odour
Disadvantages
Relatively high equipment costs
Requires large amounts of energy
Qualified professionals required for design and system maintenance
Formation of potentially harmful disinfection by-products (DBPs) in the case of brome existence in water
No residual effect is present in the distribution system
8. LITERATURE:
8.1. The basic:
8.1.1. Hygiene and ecology / under the editorship of Corresponding Member of
Academy of Medical Sciences of Ukraine, professor V. G. Bardov. –
Vinnytsya: Nova Knyha publishers, 2009. – P. 168-180, 181-198.
8.2. Additional:
8.2.1. Hygiene and ecology / Vladimir A. Korobchanskiy, Michael P. Vorontsov,
Alisa A. Musulbas. – Kharkov: Kontrast Publishing Enterprise, 2006. – P. 67-82.
8.2.2. General hygiene and environmental health / Edited by Professor M.M.
Nadvorny. – Odessa, 2005. – P. 48-57, 194-199.
Appendix 2
Scenario – based task:
"Hygienic requirements to potable water, quality estimation"
At the current state sanitary-and-epidemiologic supervision of centralized drinking water
supply in the city N. water tests at clearing station were selected. Laboratory researches showed
such results:
Investigated indicator Result of research

1. Indicators of epidemic safety:
- microbic number 170
- Coli-index 9
2. Chemical compound indicators:
- рН 6.7
- oxidation, mg/dm3 4.5
- nitrates, mg/dm3 20
- iron, mg/dm3 0.2
- residual chlorine, mg/dm3 0.4
- chloroform, mg/dm3 0.03
3. Indicators of organoleptic qualities:
- color quantity, degrees 20
17
- feculence, mg/ dm3 0.7
- aftertaste, points 2
- smell, points 2
1. Enumarate indicators, which were not correspond to the quality of potable water by
SSanR&N 2.2.4-171-10.
2. Carry out hygienic estimation quality of potable water by results of laboratory researches, and
proposed hygienic recommendation in order to supply population with good – quality potable water.
Standard answer:
Quality of water mismatches sanitary requirements: water is not safe to the epidemiological
sign (excess of microbic number in 1.7 times and coli-index in 3 times); contains toxic chemical
substances - nitrates, iron, chloroform in concentrations, which were not exceed maximum
concentration limit; favorable organoleptic properties (color quantity, feculence, aftertaste and smell
were not exceed standard value).
Carry out repeated sampling of water; strengthen sanitary inspection in zones of sanitary
protection of water source, behind technology of clearing and water disinfecting; spend
epidemiological, toxicological and organoleptic control in water distributive network.
Scenario – based task: "Hygienic requirements to water supply sources"

To the municipal hygiene of sanitary station of city N. the project of organization of the
centralized drinking water supply from a superficial water source – river K. has arrived. As a part of
the project materials about quality of water from superficial water source according to three-year
supervision (all 36 researches are executed) are resulted. Indicators of quality of water are resulted
more low:
Investigated indicator Average values

Feculence, mg/dm3 800
Color quantity, degree 80
Smell, points 2
рН 6.5
Iron (Fe), mg/dm3 72
Manganese (Мп), mg/dm3 40
Fitoplancton, mg/dm3 4
Oxidation, mg O2/dm3 10
Biochemical need in oxygen 3
General hardness, mmol/dm3 4
E. Coli, CFU/ 100cm3 1000
Dry residue, mg/dm3 400
Chlorides, mg/dm3 150
Sulphates, mg/dm3 160
1. Give hygienic estimation of class of water source by results of laboratory researches of water.
2. Offer system of water treating of water source for maintenance of the population with qualitative
potable water.
3. Carry out recommendation in order to organize regime in the sanitary protection zones.
Standard answer:
By fitoplancton superficial source has high quality (I class), by all organoleptical (feculence,
color quantity, smell) and chemical indicators as well as рН, Fe, Mn, oxidation, biochemical need in
oxygen, general hardness superficial source concerned to II class, but because of high maintenance
of chlorides, sulphates source of water concerns to ІІІ class, according to ISO 4808: 2007 "Sources
of centralized economic-drinking water supply. Sanitary and technical requirements and rules of
selection".
18
Carry repeated sampling of water; strengthen sanitary inspection in zones of sanitary
epidemiological water quality assurance in a water distributive network.
Scenario – based task: "Modern technologies of clearing of city sewage"
In the city D. drains from constructions of a city sewer network, chemical enterprises and rain drain
are dumped into river C. River C. is used for the organization of centralized drinking water supply
(above on a current). Lower on a current the zone of rest and a city beach is located. At sampling of
water of the river C. in control alignments (on 1 km above the city D.) following results are
received.
Indicator of water quality Above of the city D. Maximum concentration Class of

limit in water of reservoirs danger
Oxidation 6.4 mg О2/dm3 Not less 4.0 -
Biochemical need in 5.9 mg/dm3 Not more 3.0 -
oxygen -
Chemical need in oxygen 18.0 mg/dm3 Not more 15.0 -
Activators of intestinal Should not revealed Should not contain in 1dm3
infections -
Index intestinal sticks 8.500 Not more 10.000 in 1dm 3
Coli-phage 90 Plaque forming unit Not more 100 in 1dm3 -

Acetone Should not revealed Not more 0.7 mg/dm3 3
Freon-12 15.8 Not more 10.0 mg/dm3 2
Methanol 9.6 Not more 3.0 mg/dm3 2
1. Give hygienic estimation of water from the reservoir by results of laboratory researches.
2. Carry out recommendations focused on the prevention population health with harmful
influence pollution by wastewater discharges into water C in the city D.
3. Standard ability of EQC: calculate additive action of chemical substances by Averianov
formula.
Standard answer:
Quality of water before receipt to water distributive network mismatches sanitary
requirements: water contains toxic chemical substances - freon-12 and methanol, in concentrations,
which exceed maximum concentration limit in 1.58 and 3.2 times; biochemical need in oxygen and
chemical need in oxygen exceed maximum concentration limit (MCL) in 1.96 and 1.2 times.
Carry out repeated sampling of water; strengthen sanitary inspection in zones of sanitary
toxicological water control in water distributive network.
Standard ability of EQC:
where C -value of chemical substances (1-2 class of danger);

MCL-maximum concentration limit of chemical substances.
additive action for chemical substances (2 class of danger) exceed maximum concentration limit in
4.78 times.
Theme № 2: Sanitary protection of atmospheric air. Hygiene of planning in the

urbanized territories.
19
1. PURPOSE: carry out hygienic estimation actions for sanitary protection of
atmospheric air, system of sanitary control over sources of pollution in the
atmospheric air.
2.1.1. The characteristic of sources of pollution at the atmosphere.
2.1.2. Actions for sanitary protection of atmospheric air in the occupied places
(technological, planning, sanitary-technical, etc.).
2.1.3. Features of carrying out of the laboratory control over air in the occupied
places.
2.1.4. Principles of hygienic rationing of chemical substances in air.
2.1.5. Mechanisms of purification of atmospheric air.
2.2.1. Estimate level of air pollution in the occupied places.
2.2.2. Estimate actions for sanitary protection of air in the occupied places.
3.1. Air, as a factor of the environment: composition, physical and chemical
properties, the value for the life of living organisms, the role of the biosphere.
3.2. Hygienic characteristics of the main sources of air pollution and the quality of
the their emissions. The impact of air pollution on the state of health of the
population.
3.3. Characteristics of the measures to protect air: technology, planning, sanitation,
legal, their content.
3.4. Planning activities: functional zoning (industrial, residential, landscape and
recreational areas).
3.5. Sanitary classification of enterprises. Requirements for the size and arrangement
of buffer zones.
3.6. Hygienic regulation of pollutants in the atmosphere.
3.7. The concept of "maximum allowable concentration" and "estimated safe level of
exposure."
3.8. The organization of this quality control of atmospheric air of populated areas.
1. Standard legislative regulations using in order to estimate level of air pollution in
the settlements according to the scenario – based tasks.
2. Standard legislative regulations using in order to carry out correction of sanitary -
protective zone of an industrial enterprise.
5.1. Determine chemical composition of the atmosphere.
5.2. What is the concept of "air pollution"?
5.3. Enumarate hygienic specifications, carried out in the territory of Ukraine in the
branch of atmosphere pollution protection and planning of settlements.
5.4. What diseases are caused by high levels of an air chemical pollution?
5.5. Specify, which chemical factors caused chronich and asthmatic bronchites and
bronchial asthma?
5.6. Enumerate sources of air pollution by the priority.
5.7. Which factors have an influence on the concentration of atmospheric pollution?
20
5.8. Define the terms MCL of harmful substances in the air?
5.9. Determined the difference between maximum concentration limit (MCL) and
maximum-permissible dose (MPD).
5.10. Which chemical pollutants should not allowed to discharges into atmosphere
air.
5.11. Specify allowable conditions in order to discharge chemical pollutants into
atmosphere air.
5.12. Air preventive measures (technological measures, architectural-planning
measures, sanitary-technical measures, hygienic standardization, etc.).
5.13. Describe technological measures of air protection.
5.14. Which types of sanitary - protective zone carried out at the planning of
settlements?
5.15. Define standard document regulated sanitary classification of enterprises.
Enumerate classes of industrial enterprises according to this document?
5.16. If it possible to change the sanitary - protective zone, specify these conditions.
5.17. Carry out hygienic requirements to the sanitary - protective zone, and
requirements to its green zoning.
5.18. On the territory of industrial enterprises, where sulfur dioxide exeeds MCL, had
been observed increasing of morbidity. What impact on the human body prevails?
Which types of impact do you know?
6. STRUCTURE AND OCCUPATION MAINTENANCE:

Control of initial level of knowledge of students is spent by tests. After that
student are study standard documents by estimation of air cleanliness, control
questions of a theme. Each student receives scenario – based task and estimates
degree of air pollution in the occupied places, according to requirements of
permissible concentration of harmful substances in atmospheric air of cities.
At the end of lesson students make hygienic conclusion, sign protocols with
situational problem.
Air pollution is the addition of harmful substances into the atmosphere resulting in
continuing damage to the environment, human health, and the quality of life we experience. The
study of atmospheric or air pollution covers all those pollutants that are omitted into the
atmosphere, usually as gasses or particulates, which then directly or indirectly degrade the physical
and biological systems on the surface of the Earth
Primary sources of air pollution:
• road transport
• heat generating stations
• Industrial companies (technological and vent emissions)
• Agriculture (food chemicals, livestock complexes)
• Soil (mineral dust)
The concentration of atmospheric pollutants depends on several factors, namely the quantity
of emissions, emission height, distance from the source of emission, meteorological conditions
(direction, wind speed, humidity, pressure, temperature inversion, solar radiation).
21
In the structure of total morbidity increasing proportion acquire the disease, the development
of which is the determining factor in favor of air pollution: allergic dermatitis, acute respiratory
infections with asthmatic component, angioedema, asthma, cancer, hypertension, endemic disease.
Preventive measures carried out at the atmosphere air pollution
Technological measures - it measures to ensure environmentally friendly production:
• Substitution of hazardous substances in the production of non-hazardous or less hazardous;
• Replacement of dry processing facilities poroshkovanyh materials - wet;
• Replacement of heating by flame electric, solid and liquid fuels - gaseous;
• Cleaning materials from contaminants;
• Sealing and maximum sealing joints and combinations of process equipment to prevent the
release of hazardous substances in the production process;
• Complex mechanization, automation of processes;
• Continuity of production processes;
• Awning motorized traffic and the use of hydraulic and pneumatic transport poroshkovanyh
materials;
• Recovery of hazardous substances and cleaning them process emissions
Sanitary measures - use of equipment for clean air: camera for dust sedimentation, dust bag ,
scrubbers, cyclones, electrostatic precipitators.
Planning measures:
• Zoning territory.
Under existing SSR №173 the settlement on the basis of preferential functionality is divided
into:
 residential area - to accommodate housing, public buildings, institutions, social, cultural and
community purpose, road and transport networks, green spaces and public places, some
municipal objects
 industrial area - to accommodate enterprises and connected with their objects, a set of
scientific research institutions with industries, public-storage objects (warehouses, garages,
car parks, tram, trolleybus depot, etc.), companies in the manufacture and processing of
agricultural products, the creation of buffer zones of industrial enterprises, objects external
transport, roads/
 landscape and recreational area which includes suburban forests, parks, pond, recreation
areas and resort areas, agricultural land use, etc., together with parks, gardens, squares,
boulevards of residential area form a system of landscaping and recreational areas.
Rational arrangement residential area relatively industrial zone, taking into account the wind
rose, a dangerous wind speed, the microclimate of the area, bad weather situations for the scattering
of industrial emissions, temperature inversion, the formation of fog, background concentrations of
pollutants in the air, prospects of development of the city;
• Planting of greenery in city (landscape-gardening in residential areas must be at least 40%)
• Organization of sanitary protection zones (SPZ) for objects that are sources of air pollution.
According to the sanitary classification of enterprises, industries and construction and size of
sanitary protection zones for class IA is 3000 m, and B class - 1000 m, II - 500 m, III - 300 m, IV -
100 m, V class - 50 m.
The minimum planting area SPZ depending on its width should be: if width up to 300 m -
60%, from 300 to 1000 m - 50%, more than 1000 m - 40%.
Lowest observed adverse effect level (LOAEL) - the least (minimum) concentration of
substance established experimentally which causes adverse changes in morphology, functional
ability, growth, development, longevity of the organism-target, differing from normal (control)
organisms of the same kind, factors of environment not moving to influence.
No observed adverse effect level (NOAEL) - the greatest (maximum) concentration of
organisms of the same kind, under the set conditions of influence of the factor of environment.
22
Ways of receipt of harmful substances to the organism:
 aerogene: at inhalation of harmful substances from atmospheric air or air in premises;
 alimentary: through the gastroenteric path at the use of the polluted foodstuff and potable
water;
 intercutaneous: through the skin at contact to air, water, soil, etc.
MPC - maximum permissible concentration at which action throughout life there is no
direct or indirect impact on the present and future generations, not decreasing human performance
without deteriorating its health and sanitary living conditions. There are 2 types of MPC: maximum
single and daily.
Approximate safe level action (ASLA) - is the maximum concentration substance that is
recognized at estimated safe act on man and adopted as a temporary sanitary standard allowable
substances in the air of populated areas. ASLA established on the basis of short-term studies.
Maximum allowable pollution index (MAPI) air - relative integral criterion for assessing
air pollution settlements, which characterizes the intensity and nature of joint action and joint action
character of the totality of present therein contaminants.
The outer limits of SPZ facing the residential development, concentration and levels of
pollutants do not exceed their hygiene standards (MAC, GDR), on the verge of resort and
recreational area - the ratio of 0.8. In the SPZ should not allowed to build houses with gardening
area, hostels, hotels, homes for visitors, kindergartens, schools, medical and health institutions of
general and special purpose from the hospital, substance abuse clinics, sports facilities, gardens,
parks, gardening Society equip security zones of water sources, intakes and building water
distribution network.
Quantity indicators of estimation atmospheric air pollution

(State Sanitary Rules-201-97 Protection of atmospheric air from pollution)
Level of pollution Degree of air cleanliness Exceeding of
maximum permissible
concentration (MPC),
degree of points
admissible clean <1
inadmissible weakly polluted > 1-2
inadmissible moderate polluted > 2-4
inadmissible polluted > 4-8
inadmissible heavily polluted >8
8. LITERATURE:
8.1. The basic:
8.2. Additional:
Nadvorny. – Odessa, 2005. – P. 8-10, 21-47, 142-166.
Appendix 1
23
Scenario – based task: "Technologies and constructions for clearing of industrial aerosol and
gaseous emissions in atmosphere"
Arithmetic values of daily average concentration of chemical substances in the atmospheric
air of Lenin`sky region of Dnipropetrovs’k for 12 months on the stationary post was established:
Substances Maximum concentration limit Concentration in
atmospheric air,
mg/dm3
Dust inorganic (with maintenance SiО2 <20 %) 0.25 0.52
Anhydride sulphurous 0.05 0.09
Carbon оxide 3 4.7
Nitrogen dioxide 0.04 0.8
Formaldehyde 0.003 0.005
Maximum allowable pollution index 12,4
Index of factual pollution 34,2
1. Give hygienic estimation of quality of atmospheric air by results of laboratory researches,
according to the State Sanitary Rules-201-97 "Protection atmospheric air from pollution".
2. Carried out necessary hygienic actions for improvement of condition of atmospheric air in the
occupied places.
3. Carried out necessary architecturally – planning measures in order to improve atmospheric air
quality in the settlements.
Standard answer:
Index of factual pollution of atmospheric air of Lenin`sky region exceed maximum
allowable pollution index in 2.76 (34,2/12,4=2,76). It means that the level of pollution is
inadmissible, the degree of air cleanliness is average polluted.
Carried out sanitary inspection of industrial enterprises on the purpose of protection
atmospheric air; carry out laboratory research of air samples at the industrial enterprises on the
purpose of observance maximum-permissible emissions to atmosphere; make recommendations on
the observance of technological actions for air pollution prevention.
Тheme № 3: Sanitary protection of soil and clearing of the settlements.

1. PURPOSE: estimate sanitary condition of soil and degree of its pollution by
chemical substances; carry out hygienic assessment of soil.
2.1.1. Hygienic, epidemic and endemic importance of soil.
2.1.2. Indices and the scale for assessment of sanitary condition of soil.
2.1.3. Importance of soil as the medium for domestic and industrial waste treatment.
2.2.1. Carry out the sanitary examination of the land parcel considering its function
(territory of child institution, hospital, sewage treatment plant etc.).
2.2.2. Recommend preventive actions in order to carry out sanitary inspection
towards soils in the settlements.
2.2.3. Determine sampling points and to take soil samples for sanitary-chemical,
sanitary-bacteriological analyses.
24
1. Basic source of soil pollution, their hygienic characteristics
2. Impact of contaminated soil on public health and sanitary conditions.
3. Endogenous and anthropogenic biogeochemical provinces and infectious disease
etiology.
4. Estimation sanitary condition of the soil.
5. Specify sampling rules in order to carry out soil samples for sanitary-hygienic,
bacteriological and helminthological analyses.
6. Theoretical issues of an exogenous chemical substances (ЕCS) hygienic regulation
in the soil.
7. Sanitary protection measures focused on the soil contamination from household
waste.
1. Standard legislative regulations using in order to estimate hygienic assessment of
soil according to the scenario – based tasks.
2. Hygienic requaments carried out technique of soil samples for sanitary-chemical,
sanitary-bacteriological analyses.
5.1. Concept of soil and humus. Their hygienic significance.
5.2. Enumerate basic components of the soil and its hygienic significance.
5.3. What are the main sources of soil pollution?
5.4. Specify criteria of sanitary cleanliness of soil?
5.5. Which microbiological indicators describe fresh faecal contamination of soil?
What measures should be taken in this case?
5.6. What belongs to the direct and indirect indicators of soil pollution?
5.7. Describe procedure of estimation chemical pollution of soil?
5.8. Enumerate limiting MAC parameters, carried out in the soil?
5.9. Describe a term "biogeochemical province".
5.10. Found out examples of natural (endogenous) and anthropogenic biogeochemical
provinces.
5.11. Enumerate major endemic diseases, transfer from soil?
5.12. Define the concept of "buffering" or “buffer value”.
5.13. Specify the common intestinal infections, transferring from polluted soil?
Which of them are the most dangerous to humans?
5.14. Which sanitary measures focused on the prevention of soil pollution?
Occupation is carried out at the educational audience. The control of initial level
of knowledge is spent by tests. Student’s research standard documents to the hygienic
assessment of soil, control questions of the theme are discussed. Each student
receives a scenario – based task and estimates sanitary condition of soil, according to
requirements of hygienic assessment of soil. At the final part of occupation students
carries out hygienic conclusion, sign reports.
Soil is a surface layer of lithosphere (from few millimeters in mountains and up to 10
kilometers in lowlands), which was formed after beginnings of life on Earth as the result of climate,
25
flora and life (microorganisms and roots of higher plants) influence. Soil consists of the surface or
fertile layer (0-25 cm) or humus layer, which is characterized by fertility and which is cultivated at
growing plants, and of soil itself.
Soils are very different depending on conditions of their formation, first of all on climate and
flora. In Ukraine most common are chernozem (black earth soils) (54.0% of territory), then –– grey
forest soils (18.2% of territory).
Soil consists of biotic (soil microorganisms) and abiotic components. Abiotic components
include hard substance of soil (mineral and organic compounds and organomineral complexes), soil
moisture and soil air.
60––80% of mineral (non-organic) substances of soil are represented by crystalline silica or
quartz. The important place among mineral compounds is occupied by alumina-silicates, i.e.
feldspar and mica.
Organic substances of soil are represented both by soil organic (humic acids, fulvic acids
etc.) compounds, which are created by soil microorganisms and which are called humus, and by
strange for soil organic substances, which came into the soil from outside in the result of natural
processes and technogenic (anthropogenic) pollution.
Basic components of the soil and its hygienic significance:
- air permeability – soil ability to let air through its thickness. It increases when size of pores
is bigger and doesn’t depend on their total volume (porosity);
- water permeability – soil ability to absorb surface water and to let it pass through.
Permeability consists of two stages: imbibition, when free pores gradually get filled with water till
total saturation of soil and filtration, when, in the result of total water saturation of soil, water starts
moving in soil pores because of gravity;
- moisture capacity – amount of moisture, which soil is capable to retain due to sorptive and
capillar powers. The smaller is the size of pores and the bigger is their total volume, i. e. porosity –
the bigger is the moisture capacity. The finer is soil texture, the higher is its moisture capacity;
- soil capillarity – soil ability to lift water via capillaries from the bottom layers up. The
smaller is the size of soil texture particles - the bigger is soil capillarity, but in such soil water goes
up higher and slower.
Soil capability to transform organic compounds into mineral substances good for plants’
assimilation: carbohydrates – into water and carbon dioxide; fats– into glycerin and fatty acids
and then – also into water and carbon dioxide; proteins – into amino acids with ammonia and
ammonia salts evolvement and their further oxidation to nitrites and nitrates; protein sulfur – into
hydrogen sulfide etc.
Migration takes place both in short (soil –– plant –– soil, soil –– water –– soil, soil ––
air –– soil) and long (soil –– plant –– animal –– soil, soil –– water –– plant –– soil, soil –– water
–– plant –– animal –– soil, soil –– air –– water –– plant –– animal –– soil etc.) migration
chains;
- forms the chemical structure of foodstuffs of vegetable and animal origin;
- plays an important role in formation of water quality of surface and ground sources of
domestic and drinking water-supply;
- affects qualitative structure of contemporary atmosphere;
- of endemic importance – anomalous natural chemical structure of soil in endemic
provinces is a reason of rise and local spreading of endemic diseases (geochemical endemic
diseases): endemic fluorosis and caries, endemic goiter, foot-and-mouth disease (FMD),
molybdenum gout, endemic osteoarthritis or Kashin-Beck disease, endemic cardiomyopathy
(Keshan's disease), selenosis, boric enteritis, endemic nephropathy etc.;
- of epidemic importance – it can be a transmission factor of pathogens of infection diseases
and invasions to people: enteric infections of bacterial (typhoid, paratyphoids А and В, bacillary
dysentery, cholera, coli-entheritis), viral (virus A hepatitis, enterovirus infections: poliomyelitis,
Coxsackie virus infection, ЕСНО) and protozoa ethiology (amebiasis, lambliosis);
zooanthroponosis (types of leptospirosis: infectious jaundice or Vasyl’yev – Vail disease, anicteric
26
leptospirosis, brucellosis, tularemia, anthrax); mycobacteria of tuberculosis; spore-forming
clostridia – pathogens of tetanus, gas gangrene, botulism; geohelminthosis – ascaridiasis,
trichocephalosis, ankylostomiasis.
All indices are divided into direct (allow to assess the level of soil contamination and level
of danger for population health directly from the results of laboratory analysis of taken samples and
indirect (allow to draw a conclusion of the existence of soil contamination, its prescription and
duration by comparison of the results of soil laboratory analysis with test clean soil of the same
type, which was taken as a sample from non-contaminated areas).
Sanitary number of Khlebnikoff – is a ratio of humus nitrogen (pure soil organic
substance) to total organic nitrogen (consists of humus nitrogen and nitrogen of strange for soil
organic substances that contaminate it). If soil is pure, sanitary number of Khlebnikoff equals to
0.98-1.
Soil coli-titer – is a minimal amount of soil in grammas, in which one bacteria of
colibacillus group is found.
Soil anaerobe titer (perfingens-titer) – is a minimal amount of wastes in grammas, in
which an anaerobic clostridia is found.
Soil microbial number – is a number of microorganisms in one gram of soil that grew up
on 1.5% beef-extract agar at temperature 370С during 24 hours.
Sources of soil pollution
Waste – these are remains of substances and articles that have been created as the result of
domestic, economic and industrial human activity, and cannot be used at the scene of their creation
so that their accumulation and keeping make the sanitary condition of the environment worse. They
are divided into liquid: 1) sewage from cesspool toilets; 2) slops (from cooking and dish and floor
washing etc.) and 3) waste waters: domestic, industrial, runoffs, municipal waste water and solid: 1)
garbage (domestic refuse); 2) rubbish (kitchen waste products); 3) waste from patient care and
prophylaxis institutions (including specific ones –– used dressing, used disposable autotransfusers
and syringes, remains of medicines, remains of organs and tissues after surgical operations, dead
bodies of laboratory animals etc.); 4) institutional waste (schools, preschool institutions, high
schools and academies, offices, etc; 5) waste of public catering establishments; 6) waste of animal
origin (dead bodies of animals, pus, forfeit foodstuff); 7) waste of commercial facilities; 8)
industrial waste; 9) slags from boiler houses; 10) construction waste, urban soil; 11) street
sweepings.
Soil sanitary state criteria
Group of indices Indices
Sanitary-and-physical Texture of soil, filtration coefficient, air and water permeability,
capillarity, moisture capacity, total hygroscopic moisture
Physical-and-chemical Active reaction (рН), absorption capacity, total absorbed bases
Chemical safety criteria:
- chemical agents of natural Background content of total and movable forms of macro- and
origin microelements of non-contaminated soil
- chemical agents of Amount of pesticide residues, total content of heavy metals and
anthropogenic origin (soil arsenic, content of movable forms of heavy metals, oil and oil
pollution indices, ЕCS) products’ content, content of sulphides, content of carcinogens
(benzpyrene) etc.
Epidemic safety criteria:
- sanitary-chemical Total organic nitrogen, Khlebnikoff’s sanitary number, ammonia
nitrogen, nitrite nitrogen, nitrate nitrogen, organic carbon,
chlorides, soil oxidation
- sanitary-microbiological Total number of soil microorganisms, , microbial number, titer of
bacteria of colibacillus group (coli-titer), titer of anaerobes
(perfingens-titer), pathogenic bacteria and viruses
- sanitary-helminthological Number of eggs of helminthes
27
- sanitary-enthomological Number of larvae and chrysalides of flies
Radiation safety indices Soil activity
Soil natural purification indices Titer and index of thermophile bacteria
28
Appendix 1
Scale for assessment of sanitary state of soil*
Pollutional index Natural
Criteria of epidemic safety ЕCS –– exceeding purification
factor of MAC Radiation safety index
Level of
Danger level Number of Number of index –– –– thermophile
pollution Sanitary
Coli Anaerob eggs of larvae and soil activity titer
number of
titer e titer helminthes in chrysalides of
Khlebnikoff'
1 kg of soil flies on 0.25 m2
1.0 0.1
0.01-
Safe Pure and and 0 0 0.98-1.0 <1 Natural level
0.001
more more
Exceeding natural
Relatively Slightly single
1.0-0.01 0.1-0.01 less than 10 0.86-0.98 1-10 level by 1.5 times 0.001-0.00002
safe polluted specimen
and more
Exceeding natural
0.01- 0.01- 0.00002 -
Dangerous Polluted 11-100 10-25 0.70-0.86 11-100 level by 2 times
0.001 0.0001 0.00001
and more
Exceeding of
Very Heavily 0.001 0.0001 more than 25
<0.70 >100 natural level by 3 <0.00001
dangerous polluted and less and less 100 and more
times and more
*Under condition of soil sampling in the depth of 0-20 cm.
8. LITERATURE:
8.1. The basic:
Vinnytsya: Nova Knyha publishers, 2009. – P. 198-213.
8.2. Additional:
Nadvorny. – Odessa, 2005. – P. 191-194.
Appendix 2
Scenario – based task № 1: "Sanitary protection of soil"
To the municipal hygiene department of regional SES the administration of high school has
addressed with complaints to the local municipal enterprise, which is periodically carries out export
of dust from the apartment houses located close. Besides, in the absence of special motor transport
and enough of containers for gathering of dust from apartment houses, in the territory of school
dumps of household dust and food waste are formed. At the sanitary inspection of the soil, selected
from the school territory, such results are received:
Investigated indicator Result of research

1. Sanitary-chemical indicators:
- Nitrogen organic, mg/100 g 210
- Nitrogen soil albuminous, mg/100 g 154
2. Sanitary - bacteriological indicators:
- Coli-tytre 0.01
- Perfringens- tytre 0.001
3. Sanitary-helminthes indicator:
- number of helminthes eggs in 1 kg 7
4. Sanitary-entomological indicator:
- flies larvae in 0.25m2 2
1. Give hygienic estimation of sanitary condition of soil.
2. Define etiological factors and-or risk factors for health of pupils.
3. Find necessary standard documentation for a hygienic estimation.
4. Offer plan of hygienic measures to prevent soil pollution on the population health.
Standard answer:
1. Hygienic assessment of soil by sanitary-bacteriological, sanitary-helminthes and sanitary-
entomological indicators are low polluted, soil is clean (by sanitary index). In the soil helminthes
eggs, larvaes of flies are presents, but self-purification is normal by the quantity of nitrogen organic
to quantity of nitrogen soil albuminous (sanitary index is 1.36).
2. Risk factor for population health is: pollution degree – low polluted (by sanitary-
bacteriological, sanitary-helminthes and sanitary-entomological indicators), that promotes flash of
intestinal infectious diseases, helminthic infections among population.
3. Estimated indicators of sanitary condition of the soil.
4. Carry out liquidation of dump of household waste, remove top of low-polluted layer of
soil on the pure layer of soil and use plant cultures; regulary select tests of soil samples by sanitary-
bacteriological, sanitary-helminthes and sanitary-entomological indicators.
Scenario – based task № 2: "Sanitary protection of soil"

Carried out sanitary condition of soil in the city, where enrichment polymetallic ore company
was located in the residential zone, had been revealed heavy metals, which exceeds their clark
values. At the same time samples were selected in the outskirts behind the industrial zone, but with
similar types of the soil. Following results have been taken:
Concentration, mg/kg
Heavy metals
Factual Clark
manganese 2000,0 500,0
copper 66,0 33,0
zinc 170,0 65,0
lead 56,0 20,0
vanadium 190,0 150,0
1. Calculate concentration coefficients as well as separate heavy metals.
2. Propose complex of the primary preventive measures.
Тheme № 4: Hygiene of the residential and public buildings and facilities.

1. PURPOSE: carry out hygienic assessment quality of an internal environment of
premises, in accordance with hygienic standards and laboratory research results.
2.1.1. Basic factors of internal environment in the apartments, issues of their impact on the
human health.
2.1.2. Architectural &planning and engineering issues of modern apartments.
2.2.1. Investigate and carry out hygienic assessment quality of an internal environment in
the premises.
2.2.2. Apply basic sanitary legislation in the field of hygiene of settlements.
3.1. Apartment as a factor of an individual health formation.
3.2. Basic hygienic parameters as well as property and their hygienic assessment:
- Architectural & planning (spatial) characteristics of apartment;
- Microclimate indicators such as comfortable and acceptable (air temperature,
humidity, air velocity, temperature of the enclosing surfaces);
- Means of correction microclimate (ventilation, heating, air conditioning);
- Systems of artificial and natural illumination in the different functional premises
of the apartment;
- Illumination of the premises and methods of their correction;
- Requirements for materials of an interior surfaces, carried out for apartments and
furniture.
3.3. Methods of instrumental research main indicators of the residential
environment:
- Microclimate parameters (speed of air movement, temperature and humidity);
- Coefficient of natural illumination and light-factor;
- Acoustic characteristics of the premises (equivalent noise levels of the internal and
external sources);
- Comfortable illumination carried out orientation of windows in the premises.
1. Standard legislative regulations using in order to carry out hygienic assessment quality
of an internal environment in the premises by the data of the scenario – based tasks.
27
2. Instrumental measurement basic indicators of residential environment parameters
(temperature, relative humidity, speed of air movement in a classroom and their hygienic
assessment, in accordance with instructions of a teacher one of parameters, issue 3.3).

1. Why residential environment factors have significant influence on the formation
of individual health?
2. Which groups of factors (parameters) of the premises have a vital hygienic value
(enumerate)?
3. Which functional areas and premises types should be carried out in the apartment,
private residential building?
4. Specify spatial characteristics of the apartment (area, shape, height)?
5. Enumerate factors, which influence into the hygienic optimal set and number of
the apartment’s premises?
6. In order to carry out impact of microclimate parameters on the human health,
specify these effects.
7. Enumerate microclimate parameters, values of these parameters?
8. Which engineering systems and construction should effectively provide
microclimate parameters to an acceptable level?
9. Which are the basic ventilation systems, carried out in the premises, specify
premises for their measurement?
10. Which control parameters carried out in order to assess effectiveness of the
ventilation system?
11. Which are the basic domestic heating, carried out in the premises, specify
premises for their measurement?
12. Enumerate illumination systems which should be taken in the different
functional premises of an apartment, house?
13. Carry out methods of estimation effectiveness (sufficiency) of artificial or
natural illumination.
14. Enumerate advantages and disadvantages modern sources of artificial
illumination (fluorescent lamps and bulbs)?
15. What affects into an acoustic mode of apartment in the modern cities?
16. Carry out methods of normalization noise levels in the residential premises?
17. Concept "illumination" of the premises, specify its hygienic value.
18. Which factors determine optimum (permissible) illumination in the premises?
19. Which sanitary requirements carried out for interior decoration of apartment
materials?
Occupation is carried out in educational audience of department. Control of
initial level of knowledge is carried out by the test on the given theme. Students
work independently. After test control, students discuss questions for self-
preparation (issue 5). The teacher corrects wrong answers of the students. Students
get acquainted with Standard legislative regulations on the theme. Then students
receive scenario – based tasks and should write protocol carried out hygienic
assessment quality of an internal environment of the premises, in the copybook
28
(Appendix). Student should demonstrate practical assessment selectively carried out
by the teacher’s task one of the given factors of residential environment (issue 4). At
the final part of the practice teacher estimates students educational activity on the
given theme, signed protocols.
Ensuring optimal internal environment indoors, where the most of a person's life is
impossible without hygiene practices when architectural and planning methods and technical
means possible in order to carry out estimation of the negative and positive qualities of an
environment:
Population group
Exposure factors
Adults, working Adults,
6 y.o. children
staff unemployed
Residence time carried out in the microenvironment, hours per day
Residential premises 12 12 19,5
Transport – 1,5 0,5
Public buildings & establishments 8 9 2
Atmosphere air 4 1,5 3

In the residential premises, human body exposed constant influence numerous factors of an
internal environment, such as:
- Planning & spatial parameters of apartment;
- Microclimate;
- Quality of air in the premises;
- Illumination;
- Noise, vibration;
- Electromagnetic and ionizing radiation.
Spatial parameters of apartment
Spatial parameters of apartment and house (residential space, height residential spaces, their
configuration and number of the premises parameters, presence of open spaces, i.e. balconies, loggias),
carried out hygienic comfort.
Optimum of residential space – depend on the demographic and professional orientation of the
family members and varied on average 17.5 ± 0.5 m2 per 1 person.
Height of apartment carried out cubic content of air per one person: height of premises should be
not less than 2.7 m.
Meteorological factors should determine the thermal comfort and heat transfer
characteristics in the apartments. Microclimate should be estimated as well as:
- Temperature
- Speed of air movement,
- Relative humidity
- Rational mode of the premises carried out by the temperature of enclosing surfaces
(radiological mode).
29
For each indicator, optimal levels of vibrations with their complex effects on the human body
should be carried out. Standard microclimate parameters should ensure good health even if low
human adaptation to fluctuations of microclimatic factors takes place.
Thermal comfort should be provided by human convection, radiation (thermal radiation) and
conductive (direct contact) ways of thermal metabolism, applying engineering heating systems.
Optimal temperature varied from 20 to 230C in winter, to 20 to 220 C – between seasons and from 23
to 250C - in summer.
Basic hygiene parameters of the apartment:
Indicator Standard
1. Number of residential premises Carried out by formula n + 1, where n - number of
family members
2. Area for 1 person - residential - 17.5 m2 (minimum 9 m2)

- common - 21.5 m2
- ceiling height – should not less 2.7 m (optimal -
3 m);
3. Required set of outbuildings Front (corridor), kitchen (kitchen & dining room),

bathroom and toilet, storage room (built-in closets,
attics), balcony (balcony, veranda);
4. Zoning of residential space (spatial and Carried out by an apartment (cottage)

functional separation of residential premises communicative center - front or corridor, which
and outbuildings) on one hand, geographically delimit utility
premises (with noise sources, moisture, dust,
gases) from residential. On the other hand,
functionally connect all premises in the apartment,
provide easy access to them.
Vital importance in hygiene focused on an air temperature and horizontal adjustment

facilities. Gradient of height premises should not exceed 2 0 C. Increasing vertical meaning of the
temperature should not exceed 30, which leads to the hypothermia and caused reflex changes of
temperature an upper respiratory tract. It is vital important to support this standard in the winter
season.
Recommendations towards minimum required, maximum and optimum speed of air
movement, in winter season should be 0.1-0.25 meter / sec.
Vital importance in the heat exchange takes air humidity. Optimum relative humidity should
be on the level 30-60%. In order to obtain comfortable environment in the heated premises carried out
relative humidity 30-45%, less than 30% caused dryness of an airway mucosa.
Microclimate parameters could be controlled:
- Space heating systems;
- Ventilation system;
- Structure of the outer walls (thickness, material, special coatings) and design of the
window fittings;
- Mirrors devices;
- System of artificial air conditioning.
Aeration (ventilation) in the apartments carried out by natural ventilation systems as well as
transoms, window, ventilator weather-strips. In areas with excessive steam, gas, heat and dust
emission (bathrooms and toilets, kitchens) carried out exhaust system of natural ventilation through
30
the vents, or local mechanical exhaust ventilation (umbrella hood). Upper floors of an apartment
should be equipped with forced draft (electricity ventilation).
Effectiveness ventilation indicator in the premises is quality of indoor air, which should be
evaluated by complex indicator of CO2 concentration (less than 0.07-0.1%), or as well as MAC
harmful substances, i.e. degradation products of polymeric materials (ammonia, CO, hydrogen
sulfide, phenol, formaldehyde, etc.). Indirectly, air quality should be estimated by calculating
ventilation rate in the premises. Air pollution by organic substances could be estimated through
oxidation. Clean air oxidation – 6 mg O2 per 1m2 and for polluted premises- from 1 to 20 mg O2 per
1m2.
In the houses appointed traditional system of centralized or local water heating arrangement
of heaters (convectors) in drip niches. Temperature of water depends on the temperature of outside air
in winter; temperature of the radiator (convector) surface should not exceed 80 °C.
Illumination of the premises carried out with day sunlight. It was proved that infrared rays
have heat action and UV rays - photochemical and bactericidal effect. Visible part of spectrum caused
not only local, but the overall reaction, which is often nonspecific, reconstructs physiological and
psychological reactions change of the overall tone of a body, in order to support its activities and has
positive effect on the psycho-emotional sphere. Standard time of illumination premises varied from 2
to 3.5 hours depending on geographic latitude, type and nature of building.
Sufficient illumination carried out by correct latitudinal orientation of the house. In our
climate zone (most territory of Ukraine is located in III climatic zone), the best conditions are created
while meridian orientation of the building has long axis of the house to 19-220C on the east from
meridian (east - southeast). In this case, premises would be covered a direct sunlight continuously at
least 2.5 hours per day, in the period from 22, March to 22, September. The poor orientation of
apartments while one-way direction of the windows carried out 20 0-290 - south west - west (excessive
heat) and 290-70O - north-west - north (lack of illumination).
Illumination could be provided by natural light (natural), light energy of artificial sources of
light (artificial) and combination of natural and artificial sources (complex).
Natural illumination created by direct, diffuses and reflected from the surrounding objects
sunlight. Natural lighting is required in order to provide all premises with long-term staying of
people. In the houses shouldn’t allowed artificial illumination of premises and kitchens, staircases,
common corridors in the dormitories.
By the functional purpose visual work in the public premises are divided into 3 groups:
1 – premises, carried out for accurate visual works at the fixed direction working surface;
2 – premises, where distinction between objects and overview surrounding space carried out;
3 - premises, where inspection of the surrounding space takes place.
Light coefficient (LC) - approximate value of it should be ratio of the glass square skylights to
the floor square.
Organization of artificial illumination carried out in the residential and public apartments in
accordance with Building Norms & Rules (BNR) "Natural and Artificial Illumination" which carried
out quantitative software illumination, and its quality. Rationing of artificial illumination, as well as
natural, is differentiated. Standards are carried out depending on the conditions of visual work,
lighting system, type of light source.
Fluorescent lamps and incandescent lamps have their own advantages and disadvantages. For
example, fluorescent lamps have spectrum closer to the natural, but have excess ripple (stroboscopic
effect) and create noise. Some of them significantly distort color transfer to the objects. In residential
apartments should better use the multi-tube fluorescent lamps with reduced depth of pulsation and
triggering devices, reduce level of noise. Excessive glare and dazzling effect of lamps should be
correct by properly selected fixtures. In order to create local illumination of working surface should
not recommend using a single fluorescent lamp.
Noise in the apartments should occur outside (automobile and electric transport, air transport, rail
transport, sports grounds and facilities, open-air cafes, electric power substations, industrial enterprises,
shops, etc.) and internal sources (acoustic devices, operation of elevator, garbage disposal etc.). This is
31
called municipal noise. They are unstable and carried out by their frequency characteristics, as well as
energy equivalent sound levels (noise) LAekv. and maximum levels LAmaks., i.e. units of noise - Decibel
A(dBA).
Noise levels in the apartments are normalized differentiated: daily (7 00-2300) - LAekv. up to 45
dBA, LAmaks. 60 dBA; at night (2300-700) - LAekv. up to 30 dBA, LAmaks. up to 45 dBA.
Innovative technologies, materials, substances and products carried out for use in the economy
and everyday life are allowed to well – spread production, in accordance with "State Sanitary-
Epidemiological Expertise Conclusion".
Building materials should be corresponding to the following requirements:
a) low thermal conductivity and provide sufficient thermal resistance and heat resistance of
fences;
b) good air permeability and porosity;
c) should be non-hygroscopic with a low sound conductivity;
d) ensure the strength, fire resistance, durability structures;
e) should not allocate environment volatiles, caused smell and concentration of chemical
substances with direct or indirectly effect on the human health;
f) should not encourage development of microflora fungi and algae growth;
g) availability for processing and disinfection;
h) having a color and texture, corresponding to the physiological and aesthetic requirements of the
human organism.
8. LITERATURE:
8.1. The basic:
8.1.1. Hygiene and ecology / under the editorship of Corresponding Member of Academy
of Medical Sciences of Ukraine, professor V. G. Bardov. – Vinnytsya: Nova Knyha
publishers, 2009. – P. 168-180, 181-198.
8.2. Additional:
8.2.1. Hygiene and ecology / Vladimir A. Korobchanskiy, Michael P. Vorontsov, Alisa
A. Musulbas. – Kharkov: Kontrast Publishing Enterprise, 2006. – P. 67-82.
8.2.2. General hygiene and environmental health / Edited by Professor M.M. Nadvorny. –
Odessa, 2005. – P. 48-57, 194-199.
Appendix
Scenario – based task: "Hygiene of the residential and public buildings and
facilities"
In order to research residence conditions in the 3-premises apartment were
estimated common square 59.2 m2 and residential square 42 m2, where 3 persons family
lived. Among the family members one person was suffered from bronchial asthma, i.e.
lab results showed that temperature in the living room, carried out by dry thermometer of
Assman psychrometer – 22°C, by damp thermometer - 14 °C, an average temperature
18.5 °C, temperature on 1.5 m height - 22 °C, temperature on 0.2 m height – 16 °C,
temperature near the inner walls - 21 °C, temperature outside - 15 °C. Daily temperature
was varieties, according to the thermograph, being on the range from 23 °C to 18 °C.
Indoor air contains phenol in the concentration 0.1 mg /m3.
Carry out hygienic assessment residence conditions among the family members
and predicts possible impact of residence conditions to the bronchial asthma diseases.
Standard answer
Results of laboratory and instrumental research, carried out quality of internal air
in the premises of the given apartment, evaluated in accordance with requirements
32
SSanN&R 2.2.000-98 "Houses of an apartment type", as well as the following
conclusions:
- residential square was below than recommended square (17.5 m2/person),
which should impact of the residential conditions of the family members and
their psycho-emotional state of health;
- an average temperature (18,5 °C) mismatches acceptable level in winter
season;
- temperature difference by vertical orientation - 6 °C exceeds permissible limits,
but air temperature, carried out near the floor below than permissible level,
which caused hypothermia of the residents, especially children;
- temperature difference by horizontal orientation didn’t correspond to the
hygienic requirements (6 °C) as well as permissible temperature should be (2-3
°C);
- humidity, carried out by psychrometer (40%) corresponds optimum level;
- phenol concentration 0.1 mg/m3, exceeds MAC (maximum allowable
concentration) in 10 times for premises, which caused a severe irritant of the
respiratory system, having adverse effects on the nervous system of the family
members.
Finally, square, temperature and humidity in the 3-premises apartment, i.e. phenol
pollution (10 MAC) didn’t correspond to the sanitary regulation SSanN&R 2.2.000-98
"Houses of an apartment type", should cause significant risks for family members,
primary, case of the bronchial asthma.
Тheme № 5: Features of hygienic requirements towards planning, functioning of

health care facilities, and conditions carried out for ambulatory patients.
Complex of hygienic measures in order to prevent nosocomial infections.
1. PURPOSE: research basic architecture, sanitation and hygiene techniques and
means of prevention nosocomial infections in the modern health care facilities,
providing safety conditions for ambulatory patients and medical staff.
2.1.1. Basic hygienic requirements towards planning, engineering equipment and
functioning mode in the therapeutic, surgical, obstetric and infectious departments.
2.1.2. Key concept, classification and main ways of implementing specific epidemic
process in the case of nosocomial infections, standard architectural & planning and
sanitary & prevention measures.
2.2.1. Carry out hygienic assessment of architectural & planning issues in the
individual specialized units (ward sections) and their sanitary regime, in accordance
with standard documents by the given scenario – based task.
2.2.2. Apply scheme of standard sanitation, planning, organizational & preventive
measures in order to prevent flash of nosocomial infections.
3.1. Properties of planning and building systems carried out for multi –
departments and specialized health care facilities, outpatient clinics in the
settlements.
33
3.2. Basic hygienic principles and requirements focused on the planning and
different departments’ interior;
3.3. Basic hygienic requirements for sanitary equipment in the health care
facilities (natural and artificial illumination, heating, ventilation, water supply and
disposal such as liquid and solid wastes, primary, for infectious and surgical
departments).
3.4. Organization of sanitary-hygienic regime carried out for ambulatory patients
and outpatients health care facilities.
3.5. Complex of sanitary & technical, planning, and organizational measures in
order to prevent well - spread of nosocomial infections.
1. Standard legislative regulations using in order to carry out hygienic assessment of
planning, engineering and sanitary conditions towards specialized departments in the
health care facilities, by the data of the scenario – based tasks.
2. Background of the specific preventive measures towards nosocomial infections
with various etiologies (student should calculate by individual task of the teacher):
- maximum allowable number of beds in the different departments;
- UV – irradiation power in order to sterilize air in the premises of the health
care facilities carried out special mode (operating, sterilization, dressings,
central sterilization department, etc.);
- indicators of ventilation regime in the wards, isolation wards, operating
halls;
- carry out technique of sanitation medical staff hands for individual episodes
in the medical practice.
1. What types of health care facilities should be located within the residential area of
the settlements, which in a suburban area, specify why?
2. Which factors carried out impact on the size of land in the health care facilities,
ambulatory centers?
3. Which functional zones and entrances should be allocated in the territory of multi –
department health care facilities?
4. Which percentage of territory in the health care facilities shall be carried out as
well as landscaped?
5. What basic principle should be followed while organizing emergency and
preventive services?
6. Specify, which means of physicians services primarily directly through emergency
and preventive services?
8. What is the main unit of usual physician services; enumerate basic premises of the
usual physician services?
9. What is the main unit of infectious department; enumerate basic premises of the
infectious department?
10. Specify basic architectural & planning issue in order to prevent nosocomial
infections in an ambulatory surgical center; enumerate basic premises of the
ambulatory surgical center?
34
11. What is the main principle towards planning of operational units; enumerate basic
premises of the operational units?
12. Specify, to which department should be hospitalized pregnant woman, suffer
from infectious disease, acute stage of clinical manifestations?
13. How should be organized system of water supply in the health care facilities?
14. Which construction should have sink in the specialized premises of the health
care facilities as well as operational, obstetrics, sterilization, dressings?
15. Specify way of discharged wastewater from infectious and tuberculosis hospitals,
which features have cisterns in the toilets in these hospitals?
16. Which way (where and how) should neutralizes specific hospital waste
(potentially infectious materials and instruments, contaminated with body fluids, i.e.
blood, secretions of the patients, pathological waste, organic operating waste,
infectious departments waste, etc.)?
17. Which kind of heating system (specify why) carried out in the health care
facilities: a) the aseptic mode; b) the common mode?
18. What direction of an air flow ventilation system should provide: a) in the
operating unit; b) in the infectious department with boxes for airborne infections?
19. What main types of cleaning carried out in the health care facilities?
20. Specify way of sterilization an air in the specialized premises of health care
facilities; how should control their effectiveness (directly and indirectly)?
get acquainted with Standard legislative regulations on the theme. Then students
receive scenario – based tasks and should write protocol carried out hygienic
assessment in the copybook (Appendix). Student should demonstrate practical
assessment selectively carried out by the teacher’s task one of the given factors of
residential environment (issue 4.2). At the final part of the practice teacher estimates
students educational activity on the given theme, signed protocols.
Territory of land carried out for health care facilities discharged in accordance with general
plan or detailed planning in close proximity to the settlements. Multi - departments’ hospitals with
capacity more than 1000 beds, or same specialized hospitals (infectious, neuropsychiatric) should
be carried out in a suburban green zone at a distance not less than 1000 meters from the residential
zones.
Size of land carried out hospitals depends on the types of facilities (number of beds) or
polyclinics (number of visits per one shift).
Health care facility should be provided by functional zones: hospital (separately for somatic
and infectious diseases); long term care facility; an ambulatory surgical center; a freestanding
birthing center; or an outpatient renal dialysis center. While planning maternity, radiological,
psychosomatic, tuberculosis department, they should have separate green zone (area).
Territory of health care facilities i.e. usual physician services should be landscaped, having
internal driveways and footpaths. Area of green zone would be not less than 25 m 2 per one bed;
green zone percent should be 60% from area of land, built-up territory - 12-15%.
35
Basic principle of planning reception is streaming. Patients admitted to the hospital from a
front desk, carried out unidirectional way, i.e. through emergency department to the physician
services departments. At the centralized system of the health care facilities, the emergency
department should be designed in order to avoid cross-traffic patients at the admission and
discharge. If the smaller cycle of medical care, the greater number of patients carried out for
facilities: ambulance - ambulatory patients expected duration of services does not exceed 150 beds;
somatic departments - ambulatory patients expected duration of services does not exceed 200 beds,
psychosomatic departments - ambulatory patients expected duration of services does not exceed 600
beds; TBC dispensaries - ambulatory patients expected duration of services does not exceed 800
beds. For each patients expected duration of services hospital should have complete set of
diagnostic facilities, i.e. a waiting room, locker, observation, bath room, dressing room.
In order to provide specialized emergency care in emergency rooms of hospitals provides
separate boxes (maternity, operational, X-ray, resuscitation). In the children and infectious
departments should be organized out-of-area coverage for medical staff, which consists of locker
room, two wardrobes for personal and medical staff clothes, shower.
Main planning unit of somatic ward is a ward section - isolated complex of chambers and
medical support facilities designed for patients with same type of pathology. In order to prevent
nosocomial infections ward section any profile should be impassable, carried out a complete set of
facilities in order to provide medical and social needs of patients: usual physician chamber
(common number of beds 20-30), physician offices, leisure room for patients, procedural or
handling room, sanitary rooms, storage for clean and dirty laundry, dining room, sanitary facilities
for staff and patients. In order to prevent overcrowding of patients in the wards carried out not more
than 4 beds.
Two or more than three sections of the department should be carried out such premises as
manager office, specialized diagnostic and usual physician premises. Chambers should be located
compact, those premises, which have a high risk of nosocomial infection, as well as toilets,
dressing, etc. should be located in an Out-of-area coverage. Chambers interposition towards other
section premises should provide the shortest way of the patients and medical staff.
Infectious department. Architectural &planning issues carried out infectious departments for
patients with any infectious diseases. An infectious department of the hospital should be situated in
the separate building. In multi-departments hospitals, moreover, should be organized separate floors
or separate establishments focused on the patients with gastrointestinal diseases, respiratory
diseases, transmissive infections, i. e., diseases with same way of transmission. While patients with
different infectious pathology carried out in one floor, the separate sections should be impassable,
and separated from each other by gateways equipped with bactericidal irradiators and bactericidal
air recirculation.
Surgical departments. About 76% of nosocomial infections caused after surgery and at the
nursing postoperative patients. In the Ukrainian hospitals traditionally carried out "clean" and
"septic" surgery departments. On the hand, the
purulent postoperative complications at the "pure" patients should not be common. However,
surgical intervention against current purulent process (purulent appendicitis, peritonitis, etc.) could
be carried out in the separate operation premises, i.e. nursing these patients should take place in the
purulent surgery ("septic") premises, at their absence - in the separate ward section of the common
surgery department for patients with purulent complications. A key architectural lay-out prevention
way of nosocomial infections in the surgical departments - maximum distinction of premises as well
as "pure" and septic patients, and patients with other infectious complications, all stages of
hospitalization. Specific issues of planning surgical departments – presence of special dressing
rooms and room for processing vessels of bedridden patients.
Operating unit is designed separately from all departments of the hospital and consists of
numerous operational and support facilities. Main principle of planning operational units - presence
of two isolated from each other departments - septic and aseptic with all necessary facilities (except
for specialized cardiac and neurosurgery). Movement of medical staff and patients in the operating
36
unit is carried out on the principle of strict zoning, as well as the following zones: 1) a hospital-
wide regime; 2) limited regime (surgeons’ rooms, instrumental & material, laboratory); 3) strict
regime (preoperative, anesthetic, hardware, sterilization, sanitary inspection, personnel recovery
room); 4) sterile zone (operating rooms). Operating unit entrance should be separated from other
hospital rooms. Entrance to the operating unit could be carried out through a gateway (delivery of a
patient, passage of anesthesiologists, technicians), or through a sanitary inspection (surgeons,
surgical nurses). These flows should not be crossed.
In obstetric department, depending on power, system of organization measures would
include a) an individual maternity wards, b) family maternity wards, c) individual delivery rooms.
Former Soviet –Union observational departments have been reorganized and working in the regime
of the individual and family maternity wards, individual postnatal wards, being an effective method
of prevention nosocomial infections.
Wards for hospitalization pregnant women with infectious diseases, acute stage of clinical
manifestation, should be carried out by bathroom, with separate entrance, forced ventilation with
negative pressure. These chambers are equipped with functional bed or bed-transformer for delivery
and acceptance new pregnant women at the whole period of hospitalization, with necessary medical
equipment and facilities (balls, chair, wall bars). Medical staff at the entrance to the freestanding
birthing center i.e. wards for pregnant, childbirth and postpartum infectious diseases in acute stage
of clinical manifestations should be dressed in disposable gown dress, hat, rubber gloves. At the end
of a working day, garment should be removed; carried out sanitation of the hands. If the given
conditions are absent, should be carried out measures for maximal isolation of a patient with
infectious diseases in acute stage of clinical manifestations in order to prevent flash of nosocomial
infection.
Water supply. Health care facility connected to the system of urban drinking water supply
with standards of water consumption. Sinks with hot and cold water and mixer sinks installed in the
wards (including for babies and children), ambulatory centers, semi - boxes, boxes.
Sewerage system. Toilets for staff and patients, except sanitary appliances - toilets and
urinals, equipped with cabins, washstands, coat hooks. In women toilets, should be provided
hygiene room with shower riser ("bidet").
Wastewater from the hospitals discharged into citywide sewer system, and at its absence,
they should undergo a whole cycle of biological treatment and disinfection in the local waste water
treatment plants.
In order to carry out effective and epidemiologically safety waste management system
health care facilities should be divided into separate groups:
- Class A – non hazardous waste (waste could not contact with body fluids of patients,
infectious patients, toxic waste - food waste from all departments, except infectious,
uninfected paper, construction debris, etc.). Collected in sealed bags, gray or black color;
- Class B - hazardous (risk) waste (potentially infectious waste - materials and tools of
contaminated biological fluids, i.e. blood, secretions of the patients, pathological waste,
organic operating waste, waste from infectious departments, microbiology laboratories, 3-
4 class of pathogenesis microorganisms;
- Class C - extremely hazardous wastes (all materials being contact with especially
dangerous infections, waste microbiological laboratories, working with microorganisms,
mycological laboratories, waste from patients with anaerobic infections);
- Class D - waste of the health care facility similar by the composition with industrial waste
(drugs, wastes, containing mercury);
- Class E - radioactive waste of health care facilities.
Specific hospital waste (infected bandages, parts of organs and tissues, etc.) would be
burned in the hospital in a special oven - "incinerator", situated in the Out-of-area coverage, in a
distance not less than 50 m from ward sections. For a small amount of specific waste should be
provided electric muffles, more powerful furnaces working on a heavy fuel oil or natural gas. The
temperature inside of the incinerator chamber exceeds 3500C in order to provide a separate furnace
37
chimney. Such incinerators should be carried out in a separate building, or in a hospital-wide with
release in the boiler room or a separate entrance to the basement and ground floor of the
commercial buildings in the hospital. Removing infected specific waste towards with household
waste carried out in the hospital is strictly prohibited.
Central heating system should be centralized and followed hygienic requirements: a)
provide enough heating of air space in the whole heating season; b) couldn’t pollute air and
shouldn’t create noise during its activity; c) having special means of control and be accessible for
cleaning and maintenance. Hospitals and freestanding birthing center should be equipped with local
heating by natural gas, carried out in attics and flat roofs.
Ventilation systems depend on the functional purpose and the separate premises profile. In
order to prevent aerogenic infectious agents within the same building or functional, ventilation
systems should be carried out in the premises with aseptic mode (i.e., operational), if necessary to
create an air backup - advantage inflow before stretching; in the premises with possible release of
pathogens (i.e., infectious boxes) - vacuum, as well as preference drawing on inflows. In the whole
health care facilities, except surgical departments, provided system of natural supply & exhaust
common ventilation.
General cleaning up (mopping, wiping furniture, equipment, window sills, doors, etc.) is
carried out using detergents twice a day, if necessary – often. Wiping windows inside should be
carried out at least once a month. Household cleaning equipment (buckets, bowls, etc.) should be
marked as well as premises department, types of activity; cleaning equipment
General cleaning up chambers and other functional premises providing thorough cleaning of
the walls, floors, equipment, as well as wiping furniture, lamps should be carried out once a month.
General cleaning up (washing and disinfection) in the surgery suite, carried out once a week
with release premises from equipment, furniture, etc. Out – patient clinic should be covered with
detergents and disinfectants, carried out for 2-3-months.
Premises carried out specific sterility regime, aseptic and antiseptic (operating rooms,
dressing rooms, delivery rooms, an intensive care ward, and 1 y.o. children premises, ambulatory
centers, infectious, boxing bacteriological and virusological laboratories, etc.) after each cleaning,
as well as periodic daily routine should be irradiated by ultraviolet stationary or movable
bactericidal lamps based on 1 W per 1 m 3 of the premises, or apply recirculation bactericidal
irradiators.
Sanitation of aseptic units provides cleaning of the chambers and ancillary facilities wards
daily, as well as general cleaning, in accordance with schedule.
Chambers and other facilities in order to access fresh air through the window, transoms,
shutters carried out four times per day.
Methods of scrubbing, carried out for medical personnel:
Purpose of scrubbing Method of scrubbing
Removing of dirt, transient microflora, in a process of Routine scrubbing
contact with infected or colonized patients and / or
contaminated environment, which caused pollution of the
medical staff hands
Transient microflora sanation Hygienic antiseptics
Transient microflora sanation and decreasing an amount of Surgical antiseptics

saprophitic bacteria
A) routine scrubbing with soap is carried out:
- before and after physical contact with a patient;
- before cooking and distribution of meals, before eating;
- after physiological needs of the organism (toilet, blowing your nose, etc.);
- at the other cases of contaminated hands;
B) hygienic antiseptics carried out:
38
- before providing of an invasive procedure;
- before working with immune & sensitive patients and infants;
- before and after manipulation on the stripes, catheter;
- before and after putting on medical gloves;
- after contact with contaminated objects, i.e. containing blood or high probability of the microbial
contamination (an infected patient examination, rectal temperature measurement, etc.);
C) Surgical antiseptics carried out:
- before any surgical operations.
Ambulatory surgical center means a facility or portion of a facility that operates exclusively
for the purpose of providing surgical services to patients who do not require hospitalization and for
whom the expected duration of services does not exceed 24 hours following admission.
Ambulatory surgical center does not mean:
Individual or group practice offices of private physicians or dentists that do not contain a
distinct area used for outpatient surgical treatment on a regular and organized basis, or that only
provide surgery routinely provided in a physicians or dentists office using local anesthesia or
conscious sedation; or
A portion of a licensed hospital designated for outpatient surgical treatment.
Delegated credentialing agreement means a written agreement between an originating-site
hospital and a distant-site hospital that provides that the medical staff of the originating-site hospital
will rely upon the credentialing and privileging decisions of the distant-site hospital in making
recommendations to the governing body of the originating-site hospital as to whether to credential a
telemedicine provider, practicing at the distant-site hospital either as an employee or under contract,
to provide telemedicine services to patients in the originating-site hospital.
Distant-site hospital means the hospital where a telemedicine provider, at the time the
telemedicine provider is providing telemedicine services, is practicing as an employee or under
contract.
Essential long term care facility means an individual long term care facility that serves
predominantly rural and frontier communities, as designated by the Office of Rural Health, and
meets other criteria established by the Department of Human Services by rule.
Expenditure or capital expenditure means the actual expenditure, an obligation to an
expenditure, lease or similar arrangement in lieu of an expenditure, and the reasonable value of a
donation or grant in lieu of an expenditure but not including any interest thereon.
Freestanding birthing center means a facility licensed for the primary purpose of
performing low risk deliveries.
Governmental unit means the state, or any county, municipality or other political
subdivision, or any related department, division, board or other agency.
Gross revenue means the sum of daily hospital service charges, ambulatory service charges,
ancillary service charges and other operating revenue. Gross revenue does not include contributions,
donations, legacies or bequests made to a hospital without restriction by the donors.
Health care facility means: (a) a hospital; (b) a long term care facility; (c) an ambulatory
surgical center; (d) a freestanding birthing center; or (e) an outpatient renal dialysis center.
Health care facility does not mean:
- A residential facility licensed by the Department of Human Services or the Health Authority
- An establishment furnishing primarily domiciliary care
- A residential facility licensed or approved under the rules of the Department of Corrections;
- Facilities established for treatment of substance abuse disorders; or
- Community mental health programs or community developmental disabilities programs.
- Health maintenance organization or HMO means a public organization or a private organization
- organized under the laws of any country that:
Provides or otherwise makes available to enrolled participants health care services,
including at least the following basic health care services: usual physician services; hospitalization;
laboratory; X-ray; emergency and preventive services; out-of-area coverage.
39
Provides physicians services primarily directly through physicians who are either employees
or partners of such organization, or through arrangements with individual physicians or one or more
groups of physicians organized on a group practice or individual practice basis.
Health services means clinically related diagnostic, treatment or rehabilitative services, and
includes alcohol, drug or controlled substance abuse and mental health services that may be
provided either directly or indirectly on an inpatient or ambulatory patient basis.
Hospital means:
A facility with an organized medical staff and a permanent building that is capable of
providing 24-hour inpatient care to two or more individuals who have an illness or injury and that
provide at least the following health services: medical; nursing; laboratory; pharmacy; and dietary;
or a special inpatient care facility as that term is defined by the authority by rule.
Institutional health services means health services provided in or through health care
facilities and includes the entities in or through which such services are provided.
Intermediate care facility means a facility that provides, on a regular basis, health-related
care and services to individuals who do not require the degree of care and treatment that a hospital
or skilled nursing facility is designed to provide, but who because of their mental or physical
condition require care and services above the level of room and board that can be made available to
them only through institutional facilities.
Long term care facility means a permanent facility with inpatient beds, providing:
Medical services, including nursing services but excluding surgical procedures except as
may be permitted by the rules of the Director of Human Services; and
Treatment for two or more unrelated patients.
Long term care facility includes skilled nursing facilities and intermediate care facilities but
does not include facilities licensed and operated pursuant
New hospital means:
A facility that did not offer hospital services on a regular basis within its service area within
the prior 12-month period and is initiating or proposing to initiate such services; or
Any replacement of an existing hospital that involves a substantial increase or change in the
services offered.
New skilled nursing or intermediate care service or facility means a service or facility that
did not offer long term care services on a regular basis by or through the facility within the prior 12-
month period and is initiating or proposing to initiate such services. New skilled nursing or
intermediate care service or facility also includes the rebuilding of a long term care facility, the
relocation of buildings that are a part of a long term care facility, the relocation of long term care
beds from one facility to another or an increase in the number of beds of more than 10 or 10 percent
of the bed capacity, whichever is the lesser, within a two-year period in a facility that applied for a
certificate of need between August 1, and December 1.
Offer means that the health care facility holds itself out as capable of providing, or as having
the means for the provision of, specified health services.
Originating-site hospital means a hospital in which a patient is located while receiving
telemedicine services.
Outpatient renal dialysis facility means a facility that provides renal dialysis services
directly to outpatients.
Person means an individual, a trust or estate, a partnership, a corporation (including
associations, joint stock companies and insurance companies), a state, or a political subdivision or
instrumentality, including a municipal corporation, of a state.
Skilled nursing facility means a facility or a distinct part of a facility, that is primarily
engaged in providing to inpatients skilled nursing care and related services for patients who require
medical or nursing care, or an institution that provides rehabilitation services for the rehabilitation
of individuals who are injured or sick or who have disabilities.
5. Lіteratura:
5.1. The basic:
40
Vinnytsya: Nova Knyha publishers, 2009.
5.2. Additional:
Alisa A. Musulbas. – Kharkov: Kontrast Publishing Enterprise, 2006.
5.2.2 "Sanitary rules of design, equipment and operation of the health care facilities,
maternity hospitals and other hospitals" (SanN&R 5279-90).
Appendix 1
Standards for area of chambers in different departments
Name of the department Area per 1 bed, not more … m2
Infectious and tubercular for adults 7.5
Infectious and tubercular for children
without places of mothers 6.5
with day stay of mothers 8
with daily stay of mothers 10
Ortopedo-traumatologic, burn, radiological:
adult’s and children’s wards 10
for children with daily stay of mothers 13
Intensive therapy, postoperative: 13
- for newborns and children < 1 year 10
Nurseries not infectious:
without places of mothers 6
day stay of mothers 7.5
daily stay of mothers 9.5
For newborns 6
Psychoneurological and narcological: 6
general type 7
viewing
Psychiatric for children: 5
general type
Other premises (wards) 7
Hygienic demands to hospital environment

Premises Air, Air exchange AEH Germ pollution Catego-
t0 per hour (AEH) for GMN Streptococcus ry of pure-
inlet exhaus- natural before after before after ness
tion air work work work work
exchan-
ge
Adult`s and 20 80 m3/h per 1 bed 2 3.500* to P**
children`s wards 100% 5.000 16*
to 36
Wards for 24 80 m3/h per 1 bed 2 3.500* to P
hypothyreoidic 100% 5.000 16*
patients to 36
41
Wards for 15 80 m3/h per 1 bed 2 3.500* to P
hyperthyreoidic 100% 5.000 16*
patients to 36
1-2 beds room, 22 >10 exh. 80% 2 3.500* to VP****
intensive therapy 100% aseptic 5.000 16*
rooms, to 36
combustiological 80% 100%
rooms septic
Operating room 22 20% 2 500 1000 0 <4 VP

through
neighbour
Delivery room 22 premises 2 750 2000 0 <24 VP
inlet with
steril air
Premature 25 100% 80% 2 500 1000 0 <4 VP
children’s wards 100% aseptic
100%
septic
Newborn`s 25 100% 2 500 3000 0 44 VP
wards 100%
Boxes 22 2.5 (from 2.5 2.5 3500 16 D
corridore) 7000 36
100%
Infection wards 20 80 m3/h 80 m3/h 3500 16 D
7000 36
Therapy room 22 2 2 2 2500 32 P
*-summer/winter, **- pure, ***-dirty, ****-very pure.
Appendix 2
Scenario – based task № 1: "Features of hygienic requirements towards planning, functioning
of health care facilities and conditions carried out for ambulatory patients. Complex of
hygienic measures in order to prevent nosocomial infections"
Hospital was built in 1996 in accordance with a standard project. Therapeutic department
was located on the second floor and consists of two sections, wards for 30 beds for each section.
Entrance to the section is carried out through a single door. The internal layout of the corridor is
separating into two - way orientation windows chambers as well as west and east. Western
orientation carried out 6 chambers (4 beds) – 3 chamber in each section. During observation 72
patients were hospitalized in the department. Walls in hallways ward sections were painted with oil
yellow color, in 1.3 m height and above - bleached lime. Floor is carried out with wooden planks,
painted with oil. The corridor has a light lounge, its windows focused on the south. Walls are
covered with latex yellow-green color. Walls in the premises are covered with a layer oil paint to
1.2 m height. Ceilings in all premises are white. Toilets carried out for medical staff and patients
divided by two ward sections, having been covered with unglazed floor tiles, walls bleached with
lime in the whole height. For men premises were equipped with four toilets and two urinals, for
women - three toilets. Wards have a rectangular shape, beds are located: in the 3 – person’s
chambers - 2 beds carried out along walls and one bed – near the window, in 4 – person’s chamber
– beds are located closely to each other along walls, with one passage in the center of chamber.
Each ward has one nightstand desk for each bed and1 chair. Square per one bed carried out in 3 and
4-bed wards are 4.7, 6.0 and 6.5 m2 respectively.
Heating of health care facility is provided by local boiler as well as heaters iron radiators,
which were installed in the separate premises of ward sections. Coolant - superheated steam at the
42
temperature - 90˚C. Ventilation of the chambers, medical staff and procedural premises caused by
natural leaks in window fittings. Hot water supply is provided from the local boiler. Results of lab
examinations: humidity - 60%, temperature - 27˚C, speed of air movement- 0.01 m/s. Temperature
on an iron radiator surface in the premises – 92 ˚C. Whole functional premises of the ward sections
applied with lateral natural illumination and common artificial upper incandescent illumination with
solid spherical lenses.
Carry out hygienic assessment and conclusion.
Standard answer.
At the sanitary examination of the therapeutic department in N-regional hospital in
accordance with "Sanitary rules of design, equipment and functioning health care facilities,
maternity hospitals and other hospitals" SanN&R 5279-90, the following disadvantages was
revealed, which should cased spreading of nosocomial infections:
1. At the entering to the ward sections were absent lobbies, which lead to mismatches
hygienic requirements towards temperature mode in winter.
2. Section wards were overloading with ambulatory patients – in order to standard capacity
60 beds, in real condition carried out 72 beds.
3. Walls in the ward sections (premises with dry mode) should be painted with acrylic paints
on the whole height. Paint tone should be warm, not bright. Same sanitary conditions should be
carrying out for therapeutic department wards (yellow - green color in the wards could have
negative psychological & emotional impact on the patients).
4. Floor in the corridors and wards should be appointed by linoleum as flooring boards
would have cracks, which caused difficulties at the cleaning and disinfecting.
5. Toilets for patients should be carried out in each section of the given ward. Walls in the
bathrooms, and procedural manipulation (premises with damp mode) should be painted with
waterproof paint or covered with glazed tiles on the whole height.
6. Amount of men urinals should be correspond to the toilets - four. Amount of women
toilets – two.
7. Location of beds in the wards didn’t correspond to the hygienic requirements - bed should
be installed parallel to the wall near windows.
8. Square per one bed in the wards didn’t correspond to the hygienic standards (should be
7.0 m for therapeutic department patients).
9. Temperature of a heater would be higher than permitted (maximum - 85°C), which caused
burns in the patients and worsening microclimate in the chambers (drying air). Air temperature in
the wards is too high (optimal temperature in winter season should correspond 22-25°C), which
caused microclimate heating uncomfortable.
10. Artificial illumination in wards should be combination, i.e. near each bed in a distance
1.7 m in the wall in order to install local lamp; ward should be carried out by emergency
illumination (at the front door 0.3 m above floor).
Date Signature Name
Scenario – based task № 2: "Features of hygienic requirements towards planning, functioning

of health care facilities and conditions carried out for ambulatory patients. Complex of
hygienic measures in order to prevent nosocomial infections"
At sanitary inspection of obstetric department in connection with flash of nosocomial
infection the doctor of regional sanitary station has established: the branch is located in hospital
territory in one-storied building, leaves on a red line of street. The distance to apartment houses
makes 12 m. General entrance to the branch is situated together with other medical departments.
The hospital has a landscape gardening zone, which lying women use.
Obstetric branch has 18 beds and consists of patrimonial physiological branch (2 beds, 12
m ), postnatal physiological branch (1 chamber on 3 beds- 16 m2 and 1 chamber on 4 beds - 20 m2)
2
and observation patrimonial branch (1 bed – 6m2) and postnatal branch (1 chamber on 3 beds - 18
m2). In the physiological branch two chambers (on 2 beds - 13 m 2 and 3 beds - 15 m 2) for women
43
with pathology of pregnancy are separately divided. In obstetric department principle of isolation
women and newborns is observed.
For newborns is provided two chambers: on 12 beds (25 m2) for physiological and
pathological branches; on 3 beds (12 m2) for observation branches. Observation and physiological
branches have one input, but they are located in different parts of the building and divided by hall.
In physiological and observation branches the patrimonial chamber on 1 bed with separate entrance
and a place for newborn on 22 m2 is provided. Ventilation in all premises is natural through
window. Airing of chambers is carried out twice a day. According to the results of sanitary
inspection such indicators of air quality in the premises of obstetric branch are received in summer:
Premises Time of measurement General microbes Number of hemolytic
number streptococci’s
(GMN in 1 m ) 3
(Str. in 1 m3)
1.Adult’s and Before work 700 0
children’s wards in After work 4100 108
observation branches
2. Adult’s and Before work 900 3
children’s wards in After work 5200 125
physiological
branches
3. Newborn’s wards Before work 500 0
in observation After work 6400 55
branches
4. Newborn’s wards Before work 1000 0
in physiological After work 7250 69
branches
1. Carry out hygienic estimation obstetric department by results of sanitary inspection.
2. Define etiological factors and-or risk factors for health of patients.
3. Propose hygienic actions in order to prevent flash of nosocomial infection among newborns
and pregnant women.
4. Find necessary standard documentation for hygienic estimation obstetric department.
5. Estimate quality of air in the wards according to SanN&R 5279-90.
Standard answer:
1. Location of obstatric branches in the hospital territories didn’t correspond to the sanitary
norms. Use of landscape gardening zone for lying-in women and patients from other branches is
inadmissible, general input in physiological and observation branch promotes occurrence of
nosocomial infection. Sanitary сondition of premises mismatches hygienic requirements:
insufficient frequency rate of airing of chambers (at norm not less than 4 times a day), damp
cleaning (2 times a day), irradiation of patrimonial halls and chambers of newborns should be spent
by ultra-violet lamps after each damp cleaning, before and after work, bed-clothes replacement -
each 3 days.
2. Risk factors for health of patients in obstetric branches are: unsatisfactory sanitary
condition in the premises, pollution of air by GMN and number of hemolytic Streptococci’s on the
adult’s and children’s wards and newborn’s wards in observation and physiological branches
promotes flash of nosocomial infection among newborns, pregnant and lying women.
3. Spend bacteriological inspection (crops of nasopharynx at the presence of streptococci)
among personnel, pregnant women and lying women and isolation source of infection. Spend
extraordinary general cleaning and disinfection of the adult’s and children’s wards and newborn’s
wards in observation and physiological branches. Observe sanitary norms in the premises of
obstatric department, carry out bactericidal irradiation of chambers and provide timely replacement
of bed-clothes. Make reconstruction of a hospital with separate entrance to the physiological and
оbsarvation departments.
44
4. SanN&R 5279-90 "Sanitary rules of design, equipment and functioning health care
facilities, maternity hospitals and other hospitals".
5. Air pollution at the adult’s and children’s wards exceeds admissible norms in 4100-5200
times after work by GMN and newborn’s wards exceeds admissible norms in 2 times befor work by
GMN and in 2.13-2.42 times after work (general microbes number for adult’s and children’s wards
in summer must be not more than 3500 before work and absent after work; in winter must be not
more than 5000 before work and absent after work) / (general microbes number for newborn’s
wards must be not more than 500 before work and not more than 3000 after work).
Air pollution at the adult’s and children’s wards exceeds admissible norms in 3 times before
work by number of hemolytic Streptococc’s and in 6.75-7.8 times after work by number of hemolytic
Streptococc’s. At the newborn’s wards exceeds admissible norms in 1.25-1.57 times after work by
number of hemolytic Streptococci in 1m3 (number of hemolytic Streptococci’s for adult’s and
children’s wards in summer must be absent before work and must be not more than 16 after work;
in winter must be absent before work and must be not more than 36 after work) / (number of
hemolytic Streptococci’s for newborn’s wards must be absent before work and not more than 44
after work).
Тheme of independent out-of-class work №1. Hygienic meaning of physical

factors anthropogenic origin in the settlements.
1. PURPOSE: research basic physical factors, affecting inhabitants in the modern
settlements (cities, towns), their impact on a human health and basic preventive
measures.
2.1.1. Physical characteristics and biological effect nature of physical factors (non-
ionizing radiation, noise, electromagnetic radiation carried out from power lines,
radio - transmitters, mobile objects), their impact on a human body.
2.1.3. Theoretical background, focused on harmful effects of non-ionizing radiation,
prophylaxis.
2.2.1. Provide preventive measures in order to limit harmful effects of non-ionizing
radiation on a body in the settlements.
3.1. Classification of non-ionizing radiation, depending on a wave length, unit of
measurement.
3.2. Basic sources of non-ionizing radiation in the settlements.
3.3. Municipal noise: definition, sources, classification (wave characteristics).
3.4. Physiological basis, provided influence of noise on a human body. Hygienic
standardization of municipal noise in the settlements.
3.5. Electromagnetic radiation: sources of internal and external irradiation (domestic
appliances), general characteristic its impact on a human body.
3.6. Classification and basic preventive measures non-ionizing radiation harmful
effects on a human body.
Student should research given materials, carried out in modern educational
literature (textbooks, manuals, etc.), recommended in the higher medical
establishments. For further research of theme student should read scientific literature
(monographs and articles). In order to search professional literature, student used list
45
of questions and references, in accordance with guideline. At the Self-Study training,
student could get advice from the teacher. Self-Study preparation of students should
be carrying out on the final module control.
LITERATURE:
5.1. The basic:
Vinnytsya: Nova Knyha publishers, 2009.
5.2. Additional:
5.2.1. "Sanitary norms of allowable noise in residential and public apartments» №
3077-84.
5.2.2. "State sanitary rules and regulations towards protection of population from
impact of electromagnetic radiation" SSanR&iN-239-96.
Appendix 1
Scenario - based task "Hygienic meaning of physical factors anthropogenic origin in the
settlements"
Measurement of noise levels in the health care centers wards, doctors' premises and in the
territory of garden (green) zone was carried out by specialists of SES. It was determined, that main
external source of noise is local road, located closely to the hospital. Equivalent sound levels
(LAekv) dBA in the premises and the hospital, carried out from a mobile vehicle (measurements
were provided at 1000 a.m.): are the following
- therapy department chairman room - 45.5 dBA (maximum - 66.4);
- doctors' consulting room 46.5 dBA (maximum - 64.1);
- 4 beds ward - 48.8 dBA (maximum - 65.3);
- a garden (green) zone - 51.7 dBA (maximum - 69.9).
Visual inspection of transport zone near a hospital revealed, that it was made from stone
blocks, carrying out regulated intersection, without restriction any type of traffic passage.
Tasks.
1. Determine an origin and carry out hygienic assessment noise levels in the territory and on the
health care facilities premises. Predict the possible negative consequences its impact on the patients
and staff health.
2. Recommend preventive measures towards harmful impact of noise on a health.
3. Carry out hygienic conclusion by the results of a given task.
Standard answer:
1. Main source of noise in the hospital is a road transport. Noise produced by motor vehicles
classified: by a source - outside; by temporal characteristics – non-constant discrete; by spectral
characteristics – wide-frame with low-frequency (up to 350 Hz) and average- frequency (up to 800
Hz). Equivalent and maximum noise levels in the territory of garden (green) zone and at the
function premises of the hospital exceed maximum permissible levels (MPL), regulated by hygienic
standard "Sanitary norms of allowable noise in the settlements» № 3077-84. Daily exceeding of
MPL in the hospital interrupt treatment regime of patients and creates additional harmful working
conditions for medical staff. Given mismatches of equivalent and maximum noise levels on 5-10
dBA should cause damage of a human ear, primary. Secondly, it should create a so-called "stagnant
nidus" in the cortex of brain. Constant influence on a sick person, leads to the aesthetic and neurotic
infringements, insomnia, blood pressure fluctuations, and, finally, to decrease the therapeutic effect,
recovery.
2. In order to prevent noise impact from transport traffic on the patients and medical staff the
following preventive measures should be taken:
- administrative, focused on a source of noise: revoke heavy transport traffic through the health care
facilities; restrict other transport traffic at night time;
46
- architectural & planning: replace block-stone road into cutback asphalt; crossroads of transport
traffic at night time should be carry out along boundary line of the health care facilities; build a
fence along highway of the hospital as well as sound dampening screens; plant 2 rows crown trees
along "red line" of a hospital, provide windows – oriented on the source of noise, with noise
absorbing metal – plastic glass packet.
Date Signature Name
Hygienic standardization of municipal noise

Premises and Levels of sound pressure (dB) in octave lines with
Levels of constant noise and

territories average geometrical frequencies (Hz)
Maximum level of non-

equivalent level for non-
constant noise (dBA)

63 125 250 500 1000 2000 4000 8000
Period of time
constant noise
(dBA)
Health care facilities and 7.00-23.00 59 48 40 34 30 27 25 23 35 50
sanatorium wards 23.00-7.00 51 39 31 24 20 17 14 13 25 40
Doctor's consulting
7.00-23.00 59 48 40 34 30 27 25 23 35 50
room
Classrooms
7.00-23.00 63 52 45 39 35 32 30 28 40 55
Apartment premises 7.00-23.00 63 52 45 39 35 32 30 28 40 55

23.00-7.00 55 44 35 29 25 22 20 18 30 45
Hotels 7.00-23.00 67 57 49 44 40 37 35 33 45 60
23.00-7.00 59 48 40 34 30 27 25 23 55 70
Cafes, restaurants 7.00-23.00 75 66 59 54 50 47 45 43

Territories around 7.00-23.00 67 57 49 44 40 37 35 33 45 60
health care facilities
23.00-7.00 59 48 40 34 30 27 25 23 35 50
Territories around
residential apartments 7.00-23.00 75 66 59 54 50 47 45 43 55 70
23.00-7.00 67 57 49 44 40 37 35 33 45 60
Microdistrict 7.00-23.00 67 57 49 44 40 37 35 33 45 60
playgrounds
47
Appendix 2
Technique of definition and hygienic estimation of the direction and speed of air movement
Educational instruction for definition of air movement by anemometers
Air movements in ventilating apertures define speed of movement of atmospheric air with
anemometers: 1 type (at the speeds from 1 to 50 m/s) and 2 type (0.5-10 m/s) (fig. 1). Work
vertically established anemometer of 1-type does not depend on the wind direction; anemometer of
2-type need to focus accurately at the axis wind direction.
Fig. 1. Anemometers
(a – second type; b- first type)
For definition of speed of air movement you have to write down initial indicators of dials of
the counter (thousand, hundreds, tens and units), having disconnected it from anemometer at the
research place (for example, in an alignment of ventilating aperture). In 1-2 minutes of single
rotation include simultaneously the tachometre and stop watch. In 10 minutes the counter
disconnect, read new instruments of dials and count speed of rotation (quantity of divisions of the
scale of anemometer – see formula A):
А= ,
where: N1 - indications of scale of the device before measurement;
N2 - indications of scale of the device after measurement;
t - duration of measurement in seconds.
On value "A" divisions/seconds under the schedule (everyone anemometer has the
individual schedule according to factory number of the device, which is applied to anemometer),
find speed of movement of air in m/s.
48
Appendix 3
Technique of definition and hygienic estimation of natural illumination
Fig. 1. Luxmetre U-116.

(1 - measuring device (halvanometer); 2 - selenic photo cell; 3 - light filters-nozzles
Educational instruction
Technique of measurement of light exposure by luxmetre
Luxmetre U-116 consists of the selenic photo cell with filters-nozzles and galvanometer
with a scale. The photo cell works under the influence of light, developing an electric current which
force measure by the galvanometer. Its arrow specifies number of lux that answers investigated
light exposure.
On the panel of the measuring device buttons of the switch and the tablet with the scheme
which connects action of buttons and a nozzle with various ranges of measurements are established.
The device has two graduated scales, in lux: 0-100 and 0-30. On each scale points specify the
beginning of a range of measurements: on a scale 0 - 100 point is over a label 20, on a scale 0-30
over a label 5. Also there is a proof-reader for an arrow establishment on zero position which is
regulated by a screw-driver.
The selenic photo cell which joins the device by means of a plug, is in the plastic case. For
the purpose of error reduction use a spherical nozzle on a photo cell, made of the white light-
scattering plastic, designated on an inside, and an opaque ring. This nozzle is applied in parallel
from one of three other nozzles-filters, which have factors of easing of light, equal accordingly 10,
100, 1000, that expands ranges of measurements. Without nozzles, luxmetre is possible to measure
light exposure within 0-30 and 0-100 lux.
In the course of measurement an arrow of the device establish on zero division of a scale,
then opposite to the pressed button define the greatest value of a range of measurement chosen by
means of nozzles. By button pressing opposite to which the greatest value of a range of
measurements is written, multiple 10, it is necessary to use for readout by indications of the scale 0-
100, by button pressing, on against which are put value of a range, multiple 3, indications of the
scale 0-30. The Instrument reading in divisions on corresponding scale multiply by factor of easing
which is designated on a corresponding nozzle. The general estimation of natural illumination of
49
premises carried out on a basis of comparison all complex of the measured indicators with hygienic
specifications (table 1).
Table 1
Norms of natural illumination for different premises
Kind of premises Daylight factor (DLF) Light coefficient (LC)
not less
1. School and pre-school 1.25-1.5 % 1:4 – 1:5
educational premises
2. Public and 1.0 % 1:5 – 1:6
administrative-household
premises
3. Chambers of hospital 0.5 % 1:6 – 1:8
4. Operational rooms 2.0 % 1:2 – 1:3
Lighting method of research of natural illumination in premises - definition of factor of

natural light exposure, so called daylight factor (DLF).
Factor of natural light exposure (DLF) – is the relation of light exposure of the horizontal
surface expressed in percentage (at floor or workplace level) indoors to the light exposure measured
simultaneously a diffused light of the horizontal surface under an open sky:
DLF =
Einternal- light exposure of the horizontal surface in the premises;
Eexternal- light exposure of the horizontal surface under a sky.
Appendix 4
Technique of definition and hygienic estimation of temperature-humidity mode
Definition of humidity by psychrometer
Definition of absolute and relative humidity of air station by psychrometer August (a) and
Assman (b) (fig. 1).
The tank of psychrometer full with water. A fabric which the tank of one of device
thermometers is wrapped up, lower in water so that the tank was on distance of 3 sm over a water
surface. Then psychrometer is suspend on a support in the definition point. In 8-10 minutes remove
indicators of dry and damp thermometers.
Relative humidity defined by psychrometer of any type, see on the table 1 (at the speed of
air movement 0.2 m/s). Its values find in a point of crossing of indicators of dry and damp
thermometers.
The work principle of psychrometer is based on the intensity of evaporation of the moisture
to surface of the humidified tank of psychrometer, which is proportional to dryness of air: the more
low indicators of the humidified thermometer compared with dry because warmly humidified
psychrometer is lost on latent heat of steam formation.
50
Fig. 1. Devices for definition of humidity of air
(a - psychrometer August; - psychrometer Аssman; b- hyhrometer)
51
Тable 2
Definition of relative humidity by psychrometer August
Indicators of Indicators of the damp thermometer, ºС
the dry
thermometerºС
12 5,3 5,7 6,0 6,4 6,8 7,2 7,6 8,0 8,4 8,7 9,1 9,5 9,9 10,3 10,7 11,0 11,3 11,7 12,0
13 5,9 6,4 6,8 7,2 7,6 8,0 8,4 8,8 9,2 9,6 10,0 10,4 10,8 11,1 11,5 11,8 12,2 12,6 13,0
14 6,6 7,1 7,5 8,0 8,4 8,6 9,2 9,7 10,1 10,5 10,9 11,3 11,7 12,1 12,5 12,8 13,2 13,6 14,0
15 7,3 7,8 8,2 8,7 9,2 9,6 10,0 10,5 10,9 11,4 11,8 12,2 12,6 13,0 13,4 13,8 14,2 14,6 15,0
16 8,0 8,5 9,0 9,4 9,9 10,3 10,8 11,3 11,8 12,2 12,6 13,1 13,5 14,0 14,4 14,8 15,6 15,6 16,0
17 8,0 9,1 9,7 10,2 10,7 11,2 11,6 12,1 12,6 13,0 13,5 13,9 14,4 14,9 15,3 15,8 16,2 16,6 17,0
18 9,3 9,9 10,4 10,9 11,4 11,9 12,4 12,9 13,4 13,9 14,4 14,8 15,3 15,7 16,2 16,6 17,1 17,5 18,0
19 10,0 10,6 11,1 11,7 12,2 12,7 13,2 13,8 14,8 14,8 15,3 15,7 16,2 16,7 17,2 17,6 18,1 18,5 19,0
20 10,6 11,2 11,8 12,4 12,9 13,4 14,0 14,5 15,1 15,6 16,1 16,6 17,1 17,6 18,1 18,5 19,0 19,5 20,0
21 11,2 11,9 12,6 13,1 13,6 14,2 14,8 15,3 15,9 16,6 17,1 17,5 18,0 18,6 19,1 19,5 20,0 20,5 21,0
22 11,8 12,5 13,2 13,8 14,4 15,0 15,6 16,1 16,7 17,3 17,9 18,4 18,9 19,5 20,0 20,5 21,0 21,5 22,0
23 12,5 13,1 13,8 14,4 15,1 15,7 16,4 17,0 17,6 18,2 18,8 19,3 19,8 20,4 20,9 21,5 22,0 22,5 23,0
24 13,1 13,8 14,5 15,2 15,9 16,5 17,1 17,8 18,4 19,0 19,6 20,1 20,7 21,3 21,9 22,4 23,0 23,0 24,0
25 13,7 14,5 15,2 15,9 16,6 17,2 17,9 18,5 19,2 19,8 20,5 21,2 21,7 22,2 22,8 23,3 23,9 24,4 25,0
Relative 10 15 20 25 30 35 40 45 50 55 60 65 70 75 80 85 90 95 100
humidity,%
Substantial module 2. Hygiene of nutrition.
Concrete purposes:
 Give hygienic estimation of rational nutrition for harmonic physical
development, resistance health, long way activity.
 Know functions of separate food nutrients (proteins, fats, carbohydrates,
vitamins, mineral substances, taste properties of nutrients) in the human body.
 Planning organization of preventive measures to protect organism from
infection diseases with alimentary way of transfer, biohelmintoses,
geohelmintoses, food poisonings.
 Substantiation conditions of rational nutrition (quantity and quality
components, regimen of meals, enzyme properties of the digestive system,
safety of toxicological and epidemiological properties) on resistance health.
 Substantiation and planning organization of dietetic and medical-preventive
nutrition for separate groups of population and individuums.
 Planning organization of sanitary inspection of food blocks in the hospitals and
medical-preventive establishments.
Тheme № 6. Nutrition in the preventive medicine. Organization of the treatment-

and-prophylactic nutrition on the industrial enterprises.
1. PURPOSE: research types of rational nutrition. Carry out hygienic assessment of
medical-preventive nutrition at the industrial enterprises.
2.1.1. Types of nutrition (rational, preventive, treatment-and-prophylactic, treatment
(diet)). Principles of rational nutrition.
2.1.2. Hygienic issues of the staff nutrition, working in the harmful and dangerous
labour conditions.
2.1.3. Hygienic requirements to organization of treatment-and-prophylactic nutrition
the industrial enterprises staff.
2.2.1. Carry out hygienic estimation of the nutrition ration.
2.2.2. Provide medical control over organization of treatment-and-prophylactic
nutrition the industrial enterprises.
2.2.3. Analyse treatment-and-prophylactic nutrition effectiveness.
3.1. Food functions and its major factors.
3.2. Alimentary diseases (primary and secondary diseases of the insufficient and
superfluous food).
3.3. Apply of protective and pharmacological action of the food for organization
treatment-and-prophylactic and other types of nutrition.
3.4. Proteins, fats, carbohydrates, vitamins, mineral elements and their importance in
the nutrition.
3.5. Basic requirements to the human food ration.
3.6. Energy value and nutrient composition of the nutrition rations. Sources of energy
in the nutrition.
3.7. Basic principles and types of treatment-and-prophylactic nutrition.
3.8. Purposes of the treatment-and-prophylactic nutrition. Peculiarities of
organization treatment-and-prophylactic nutrition for various types of industrial
enterprises.
3.9. Rations of the treatment-and-prophylactic nutrition, analysis of their
effectiveness.
1. Standard legislative regulations using in order to estimate hygienic assessment of
treatment-and-prophylactic nutrition rations, by the scenario – based tasks.
2. Laboratoty and instrumental research carried out specific gravity of milk.
5.1. Why nutrition has significant influence to the human health?
5.2. What is the specific action of nutrition?
5.3. What is the treatment action of nutrition?
5.4. What is the preventive action of nutrition?
5.5. What is the parapharmacological action of nutrition?
5.6. Enumerate types of nutrition.
5.7. What is the purpose of a balanced diet; specify to which population group apply
a balanced diet?
5.8. What is the purpose of a preventive diet; specify to which population group
apply a preventive diet?
5.9. What is the purpose of the treatment-and-prophylactic nutrition; specify to which
population group apply the treatment-and-prophylactic nutrition?
5.10. What is the purpose of the treatment (dietetic) nutrition; specify to which
population group apply the treatment (dietetic) nutrition?
5.11. What is the principle of quantitative usefulness of a diet?
5.12. What is the principle of a high quality balanced diet?
5.13. What is the principle of a balanced diet?
5.14. What is the principle of an optimality diet?
5.15. What is the principle of a diet adequacy?
5.16. What is the principle of a diet safety?
5.17. What is the background of the treatment-and-prophylactic nutrition
appointment?
5.18. Enumerate types of the treatment-and-prophylactic nutrition.
5.19. Specify purposes of apply ration №1?
5.21. Specify purposes of apply ration №2а?
5.24. Specify purposes of apply ration №4 а?
5.25. Specify purposes of apply ration №4 b?
Practical training is carried out at an educational audience. The control of initial level
of knowledge is carried out by tests from the given theme. Students work
54
independently. After test control, students discuss questions for self-preparation
(issue 5). The teacher corrects wrong answers of the students.
In order to carry out practical training, using normative documents students solve
scenario – based tasks focused on the treatment-and-prophylactic nutrition
organization, hereafter students should carry out hygienic conclusion as well as
protocol at the notebook (Appendix). Student should demonstrate practical
assessment towards treatment-and-prophylactic nutrition at the industrial enterprises
(issue 4).
At the final part of the practice teacher estimates students educational activity on
the given theme, signed protocols.
Hygiene of nutrition – branch of science, which research influence of the food supply on the
individual health, various staff, population and develops scientific basis and practical guidelines for
the rational organization different gender and professional groups in order to prevent malnutrition
diseases; food poisoning and infectious diseases, etc.
Biological functions of nutrition:
1.Ensures process of the organism growth and development.
2.Forming a high level of health.
3.Restores working efficiency.
4.Increases life expectancy.
5.Reduces alimentary diseases and major non-communicable diseases with nutritional factor of
transfer.
6.Impact on the recovery and prevent recurrence.
7. Protect population from negative effects of harmful and dangerous environmental conditions.
Axioms of biological human activity:
1 Primary energy vital needs compare with other human needs.
2 Adult human bodies should have function at the isoenergy conditions.
3 Maximum energy value of the diet should correspond to a high physical activity.
4 Processes of degradation (catabolism) occur in the body permanently, regardless of the receipt of
food.
5. Processes of assimilation (anabolism) occur under the condition of providing the body energy,
plastic and bioregulatory substances.
6. Nutrition should be biologically informative, meaning that it contains necessary substances for
the regulation of metabolism.
7. Glucose, triglycerides and cholesterol in the diet are basic risk factors for common non-
communicable diseases (diabetes, obesity, and atherosclerosis).
8. Food should exceed its adoption in order to carry out a high activity of plastic processes for
young organisms, athletes, and military staff.
9. In the case of quantitative and qualitative malnutrition, the immune system has a breakdown
(protective and adaptive capacity of the organism), as well as high level of communicable and
noncommunicable diseases.
Biological effects of food and variety of food
Biological Purpose of nutrition Type of nutrition Population groups
activity
Specific Prevention of alimentary Rational Healthy
diseases
Wellness Prevention of non-specific Preventive Risk groups
(multi-factor) nature
Protective Prevention of occupational Treatment-and- Groups with harmful and
diseases prophylactic dangerous working
55
conditions
Parapharmacological Restoration of disturbed Diet (therapeutic) Patients
homeostasis and low
activity of functional
systems of the body
Rational nutrition - (lat. rationalis - clever) is a physiologically balanced diet of healthy

people. At the organizing of a balanced diet carried out by scientifically based physiological norms
of consumption nutrients and energy for different population groups.
Principles of rational nutrition
1. Principle of quantitative aptitude - energy value of a ration should covered energy of the
body.
2. Principles of good-balanced-diet should contain all nutrients necessary for cosmetic
purposes and regulation of physiological functions.
3. Principle of a balanced-diet – all nutrients should be balanced.
4. Principle of optimality – to follow a timetable of meals.
5. Principle of adequacy – chemical composition of food absorption and digestion should
correspond to the metabolic processes of the person.
6. Principle of enjoy – nutrition should be delicious, with pleasant flavor and should be
consumed in a comfortable environment.
7. Principle of safety – food should be safe in epidemiological, toxicological and radiological
issues.
At the superfluous or insufficient food, according to physiological requirements of
receipt for an organism of food substances alimentary diseases are developed.
Alimentary diseases (scurvy, beri-beri, pellagra, alimentary adiposity, etc.) are possible
to warn, observing balanced diet principles as deficiency or surplus of nutrients is the main
reason of their occurrence, i.e. etiological factor. Long term alimentary diseases can act as the
primary pathogenetic factors of nonspecific diseases (atherosclerosis, hypertensive illness,
ischemic illness of heart, diabetes, urolithic illness, etc.)
Classification of illnesses of the alimentary origin
1.Illnesses and syndromes of the insufficient food
1.1. Diseases associated with hunger or partial malnutrition.
1.2. Diseases related to nutrient malnutrition:
– Protein insufficiency (Kwashiorkor disease);
– Protein-power insufficiency of I-III degree (alimentary marasmus; delay of physical
development);
– Vitamin insufficiency (vitamin A - xerophthalmia; vitamin Д - rickets; vitamin C - scurvy; B1 –
beri-beri; PP - pellagra; vitamin B12 - anemia; absence of vitamins B6, Е, B2 etc.);
– Mineral insufficiency: iron (anemia), iodine (endemic craw, congenital insufficiency of iodine);
fluorine (caries of teeth); insufficiency of calcium, phosphorus, magnesium, sodium, chlorine,
copper, etc.;
– Failure of essential polyunsaturated fatty acids (PUFA) ω9, ω6, ω3 in the cis-form
(atherosclerosis).
1.3. Illnesses and syndromes of the superfluous food:
– Caloricity redundancy (metabolic syndrome, atherosclerosis, diabetes, etc.);
– Syndrome of protein redundancy of food (gout);
– Syndrome of redundancy of fat acids in the trans-form (atherosclerosis, cancer);
– Redundancy of vitamins: A and D, E etc.
– Mineral redundancy: fluorine (fluorosis); selenium (selenosis); molybdenum (gout); iron
(hemosiderosis); calcium, phosphorus, etc.
1.4. Disease of irrational food combinations (diarrhea).
1.5. Disease of irrational nutrition mode (gastritis, gastric ulcer and duodenal ulcer, pancreatitis).
56
2. Secondary alimentary diseases associated with disruption processes of assimilation nutrients
(secondary malnutrition, vitamin deficiencies, and hypomicroelementoses).
3. Diseases associated with alimentary risk factors (alimentary diseases as well as atherosclerosis,
cancer, diabetes, etc.).
4. Diseases associated with food intolerance (food allergy, food idiosyncrasy, psychogenic food
intolerance).
5.Diseases associated with epidemically and sanitary hazardous food (food infection, helmintes,
food poisoning).
Illnesses of the alimentary origin classification
The illness name Groups of diseases Etiological risk factor
The alimentary External factors Lack or surplus of nutrients in
(monofactorial) food
Internal factors Infringement of mastering of the
food, strengthened
disintegration of nutrients
Alimentary caused Illnesses of systems of bloodInfringement of diet - one of the
(multifactorial) circulation, digestion, endocrinerisk factors
systems, immune system, etc.
Infectious or parasitic Zooanthroponosis Participation of foodstuff in the
realization of mechanism of
transfer infecting agent
Treatment-and-prophylactic nutrition – is a special type of diet, designed in order to
protect worker staff, working in hazardous and dangerous conditions, carried out by increasing
resistance of the organism against harmful factors, regulation mechanisms of biotransformation and
detoxification of xenobiotics, prevention of professionally caused nutrient deficiencies.
Vital importance of the treatment-and-prophylactic nutrition apply concerned to the
preventive medicine, arose manufacturing activity in some branches of industries, mining,
processing industry, agriculture, medicine, etc. associated with possible adverse effects of
hazardous chemical, physical or biological environmental factors on the organism of workers.
These factors lead to the specific consequences (occupational diseases or professional poisoning),
and nonspecific (deterioration of public health, working capacity reduced, nonspecific disease,
worsening of chronic somatic illness, etc.).
Functional purposes of treatment-and-prophylactic nutrition:
1) protective functions of physiological body barriers (skin, mucous membranes, etc.) carried out on
the prevention impact of harmful environmental factors to the body;
2) differential influence on the xenobiotics biotransformation processes, stimulation mechanisms of
creation low toxic metabolic reactions products, blocking of biotransformation processes in case of
formation more toxic metabolites;
3) activation an antioxidant defense system of the body, increasing its effectiveness;
4) activation processes of binding, neutralization and excretion of toxic substances and products of
their transformation;
5) support of organs and systems functional state, susceptible to harmful production factors;
increased antitoxic function of the liver-specific detoxification, especially hepatotropic harmful
factors;
6) compensation nutrients deficiency in the body caused by direct exposure of harmful factors in the
process of their metabolic conversion;
7) support of self-regulatory processes of the organism, i.e. adaptive, compensatory,
immunoregulatory;
8) increase of the organism resistance, its adaptation reserves, health improvement, reduction of
common and occupational diseases, extension of active life, prevention of premature aging.
Treatment-and-prophylactic rations types
57
Treatment-and- Harmful occupational factors
prophylactic rations
№1 Radionuclides and ionizing radiation
№2 Compounds of fluorine, alkali metals, chlorine and inorganic
compounds, oxides of nitrogen, phosgene, acid
№2а Chromium, chromium compounds, and other chemical allergens
№3 Inorganic and organic lead compounds
№4 Chlorinated hydrocarbons, arsene, tellurium, mercury compounds

№4а Phosphorus and phosphorus-containing compounds in the
chemical industry (organic products)
№4b Amino and nitro compounds of the benzene in the chemical
industry (organic products)
№5 Tetraethyl lead, brominated hydrocarbons, carbon disulfide,
manganese compounds and barium
Whole milk Aliphatic and acyclic hydrocarbons, halogen derivatives of the
fatty and aromatic carbohydrates, chlorinated multicore
carbohydrates, alcohols, phenols, acyclic & aliphatic ethers their
halogen derivatives, esters, phenols, organic oxides and peroxides,
thiophenol, thioethers, aldehydes and ketones, organic acids,
esters and amides of phosphorus acids, nitro - and amino
compounds fatty polymethene and aromatic spycies and their
derivatives, benzo-, oil - and anthraquinones, heterocyclic
compounds, alkaloids, aerosol silicon compounds (> 10% SiO2),
sulfur, nitrogen, phosphorus, halogen and halogen derivatives,
metals and their compounds, methanol, antibiotics, components of
microbiological origin, derived medicines A and B, soot,
pesticides, etc.
Dairy products and pectin Inorganic lead compounds
Vitamins High temperatures and intense radiation, nicotine in an aerosol
Food packages, nutrients and energy value treatment-and-prophylactic rations

for one time intake (breakfast, lunch) in the occupational conditions
Food (gross №1 №2 №2а №3 №4 №4а №4b №5
weight),
gramm
Wholemeal 100 100 100 210 75 100
bread
Brown bread 100 100 100 100 100 75 100
Wholemeal 100
white
bread, 2 – nd
sorts of wheat
Wheaten flour 10 15 15 15 5 16 3
(Wheaten
flour &
pasta)
Potato flour 1
Croutons 5 3
Cereals, pasta 25 40 15 (millet, 35 15 7 (barley 8 (pasta), 20
rice, (cereals) & pasta), 10 (millet,
buckwheat 10 (rice) rice,buck-
58
Food (gross №1 №2 №2а №3 №4 №4а №4b №5
weight),
gramm
) wheat)
Pasta 5
Beans 10 10
(green
peas)
Sugar 17 35 5 35 45 8 15 40
Meat 70 150 81 100 100 110 74 100
(beef II sort)
Liver 30 25 40 (heart) 20 20 25
Chickens 37
Fish 20 25 25 50 40 35
Eggs Per Per ¼ Per 1/3 Per ¼ 1 piece 1 piece 1
¾ piece piece piece piece
piec
e
Buttermilk 200 125
Мilk 70 200 156 (milk, 200 200 124 200
(butter- buttermilk, (butter- (milk, (milk,
milk, skimmed, milk, butter- butter-
etc.) etc.) etc.) milk) milk)
Farmhouse 40 71 (11% 80 (18% 110 50 40 35
cheese of fat) of fat)
Sour cream 10 32 (30% 7 20 23 28 10
of fat)
Fat cottage 10 25
cheese (30%
of fat)
Butter 20 15 13(melted) 10 15 7 18 17
Vegetable oil 7 13 20 5 10 12 13 15
(sunflower
)
Fat of animal 5
origin
Potato 160 100 120 100 150 213 170 125
Cabbage 150 150 100
Carrots 90 82
Vegetables 247 160 25 242 Beetroot – 100
19,
salads 20,
radish –
12,
cucembers
– 10, bulb
onion – 27,
cabbage -
100
Tomato 7 2 5 3 8 (tomato 3
smoothie paste)
Fruit fresh 130 73 (juices) 100 75 (fruits, 10 (apples)
berries)
Dried fruits 7
(raisins, apricots,
59
Food (gross №1 №2 №2а №3 №4 №4а №4b №5
weight),
gramm
prunes)
Lemons 2
Fruit juices 60
Salt 5 5 4 5 5 5
Tea 0.4 0.5 0.5 0.5 0.1 0.1
Rations
chemical
composition: 59 63 52 64 65 54 56 58
proteins, grams 51 50 63 52 45 43 56 53
fats, grams 159 185 156 188 181 200 164 127
carbohydrates,
grams
Energy value of 138 1481 370 1466 1428 1368 1484 1438
rations, kcal 0
8. LITERATURE.
8.1. The basic:
Vinnytsya: Nova Knyha publishers, 2009. – P. 246-256, 257-263, 264-275, 288-297.
8.2. Additional:
Appendix 1
The chart below, based on Body Mass Index, is applicable to both men and women and shows the
`healthy range` we should be aiming for as currently advised by the medical profession.
Body Mass Index is calculated from weight in kilos divided by height in meters squared, or
BMI =
Hygienic estimation of Body Mass Index (BMI)

(recommended by WHO)
BMI ESTIMATION OF CALORIC STATUS
men women
< 16 < 16 Hypotrophy of III stage
16,0-16,99 16,00-17,99 Hypotrophy of II stage
17,00-18,49 18,00-20,00 Hypotrophy of I stage
18,50-20,80 20,10-22,00 Normal caloric status
23,90-28,50 25,00-29,99 Obesity of I stage
28,60-38,99 30,00-39,99 Obesity of II stage
39,00 and more 40,00 and more Obesity of II stage and heavy obesity
Definition, classification of obesity, Body Mass Index (BMI) as a measure for assessing
obesity
Obesity is characterized by excess adipose tissue. Quantification of adipose tissue mass can
be achieved by a number of laboratory methods including underwater body measurement and body
60
fat content estimated by the dual energy of X – ray absorption (DEXA). In addition, the
development of new technique, such as magnetic resonance imaging (MRI) and computed
tomography (CT), has provided researchers with opportunities to describe human adiposity in more
detail. However, these methods require costly equipment and are difficult to implement in
epidemiological studies, although some exceptions exist, such as bioelectrical impedance.
In large-scale population surveys, body weight adjusted for stature (body mass index) is
commonly used as a surrogate for body fat content. These indices are defined as different
combinations of weight and height, such as weight divided by height and weight expressed as a
percentage of mean weight for a given height and sex. The most widely used is Quetelet’s index,
better known as body mass index (BMI), which is body weight (kg) divided by height squares (m 2).
This index has been shown to correlate weakly with height and strongly with body fatness.
Although the correlation between BMI and body fat adjusted for height is high (γ=0,82-
0,91), BMI fails to distinguish between lean body mass and fat. Thus, the relationship between BMI
and body fatness varies according to body composition proportions. For instance, the percentage of
body fat mass is higher in women than in men with a similar BMI. In addition, body fatness has
been shown to increase with ageing, meaning that a given BMI may correspond to a greater body
fat content in older subjects compared with younger ones.
Any age-related change in height has an influence on BMI as well. In adults, height is lost
with normal ageing in a recent study, an average height loss of 3 cm from age 30 to 70 years was
estimated to account for an artificial increase in BMI of 0.7 kg/m2 for men.
In women, the height loss averaged about 5 cm over the same 40 – year period, accounting
for an increase of 1.6 units in BMI. During growth in childhood and adolescence, not only does
height increase but body composition changes as well, thus classification of obesity according to
BMI is complicated. Because the age of onset of puberty varies, international BMI-based estimates
of overweight in children and adolescents are rendered even more difficult to determine (World
Health Organization, 2000). The need for these estimates has, however, been emphasized.
Consequently, internationally based cut-off points for children have recently been published.
Despite its limitations, BMI provides a simple and the most useful population-level measure
of obesity in adults. A BMI of 30 kg/m2 is widely recognized as a cut-off point for obesity. The
latest classification of overweight according to BMI (table) was introduced in a WHO report
published in 2000 (World Health Organization, 2000). BMI-based classification of overweight and
obesity has been well received by the research community, making comparisons for obesity
prevalence between or within populations feasible. However, in some studies, alternative cut-off
points have been used.
For example, obesity has been classified on the basis of the BMI distribution in the reference
population, the 85% being the cut-off point for overweight and the 95% for obesity, or subjects with
a relative weight index (100 × weight divided by ideal weight) larger than 130% have been
considered to be obese.
Classification of under- and overweight in adults according to BMI
(World Health Organization, 2000)
Classification BMI, kg/m2 Population description
Underweight < 18.5 Thin
Normal range 18.5 – 24.9 Normal, healthy, acceptable weight
Overweight > 25 Overweight
Pre-obese 25 – 29.9 Overweight
Obese class I 30.0 – 34.9 Obesity
Obese class II 35.0 – 39.0 Obesity
Obese class III > 40 Morbid obesity
61
It should be acknowledged, however, that the classification of obesity according to BMI is
artificial, and the cut-off point of BMI 30 for obesity is purely arbitrary. The population is not
composed of two distinct groups, namely the obese and the non-obese. The cut-off point for obesity
merely indicates the greatly increased health risks above this level of body fatness. It does not,
however, imply that BMI below this level is free from associated risks because the risks of
morbidity and mortality begin at relatively low levels of BMI (World Health Organization, 2000).
Overall, guidelines for healthy weight are difficult to determine.
Appendix 2
„Physiologic amounts for major dietary ingredients and energy”
Order 18.11.1999 year by Ministry of Public Health of Ukraine
Daily caloric value and quantity of proteins, fats and carbohydrates for different professional groups
of population (men)
Professional Coefficient Age Caloricity Proteins (gr.) Fats Carbohydrates
groups of physical years Kcal (gr.) (gr.)
activity Total Animal
origin
I 1.4 18-29 2450 67 37 68 392
30-39 2300 63 35 64 368
40-59 2100 58 32 58 336
II 1.6 18-29 2800 77 42 78 448

30-39 2650 73 40 74 424
40-59 2500 69 38 69 400
III 1.9 18-29 3300 91 50 92 528
30-39 3150 87 48 88 504
40-59 2950 81 45 82 472
IV 2.3 18-29 3900 107 59 100 624
30-39 3700 102 56 100 592
40-59 3500 96 53 97 560
Daily caloric value and quantity of proteins, fats and carbohydrates for different professional groups
of population (women)
Professional Coefficient Age Caloricity Proteins (gr.) Fats Carbohydrates
groups of physical years Kcal (gr.) (gr.)
activity Total Animal
origin
I 1.4 18-29 2000 55 30 56 320
30-39 1900 52 29 53 304
40-59 1800 50 28 51 288
II 1.6 18-29 2200 61 34 62 362
30-39 2150 59 32 60 344
40-59 2100 58 32 59 336
III 1.9 18-29 2600 72 40 73 416
30-39 2550 72 39 71 408
40-59 2500 69 38 70 400
IV 2.2 18-29 3050 84 46 85 488
30-39 2950 81 45 82 472
40-59 2850 78 43 79 456
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Daily needs of vitamins for different professional groups of population (men)
Professional Coefficient Vitamins

groups of physical
activity E D A B1 B2 B6 PP Folat B12 C
mg mcg mcg mg mg mg mg mcg mcg mg
I 1.4 15 2.5 1000 1.6 2.0 2.0 22 250 3 80
II 1.6 15 2.5 1000 1.6 2.0 2.0 22 250 3 80
III 1.9 15 2.5 1000 1.6 2.0 2.0 22 250 3 80
IV 2.3 15 2.5 1000 1.6 2.0 2.0 22 250 3 80
Daily needs of vitamins for different professional groups of population (women)
Professional Coefficient Vitamins

groups of physical
activity E D A B1 B2 B6 PP Folat B12 C
mg mcg mcg mg mg mg mg mcg mcg mg
I 1.4 15 2.5 1000 1.3 1.6 1.8 16 200 3 70
II 1.6 15 2.5 1000 1.3 1.6 1.8 16 200 3 70
III 1.9 15 2.5 1000 1.3 1.6 1.8 16 200 3 70
IV 2.2 15 2.5 1000 1.3 1.6 1.8 16 200 3 70
Daily needs of mineral substances for different professional groups of population (men)
Professional Coefficient Mineral substances

groups of physical
activity Ca P Mg Fe F Zn I Se
mg mg mg mg mg mg mg mcg
I 1.4 1200 1200 400 15 0.75 15 0.15 70
II 1.6 1200 1200 400 15 0.75 15 0.15 70
III 1.9 1200 1200 400 15 0.75 15 0.15 70
IV 2.3 1200 1200 400 15 0.75 15 0.15 70
63
Daily needs of mineral substances for different professional groups of population (women)
Professional Coefficient Mineral substances

groups of physical
activity Ca P Mg Fe F Zn I Se
mg mg mg mg mg mg mg mcg
I 1.4 1100 1200 350 17 0.75 12 0.15 50
II 1.6 1100 1200 350 17 0.75 12 0.15 50
III 1.9 1100 1200 350 17 0.75 12 0.15 50
IV 2.2 1100 1200 350 17 0.75 12 0.15 50
Appendix 3
Scenatio – based task № 1 "Nutrition in the preventive medicine. Organization of the
treatment-and-prophylactic nutrition on the industrial enterprises"

Carry out hygienic conclusion of organization of treatment-and-prophylactic nutrition in the
industrial enterprise, which characterized by harmful occupational factors, as well as radionuclides and
ionizing radiation (loparite concentrates processing on mining companies):
• ration is carried out at the end of a working day;
• menu of a ration for 2 days:
1 day 2 day
Smoked fish with pickled beet Fresh cabbage salad
Fried meat with vegetables Meat stew with potatoes
Apples, buttermilk Fruits, buttermilk, wholemeal bread
Tea, brown bread Dried fruit drinks
• In addition to the ration worker staff should receive 100 mg ascorbic acid and 4 mg thiamine
• Energy value intake and chemical composition of ration № 1:
Protein – 49 g
Fats – 49 g
Carbohydrates – 178 g
Energy value intake – 1349 kcal
Standard answer.
Organization of treatment-and-prophylactic ration carried out worker staff doesn’t
correspond to the hygienic requirements. Appointment of treatment-and-prophylactic ration,
according to the hygienic standards should be carried out before a work shift, or at the lunch – time,
confirmed by hygienist – doctor of the regional Sanitary & Epidemiology Station.
Preventive actions of ration № 1 should be provided by standard values of nutrients, caused
radionuclides removing (radioprotectors), neutralize free radicals (antioxidants).
Given menu was focused on the routine cooking separate dishes (meat), absence of high – content
antioxidants, lipotropic and hematopoiesis substances, as well as: eggs, milk & dairy products
(farmhouse cheese, sour cream, fat cottage cheese), vegetable oil, fish, liver, etc.
In addition to the ration worker staff receive 150 mg ascorbic acid and didn’t receive
thiamine.
Chemical composition of ration № 1 has the following disadvantages:
1) protein – 49 g; instead of recommended – 59 g, which is correspond to the
low protein diet (milk & dairy products, fish, etc.).
2) fat – 49 g; instead of recommended – 51 g, which is correspond to the low
vegetable fats diet, as well as polyunsaturated fatty acids (PUFA) ω9, ω6, ω3.
64
Energy value intake of the given ration on 31 kcal less than recommended value, which is
correspond to the high – carbohydrates diet.
Scenatio – based task № 2 "Nutrition in the preventive medicine. Organization of the

treatment-and-prophylactic nutrition on the industrial enterprises"
Daily average diet of technical worker (man) at the age of 40-59 y.o. (III professional group)
contains: 4974 calories, 40 grams of proteins, including 25 grams of animal origin, 304.6 grams of
fats, 850 grams of carbohydrates.
Daily amount of mineral substances of 40-59 years old man (III professional group): 500 mg
of calcium, 850 mg of phosphorus, 350 mg of magnesium, 10 mg of iron.
Daily amount of vitamins of 40-59 years old man (III professional group): С-75 mg, В1-1.3
mg, В2-1.6 mg, В6 – 1.8 mg, РР-16 mg, Д- 3.0 mcg, А- 250 mcg.
Treatment-and-prophylactic ration, 40-59 years old man:
Breakfast CALORIES FAT (grams)
Coffee with sour-cream……………………………………………..…… 20…………………0.7

Baked Potato with Butter…………………………………………………350
Sausage, Bacon and Egg Sandwich………………………........................409………………..25
Second breakfast
Turkey Breast with Herbs………………………………………………...46………………….15
Apple Sauce…………………………………………………....................14………………….0
Carrot and Coriander Soup………………………………..……………...330………………..10
Egg and Tomato with Salad Cream………………………………………462……………......11
Fresh Grapefruit Marmalade……………………………………………...74…………………23
Mango Slices……………………………………………………………...18…………………0.8
Pineapple Slices………………………………………………………….. 12………………….0.9
Dinner
Citrus Salad in Juice 100g………………………………………………..35………………….0.5
Tropical Fruit Salad in Light Syrup 432g………………………………..259…………………15
Liver and Bacon Meal, 440g…………………………………………….506………………….35
Pasta in Chicken and Mushroom Sauce…………………………………333………………….15
Cheese, Garlic and Herbs, 200g………………………………………....382………………….35
Tea
Butter Cream Sandwich……………………………………....................107……………...…..11
Lemon Slice…………………………………………………..................115………………….22
Coffee Black…………………………………………………..................0…………………….0
Supper
Creamed Potatoes with Cabbage, 350g………………………...............254………...………...12
Sardines in Oil…………………………………………………………...82…………………...25
Cheese and Tomato Pizzas, 280g……………………………………….638…………………..39
Fresh Cream Fruit Cocktail……………………………………………..196…………………..4.2
Lemon Cheesecake…………………………………………...................332………………….4.5
1. Carry out hygienic estimation of treatment-and-prophylactic ration, 40-59 y.o. man
(III professional group).
2. Define etiological factors and-or risk factors for health of man.
3. Find necessary standard documentation for hygienic estimation of treatment-and-
prophylactic ration, 40-59 y.o. man (III professional group).
4. Recommend preventive measures in order to correct treatment-and-prophylactic ration,
40-59 y.o. man (III professional group).
65
5. Standard ability with EQC: compare daily amount of nutrients according to „Physiologic
amounts for major dietary ingredients and energy” order 18.11.1999 by Ministry of Public Health
of Ukraine.
Standard answer.
1. 40-59 y.o. man (III profeccional group) has insufficient quantity of proteins, including
animal origin, surplus of fats and carbohydrates. Insufficient of all mineral substances. Insufficient
quantity of all vitamins unsatisfies physiological requirements, especially vitamin D (surplus) and
vitamin A (lack).
2. Risk factor for health of 40-59 y.o. man is superfluous use of fats and carbohydrates
against an insufficient of proteins that promotes metabolism infringement. Treatment-and-
prophylactic ration promotes risk-factor for obesity, atherosclerosis, diabetes, ischemic illness of
heart, etc. Lack of vitamin A caused xerophthalmia, and surplus of vitamin D – hypervitaminoses
D.
3. „Physiologic amounts for major dietary ingredients and energy” order 18.11.1999 by
Ministry of Public Health of Ukraine.
4. At the treatment-and-prophylactic ration, 40-59 y.o. man should reduce fat and
carbohydrates, i.e. proteins of animal origin (milk and milk products, meat and fish, as well as the
mineral substances and vitamins sources).
5. According to physiological norms for 40-59 y.o. man (professional group III), maximum
intake of major ingredients and energy with daily average diet: 2950 kcal, 81 grams of proteins,
including 45 grams of animal origin, 82 grams of fat, 472 grams of carbohydrates. Maximum intake
of mineral substances for 40-59 y.o. man: Са - 1200 mg, P - 1200 mg, Mg - 400 mg, Fe - 15 mg.
Maximum intake of vitamins for 40-59 y.o. man: С-80 mg, B1-1.6 mg, В2-2.0 mg, В6- 2.0 mg, РР-
22 mg, Д-2.5 mcg, А-1000 mcg.
Тheme №7. Medical control over organization of the treatment (dietary)

nutrition at the treatment and-prophylactic establishments in the public care
system.
1. PURPOSE: reseach principles of dietetic therapy appointment at the treatment
and-prophylactic establishments in the public care system in order to prevent
infectious diseases with alimentary way of transfer, prevention of food poisonings.
2.1.1. Pathogenetic principles of the dietary nutrition.
2.1.2. Classification of the dietary food.
2.1.3. Risk of hospital infections and food poisoning in the treatment and-
prophylactic establishments (hospitals) and public care system.
2.2.1. Organization of medical nutrition surveillance patients in the treatment and-
prophylactic establishments.
2.2.2. Carry out preventive measures in order to optimize nutrition in the treatment
and-prophylactic establishments, sanatoriums and dispensaries.
3.1. Principles of the treatment (dietary) nutrition.
3.2. Characteristics of the therapeutic diets.
3.3. Functional duties of the treatment and-prophylactic establishment’s staff carried
out organization of dietary nutrition.
3.4. Enumerate foods and dishes, which receiving, production and implementation in
health care facilities were prohibited.
66
3.5. Enumerate foods and dishes which are not allowed to take from the patient's
relatives.
3.6. Features of treatment (diet) nutrition in the health care centers and dispensaries.
3.7. Features of treatment (diet) nutrition in the treatment and-prophylactic
establishments.
3.8. Preventive measures focused on the acute intestinal infections and food
poisoning occuarence at the organization of medical nutrition in the treatment and-
prophylactic establishments.
1. Carry out hygienic conclusion towards organization of medical nutrition in the
treatment and-prophylactic establishments, by the scenario – based tasks.
2. Calculation and evaluation of biomass-index.
5.1. What is the purpose of the treatment (diet) nutrition?
5.2. What are the differences towards "treatment nutrition" and a "diet"?
5.3. On what principles based treatment (diet) nutrition?
5.4. Why individualization of treatment (diet) nutrition is important?
5.5. Specify factors carried out at the individualization of treatment (diet) nutrition?
5.6. Which factors caused differences at the organization treatment (diet) nutrition in
the
sanatoriums and hospitals?
5.7. Which issues of organization treatment (diet) nutrition in the dispensaries?
5.8. What requirements should be correspond food products, carried out to the
treatment and-prophylactic establishments’ kitchen?
5.9. What are the requirements for cooking treatment (diet) nutrition in the treatment
and-prophylactic establishments’ kitchen?
5.10. Enumarate staff of the Food Control Commission?
5.11. Speciry the way, how staff of Food Control Commission have to take laboratory
samples of dishes?
5.12. What rules should be followed at the process of washing dishes in the treatment
and-prophylactic establishments?
5.13. Which products are prohibited to transfer patients in the treatment and-
prophylactic establishments?
5.14. Which products are prohibited to keep in the treatment and-prophylactic
establishments?
Practical training is carried out at an educational audience. The control of initial
level of knowledge is carried out by tests from the given theme. Students work
(issue 5). The teacher corrects wrong answers of the students.
In order to carry out practical training, using normative documents students solve
scenario – based tasks focused on the treatment-and-prophylactic nutrition
organization, hereafter students should carry out hygienic conclusion as well as
protocol at the notebook (Appendix). Student should demonstrate practical
67
assessment towards treatment-and-prophylactic nutrition at the industrial enterprises
(issue 4).
At the final part of the practice teacher estimates students educational activity on
the given theme, signed protocols.
Treatment (dietary) food - the food of the persons, suffering from various chronic diseases
(in the remission stage). Its purpose - secondary prevention of chronic diseases. " Therapeutic
nutrition" is used as the pathogenesis factor at sharp diseases and aggravations of chronic diseases
in treatment-and-prophylactic establishments. "Dietary food" - the food of the persons, suffering
from various chronic diseases (in the remission stage). Its major purpose - secondary prevention of
chronic diseases. Diet – many people are often on restricted diets either because certain foods tend
to worsen symptoms, they are recovering from surgery or a flare-up, or nausea and vomiting make
it difficult to eat a balanced diet. A restricted diet can limit the vitamins and minerals available to
the body and further contribute to deficiencies.
Value of the therapeutic nutrition
Therapeutic nutrition is the primary method of treatment, secondary prevention of disease

(in the case of congenital or acquired disorders of absorption several nutrients, their intolerance, for
example, in the case of intestinal fermentates), or one of the basic methods (in the case of maltiple
diseases as well as digestive and kidney disease, obesity, non-insulin-dependent diabetes, etc.). In
other cases, healthy based food supplements effect of different therapies, preventing complications
and the progression of diseases (chronic & active hepatitis, circulatory failure, myocardial
infarction, gout, kidney stone disease, insulin-dependent diabetes, etc.). Therapeutic nutrition is one
of the main methods of non-pharmacological therapy as well as hypertension or obligatory adjuncts
to pharmacotherapy. In the case of infectious diseases, tuberculosis, radiation and burn disease after
surgical operations and injuries nutritional therapy promote protective forces of the organism, its
immune status, restoration of damaged tissues, accelerate healing, and prevent transfer of disease
into a chronic form. Therefor, vital importance has specific types of therapeutic nutrition as well as
enteral and parenteral.
Long-term pharmacotherapy of the chronic diseases accompanied by side effects with the
appearance of new pathological conditions as well as metabolic disorders, disorders of the digestive
functions, allergic reactions, etc. In this regard, increases value of non – traditional methods of
treatment and secondary prevention of chronic diseases, i.e. the most important of them is diet
therapy. On the other hand, nutritional therapy can improve effectiveness of pharmacotherapy and
reduce a likelihood of adverse effects some medications.
Principles of the therapeutic nutrition
Substantiation of the therapeutic nutrition and therapeutic diets, as well as patients’ services
carried out on the following principles:
1. Covered patients needs with nutrients and energy. Therapeutic nutrition is based on the
physiological norms of nutrition, daily values of energy and nutrients, which depend on the
pathogenesis, clinical course, stage of the disease, origin of the metabolic, functional and organic
disorders for various diseases. For example, in chronic renal failure in the diets reduce amount of
protein, depending on the degree of renal dysfunction. However, protein restriction has limits,
because the diet should provide at least minimum requirement for essential amino acids, in order to
avoid protein deficiency. Finaly, the diet should correspond to the patients’ needs in energy covered
with carbohydrates and fats as well as vitamins, minerals, essential fatty acids, dietary fibers. In the
case of some diseases vital nessasity have compensation of nutrients. In these cases, content of
these nutrients in the diet should be higher than normal. It is difficult to provide vitamin daily
68
intake, especially in the hospitals. In this point of view, well spread multivitamin deficiency of the
organism is common among majority of the population.
Method of appointment diet contributes to a loss of vitamins for patients. In the hospitals,
sanatoriums and dispensaries should been provided appointment of ascorbic acid, 80 mg per day for
adults – at the breakfast and lunch time. Primary, the dietary needs covered patients with vitamin C
and other vitamins. Secondary, C – vitaminisation should be replaced on the daily use of
multivitamins in physiological doses (1 pill multivitamins "Undevit" or similar drugs). For
individual vitamins should be assigned pharmacological doses.
2. Ensuring compliance of food consumed to the capabilities a patient’ body in order to
assimilate all stages of assimilation. For these purposes should be carried out appointment of a
certain nutrients, ingredients and methods of cooking, diet, taking into account metabolic features of
the patients’ organs and systems. In case of deficiency in the intestine of enzyme peptidases, which
breaks down protein gluten of wheat, rye, barley, oats (gluten enteropathy, celiac disease), protein –
containing foods should be eliminated from a diet. Therefor, it’s carried out to the correspondence
towards enzyme systems of the body and chemical composition of nutrition. Similar fructose and
sucrose intake covered blood glucose and insulin requirement, which should be higher while apply
sucrose then fructose, caused by it’s slowly absorbtion from intestine. This is a key aspect of the
diet therapy of diabetes.
3. Provide local and common effects of nutrition on the body. Local nutrition affects the
senses (sight, smell, taste) and directly impact on a digestive canal. Attractive dietary needs,
improve their taste and aroma with permitted spicy vegetables, herbs, seasonings, spices are
important in the diets with limited lists of products, salt, prevalence of healthy – based dishes.
Chemical irritants are extractive substances of meat, fish, mushrooms, essential oils numerous
vegetables and spices, organic acids, etc. Mechanical effect of food is determined by its volume,
consistency, degree of comminution, way of thermal cooking mode (cooking, frying, stewing, etc.),
and qualitative composition (dietary fiber, connective tissue, etc.). Some foods have a high
mechanical and chemical effects (grilled meat, smoked products, etc.), others – weak (steam and
boiled dishes of minced meat or chopped vegetables).
Common effect of food, its nutrients impact on the metabolic processes in cells, tissues and
organs, leading to the changes in their functional and morphological state. Common effect of food
should be focused on the correction disturbed functions of regulatory organism systems, its
immunological reactivity. Dietary factors, modulating immune and inflammatory responses, could
change sensitivity of organism to infectious agents in order to reduce disorders of autoimmune
origin.
4. Appoint in nutrition methods of sparing, training and unloading. Sparing carried out at the
irritation functional failure organ or system. Degree of restrictions of the chemical, mechanical or
thermal irritants depends on the severity of this disease. Long-sparing diet carried out at the case of
diarrhea could lead to constipation. Therefore sparing combined with strict diet as well as gentle
products, taking into account responses of a patient. While ulcers appoint mechanically, chemically
and thermally gentle at the stomach diet. In the case of remission a patient is transferred on a diet
without mechanically, sparing serves. On the background of diets sometimes used "low-fat diets" –a
diet with previously limited nutrients (sodium chloride, proteins, dietary fiber, etc.). This low-fat
diet is a breakdown on the functional endurance. Reducing total fat intake leads to reductions in
caloric intake, resulting in weight loss or less weight gain. The overall benefit is small but
beneficial. With respect to weight loss low-fat diets do not appear to differ from other diets that also
reduce overall calories.
Vital important have a low-fat diet, a partial fasting at the treatment of obesity. In the
treatment of acute and chronic diseases include short-term (1-3 days) and long term (2-4 weeks)
fasting. Last one is called fasting-diet therapy.
5. Individualization of nutrition. Recommendations carried out therapy of various diseases
should be scientifically based, but designed for "average", not on the particular patient. In the
hospitals, sanatoriums and preventoriums these recommendations concerned to diets with standard
69
chemical composition, energy value, variety of products and dishes. Therefore, individualized of
nutrition, taking into account the possible presence in a patient multiple diseases, gender, age, body
weight, condition of a masticatory apparatus, intolerance sick for individual products as well as
food allergies and pseudoallergy, intestinal fermentopathy and other factors as a key aspect of
pharmacotherapy. Energy value intake any of the standard diet chould be adequate to the patients’
needs, as usually higher for most of women, and for geriatric patients.
Therapeutic nutrition is impossible without active participation of the patient at his dietary
prescriptions, without his belief in the importance of diet. A low nutrients diet (compared to
physiological norms) should be used mainly in the case of acute illness or exacerbation of chronic
diseases. This is vital important to prevent eating disorders of a body, occurrence of nutritional
pathology, impairment of any diseases current.
Characteristics of the therapeutic nutrition

In the hospitals, sanatoriums and dispensaries carried out a single official numbering system
of diets. Enumeration main item of the diets is present in the table below. In the list should not
included diets that are rarely used: № 4a/h (free – gluten) in the case of gluten enteropathy, № 5 r
while dumping syndrome after gastrectomy, № 10 r – in the case of rheumatoid arthritis, № 14 in
the case of urolithiasis with phosphaturia, etc.
Diets Indications to application
№ 0а Unconsciousness of the patient
№ 0b (1а surgical) a condition after operation on digestion bodies
№0c (1b surgical) transitive after a diet 0b to the high-grade food
№ 1а Stomach ulcer in the aggravation phase (the first 8-12 days); sharp gastritis, an aggravation of
chronic gastritis; the condition after operations on a stomach (in a 6-7 days); gullet burn
№ 1b Stomach ulcer in an aggravation phase (after 8-12 days of finding on the diet №1а); sharp
gastritis, an aggravation of chronic gastritis; the condition after operations on a stomach (after
the diet №1а)
№1 (Basic) stomach ulcer and chronic gastritis with the normal and raised secretion in the
remission stage (3-5 months); the chronic gastritis with the lowered secretion in the
aggravation stage; conditions after operations on a stomach (after diets №№ 1а-1b)
№2 Chronic gastritis with lowered secretion in the remission stage; chronic enterocolitis in the
remission stage; the period after sharp infections and operations
№3 Alimentary lock and rectum diseases (crack, hemorrhoids), in the absence of other diseases of
bodies of digestion
№4 Chronic colitis and entorocolitis in the aggravation stage; dysentery, belly typhus, intestines
tuberculosis (at the first 5-7 days)
№5 Sharp hepatitis in a recover phase; the chronic hepatitis, cirrhosis, cholecystitis in a remission
stage; infringements of functions of the liver and bilious ways without accompanying
diseases of stomach and intestines
№6 Gout, urolithic illness with formation of stones from salts of uric acid
№7 Chronic and sharp glomerulonephritis (in remission), etc.
№8 Adiposity (at the absence of illnesses of digestion bodies)
№9 At the diabetes with normal or superfluous weight of body, receiving insulin; diabetes with
easy or moderate severity; allergic conditions and diseases (rheumatism, the infectious
nonspecific polyarthritis, bronchial asthma, etc.).
№ 9a Diabetes (easy or moderate severity) without insulin application, with superfluous weight of
body (II and III degree of adiposity)
№ 9b Diabetes (moderate severity and heavy) in the conditions of carrying out insulin and the
expanded impellent mode
№ 10 Heart diseases in the stage of indemnification or insufficiency of blood circulation (I-II A
stage), hypertensive illness I-II stage, chronic nephritis without infringement of function of
70
kidneys
№ 10a Diseases of cardiovascular system with sharply expressed insufficiency of blood circulation
(II-III stage)
№ 10c Ischemic illness of heart, atherosclerosis of coronary, brain, peripheral vessels, hypertensive
illness of II-III stage
№ 10i Myocardium heart attack
№ 11 Tuberculosis of lungs, bones, lymph nodes; fall of resistibility of an organism after infectious
diseases, traumas, operations, anemia
№ 12 Diseases of nervous system
№ 13 Sharp infectious diseases; quinsy; after operations on the soft fabrics, bones, thyroid gland,
etc.
№ 14 Urolithic illness and pyelonephritis, cystitis
№ 15 At the absence of indications to appointment of special medical diet (at the normal condition
of digestive channel)
Low-carbohydrate diets or low-carb diets are dietary programs that restrict carbohydrate
consumption, often for the treatment of obesity or diabetes. Foods high in easily digestible
carbohydrates (e.g., sugar, bread, pasta) are limited or replaced with foods containing a higher
percentage of fats and moderate protein (e.g., meat, poultry, fish, shellfish, eggs, cheese, nuts, and
seeds) and other foods low in carbohydrates (e.g., most salad vegetables), although other vegetables
and fruits (especially berries) are often allowed. The amount of carbohydrate allowed varies with
different low-carbohydrate diets. Such diets are sometimes 'ketogenic' (i.e., they restrict
carbohydrate intake sufficiently to cause ketosis). The induction phase of the Atkins diet is
ketogenic. The term "low-carbohydrate diet" is generally applied to diets that restrict carbohydrates
to less than 20% of caloric intake, but can also refer to diets that simply restrict or limit
carbohydrates to less than recommended proportions (generally less than 45% of total energy
coming from carbohydrates). Low-carbohydrate diets are used to treat or prevent some chronic
diseases and conditions, including cardiovascular disease, metabolic syndrome, high blood pressure,
and diabetes.
low-fat diet is one that restricts fat and often saturated fat and cholesterol as well. Low-fat
diets are intended to reduce diseases such as heart disease and obesity. Reducing fat in the diet can
make it easier to cut calories. Fat provides nine calories per gram while carbohydrates and protein
each provide four calories per gram, so choosing low-fat foods makes it possible to eat a larger
volume of food for the same number of calories. The Institute of Medicine recommends limiting fat
intake to 35% of total calories to help prevent obesity and to help control saturated fat intake.
Low-fat diets have been promoted for the prevention of heart disease. Lowering fat intake
from 35-40% of total calories to 15-20% of total calories has been shown to decrease total and LDL
cholesterol by 10 to 20%; however, most of this decrease is due to a reduction in saturate fat intake.
Saturated fat has been shown to raise total and LDL cholesterol in a large number of studies and has
also been correlated with a higher risk of heart disease. Furthermore, a high-fat diet can contain
"unacceptably high" amounts of saturated fat, even if saturated fats from animal products and
tropical oils are avoided. This is because all fats contain some saturated fatty acids. For example, if
a person chose fats with only 20% saturated fatty acids, setting fat intake at 35% of total calories
would mean that 7% of calories would come from saturated fat. For this reason, the Institute of
Medicine recommends consuming no more than 35% of calories from fat.
While low-fat diets lower total and LDL cholesterol, a sudden increase in carbohydrate has
been "consistently" shown to raise triglycerides. Increasing the carbohydrate content of the diet
gradually has been shown to prevent hypertriglyceridemia.
Very low calorie diet (VLCD) is a diet with very or extremely low daily food energy
consumption. It is defined as a diet of 800 kilocalories (3,300 kJ) per day or less. VLCDs are
formulated, nutritionally complete, liquid meals containing 800 kilocalories or less per day. VLCDs
also contain the recommended daily requirements for vitamins, minerals, trace elements, fatty acids
and protein. Carbohydrate may be entirely absent, or substituted for a portion of the protein; this
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choice has important metabolic effects. The VLCD products are usually a powder which is mixed
with water or another low-food-energy liquid. The VLCD is prescribed on a case to case basis for
rapid weight loss (about 1.5 to 2.5 kilograms or 3 to 5 pounds per week) in patients with Body Mass
Index of 30 and above. The health care provider can recommend the diet to a patient with a BMI
between 27 and 30 if the medical complications the patient has due to being overweight present
serious health risks.
Vegan diet. Soy milk is a complete protein.Vegan diets are based on grains and other seeds,
legumes (particularly beans), fruits and nuts. Meat analogues (mock meats) based on soybeans
(tofu), or wheat-based seitan/gluten, are a common source of plant protein, usually in the form of
vegetarian sausage, mince and veggie burgers. Dishes based on soybeans are a staple of vegan diets,
because soybeans are a complete protein; this means they contain all the essential amino acids for
humans, and can be relied upon entirely for protein intake. They are consumed most often in the
form of soy milk and tofu (bean curd), which is soy milk mixed with a coagulant; tofu comes in a
variety of textures, depending on water content, from firm, medium firm and extra firm for stews
and stir-fries, to soft or silken for salad dressings, desserts and shakes. Soy is also eaten in the form
of tempeh and texturized vegetable protein (TVP) (also known as textured soy protein, TSP); TVP
is often used in pasta sauces.
Nutritional content of cows', soy and almond milk
Nutrients Cows' milk (whole) Soy milk Almond milk
Calories (cup, 243 g) 149 80 40

Protein (g) 7.69 6.95 1
Fat (g) 7.93 3.91 2.5
Saturated fat (g) 4.55 0.5 0
Carbohydrate (g) 11.71 4.23 2

Fibre (g) 0 1.2 1
Sugars (g) 12.32 1 0
Calcium (mg) 276 301 n/a
Potassium (mg) 322 292 170

Sodium (mg) 105 90 180
Vitamin B12 (µg) 1.10 2.70 n/a
Vitamin A (IU) 395 503 n/a
Vitamin D (IU) 124 119 n/a
Cholesterol (mg) 24 0 0
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Plant milk, cheese. Plant cream and plant milk, such as soy milk, almond milk, grain
milk (oat milk and rice milk) and coconut milk, are used instead of cows' or goats' milk. Soy and
almond milk are widely available. Soy milk provides around 7 g of protein per cup (240 ml or 8
fluid ounces), compared with 8 g of protein per cup of cow's milk. Almond milk is lower in
calories, carbohydrates and protein. Soy milk should not be used as a replacement for breast milk
for babies; babies who are not breastfed need commercial infant formula, which is normally
based on cows' milk or soy (the latter is known as soy-based infant formula, or SBIF). Cheese
analogues are made from soy, nuts and tapioca. Vegan cheeses such as Chreese, Daiya, Sheese,
Teese and Tofutti can replace both the taste and meltability of dairy cheese. Nutritional yeast is a
common cheese substitute in vegan recipes. One recipe for vegan brie involves combining
cashews, soy yogurt and coconut oil. Butter can be replaced with a vegan margarine such as Earth
Balance. The team identified casein-producing genes in cow DNA, then optimized the genes to
work within yeast. They synthesized the gene in a gene compiler. With added sugar and vegetable
oil, the resulting mixture could be used to make any cheese. The group said that no genetically
modified material remained in the casein, so that the cheese itself was not genetically modified,
nor were any animals directly involved.
Egg replacements. Eggs are used in recipes as thickeners and binders; the protein in eggs
thickens when heated and binds the other ingredients together. This effect can be achieved in
vegan recipes with ground flax seeds; replace each egg in a recipe with one tablespoon of
flaxseed meal mixed with three tablespoons of water. Commercial egg substitutes, such as Bob's
Red Mill egg replacer and Ener-G egg replacer, are also available. For vegan pancakes a
tablespoon of baking powder can be used instead of eggs. Other ingredients include, to replace
one egg, one tablespoon of soy flour and one tablespoon of water; a quarter cup of mashed
bananas, mashed prunes or apple sauce; or in batter two tablespoons of white flour, half a
tablespoon of vegetable oil, two tablespoons of water and half a tablespoon of baking powder.
Silken (soft) tofu and mashed potato can also be used.
Vegan food groups. Since 1991 the Physicians Committee for Responsible Medicine
(PCRM) has recommended a no-cholesterol, low-fat vegan diet based on what they call the New
Four Food Groups: fruit, legumes, grains and vegetables. Legumes include peas, beans, lentils
and peanuts. PCRM recommends three or more servings a day of fruit (at least one of which is
high in vitamin C, such as citrus fruit, melon or strawberries), two or more of protein-rich legumes
(such as soybeans, which can be consumed as soy milk, tofu or tempeh), five or more of whole
grains (such as corn, barley, rice and wheat, in products such as bread and tortillas), and four or
more of vegetables (dark-green leafy vegetables such as broccoli, and dark-yellow and orange
such as carrots or sweet potatoes). Vegan food group is divided into five food groups: grains,
vegetables, fruits, dairy (or calcium-fortified soymilk), and protein; the protein includes meat,
poultry, seafood, beans and peas, eggs, processed soy products, nuts and seeds). In the UK the
National Health Service recommends the Eatwell Plate, also with five food groups that are
consistent with a vegan diet: fruits and vegetables; potatoes, bread and other starchy foods; dairy
or non-dairy alternatives; meat, fish, eggs or beans for protein; and fat and sugar.
Nutrients. Vegan diets tend to be higher in dietary fibre, magnesium, folic acid, vitamin
C, vitamin E, iron and phytochemicals, and lower in calories, saturated fat, cholesterol, long-
chain omega-3 fatty acids, vitamin D, calcium, zinc and vitamin B12.
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Protein. Rice and beans is a common vegan protein combination. Proteins are composed
of amino acids. Nutritionist Reed Mangels writes that omnivores generally obtain a third of their
protein from plant foods, and ovo-lacto vegetarians a half. Vegans obtain all their protein from plant
sources. A common question is whether plant protein supplies an adequate amount of the essential
amino acids, which cannot be synthesized by the human body. Sources of plant protein include
legumes, such as soy beans (consumed as tofu, tempeh, texturized vegetable protein, soy milk and
edamame), peas, peanuts, black beans and chickpeas (the latter often eaten as hummus); grains
such as quinoa (pronounced keenwa), brown rice, corn, barley, bulgur and wheat (often eaten as
whole-wheat bread and seitan); and nuts and seeds, such as almonds, hemp and sunflower seeds.
Soy beans and quinoa are known as complete proteins because they each contain all the essential
amino acids. Mangels et al write that consuming the recommended dietary allowance (RDA) of
protein (0.8 g/kg body weight) in the form of soy will meet the biologic requirement for amino
acids.
Vitamin B12. Tofu (soybeans) with spinach and mushroom Vitamin B12 is a bacterial
product needed for cell division, the formation and maturation of red blood cells, the synthesis of
DNA, and normal nerve function. A deficiency can lead to several health problems, including
megaloblastic anemia and nerve damage. The consensus among nutritionists is that vegans and
even vegetarians should eat foods fortified with B12 or use supplements. That vegans are unable in
most cases, at least in the West, to obtain B12 from a plant-based diet is often used as an argument
against veganism.
Neither plants nor animals make B12; it is produced by microorganisms, such as bacteria,
fungi and algae. Herbivorous animals obtain it from bacteria in their rumens, either by absorbing it
or by eating their own cecotrope faeces; rabbits, for example, produce and eat cecal pellets. When
those animals are eaten, they become sources of B12. Plants from the ground that are not washed
properly may contain B12 from bacteria in the soil, often from faeces; drinking water may also be
contaminated with B12-producing bacteria, particularly in the developing world. Mangels et al
write that bacteria in the human digestive tract produce B12, but most of it is not absorbed and is
expelled in the faeces, with tiny amounts also expelled in the urine. Western vegan diets are likely
to be deficient in B12 because of increased hygiene. Vegans can obtain B12 by taking a supplement
or by eating fortified foods, such as fortified soy milk or cereal, where it may be listed as cobalamin
or cyanocobalamin. B12 supplements are produced industrially through bacterial fermentation-
synthesis; no animal products are involved in that process. The RDA for adults (14+ years) is 2.4
mcg (or µg) a day, rising to 2.4 and 2.6 mcg for pregnancy and lactation respectively; 0.4 mcg for
0–6 months, 0.5 mcg for 7–12 months, 0.9 mcg for 1–3 years, 1.2 mcg for 4–8 years, and 1.8 mcg
for 9–13 years.
74
Calcium. Calcium is needed to maintain bone health and for a number of metabolic
functions, including muscle function, vascular contraction and vasodilation, nerve transmission,
intracellular signalling and hormonal secretion. Ninety-nine percent of the body's calcium is
stored in the bones and teeth. The RDA for adults is 1,000 mg for 19–50 years, 1,000 mg for 51–70
years (men) and 1,200 mg (women), and 1,200 mg for 71.Vegans are advised to eat three servings
per day of a high-calcium food, such as fortified soy milk, fortified tofu, almonds or hazelnuts, and
to take a supplement as necessary. Plant sources include broccoli, turnip and cabbage, such as
Chinese cabbage (bok choi) and kale; the bioavailability of calcium in spinach is poor. Whole-
wheat bread contains calcium; grains contain small amounts. Because vitamin D is needed for
calcium absorption, vegans should make sure they consume enough vitamin D.
Vitamin D. Vitamin D (calciferol) is needed for several functions, including calcium
absorption, enabling mineralization of bone, and bone growth. Without it bones can become thin
and brittle; together with calcium it offers protection against osteoporosis. Vitamin D is produced
in the body when ultraviolet rays from the sun hit the skin; outdoor exposure is needed because
UVB radiation does not penetrate glass. It is present in very few foods (mostly salmon, tuna,
mackerel, cod liver oil, with small amounts in cheese, egg yolks and beef liver, and in some
mushrooms). Most vegan diets contain little or no vitamin D, unless the food is fortified (such as
fortified soy milk), so supplements may be needed depending on exposure to sunlight. Vitamin D
comes in two forms. Cholecalciferol (D3) is synthesized in the skin after exposure to the sun, or
consumed in the form of animal products; when produced industrially it is taken from lanolin in
sheep's wool. Ergocalciferol (D2) is derived from ergosterol from yeast and is suitable for vegans.
Conflicting studies have suggested that the two forms may or may not be bioequivalent. According
to report by the Food and Nutrition Board of the National Academy of Sciences, the differences
between D2 and D3 do not affect metabolism, both function as prohormones, and when activated
exhibit identical responses in the body. Suplements should be used with caution because vitamin D
can be toxic, especially in children. Standard is 10 mcg for 0–12 months, 15 mcg for 1–70 years,
and 20 mcg for 70. People with little or no sun exposure may need more, perhaps up to 25 mcg
daily. The extent to which sun exposure is sufficient to meet the body's needs depends on the time
of day, cloud and smog cover, skin melanin content, whether sunscreen is worn, and the season.
Most people can obtain and store sufficient vitamin D from sunlight in the spring, summer and fall
months, even in the far north. They report that some researchers recommend 5–30 minutes of sun
exposure without sunscreen between ten in the morning and three o'clock in the afternoon, at least
twice a week. They also report that tanning beds emitting 2–6 per cent UVB radiation will have a
similar effect, though tanning may be inadvisable for other reasons.
Iron. Vegetarian and vegan diets usually contain as much iron as animal-based diets, or
more; vegan diets generally contain more iron than vegetarian ones because dairy products contain
very little. There are concerns about the bioavailability of iron from plant foods, assumed by some
researchers to be around 5–15 percent compared to 18 percent from a nonvegetarian diet. Iron
deficiency anaemia is found as often in nonvegetarians as in vegetarians, though studies have
shown vegetarians' iron stores to be lower. The RDA for non-vegetarian adults is 8 mg for 19–50
years (men); 18 mg for 19–50 years (women); 8 mg for 51+ years (men and women). Supplements
should be used with caution after consulting a physician, because iron can accumulate in the body
and cause damage to organs; this is particularly true of anyone suffering from hemochromatosis, a
relatively common condition that can remain undiagnosed. The daily tolerable upper intake level,
according to the National Institutes of Health, is 40 mg for 7 months to 13 years, and 45 mg for
14.According to the Vegetarian Resource Group, high-iron foods suitable for vegans include black-
strap molasses, lentils, tofu, quinoa, kidney beans and chickpeas. Iron absorption can be enhanced
by eating a source of vitamin C along with a plant source of iron, and by avoiding coingesting
anything that would inhibit absorption, such as tannin in tea. Sources of vitamin C might be half a
cup of cauliflower, or five fluid ounces of orange juice, consumed with a plant source of iron such
as soybeans, tofu, tempeh or black beans. Some herbal teas and coffee can inhibit iron absorption,
as can spices that contain tannins (turmeric, coriander, chillies and tamarind).
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Omega-3 fatty acids. Flaxseed oil contains a high level of alpha-linolenic acid, an omega-3
fatty acid.Alpha-linolenic acid (ALA), an omega-3 fatty acid, is found in leafy green vegetables
and nuts, and in vegetable oils such as canola and flaxseed oil. The Adequate Intake for ALA is
1.1–1.6 g/day. Vegan Outreach suggests vegans take 1/4 teaspoon of flaxseed oil (also known as
linseed oil) daily, and use oils containing low amounts of omega-6 fatty acids, such as olive,
canola, avocado or peanut oil.
Iodine. Iodine supplementation may be necessary for vegans in countries where salt is not
typically iodized, where it is iodized at low levels, or where, as dairy products are relied upon for
iodine delivery because of low levels in the soil. Iodine can be obtained from most vegan
multivitamins or from regular consumption of seaweeds, such as kelp. The RDA is 110 mcg (0–six
months), 130 mcg (7–12 months), 90 mcg (1–8 years), 120 mcg (9–13 years), 150 mcg (14+). The
RDA for pregnancy and lactation is 220 and 290 mcg respectively.
Features of treatment (diet) nutrition in the sanatoriums and dispensaries
Sanatoriums have a great importance in the treatment and secondary prevention most
diseases. Major factors contributing to the rehabilitation of patients, occupies an important place in
the treatment (diet) nutrition, especially in specialized hospitals as well as gastroenterology,
cardiology, nephrology, etc.
1. Sanatoriums visit patients with chronic diseases on a remission, and convalescents. This
allows carrying out restrictions in the diets, compared with a hospital, or appointing a strict diet (№
1а, 5а, 10а, etc.,) which is seldom used.
2. In the sanatoriums patients have active way of life and their energy consumption is higher
than the same patients in the hospitals. Therefore, in sanatoriums energy value of diets increase on
15-20 % compare with the hospitals, due to a balanced increase all nutrients.
3. Appointment spas balneological & mud procedures should correspond to a diet. These
treatments are recommended in a 2-3 hours after meals, not recommended on an empty stomach and
after meals.
4. The budget for nutrition in the sanatoriums is higher than in the hospitals. This approach
satisfies a patient taste, but could disrupt a balance of nutrients in the diet, its energy value.These
diets are similar by energy value and chemical composition, but menu is different. This system is
provided mainly for diets № 5р, 7b, 8, 9, 10c. Sanatorium-preventorium usually organizes on a
basis of industrial enterprises, offices, educational institutions. In the dispensaries carry out health
activities of sanatorium type, part of which is the diet and healthy nutrition.
Features of organization nutrition in the dispensaries:
1. Persons, carried out their vacationing in the dispensaries, are working or styding at the same
time. Therefore, a diet energy values and chemical composition should take into account both
physiological norms of nutrition for the population, provided for different groups of physical
activity.
2. In the dispensaries usually stay working-age people with chronic disease exacerbation.
Primary, dispensaries are designed for healthy people, working at the hot shops, underground
works, contact with professional hazards, pregnant women. Reconvalescents after infectious or
other severe diseases appoint a balanced diet (№ 15).
3 Dispensaries, located on a basis of enterprises with industrial process carried out in 2 or 3
shifts, should have continuous schedule as well as providing worker staff by hot meals each shifts.
4. In the dispensaries, located on a basis of industrial enterprises with hazardous conditions
employees receive the therapeutic and preventive nutrition. Diets in these dispensaries should
combine principles of a diet therapy in certain chronic diseases and major principles of therapeutic
nutrition.
Sanitary control over organization of the patients and medical staff nutrition
While cooking in the treatment & profilactic establishments (TPE) kitchen staff should observe
a fluidity of production process and, primary, to prevent flows of ready dishes and raw foods.
76
Products are delivered to TPE kitchen should be corresponding to the requirements of regulatory
and technical standard documentation.
It is forbidden to take waterfowl without evisceration, raw eggs geese and ducks, and chicken
eggs from the incubator, cereals and flour damaged barn pests.
According to sanitary standards should not allowed to keep raw and processed foods together
with ready dishes, storage spoiled and suspicious quality products together with high – quality
foods in the premises specify for packaging, household materials and non-food products. Fragrant
products (herring, spices, etc.,) should be stored separately from other products.
While planning a menu-layout TPE kitchen staff should take into account nutritional standards,
as well as the basic principles of menus and diets composition.
Quality of ready dishes carried out a control mainly by a cook, who prepares dishes, and
brokerage commission. Brokerages commission staff consists of a dietitian, chaireman of
production (chef) and sanitary – doctor.
Brokerages commission staff should take laboratory sample of the dishes as follows: separate
spoon for soups and spoon for second dishes takes ready foods. Process of taking lab samples is
carried out with a separate spoon from a plate of dishes. Spoon, which is used for taking cooked
foods, should be washed with hot water after each meal.
Daily in the TPE kitchen after nutrition should remain daily sample of prepared dishes that
could be required in a case of food poisoning and used for further laboratory analysis. After 24
hours a daily sample is released into food waste. Cover and banks before taking of daily samples are
boiled not less than 5 minutes. For daily samples were taken half portion of the first dishes, second
portion from main dishes (burgers, patties, cakes, etc.) select a whole portion not less than 100 g.
While serving a food, temperature of the first dishes and hot drinks should not be below 75 ° C,
second dishes – 65 ° C, cold dishes and soft drinks from 7 to 14°C. Period of time preparation and
distribution of the first and second dished should not be more than 2 hours.
In the TPE kitchen is forbidden to wash dishes and cutlery. For washing and storage the kitchen
utensils branch (flasks, pots, buckets, etc.,) on the kitchen should be a separate premise.
For transportation of raw products and ready meals should use special transport with
permission (sanitary certificate) from SES. Transportation of bakery products is carried out in
polyethylene bags; keep bread in them should not allow. Periodically, the bags are washed with
water and dried. Transportation of bakery products in carried out in the closed lid containers
(buckets, pots).
The cupboards should be provided by 2 separate premises (not less than 9 m 2) and for
washing purposes (not less than 6 m2) with 5 – tubes bath.
Food distribution should be performed in a 2 hours after cooking. It is strictly forbidden to
keep food remaining after distribution to the patients in cupboards.
In the reception of foods transmission to the patients, carried out in the wards should be
posted lists of allowed (with indication of their maximum amounts) and prohibited products.
Products for patients transferred in plastic bags with indication of surname, name of the patient,
date of transfer.
Special rules of washing are the following:
a) mechanical release dishes from food debris with a brush or wooden spoon;
b) washing the brush in the first tibe of a bath at water temperature 50°C, using 1% solution
of trisodium phosphate or sodium carbonate and other detergents;
c) disinfection utensils as well as 15 minutes boiling or in a second tube of the bath 30
minutes, 0.5% chroramine solution, 0.1% sulphochlorination solution etc.;
g) washing utensils in a third tube of the bath; water temperature should not be below 65°C;
d) drying utensils on the shelves.
Equipment for cleaning after washing a floor pours with 0.5% bleached chlorine solution or
1% chlorine solution for 60 min in the same bucket, which is used for cleaning.
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Weekly disinfectants and detergents used in order to washe walls, lighting fittings, clean
glass from dust and grime. For disinfection premises (floors, walls, doors, etc.) used 1 % of clarified
chlorinated solution, or 0.5% chlorine solution.
Seniur nurse of a ward department should carry out strict control over food and items set by
the administration of a medical institution for individual branches. Seniur nurse should have a list of
patients, which specifies the number of a diet assigned to each patient. Each department should
provide adequate storage of food, which bring visitors to the patients. Finaly, each chamber, or at
least ward section, are provided household refrigerators with temperature storing food in the main
chamber 4-6°C. Products taking in new plastic bags within one, two-day needs in order to prevent
overeating and food poisoning. Absolutely excludes alcoholic drinks, spices, spicy dishes. It is
strictly forbidden to store in the chambers products that spoil quickly (dairy dishes, beafs, salads,
etc.).
8. LITERATURE.
8.1. The basic:
8.2. Additional:
Alisa A. Musulbas. – Kharkov: Kontrast Publishing Enterprise, 2006. – P. 102.
Appendix 1
Scenario – based task № 1 "Medical control over organization of the treatment (dietary)
nutrition at the treatment and-prophylactic establishments in the public care system"
In TPE dining room, covered 90 persons (seats) in order to prevent atherosclerosis, acute
coronary heart disease the recommended diet should be complemented by specialized dietary
products.
Tasks.
1. Appoint an appropriate diet for prevention cardiovascular diseases.
2. Whould a prescribed diet carried out itself, of possibly used for treatment of other
diseases?
3. Which specialized dietary products may be supplemented this diet:
a) low – proteins content;
b) modified carbohydrate component;
c) low – fat content and high – polyunsaturated fatty acids (PUSFA).
4. Could the given TPE be called as well as "dining room for diet purposes"?
Standard answer.
For prevention of atherosclerosis, acute coronary heart disease in TPE system should be
appointing diet №10. While organization treatment (diet) nutrition for patients with chronic kidney
disease, as well as above mentioned pathologies carried out diet № 7/10. This diet combined with
low –content sodium, low energy value and should be supplemented diet with low – fat content and
high –polyunsaturated fatty acids (PUSFA).
TPE network of a dietetic nutrition should be represented by the dining rooms for diet
purposes
and dietary departments (public care canteens). Dining room for diet purposes is an independent
specialized establishment, covered not less than 50 persons (seats).
Appendix 2
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During medical examination was established: woman height - 169 cms, weight – 96 kg. Daily
diet of 35 years old woman (II group of intensity of work) contains 50 g fibers, including an animal
origin 25 g, 70 g fats, including vegetative 20 g, 370 g carbohydrates, 600 mg of calcium, 950 mg
of phosphorus, 350 mg of magnesium, 14 mg of iron, vitamins: С-50 mg, В1-1.3 mg, В2-1.6 mg, В6
– 1.8 mg, РР-16 mg, Д-3 mkg, А-0.9 mg. Daily average consumption of milk makes 300 g, cheese
throughout a week joined in a diet - 1 times. Meat is included in a food allowance (mainly chicken),
vegetables (mainly in stewed kind), one-two time a week sour-milk drinks, fish, seafood, fresh
vegetables and fruit, groats.
Tasks.
1. Carry out hygienic estimation of daily average diet of woman.
2. Appoint special diet for a patient.
3. Recommend preventive measures in order to correct an average diet of woman.
Standard answer.
30-39 y.o. woman (II profeccional group) has insufficient quantity of proteins, including
animal origin, surplus of fats and carbohydrates. Insufficient of all mineral substances, except
magnesium. The quantity of vitamins satisfies physiological requirements, except vitamin D
(surplus) and vitamin A (lack).
In order to estimate energy status of a woman should be used BMI: weight, kg/ height, m² =
96 kg/2,86 m² = 33.61. According to BMI, a given woman has obesity, II stage. Patient in this case
was assigned diet № 8a.
Basic principles of nutrition patients with obesity are following:
1. Low calorie diet (on average 1800-2000 kcal).
2. Low calorie diet carried out by reducing carbohydrates, which are easily digested (sugar,
sweets, cakes), and reducing animal fats.
3. In the diet should be appointed high – polyunsaturated fatty acids (PUSFA) ut to 25 –
30 grams, as well as ω9, ω6, ω3.
4. Extractives, spicy seasonings, spices, fried foods, alcoholic drinks, which stimulate appetite
and impair liver and gallbladder should be exclude from a diet.
5. Foods are cooking without a salt, in a diet should be allowed 2-3 grams of salt per day.
6. Carry out in a diet numerous mineral substances as well as potassium and magnesium
(apricots, prunes, raisins, tomato juice, etc.), having a positive effect on the cardiovascular system,
high hypotensive and diuretic effects, normalized lipid metabolism.
7. C – vitaminisation of foods as well as rosehip drinks, black currants, fresh vegetables and
fruits. Content of other vitamins should correspond to the physiological norms of a body.
Hypervitaminoses of thiamine, pyridoxine and vitamin D leads to a high–fat & high–carbohydrates
and high–proteins contents (glycogenesis).
8. Diet should consist of 5-6 meals a day. Primary, such distribution of meals during the day
promotes slowly transfer of carbohydrates into fats. Frequent meals have inhibitory effect on a food
centre and reduce appetite.
9. Limit consumption of free liquid to 1-1 .5 liters per day. Fluid restriction promotes low fat
content with release of endogenous water.
10. Diet №8а is recommended towards very low fat / calory diets. Mainly, should be used such
foods as meat products & vegetables, cottage cheese & buttermilk, fruit & vegetable days.
In the diet of working woman should be carried out low – fat content, increase quantity of
milk and dairy products, appoint Са and proteins of animal origin. According to physiological
norms 30-39 y.o. woman, professional group II, should receive a daily average diet: 2150 kcal, 59 g
proteins, including animal origin 32 g, 60 g fats (30 % of phytogenesis (18 g)), 344 g carbohydrates,
Са - 1100 mg, P - 1200 mg, Mg - 350 mg, Fe - 17 mg, vitamins: С-70 mg, B1-1.3 mg, В2-1.6 mg,
В6- 1.8 mg, РР-16 mg, Д-2.5 mcg, А-1 mg.
Appendix 3
79
Fat metabolism and glucose blood level indicators
Indicator Concentration in the blood Estimation of concentration in the
blood
Cholesterol 5,2 mmol/ liter Normal
5,3-6,2 mmol/ liter Over normal
6,3 mmol/ liter and more Hypercholesterolemia
Triglycerides 2,26 mmol/ liter Normal
4,6-11,3 mmol/ liter Hypertriglyceridemia
Cholesterol of lipids low density 3,4 mmol/ liter Normal
4,2 mmol/ liter and more High risk
Cholesterol of lipids high 0,9 mmol/ liter Low level
density
Glucose 3,89-6,1 mmol/ liter Normal
6,2 mmol/ liter and more Hyperglycemia
3,88 mmol/ liter and less Hypoglycemia
Appendix 4
At the medical examination of 39 years old woman, working at the enterprise as the
bookkeeper, she complains on weakness, thirst, and frequent urination.
During medical examination was established: woman has a growth - 150 cms, weight is 100
kg, volume of waist is 100 cms, volume of hips is 99 cms, arterial pressure is 151/89, and pulse is
76 / per minute. She prefers to eat meat (pork), vegetables (potato); twice a week she eats seafood,
milk and sour-milk products. Woman is usually uses fat and sweet food. Doctor diagnosed diabetes
of II type.
Results of the laboratory researches:
Cholesterol general – 7,2 mmol/ liter
Cholesterol of lipids low density – 5,4 mmol/ liter
Cholesterol of lipids high density -0,9 mmol/ liter
Triglycerides – 11,9 mmol/ liter
Glucose – 6,5 mmol/ liter
Tasks.
1. Carry out hygienic estimation of caloric status of the woman.
2. Define etiological factors and-or risk factors for the woman.
3. Find necessary standard documentation for a hygienic estimation of caloric status of the
woman.
4. Offer plan of necessary hygienic actions.
5. Standard ability with EQC: calculate Body Mass Index and Index hips to waist.
Standard answer.
1. Patient has raised arterial pressure (hypertensia ІI degree), the accelerated pulse,
infringement of lipid metabolism: high level of cholesterol general, cholesterol of lipids low
density, high level of triglycerides and glucose in the blood.
2. Risk factor is the adiposity of II degree connected with infringement of power caloric
content of a food.
3. «Physiologic amounts for major dietary ingredients and energy» order 18.11.1999 year by
4. It is necessary for patient to appoint a diet №10, which main principles are decrease in
weight of body, reduction of using salt, an antisclerous direction of the food, an exception of the
dishes with raising excitation of central nerves system.
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5. Body Mass Index is calculated from weight in kilograms divided to height in meters
squared.
Index hips to waist is calculated from volume of hips divided to volume of waist (abdominal
adiposity by index hips&waist is for men >0,94, for women > 0,85). 39 years old woman has heavy
obesity (BMI=44.4), and abdominal adiposity (index hips&waist is 0.99).
Тheme of independent out-of-class work №2. Food poisonings as the hygienic

problem. Technique of investigation cases of food poisonings.
1. PURPOSE: give hygienic estimation of different nosological forms of food
poisonings, study methods of invistigation cases of food poisonings.
2.1.1. Classification of food poisonings.
2.1.2. Different nosological forms of food poisonings and their prevention. .
2.1.3. Methods of invistigation cases of food poisonings.
2.2.1. Propose preventive measures of profilactice cases of infections diseases of
alimantary origin.
3.1. Food poisonings, determination, classification.
3.2.Toxic infections: determination, diagnostic, clinical symptoms, preventive
measures.
3.3.Bacterial toxicoses: determination, diagnostic, clinical symptoms,
preventive measures.
3.4. Mycotoxicoses: determination, diagnostic, clinical symptoms, preventive
measures.
3.5. Poisonings of mixed etiology: determination, diagnostic, clinical symptoms,
preventive measures.
3.6. Poisonings of non-microbial origin: determination, diagnostic, clinical
symptoms, preventive measures.
3.7. Poisonings of non-identified origin: determination, diagnostic, clinical
symptoms, preventive measures.
3.8. Methods of invistigation cases of food poisonings, standard sanitary norms
and rules from invistigation cases of food poisonings.
3.9. Role of airborne and purulent diseases, intestinal infections among hospital
staff in the occurrence of food poisoning microbial nature and infections.
4. LITERATURE.
4.1. The basic:
4.2. Additional:
81
Scenario – based task "Food poisonings as the hygienic problem. Technique of
investigation cases of food poisonings"
In May to the sanitary-epidemic station message about acute disease of one family has
arrived. Members of the family had nausea, weakness, dizziness. An hour later vomiting and pain in
the stomach has begun. Vomiting proceeded for 1 day, diarrhea was absent. At survey pallor of the
skin, without yellowness is revealed. After rendering of the first medical aid the condition of
victims has improved. One of family members is the boy, was hospitalized. For the second day he
had yellowness, which remained 5 days. For 17 days the boy has recovered. At the sanitary
investigation was established that disease is begin in 8 hours after using mushrooms, which were
bought in the market. Mushrooms have been fried in the oil. The boy has eaten many mushrooms.
Carry out hygienic estimation of acute disease among family members.
Standard answer:
Diagnosis – food poisoning with poisonous mushrooms (pale toadstool). Diafnosis is based
on the sudenly flash of clinical sumptoms among all members of the family. Incubation period is 4-
6 hours, clinical symptoms (acute poisoning, pallor of the skin, without yellowness, nausea,
weakness, dizziness, in an hour later vomiting and pain in the stomach has begun, vomiting
proceeded for 1 day, diarrhea was absent), characteristic of food product is mushrooms, which were
bought in the local market.
In order to prove the diagnosis of food poisoning with poisonous mushrooms (pale
toadstool) it is nessessery to invistigate samples of food (mushrooms fried in the oil), vomiting rest
and take blood for laboratory analases.
Appendix 1
Foodborne illness (also foodborne disease and colloquially referred to as food poisoning)
is any illness resulting from the consumption of contaminated food, pathogenic bacteria, viruses, or
parasites that contaminate food, as well as chemical or natural toxins such as poisonous mushrooms.
Symptoms vary depending on the cause, and are described below in this article. A few broad
generalizations can be made, e.g.: The incubation period ranges from hours to days, depending on
the cause and on how much was consumed. The incubation period tends to cause sufferers to not
associate the symptoms with the item consumed, and so to cause sufferers to attribute the symptoms
to stomach flu for example. Symptoms often include vomiting, fever, and aches, and may include
diarrhea. Bouts of vomiting can be repeated with an extended delay in between, because even if
infected food was eliminated from the stomach in the first bout, microbes (if applicable) can pass
through the stomach into the intestine via cells lining the intestinal walls and begin to multiply.
Some types of microbes stay in the intestine, some produce a toxin that is absorbed into the
bloodstream, and some can directly invade deeper body tissues.
Classification of food poisonings

Nozological form Etiological factor
Microbial origin
Toxic infections Potentially pathogenic microorganisms: Proteus
mirabils and vulgaris, E.coli (enteropathogenic
serotypes), Bac. cereus, Cl. Perfringens type A,
Str.faecalis var.Liquefaciens and Zymogenes,
Vibro parahaemoliticus, others less studied
microbes (Citrobacter, Hafnia, Klebsiella,
Eduradsiella, Jersinia, Pseudomonas, Aeromonas,
etc.)
Toxicoses Bacterial toxins produced by
Bacterial toxicoses Staphylococcus aureus and Cl.botulinum
82
Mycotoxicoses Mycotoxins produced by microscopic fungi of
genus of Aspergillus, Fusarium and Claviceps
purpurea, etc.
Mixed etiology Bac. cereus and enterotoxic staphylococcus,
Bac.proteus and enterotoxic staphylococcus
Non- microbial origin
1. Poisonings of poisonous plants and Poisoned fungi (pale toadstool, fly agarics, devil
animals tissues fungus and others); conditionally edible fungi that
1.1. Plants are poisoned by their nature under went incorrect culinary treatment (gruzd,
volnushka, valuy, morel and others); plants (fad,
torn apple, hemlock, belladonna, water hemlock,
aconite, elderberry and so on); seeds of culture
cereal weeds (sophora, trichodesma, heliotrope,
etc.)
1.2. Animal tissues are poisoned by their Organs of some fish (marinka, madder, whisker,
nature sevanskaya krivulya, igolkobruch, etc.)
2. Poisonings from the products of the plant Cores stones of pit fruits (peach, apricot, cherry,
and animal origin which are poisoned in migdal), that have amigdalin; nuts (beech,
certain conditions tungtree, ricina), growning (green potatoes),
2.1. Products of plant origin which contain solanin; bobs of raw beans that
have fasin
2.2. Products of animal origin Liver, roe and milk of some fish types in the
period of spawning (min, pike, mackerel and so
on); bee honey when bees collects nectar from the
poisoned plants
Non- microbial origin
3. Poisonings with chemical substances Pesticides, salts of heavy metals, food additives
entered in the amounts that exceed admissible
values; substances that migrate in food products
from equipment, stock, containers, packing
material; other chemical impurity
Non-identified origin
Alimentary paroxysmal-toxic myoglobinuria Fish grains of some areas of the world in some
(Gaffskaia disease) years
Bacteria. Bacteria are a common cause of foodborne illness. In the United Kingdom
during 2000, the individual bacteria involved were the following: Campylobacter jejuni 77.3%,
Salmonella 20.9%, Escherichia coli O157:H7 1.4%, and all others less than 0.56%.In the
past, bacterial infections were thought to be more prevalent because few places had the
capability to test for norovirus and no active surveillance was being done for this
particular agent. Toxins from bacterial infections are delayed because the bacteria need
time to multiply. As a result symptoms associated with intoxication are usually not seen
until 12–72 hours or more after eating contaminated food. Usually the symptoms are seen
the day after the food has been ingested and digested completely. However if the
intoxication involves preformed toxins as is the case with Staphylococcal food poisoning,
the symptoms appear within a few hours.
Most common bacterial foodborne pathogens are:
 Campylobacter jejuni which can lead to secondary Guillain–Barré syndrome
and periodontitis
 Clostridium perfringens, the "cafeteria germ
83
 Salmonella spp. – its S. typhimurium infection is caused by consumption of
eggs or poultry that are not adequately cooked or by other interactive human-animal
pathogens
Salmonella
 Escherichia coli O157:H7 enterohemorrhagic (EHEC) which can cause
hemolytic-uremic syndrome
Other common bacterial foodborne pathogens are:
 Bacillus cereus
 Escherichia coli, other virulence properties, such as enteroinvasive (EIEC),
enteropathogenic (EPEC), enterotoxigenic (ETEC), enteroaggregative (EAEC or EAgEC)
 Listeria monocytogenes
 Shigella spp.
 Staphylococcus aureus
 Staphylococcal enteritis
 Streptococcus
 Vibrio cholerae, including O1 and non-O1
 Vibrio parahaemolyticus
 Vibrio vulnificus
 Yersinia enterocolitica and Yersinia pseudotuberculosis
Less common bacterial agents:
 Brucella spp.
 Corynebacterium ulcerans
 Coxiella burnetii or Q fever
 Plesiomonas shigelloides
Enterotoxins
Botulism. In addition to disease caused by direct bacterial infection, some foodborne
illnesses are caused by a enterotoxins (an exotoxin targeting the intestines). Enterotoxins can
produce illness even when the microbes that produced them have been killed. Symptom appearance
varies with the toxin but may be rapid on-set, as in the case of enterotoxins of Staphylococcus
aureus in which symptoms appear in 1–6 hours. This causes intense vomiting including or not
including diarrhea (resulting in staphylococcal enteritis), and staphylococcal enterotoxins (most
commonly Staphylococcal Enterotoxin A but also including Staphylococcal Enterotoxin B) are the
most commonly reported enterotoxins although cases of poisoning are likely underestimated. It
occurs mainly in cooked and processed foods due to competition with other biota in raw foods, and
humans are the main cause of contamination as a substantial percentage of humans are persistent
carriers of S. aureus. The CDC has estimated about 240,000 cases per year in the United States.
 Clostridium botulinum
 Clostridium perfringens
 Bacillus cereus
The rare but potentially deadly disease botulism occurs when the anaerobic bacterium
Clostridium botulinum grows in improperly canned low-acid foods and produces botulin, a
powerful paralytic toxin.
Pseudoalteromonas tetraodonis, certain species of Pseudomonas and Vibrio, and some other
bacteria, produce the lethal tetrodotoxin, which is present in the tissues of some living animal
species rather than being a product of decomposition.
Emerging foodborne pathogens
Many foodborne illnesses remain poorly understood. Approximately 99.9% percent of
outbreaks are caused by unknown sources
 Aeromonas hydrophila, Aeromonas caviae, Aeromonas sobria
Preventing bacterial food poisoning
Proper storage and refrigeration of food help in the prevention of food poisoning
84
Prevention is mainly the role of the state, through the definition of strict rules of hygiene and
a public services of veterinary surveying of animal products in the food chain, from farming to the
transformation industry and delivery (shops and restaurants). This regulation includes:
 traceability: in a final product, it must be possible to know the origin of the
ingredients (originating farm, identification of the harvesting or of the animal) and where
and when it was processed; the origin of the illness can thus be tracked and solved (and
possibly penalized), and the final products can be removed from the sale if a problem is
detected;
 enforcement of hygiene procedures such as HACCP and the "cold chain";
 power of control and of law enforcement of veterinarians.
At home, prevention mainly consists of good food safety practices. Many forms of bacterial
poisoning can be prevented even if food is contaminated by cooking it sufficiently, and either eating
it quickly or refrigerating it effectively Many toxins, however, are not destroyed by heat treatment.
Techniques that help prevent food borne illness in the kitchen are hand washing, preventing
cross-contamination, proper storage, and maintaining cooking temperatures. In general, freezing or
refrigerating prevents virtually all bacteria from growing, and heating food sufficiently kills
parasites, viruses, and most bacteria. The "danger zone" is a zone of temperatures in which bacteria
grow most rapidly, which is 40 °F-140 °F. Storing food below or above the "danger zone" can
effectively limit the production of toxins. For storing leftovers, the food must be put in shallow
containers for quick cooling and must be refrigerated within two hours. When food is reheated, it
must reach an internal temperature of 165 °F or until hot or steaming to kill bacteria.
Mycotoxins and alimentary mycotoxicoses
The term alimentary mycotoxicoses refers to the effect of poisoning by Mycotoxins (The
term 'mycotoxin' is usually reserved for the toxic chemical products produced by fungi that readily
colonize crops) through food consumption. Mycotoxins sometimes have important effects on
human and animal health. The common foodborne Mycotoxins include:
 Aflatoxins – originated from Aspergillus parasiticus and Aspergillus flavus.
They are frequently found in tree nuts, peanuts, maize, sorghum and other oilseeds,
including corn and cottonseeds. The pronounced forms of Aflatoxins are those of B1, B2,
G1, and G2, amongst which Aflatoxin B1 predominantly targets the liver, which will result
in necrosis, cirrhosis, and carcinoma. In the US, the acceptable level of total aflatoxins in
foods is less than 20 μg/kg, except for Aflatoxin M1 in milk, which should be less than 0.5
μg/kg. The official document can be found at FDA's website.
 Altertoxins – are those of Alternariol (AOH), Alternariol methyl ether
(AME), Altenuene (ALT), Altertoxin-1 (ATX-1), Tenuazonic acid (TeA) and Radicinin
(RAD), originated from Alternaria spp. Some of the toxins can be present in sorghum, ragi,
wheat and tomatoes. Some research has shown that the toxins can be easily cross-
contaminated between grain commodities, suggesting that manufacturing and storage of
grain commodities is a critical practice.
 Citrinin
 Citreoviridin
 Cyclopiazonic acid
 Cytochalasins
 Ergot alkaloids / Ergopeptine alkaloids – Ergotamine
 Fumonisins – Crop corn can be easily contaminated by the fungi Fusarium
moniliforme, and its Fumonisin B1 will cause Leukoencephalomalacia (LEM) in horses,
Pulmonary edema syndrome (PES) in pigs, liver cancer in rats and Esophageal cancer in
humans. For human and animal health, both the FDA and the EC have regulated the content
levels of toxins in food and animal feed.
 Fusaric acid
 Fusarochromanone
 Kojic acid
85
 Lolitrem alkaloids
 Moniliformin
 3-Nitropropionic acid
 Nivalenol
 Ochratoxins – In Australia, The Limit of Reporting (LOR) level for
Ochratoxin A (OTA) analyses in 20th Australian Total Diet Survey was 1 µg/kg, whereas
the EC restricts the content of OTA to 5 µg/kg in cereal commodities, 3 µg/kg in processed
products and 10 µg/kg in dried vine fruits.
 Oosporeine
 Patulin – Currently, this toxin has been advisably regulated on fruit products.
The EC and the FDA have limited it to under 50 µg/kg for fruit juice and fruit nectar, while
limits of 25 µg/kg for solid-contained fruit products and 10 µg/kg for baby foods were
specified by the EC.
 Phomopsins
 Sporidesmin A
 Sterigmatocystin
 Tremorgenic mycotoxins – Five of them have been reported to be associated
with molds found in fermented meats. These are Fumitremorgen B, Paxilline, Penitrem A,
Verrucosidin, and Verruculogen.
 Trichothecenes – sourced from Cephalosporium, Fusarium, Myrothecium,
Stachybotrys and Trichoderma. The toxins are usually found in molded maize, wheat, corn,
peanuts and rice, or animal feed of hay and straw. Four trichothecenes, T-2 toxin, HT-2
toxin, diacetoxyscirpenol (DAS) and deoxynivalenol (DON) have been most commonly
encountered by humans and animals. The consequences of oral intake of, or dermal
exposure to, the toxins will result in Alimentary toxic aleukia, neutropenia, aplastic anemia,
thrombocytopenia and/or skin irritation.
 Zearalenone
 Zearalenols
Viruses. Viral infections make up perhaps one third of cases of food poisoning in
developed countries. Foodborne viral infection are usually of intermediate (1–3 days)
incubation period, causing illnesses which are self-limited in otherwise healthy
individuals; they are similar to the bacterial forms described above.
 Enterovirus
 Hepatitis A is distinguished from other viral causes by its prolonged (2–6
week) incubation period and its ability to spread beyond the stomach and intestines into the
liver. It often results in jaundice, or yellowing of the skin, but rarely leads to chronic liver
dysfunction. The virus has been found to cause infection due to the consumption of fresh-cut
produce which has fecal contamination.
 Hepatitis E
 Norovirus
 Rotavirus
Parasites. Most foodborne parasites are zoonoses.
 Platyhelminthes:
o Diphyllobothrium sp.
o Nanophyetus sp.
o Taenia saginata
o Taenia solium
o Fasciola hepatica
Tapeworm and Flatworm
 Nematode:
o Anisakis sp.
o Ascaris lumbricoides
86
o Eustrongylides sp.
o Trichinella spiralis
o Trichuris trichiura
 Protozoa:
o Acanthamoeba and other free-living amoebae
o Cryptosporidium parvum
o Cyclospora cayetanensis
o Entamoeba histolytica
o Giardia lamblia
Giardia lamblia
o Sarcocystis hominis
o Sarcocystis suihominis
o Toxoplasma gondii
Natural toxins. Several foods can naturally contain toxins, many of which are not
produced by bacteria. Plants in particular may be toxic; animals which are naturally
poisonous to eat are rare. In evolutionary terms, animals can escape being eaten by fleeing;
plants can use only passive defenses such as poisons and distasteful substances, for example
capsaicin in chili peppers and pungent sulfur compounds in garlic and onions. Most
animal poisons are not synthesised by the animal, but acquired by eating poisonous plants to
which the animal is immune, or by bacterial action.
 Alkaloids
 Ciguatera poisoning
 Grayanotoxin (honey intoxication)
 Mushroom toxins
 Phytohaemagglutinin (red kidney bean poisoning; destroyed by boiling)
 Pyrrolizidine alkaloids
 Shellfish toxin, including paralytic shellfish poisoning, diarrhetic shellfish
poisoning, neurotoxic shellfish poisoning, amnesic shellfish poisoning and ciguatera fish
poisoning
 Scombrotoxin
 Tetrodotoxin (fugu fish poisoning)
Some plants contain substances which are toxic in large doses, but have therapeutic
properties in appropriate dosages.
 Foxglove contains cardiac glycosides.
 Poisonous hemlock (conium) has medicinal uses.
Substantial module 3. Occupational hygiene.

Concrete purposes:
 Determine term „work” by physical, physiological, social meaning.
 Explaine physiological changes in the organism during physical and mental
work to prevent premature weariness and infringement health status of
workers.
 Know principles of preventive measures for limitation compelled position of
body, overstrain of separate bodies and systems, monotony of work, severity
and intensity of work, pathological signs, connected with work.
 Describe preventive measures on negative influence harmful and dangerous
factors of industrial environment (physical, chemical, biological,
psychophysiological) to the health status of workers and protect occupational
pathology.
87
 Explaine principles of sanitary and labor legislation in the branch of
occupational hygiene and using on the practice of medico-sanitary departments
of industrial enterprises.
Тheme № 8. Legislative basis of sanitary surveillance over organization and
implementation of preventive medical examinations & investigation
occupational diseases in the industrial enterprises.
1. PURPOSE: research technique of investigation cases of occupational diseases in
the industrial enterprises; carry out sanitary surveillance over organization and
implementation of preventive medical examinations.
2.1.1. Order, focused on the prophylactic medical examination worker staffs certain
categories of industry.
2.1.2. Responsibilities of an employer, medical and sanitary-epidemiological bodies
over organization and implementation of preventive medical examinations.
2.1.3. Procedure carried out occupational diseases diagnosis and etiological
connection towards disease and harmful factors.
2.1.4. Procedure of investigation and occupational diseases accidents accounting in
the workplace.
2.2.1. Determine frequency of periodic medical examinations, commission,
enumeration of the laboratory and functional investigations and contraindications
towards admission at work with harmful and dangerous working conditions.
2.2.2. Carry out hygienic estimation towards legal procedure of occupational disease
or poisoning investigations.
2.2.3. Recommend therapeutic and preventive measures for the occupational diseases
prevention.
3.1. Sanitary legislation in the field of occupational health.
3.2. Purpose of the preliminary medical examinations towards employment and
periodic medical examinations of the employees.
3.3. General requirements towards the preliminary medical examination.
3.4. General requirements towards the periodic medical examinations.
3.5. Duties of medical institution over organization and carrying out preventive
medical examinations.
3.6. Basic accounting documents, which are issued at the medical examinations,
"act of the medical examination results", order of its carry out.
3.7. Definition of "occupational disease", "professional poisoning", procedure of
diagnosis and etiological connection towards disease and harmful factors.
3.8. Principles of hygienic standardization carried out air of working zone
industrial poisons. Concept towards maximum permissible concentration (MPC).
3.9. Procedure of notification and investigation cases of acute occupational
diseases and poisonings (accidents), composition of the Commission.
3.10. Procedure of notification and investigation cases of chronic occupational
diseases and poisonings (accidents), composition of the Commission.
88
3.11. Procedure of notification and investigation special cases of acute
occupational diseases and poisonings (accidents), composition of the Commission.
3.12. Accounting and registration of the acute and chronic occupational diseases.
1. Standard legislative regulations: Cabinet of Ministers of Ukraine Resolution
№ 1232, November 30, 2011 "Procedure of investigation and accounting accidents,
occupational diseases and emergency at the industry" and carried out conclusion any
case of occupational diseases, by the scenario – based tasks.
2. Determination of the periodic medical examinations data, composition of the
medical board and necessary laboratory tests while dealing with physical, chemical,
biological factors, factors of severity and intensity of labour, according to the
normative document: Ministry of Health of Ukraine Order № 246 published in
21.05.2007 "Order towards medical examination employees of certain categories"
(hereafter – Order).
1. What is the main purpose of preliminary medical examinations working
population?
2. What is the main purpose of periodic medical examinations working
population?
3. For which categories of workers required medical examination?
4. What are the responsibilities of an employer towards organization of the
medical examinations?
5. List of professions with mandatory preliminary (periodic) medical
examination of workers.
6. Define acute occupational disease or poisoning.
7. Organization procedures of the mandatory medical examinations.
8. Describe procedure of medical examination an employee.
9. Enumarate documents towards results of the medical examinations.
10. Define list of professions with special needs for professional selection.
11. Describe investigation and registration cases of chronic occupational
diseases and poisoning.
12. Enumerate harmful and dangerous factors of working environment and
working process.
13. Specify main causes of occupational injuries and occupational morbidity and
measures for their prevention.
14. Enumerate measures focused on the prevention and elimination causes of
accidents and occupational diseases.
initial level of knowledge is carried out by the test on the given theme. Students work
(issue 5). The teacher corrects wrong answers of the students. Students get acquainted
with Standard legislative regulations: Cabinet of Ministers of Ukraine Resolution
№ 1232, November 30, 2011 "Procedure of investigation and accounting accidents,
occupational diseases and emergency at the industry" and Ministry of Health of
89
Ukraine Order № 246 published in 21.05.2007 "Order towards medical examination
employees of certain categories". Then students receive scenario – based tasks and
should write protocol on investigation of a case of occupational disease or poisoning
in the copybook (Appendix). Student should demonstrate practical assessment
selectively carried out by the teacher’s task one of the given factors of industrial
environment (issue 4). At the final part of the practice teacher estimates students
educational activity on the given theme, signed protocols.
Medical examinations of employees: backgrounds and procedure
Subject carried out to compulsory medical examination
Medical examinations is required for the following categories of employees:
1) workers engaged in severe, harmful or dangerous conditions, or those staff who needs the
professional selection;
2) workers of the certain occupations, industries and organizations, dealing with public care survice
of (article 21 Law of Ukraine "On protection population from infectious diseases" from 6 April
2000 № 1645-III).
Mainly, according to art. 17 law of Ukraine "On labour protection" annual medical
examination should be persons up to 21 years old, regardless of profession and type of activity.
Frequency of medical examinations:
1) preliminary (while hiring);
2) periodic (at the labour activity);
3) annual – for persons up to 21 years old.
List of professions with mandatory preliminary (periodic) medical examination of
employees:
According to the Ministry of Health of Ukraine Order № 246 published in 21.05.2007
"Order towards medical examination employees of certain categories" (hereafter – Order), medical
examination carried out for:
1) workers engaged in heavy work;
2) work with harmful or dangerous conditions, or staff with special needs for professional
selection;
3) persons up to 21 years old;
4) physical persons - subjects of commercial activity, which used the hired labour;
5) individuals, who provide work themselfs;
6) public bodies of the Sanitary & Epidemiology Station (hereafter – SES);
7) public bodies of health care centers;
8) military-medical and committees of the ministries and other сentral bodies of executive
power, performing medical examinations of workers, specialized health care facilities should
establish a diagnosis concerning occupational diseases, departments and courses diseases of
higher medical educational institutions III - IV levels of accreditation;
9) worker staff of an executive directorate social insurance Fund (hereafter – Fund) against
accidents and occupational diseases in the enterprises of Ukraine.
List of working activity with special needs for professional selection
— all kinds of underground work;
— work in the caissons, chambers, confined spaces;
— diving activities;
— work at heights, climbing works, works related to the height;
— activities focused on electrical installations above 1000 V, i.e. operational switching,
adjustment, assembly and high voltage testing;
— work over voltage in the electrical equipments and above 1000 V direct current
— work focused on the forest protection, shaft, alloy, transportation and primary processing of
the forest;
90
— work in the oil and gas industry and offshore drilling;
— work focused on the hydro-meteorological stations, communication facilities;
— geological, topographic, construction works;
— work of machinists (stoker), boiler operators;
— works which are associated with the explosives, work in explosive and fire hazardous
production facilities;
— work in the military security, services, special communication, apparatus of the collection,
banking institutions, other institutions and services which should apply firearms;
— work in the gas rescue service, voluntary gas rescue teams, military units and detachments,
in order to prevent occurrence and elimination of open gas and oil gushers, military, rescue
services, etc.
— emergency services (works) on liquidation of emergency situations carried out natural and
technogenic character;
— work on the mechanical equipment (lathes, milling machines and other machines, punch
presses, etc.).
Harmful and dangerous factors of working environment and process are the following:
— chemical compounds, and elements (inorganic and organic origin);
— complex chemical mixtures, compositions, chemical specific compounds (dyes and organic
pigments, pesticides, synthetic polymeric materials: resin, varnish, glue, plastics, sealants,
paints, enamels, fertilizers);
— industrial aerosols fibrogenic and mixed types of action (asbestos, cement, fiberglass,
carbon dust);
— biological factors (protein-vitamin concentrates, feeds, enzyme preparations, an infected
material and material infected with parasites, causative agents of infectious diseases);
— physical factors;
— physical overload of separate organs and systems, and other factors (lifting and manual
movement of goods, visually intense work (optical devices).
Procedure organization of medical examinations
Any worker entitled to receive compensation under this chapter is required, if requested
by the Director of the Department of Consumer and Business Services, the insurer or self-insured
employer, to submit to a medical examination at a time reasonably convenient for the worker as
may be provided by the rules of the director, according to the art. 17 law of Ukraine "On labour
protection".
Director shall adopt rules applicable to independent medical examinations conducted
pursuant to this subsection that:
Provide a worker the opportunity to request review by the director of the reasonableness of
the location selected for an independent medical examination. Upon receipt of the request for
review, the director shall conduct an expedited review of the location selected for the independent
medical examination and issue an order on the reasonableness of the location of the examination.
The director shall determine if there is substantial evidence for the objection to the location for the
independent medical examination based on a conclusion that the required travel is medically
contraindicated or other good cause establishing that the required travel is unreasonable. The
determinations of the director about the location of independent medical examinations are not
subject to review.
Art. 169 KZOT of Ukraine (issue 2.5) impose a monetary penalty against a worker who fails
to attend an independent medical examination without prior notification or without justification for
not attending the examination. A penalty imposed under this subparagraph may be imposed only on
a worker who is not receiving (Temporary partial disability). An insurer or self-insured employer
may offset any future compensation payable to the worker to recover any penalty imposed under
this subparagraph from a claim with the same insurer or self-insured employer.
Medical services should to be provided services by providers not members of managed
care organizations, authorizing temporary disability compensation and making finding of
91
impairment for disability rating purposes by certain providers, review of disputed claims for
medical services rules. For every compensable injury, the insurer or the self-insured employer shall
cause to be provided medical services for conditions caused in material part by the injury for such
period as the nature of the injury or the process of the recovery requires, subject to the limitations in
"Act of the medical examination results", carried out 5 years in the enterprises. Issue 2.21 Order
including such medical services as may be required after a determination of permanent disability. In
addition, for consequential and combined conditions, the insurer or the self-insured employer shall
cause to be provided only those medical services directed to medical conditions caused in major
part by the injury.
Art. 31 Health care services and art. 26 Law of Ukraine about SES carried out medical
examination of the employer of an injured worker, or the employers insurer determines that the
injured worker has failed to follow medical advice from the attending physician or nurse
practitioner authorized to provide compensable medical services or has failed to participate in or
complete physical restoration or vocational rehabilitation programs prescribed for the worker
pursuant to this chapter, the employer or insurer may petition the director for reduction of any
benefits awarded the worker. Notwithstanding any other provision of this chapter, if the director
finds that the worker has failed to accept treatment as provided in this subsection, the director may
reduce any benefits awarded the worker by such amount as the director considers appropriate.
Types of medical examinations:
— preliminary (while hiring);
— periodic (at some period of the labour activity);
— annual (once per year);
— extraordinary (which are connected, as a rule, with emergency, or conducted at the request of
employees).
Types of medical examinations: previous and periodic
Preliminary medical examination carried out for those workers who are subject to the
contract shall receive medical services in the manner prescribed in the contract. Workers subject to
the contract include those who are receiving medical treatment for an accepted compensable injury
or occupational disease, regardless of the date of injury or medically stationary status, on or after
the effective date of the contract. If the managed care organization determines that the change in
provider would be medically detrimental to the worker, the worker shall not become subject to the
contract until the worker is found to be medically stationary, the worker changes physicians or
nurse practitioners, or the managed care organization determines that the change in provider is no
longer medically detrimental, whichever event first occurs.
Periodic medical examination carried out after the workers condition is medically
stationary are not compensable except for the following purposes:
 Services provided to a worker who has been determined to be permanently and totally
disabled.
 Services necessary to administer prescription medication or monitor the administration
of prescription medication, prosthetic devices, braces and supports.
 Services necessary to monitor the status, replacement or repair of prosthetic devices,
braces and supports.
 Services that are necessary to diagnose the workers condition.
 cessation or reduction of temporary total disability benefits
Procedure of medical examination an employee
Art. 169 KZOT carried out the objectives of medical screening in the control of work-related
diseases are the subjects of this paper. Screening procedures include questionnaires, diagnostic
tests, function measurements, and biological tests of exposure levels to environmental agents.
Achieving the objectives of medical examinations depends on selecting appropriate tests that are
acceptable to workers up to 21 y.o.; discarding tests that cannot meet requirements with respect to
reproducibility, specificity, and sensitivity; and periodically reviewing health surveillance programs
92
as a whole, and modifying or abandoning them as necessary in the light of improved working
conditions.
Medical services shall include medical, surgical, hospital, nursing, ambulances and other
related services, and drugs, medicine, crutches and prosthetic appliances, braces and supports and
where necessary, physical restorative services.
Curative care for mandatory preliminary (periodic) medical examination of employees
provided to a worker up to 21 y.o. to stabilize a temporary and acute waxing and waning of
symptoms of the workers condition. When the medically stationary date in a disabling claim is
established by the insurer or self-insured employer and is not based on the findings of the attending
physician, the insurer or self-insured employer is responsible for reimbursement to affected medical
service providers for otherwise compensable services rendered until the insurer or self-insured
employer provides written notice to the attending physician of the workers medically stationary
status, by Order № 246.
Preliminary (periodic) medical examination of employees carried out for any period of time
during which any worker commits insanitary or injurious practices which tend to either imperil or
retard recovery of the worker, or refuses to submit to such medical or surgical treatment as is
reasonably essential to promote recovery, or fails to participate in a program of physical
rehabilitation, the right of the worker to compensation shall be suspended (infectious diseases) with
the consent of the director and no payment shall be made for such period. The period during which
such worker would otherwise be entitled to compensation may be reduced with the consent of the
director to such an extent as the disability has been increased by such refusal.
Preliminary (periodic) medical examination of employees carried out by the Commission.
Commission may choose an attending doctor, physician or occupational practitioner, without
approval from the director.
Documents of the medical examinations results
For initial or aggravation claims the insurer or self-insured employer may require an injured
worker, on a case-by-case basis, immediately to receive medical services from the managed care
organization. If the insurer or self-insured employer gives notice that the worker is required to
receive treatment from the managed care organization, the insurer or self-insured employer must
guarantee that any reasonable and necessary services so received, that are not otherwise covered by
health insurance, will be paid as provided in ORS (Medical service fee schedules), even if the claim
is denied, until the worker receives actual notice of the denial or until three days after the denial is
mailed, whichever event first occurs, appendix 7 to Order № 246. The worker may elect to receive
care from a primary care physician or nurse practitioner authorized to provide compensable medical
services under this section who agrees to the conditions of ORS (Certification procedure for
managed health care provider). However, guarantee of payment is not required by the insurer or
self-insured employer if this election is made, appendix 8 to Order № 246.
A medical service provider who is not qualified to be an attending physician may provide
compensable medical service to an injured worker for a period of 15 years from the date of the first
visit, whichever first occurs, without the authorization of an attending physician. Thereafter,
medical service provided to an injured worker without the written authorization of an attending
physician is not compensable.
When an injured worker treating with a nurse practitioner authorized to provide
compensable services under this section becomes medically stationary in which the nurse
practitioner is authorized to treat the injured worker, shall refer the injured worker to a physician
qualified to be an attending physician as defined for the purpose of making findings regarding
the workers impairment for the purpose of evaluating the workers disability, by Law № 1645, and
other normative-legal acts, such as List № 559 and Order № 559.
Responsibilities of the employer

When a worker is requested by the director, the insurer or self-insured employer to attend
an independent medical examination, the examination must be conducted by a physician selected
93
from a list of qualified physicians established by LIST ‘Harmful and hazardous factors of an
industrial environment and labor process, carried out at the obligatory preliminary (periodic)
medical examination of employees’.
Director shall adopt rules applicable to independent medical examinations conducted
pursuant to this subsection that:
—hold sessions at any place within the state.
—administer oaths.
A worker becomes subject to the contract upon the workers receipt of actual notice of the
workers enrollment in the managed care organization, or upon the third day after the notice was sent
by regular mail by the insurer or self-insured employer, whichever event first occurs. A worker
shall not be subject to a contract after it expires or terminates without renewal. A worker may
continue to treat with the attending physician or nurse practitioner authorized to provide
compensable medical services under this section under an expired or terminated managed care
organization contract if the physician or nurse practitioner agrees to comply with the rules, terms
and conditions regarding services performed under any subsequent managed care organization
contract to which the worker is subject.
Each such contract must comply with the certification standards. However, a worker may
receive immediate emergency medical treatment that is compensable from a medical service
provider who is not a member of the managed care organization. Insurers or self-insured employers
who contract with a managed care organization for medical services shall give notice to the workers
of eligible medical service providers and such other information regarding the contract and manner
of receiving medical services as the director may prescribe.
Work-related disease is the product of multiple factors, including host susceptibility, the
external environment, and individual behavior. The concept of multiple causality is relevant to the
etiology of diseases, in which work and exposures are contributory agents, and of diseases that have
a single necessary cause, eg, lead poisoning.
Acute occupational diseases and acute occupational poisoning cases belong, which
happened after a single (not more than one working shift) impact of hazards harmful substances.
Acute occupational diseases are drawn by the action of chemicals, ionizing and non-ionizing
radiation, significant physical stress and strain of individual organs and systems. They belong to the
infectious, parasitic and allergic diseases.
Investigation and registration cases of chronic occupational diseases and poisonings
Occupational diseases and their classification. A worker who has received an award for
permanent total or permanent partial disability should be encouraged to make a reasonable effort to
reduce the disability; and the award shall be subject to periodic examination.
Occupational diseases with the approval of the director, curative care arising from a
generally recognized, nonexperimental advance in medical science since the workers claim was
closed that is highly likely to improve the workers condition and that is otherwise justified by the
circumstances of the claim. The insurer or self-insured employer shall pay the costs of the medical
examination and related services which are reasonably necessary to allow the worker to submit to
any examination requested under this section. As used in this paragraph, related services includes,
but is not limited to, child care, travel, meals, lodging and an amount equivalent to the workers net
lost wages for the period during which the worker is absent if the worker does not receive benefits
pursuant during the period of absence. Notwithstanding any provision of law or rule to the contrary,
a worker of a noncomplying employer is considered to be subject to a contract between the State
Accident Insurance Fund Corporation as a processing agent or the assigned claims agent and a
managed care organization.
Well – known classification of occupational diseases focused on the etiological principles of
the diseases.
On this basis, occupational diseases are subdivided into five groups:
94
1) First group of occupational diseases, caused by chemical factors (acute and chronic
toxicity, their consequences carried out with isolated or combined damage various organs and
systems);
2) Second group of occupational diseases, caused by dust impact (pneumoconiosis, as well
as silicosis, silicates, pneumoconiosis welders and burner, polishers, etc.);
3) Third group of occupational diseases, caused by physical factors: vibration disease;
diseases associated with exposure of contact ultrasound: vegetative polyneuritis; cochlear neuritis,
noise disease; diseases associated with exposure of electromagnetic radiation and scattered laser
radiation; exposure of ionizing radiation: radiation sickness; caused significant and relatively rapid
changes in atmospheric pressure: decompression sickness, acute hypoxia, caused by adverse
weather (micro-climatic) conditions, overheating, convulsive disease, occlusive disease, autonomic-
sensitive polyneuritis;
4) Fourth group - occupational diseases, caused by overvoltage: diseases of peripheral
nerves and muscles as well as neuritis, radiculoneuritis, vegetarienne polyneuritis, cervico-brachial
plexitis, myofascitis; musculoskeletal chronic tendovaginitis, bursitis, deforming arthrosis;
coordinative neurosis - writing spasm, other forms of functional dyskinesias; vocal apparatus
diseases - asthenopia and myopia;
5) Fifth group - professional diseases, caused by biological factors: infectious and parasitic
diseases - tuberculosis, brucellosis, anthrax, dysbiosis, candidiasis of skin and mucous membranes,
visceral candidiasis, etc.
Etiology of this disease with occupational factors carried out on the basis of clinical research
and hygienic working conditions, determined by Comission. Workers Compensation Board in its
name and the Director of the Department of Consumer and Business Services in the director’s name
as director may sue and be sued, and each shall have a seal. The board hereby is charged with
reviewing appealed orders of Administrative Law Judges in controversies concerning a claim
arising under this chapter, exercising own motion jurisdiction under this chapter and providing such
policy advice as the director may request, and providing such other review functions as may be
prescribed by law.
For each case of occupational disease Director of the Department carried out standard
document in accordance with form P-3, which should be sent in a three days after diagnosis to the
following members of Comission:
• Director of the Department of Consumer and Business Services;
• state sanitary and epidemiological service;
• medical service provider
• Executive Directorate of the Fund.
Occupational case investigation is carried out by the following Commission:
• Director of the Department of Consumer and Business Services;
• medical service provider
• Trade Union organization (or labor protection bodies);
• Executive Directorate of the Fund.
Commission should provide:
• carry out investigation causes of occupational diseases;
• distribute functions between members of the Commission;
• involve qualified physicians;
• claimants duty to reduce disability
• carry out investigation of chronic occupational diseases by form N-4 (further - act P-4), in which
no more than three independent medical examinations may be requested except after notification to
and authorization by the director. If the worker refuses to submit to any such examination, or
obstructs the same, the rights of the worker to compensation shall be suspended with the consent of
the director until the examination has taken place, and no compensation shall be payable during or
for account of such period.
8. LITERATURE:
95
8.1. The basic:
8.2. Additional:
Appendix 1
Scenario – based task № 1: "Legislative basis of sanitary surveillance over organization and
implementation of preventive medical examinations & investigation occupational diseases in
the industrial enterprises"
In the enterprise carried out accidents with worker staff, who drank alcoholic drinking
during working day. As a result, one worker has injured right ankle, another, did not hold back on
the railing, fell and injured his hip. Commission towards investigation of these cases on the basis of
issue 5 "Provisions carried out investigation and recording of accidents..." refused victims in
drafting act N-1, however, SES inspector of labour protection requires on the act N-1 submition.
Whether SES inspector of labour protection rights in such situation?
Standard answer.
In accordance with "Regulations on investigation and registration of accidents..." should be
provided these injuries, which occurred in a state of alcoholic intoxication, should not taken into
consideration as a result of alcohol poisoning or its effects on the worker staff body, i.e. in the
absence of physical injury. In these examples, SES inspector of labour protection is right, because
accidents occurred not as a result of alcohol poisoning, but because of improper storage castings
and employees carrying out work not by profession. According to "Standard rules of labor
regulations", administration should not be allowed to work in this day (shift) employee, appeared at
a workplace under an impact of alcohol. Thus, the investigation of an accident is carried out
incorrectly, because it does not correspond to the requirements "Regulations on investigation and
registration of accidents, occupational diseases and emergency at workplace".
Scenario – based task № 2: "Legislative basis of sanitary surveillance over organization and
implementation of preventive medical examinations & investigation occupational diseases in
the industrial enterprises"
Worker N start to work at 8 o’clock and not getting a job, decided himself to sharp the knife
on the unequipped equipment machine. During sharpening grinding wheel exploded (it was
revealed that it would not have passed tests for mechanical strength) and an employee was
seriously injured. He hadn’t admission to work on a grinding machine. Carry out investigation and
registration of the given accidents.
Standard answer.
Injury of employee N occurred due to operation in the grinding machine, which was not
equipped with means of protection workers and a grinding wheel has not passed tests for
mechanical strength. This case qualifies as an accident according to issue 8 "Regulations on
investigation and registration of accidents, occupational diseases and emergency at workplace".
The accident, which occurred with an employee N should be carried out, and should be submitted
by Act N-1.
96
Order № 246 from 21.05.2007
„APPROVAL PROCEDURE OF THE MEDICAL EXAMINATIONS FOR
CERTAIN CATEGORIES OF WORKERS”
LIST ‘Harmful and hazardous factors of an industrial environment and labor process, carried out at the obligatory preliminary (periodic)
medical examination of employees’
№ Harmful & hazardous Frequency of Specialty of Laboratory, functional & other Medical contraindications
factors of industrial medical physicians, carried medical examinations
environment and examination out medical
labor process in the health examinations
care centers
1 2 3 4 5 6
1. Chemical substances, their compounds & elements
1.1. Manganese & its Once per 1 year neurologist General analysis of blood, 1. Chronic diseases of nervous
compounds otolaryngologist fibrogastroduodenoscopy (FGDs), system
dermatologist x-ray of chest 2. Dystrophic disorders
3.Chronic diseases of
bronchopulmonary system
4. Allergic diseases
1.2. Pesticides Once per 1 year neurologist Common blood analysis, blood 1. Chronic diseases of hepatobiliary
otolaryngologist bilirubin, alanine aminotransferase, system
dermatologist alkaline phosphatase, urine 2. Allergic diseases, including skin
ophthalmologist analysis, fibrogastroduodenoscopy, 3. Chronic diseases of peripheral
allergist aspartate transaminase, audiogram nervous system
4. Dystrophic disorders
5. Neuritis of the auditory nerve
6. Chronic diseases of anterior
segment of an eye
7. Chronic diseases of
8. Hemoglobin less than 120 gr/liter
in women and 130 gr/liter in men
9. Chronic kidney disease
1.3. Mercury and its Once per 1 year neurologist Determination of mercury in urine, 1. Chronic diseases of the nervous
inorganic compounds dentist ALT, AST system
dermatologist 2. Diseases of the teeth and the
mucous membranes (chronic
gingivitis, stomatitis, periodontitis)
3. Kidney disease
4. Chronic diseases of digestive
organs
5. Chronic diseases of the
hepatobiliary system
6. Chronic skin diseases
1.4. Alcohol methyl One time in 2 neurologist Common blood analysis, study of 1. Diseases of the optic nerve and
years ophthalmologist the fundus the retina
2. Chronic diseases of
3. Chronic diseases of the nervous
system
4. Alcoholism, drug addiction
2. Industrial aerosols mainly fibrogeneous and mixed types of actions
2.1 Cement dust Once per 1 year otolaryngologist Chest X-ray with an explanation; 1. Dystrophic diseases of an airway
dermatologist fibrogastroduodenoscopy system
phtisiatrist 2. Chronic diseases of
oncologist bronchopulmonary system
3. The curvature of the nasal septum,
which prevents to the nasal
breathing
4. Chronic, often relapsing, disease
of the skin
5. Allergic diseases at working with
aerosols, which have allergenic
action
6. Tuberculosis of the lungs, even in
an inactive phase (in employment)
97
3. Physical factors
3.1. Ultrasound Once per 1 year neurologist Vibration sensitivity, 1. Chronic diseases of peripheral
(contact ophthalmologist according to the testimony: nervous system
transmission) surgeon rheovasography (RVG) peripheral 2. Obliterating diseases of the
vessels arteries, peripheral angiospazm
3.2. Thermal radiation 1 time during neurologist General analysis of blood, heat 1. Chronic recurrent diseases of the
the first year, ophthalmologist resistance of erythrocytes skin
then 1 time in 2 dermatologist 2. Frank vegetative-vascular
years dystonia
3. Hypertension any stage
4. Cataract
3.3. Local vibration Once per 1 year otolaryngologist Cold test, vibration sensitivity; 1. Obliterating diseases of the
neurologist according to the testimony: RVG of peripheral arteries,
surgeon the peripheral vessels, audiometry 2. Frank vegetative-vascular
orthopedist dystonia
3. The anomaly of the female genital
organs
4. Chronic inflammatory diseases of
uterus and appendages
5. High and complicated myopia
(above 8,0 D)
6. Not to hire women when
exceeding the remote control
vibration of sanitary standards 3
dBA and more
7. Hypertension any stage
8. Coronary heart disease in all cases
9. Prolapse of the rectum and female
sex organs
10. Polyneuritis of different etiology
98
4. Pharmacological products
4.1. Antibiotics Once per 1 year dermatologist General analysis of blood, 1. Allergic diseases
Production and otolaryngologist fibrogastroduodenoscopy 2. Chronic diseases of
professional use neurologist bronchopulmonary system
ophthalmologist 3. Candidiasis, fungal infections,
urologist goiter
4. Chronic diseases of the urinary
tract
5. Rheumatism, systemic vasculitis
6. Chronic diseases of the anterior
segment of the eye
7. Piodermii and other dermatoses
99
Appendix 1
Technique of the hygienic estimation of noise
Educational instruction
to the measurement of noise by noise-meter 1-М (fig. 1)
Fig. 1. Noise-meter of type

„1М”
Preparation of the device
for work
1. The device of noise
source has near.
2. A microphone cap
screw on the electronic block.
3. The switch "Quickly -
Slowly" establish at position
"Quickly".
4. Switch "Range"
expected level of a sound steals
up.
5. The switch "a work
Sort" translate in position "Bath"
(the arrow should be in the left part of black sector, in other case is necessary to replace the battery).
6. The switch "a work Sort" translate in position "Calibre." And by means of the handle
"Calibre." Establish an arrow on adjusting level of a cap of a microphone.
Carrying out of measurements
7. The switch "Sort" establish on the characteristic «A».
8. Switch "Range" rotate in a left-hand side or in the right party until the arrow will be
established in limits from 0 to 10 dB.
9. Remove result of measurement: to value of dB switch "Range" add (if the arrow of a scale
of the device is on the right party from zero) or take away (if the arrow of the device is on a left-
hand side from zero) the indication of an arrow of a scale of the device, also in dB. For example, 60
dB switch "Range" + 3,5 dB scales = 63.5 dB.
10. After the termination of measurements the switch "a work Sort" establish in position "is
switched off".
Тheme №9. Hygienic estimation occupational factors of an industrial

environment, in accordance with "Hygienic classification of work".
1. PURPOSE: estimate working conditions of workers by the harmful, danger,
severity and intensity of work, in accordance with "Hygienic classification of work".
2.1.1. Concept about working conditions, harmful and dangerous factors of the
industrial environment, their classification.
2.1.2. Principles of classification working conditions in accordance with „Hygienic
classification of work”.
2.1.3. Physiological changes in the organism of employed in the process of physical
and mental labor, methods of their research.
2.2.1. Classify factors of industrial environments by their nature.
2.2.2. Carry out at complex hygienic estimation working conditions in accordance
with „Hygienic classification of work”.
2.2.3. Classify working conditions on weight and intensity, harmful, danger.
2.2.4. Determine basic preventive measures carried out on the rationalization of
working conditions.
3.1. Definitions: workplace, work shift, permanent and non-permanent workplace.
3.2. Hygienic criteria "severity and intensity" of labour process.
3.3. Concept about working conditions, harmful and dangerous factors of industrial
environments.
3.4. Classification of harmful and dangerous factors of an industrial environment
(SSanR&N 12.0.003-74).
3.5. Concept about basic hygienic specifications (MAC, MAL).
3.6. Concept about professional risk, occupational disease, professional pathologie.
3.7. Hygienic issues towards appling "Hygienic classification of work”.
3.8. Differentiation working conditions in accordance with „Hygienic classification
of work”.
3.9. Definition 1 class of working conditions – OPTIMAL conditions of work.
3.10. Definition 2 class of working conditions – ACCEPTABLE conditions of work.
3.11. Definition 3 class of working conditions – HARMFUL conditions of work.
3.12. Definition 4 class of working conditions – DANGEROUS conditions of work.
1. Standard legislative regulations: «Hygienic classification of work by indicators of
hazard and danger of an industrial environment factors, weight and intensity of work»
№ 248, Order Ministry of Public Health of Ukraine from 08.04.2014 year, and hygienic
conclusion towards factors of industrial environments, in accordance with a scenario –
based task.
2. Instrumental measurement working environmental parameters (temperature,
relative humidity, speed of air movement) in a classroom and their hygienic
assessment, in accordance with "Hygienic classification of work".
3. Calculation by the formula normal conditions an air volume samples, taken at
different temperatures and atmospheric pressure.
4. Calculation coefficients of an additive action at the working zone air by chemical
substances (carried out selectively on the teacher instructions, according to
enumeration
chemical compounds in the normative document: "Maximum permissible
concentration (MPC) harmful substances in the air of working zone").
5. Methods of determination concentration of dust in the workplace of industrial
enterprises.
1. Definition "harmful factors of working environment and working process".
2. What means dangerous working environment and working process?
3. Enumarate basic principles of classification factors of working environment,
in accordance with their nature.
102
4. Classification working conditions, harmful and dangerous factors of
industrial environments.
5. Carry out definition I class of working conditions by harmful and dangerous
factors of industrial environments.
6. Carry out definition II class of working conditions by harmful and dangerous
factors of industrial environments.
7. Carry out definition III class of working conditions by harmful and
dangerous factors of industrial environments.
8. Carry out definition IV class of working conditions by harmful and
dangerous factors of industrial environments.
9. Definition severity of a labour process, in accordance with "Hygienic
classification of work".
10. What means harmfulness of labor process?
11. Define hygienic standards of working conditions: maximum permissible
concentration harmful substances in working zone air (hereafter – MAC m.s.);
maximum permissible average (working shift) concentration of harmful substances in
air of working zone (hereafter – MACa.w.s).
12. What means concept towards labor conditions?
13. Enumarate criteria in order to determine permanent and non-permanent
workplace?
14. What means "occupational disease" and "profession-related morbidity"?
15. Enumerate physical factors of working environment and labor process
(according to SSanR&N 12.0.003-74).
16. Enumerate chemical and biological factors of working environment and
labor process (according to SSanR&N 12.0.003-74).
17. What are the basic principles of classification industrial poisons, depending
on a degree of toxicity and danger?
18. Specify criteria in order to assess severity, intensity, hazard and danger of
labor?
19. Determine the basic principles of hygienic standardization industrial
poisons in the air of working zone.
20. Hygienic assessment working conditions by microclimate, according to the
"Hygienic classification of work".
21. Hygienic assessment working conditions by industrial vibration, according

to the "Hygienic classification of work".
22. Hygienic assessment working conditions by noise, infrasound, ultrasound,
according to the "Hygienic classification of work".
with Standard legislative regulations: "Hygienic classification of work by indicators of
hazard and danger of an industrial environment factors, weight and intensity of work"
103
№ 248, Order Ministry of Public Health of Ukraine from 08.04.2014 year. Then students
receive scenario – based tasks and should write protocol on investigation of a case of
occupational disease or poisoning in the copybook (Appendix). Student should
demonstrate practical assessment selectively carried out by the teacher’s task one of
the given factors of industrial environment (issue 4). At the final part of the practice
teacher estimates students educational activity on the given theme, signed protocols.
Workplace hazards – although work provides many economic and other benefits, a wide
array of workplace hazards also present risks to the health and safety of people at work. These
include but are not limited to, "chemicals, biological agents, physical factors, adverse ergonomic
conditions, allergens, a complex network of safety risks," and a broad range of psychosocial risk
factors.
Professional-caused disease - the general diseases of a different etiology with a tendency
to increase at the increasing of experience of work in adverse working conditions.
Hygienic specifications of working conditions (maximum concentration limit, maximum
permissible level) - levels of harmful production factors which are during 8 - hour work, but no more
than 40 hours per week, with the whole working experience should not cause diseases or deviations
in a state of health, found out by modern methods of researches.
Maximum permissible concentration of harmful substance at the air of working zone
(MACm.s) concentration of substance, which 8-hour work daily action (not more than 40 hours per
week), should not cause diseases or deviations in a state of health, diagnosed by a innovative
methods of researches.
Maximum permissible average single concentration of harmful substances in air of
working zone (MACa.s) – concentration of substance, carried out in the air of working zone every
15 minutes (30 minutes for fibrogenic actions aerosols) at the whole working shift. Concentration of
substance that equals MACa.s, should not carried out more than 15 minutes and should be repeated at
this level during work shift more than 4 times, at intervals not less than 1 hour.
Maximum permissible average (working shift) concentration of harmful substances in air
of working zone (MACa.w.s) – concentrations of harmful substances in the air of working zone,
carried out at the timetable that equals 75% of a shift (not more than 8 hours), at the same time
should not exeeds MACm.s MACa.s for those substances, which are characterized by cumulative
properties.
Heaviness of work is characteristic of labour process which reflects level of general caloric
losing, loading to the support and movement, cardiovascular, respiratory and other systems.
Weight of work is characterised by physical dynamic loading, weight of cargo which rises and
moves, the general number of stereotypic movements, size of static pressure, working pose, moving in
space.
Intensity of work is characteristic of labour process which reflects loading on the central
nervous system, sense organs, emotional sphere.
Indicators of intensity of work: mental, touch, emotional pressure, monotony of work, a mode of
work.
Dangerous factor - the factor of environment and labour process which caused sharp
disease, sudden deterioration of health or death.
Occupational diseases - are the diseases which occurrence promoted by adverse factors
of the industrial environment and labour process.
Professional disease - is the indicator of quanity first found out patients on an extent of
year with occupational diseases and the poisonings, counted on 100, 1000, 10000, 100000
working in the conditions of harmful production factors.
Working day (change) - a duration established by the legislation (in hours) works
throughout days.
104
Constant workplace - a place on which workers more than 50% of their working hours, or
more than 2 hours continuously are located.
Harmful occupational factors are the following:
Physical and mechanical hazards. Physical hazards are a common source of injuries in
many industries. They are perhaps unavoidable in certain industries, such as construction and
mining, but over time people have developed safety methods and procedures to manage the risks of
physical danger in the workplace. Employment of children may pose special problems.
Falls are a common cause of occupational injuries and fatalities, especially in construction,
extraction, transportation, healthcare, and building cleaning and maintenance. Machines are
commonplace in many industries, including manufacturing, mining, construction and agriculture,
and can be dangerous to workers. Many machines involve moving parts, sharp edges, hot surfaces
and other hazards with the potential to crush, burn, cut, shear, stab or otherwise strike or wound
workers if used unsafely. Various safety measures exist to minimize these hazards, including
lockout-tagout procedures for machine maintenance and roll over protection systems for vehicles.
That same year, machines were the primary or secondary source of over 600 work-related fatalities.
Machines are also often involved indirectly in worker deaths and injuries, such as in cases in which
a worker slips and falls, possibly upon a sharp or pointed object. The transportation sector bears
many risks for the health of commercial drivers, too, for example from vibration, long periods of
sitting, work stress and exhaustion. These problems occur in Europe but in other parts of the world
the situation is even worse. More drivers die in accidents due to security defects in vehicles. Long
waiting times at borders cause that drivers are away from home and family much longer and even
increase the risk of HIV infections.
Confined spaces also present a work hazard. The National Institute of Occupational Safety
and Health defines "confined space" as having limited openings for entry and exit and unfavorable
natural ventilation, and which is not intended for continuous employee occupancy. Spaces of this
kind can include storage tanks, ship compartments, sewers, and pipelines. Confined spaces can pose
a hazard not just to workers, but also to people who try to rescue them.
Noise also presents a fairly common workplace hazard. Noise is not the only source of
occupational hearing loss; exposure to chemicals such as aromatic solvents and metals including
lead, arsenic, and mercury can also cause hearing loss.
Temperature extremes can also pose a danger to workers. Heat stress can cause heat stroke,
exhaustion, cramps, and rashes. Heat can also fog up safety glasses or cause sweaty palms or
dizziness, all of which increase the risk of other injuries. Workers near hot surfaces or steam also
are at risk for burns. Dehydration may also result from overexposure to heat. Cold stress also poses
a danger to many workers. Overexposure to cold conditions or extreme cold can lead to
hypothermia, frostbite, trench foot, or chilblains.
Electricity poses a danger to many workers. Electrical injuries can be divided into four
types: fatal electrocution, electric shock, burns, and falls caused by contact with electric energy.
Vibrating machinery, lighting, and air pressure can also cause work-related illness and
injury. Asphyxiation is another potential work hazard in certain situations. Musculoskeletal
disorders are avoided by the employment of good ergonomic design and the reduction of repeated
strenuous movements or lifts.
105
Chemical hazards: heavy metals, solvents, petroleum, fumes (noxious gases/vapors),
highly-reactive chemicals, fire, conflagration and explosion hazards: explosion, deflagration,
detonation, conflagration. In accordance with SSanR&N 12.1007-76 SSBT „Harmful substances.
Classification and general requirements of safety” classes of chemical substances such as the
following:
 1 – very dangerous;
 2 - dangerous;
 3 - considerably dangerous;
 4 – weakly dangerous.
Biological hazards:bacteria, virus, fungi, mold, blood-borne pathogens, tuberculosis.
Psychosocial hazards. Employers in most countries have an obligation not only to protect
the physical health of their employees but also the psychological health. Therefore as part of a risk
management framework psychological or psychosocial hazards (risk factors) need to be identified
and controlled for in the workplace. Psychosocial hazards are related to the way work is designed,
organised and managed, as well as the economic and social contexts of work and are associated
with psychiatric, psychological and/or physical injury or illness. Linked to psychosocial risks are
issues such as occupational stress and workplace violence which are recognized internationally
as major challenges to occupational health and safety.
Most important emerging psychosocial risks are: precarious work contracts, increased
worker vulnerability due to globalization, new forms of employment contracts, feeling of job
insecurity, aging workforce, long working hours, work intensification, lean production and
outsourcing, high emotional demands, poor work-life balance.
106
By industry. Specific occupational safety and health risk factors vary depending on the
specific sector and industry. Construction workers might be particularly at risk of falls, for instance,
whereas fishermen might be particularly at risk of drowning. Bureau of Labor Statistics identifies
the fishing, aviation, lumber, metalworking, agriculture, mining and transportation industries as
among some of the more dangerous for workers. Similarly psychosocial risks such as workplace
violence are more pronounced in certain occupational groups such as health care employees,
correctional officers and teachers.
Construction is one of the most dangerous occupations in the world, incurring more
occupational fatalities than any other sector. Falls are one of the most common causes of fatal and
non-fatal injuries among construction workers Proper safety equipment such as harnesses and
guardrails and procedures such as securing ladders and inspecting scaffolding can curtail the risk of
occupational injuries in the construction industry. Due to the fact that accidents may have disastrous
consequences for employees as well as organizations, it is of utmost importance to ensure health
and safety of workers and compliance with construction requirements. Health and safety legislation
in the construction industry involves many rules and regulations.
Agriculture. Agriculture workers are often at risk of work-related injuries, lung disease,
noise-induced hearing loss, skin disease, as well as certain cancers related to chemical use or
prolonged sun exposure. On industrialized farms, injuries frequently involve the use of agricultural
machinery. The most common cause of fatal agricultural injuries is tractor rollovers, which can be
prevented by the use of roll over protection structures which limit the risk of injury in case a tractor
rolls over Pesticides and other chemicals used in farming can also be hazardous to worker health,
and workers exposed to pesticides may experience illnesses or birth defects As an industry in which
families, including children, commonly work alongside their families, agriculture is a common
source of occupational injuries and illnesses among younger workers. Common causes of fatal
injuries among young farm worker include drowning, machinery and motor vehicle-related
accidents. Prevalence rates of several occupational exposures in the agriculture, forestry, and
fishing sector which may negatively impact health. These workers often worked long hours. The
prevalence rate of working more than 48 hours a week among workers employed in these industries
was 37%, and 24% worked more than 60 hours a week.
Service sector. As the number of service sector jobs has risen in developed countries, more
and more jobs have become sedentary, presenting a different array of health problems than those
associated with manufacturing and the primary sector. Contemporary problems such as the
growing rate of obesity and issues relating to occupational stress, workplace bullying, and
overwork in many countries have further complicated the interaction between work and health.
According to data, hazardous physical/chemical exposures in the service sector were lower than
national averages. On the other hand, potentially harmful work organization characteristics and
psychosocial workplace exposures were relatively common in this sector. Among all workers in the
service industry, 30% experienced job insecurity, 27% worked non-standard shifts (not a regular
day shift), 21% had non-standard work arrangements (were not regular permanent employees).
Mining and oil & gas extraction. Workers employed in mining and oil & gas extraction
industries had high prevalence rates of exposure to potentially harmful work organization
characteristics and hazardous chemicals. Many of these workers worked long hours: 50% worked
more than 48 hours a week and 25% worked more than 60 hours a week. Additionally, 42% worked
non-standard shifts (not a regular day shift). These workers also had high prevalence of exposure to
physical/chemical hazards. 39% had frequent skin contact with chemicals. About two-thirds were
frequently exposed to vapors, gas, dust, or fumes at work.
107
Healthcare and Social Assistance. Healthcare workers are exposed to many hazards that
can adversely affect their health and well-being. Long hours, changing shifts, physically demanding
tasks, violence, and exposures to infectious diseases and harmful chemicals are examples of hazards
that put these workers at risk for illness and injury. According to the Bureau of Labor statistics,
hospitals recorded 253,700 work-related injuries and illnesses in 2011, which is 6.8 work-related
injuries and illnesses for every 100 full-time employees. The injury and illness rate in hospitals is
higher than the rates in construction and manufacturing – two industries that are traditionally
thought to be relatively hazardous.
Hygienic criteria of working conditions. Classes of working conditions
1 class - Optimum working conditions - conditions at which health of workers
remains, and created conditions for maintenance of high level of working capacity.
2 class - Admissible working conditions - are characterised by such levels of factors of the
industrial environment and labour process which do not exceed hygienic specifications, and possible
changes of organism functions restored during breaks or to the beginning of the following change.
3 class - Harmful working conditions - are characterised by such levels of
production factors which exceed hygienic specifications and adverse impact on an organism
of worker.
Harmful working conditions, on degree of excess of hygienic specifications and degree of
expressiveness possible changes in an organism, share on 4 degrees:
1 degree (3.1) - working conditions are characterised by such levels of harmful
factors of an industrial environment and labour process, which cause to the functional changes,
falling outside the limits of physiological fluctuations (which not restored to the beginning of a
following labour shift) and increase risk of deterioration of health;
factors of an industrial environment and labour process, which are capable lead to the industrial-
caused pathology, occurrence of easy forms professional pathology (without disability), arise
after a long exposition (more than 10 years);
factors of an industrial environment and labour process, which are resulted to development of
occupational diseases, easy or moderate severity level (with loss of professional work capacity in
labour activity);
4 degree (3.4) - working conditions are characterised by such levels of harmful factors of
an industrial environment and labour process, which can lead to increase of chronic pathology
and level of disease with time disability, to development of heavy forms occupational diseases
(with loss of the general work capacity);
4 class – Dangerous (Extreme) - working conditions are characterised by such levels of
harmful factors of an industrial environment and labour process, which influence on a labour
shift creates threat for a life, high risk of heavy forms professional defeats.
"Hygienic classification of work by indicators of hazard and danger of an industrial environment

factors, weight and intensity of work" № 248, Order Ministry of Public Health of Ukraine from
08.04.2014 year
Tab.1. Biological factor
Factors of the III class - harmful and dangerous working conditions and
industrial environment character of labour process
and labour process 1 level 2 level 3 level
Biological factors
Microorganisms Exceeds of maximum concentration limits
1 class of danger Up to 2 times 2,1-4 >4
108
3-4 class of danger Up to 5 times 5,1-10 >10
Factors of the III class - harmful and dangerous working conditions and character of
industrial environment labour process
and labour process 1 level 2 level 3 level
Biological factors
Albuminous preparations
3-4 class of danger Up to 10 times 10,1-20 >20
Amino acids, vitamins, etc.

3-4 class of danger Up to 10 10,1-20 >20
Tab 2. Principles of classification of biological factors of the industrial environment

with the account of the mechanism of action on the human body
Biological factor Indicators of estimation of risk
biological factors of the industrial
environment
A. Pathogenic and not pathogenic Classes of working conditions on hygienic
microorganisms: classification: maximum concentration limit;
Activators of especially dangerous the admissible; the harmful 3.1, 3.2, 3.3.4;
infections; extreme
Activators of diseases; Class of dangers II, III, IV.
Natural microflora; Danger class on allergenicity
Microorganisms-producers (strong, average, weak)
B. Substances of phytogenesis: Indicators of selective action (central nerve
Dust vegetative, flour, grain, wood, system, endocrine system, respiratory, blood,
tobacco, microorganisms-producers; digestive, cardiovascular systems)
C. Products of ability of microorganisms Indicators of danger of specific action:
D. Products of ability of animals pathogenic, cancerogenic, terathogenic,
embriotoxicity)
Tab. 3. Classes of working conditions depending on the maintenance at the air of working
zone harmful substances of chemical origin (maximum concentration limit exceeds (MCL),
how many times)
Harmful substances Class of working conditions
Admissible Harmful - 3 Dangerous
2 3.1 3.2 3.3 3.4 4
Harmful substances
1-2 classes of danger < MCL 1.1-3.0 3.1-6.0 6.1-10.0 10.1- > 20.0
20.0
Harmful substances
3-4 classes of danger < MCL 1.1-3.0 3.1-10.0 > 10 - -
109
Substances with
sharply directed < MCL 1.1-2.0 2.1-4.0 4.1-6.0 6.1- > 10*
mechanism of action, 10.0
or irritating action
Carcinogens < MCL 1.1-3.0 3.1-6.0 6.1-10.0 > 10 -
Allergens < MCL 1.1-3.0 3.1-10.0 > 10 -
Substances mainly
fibrinogen actions < MCL 1.1-2.0 2.1-5.0 5.1-10.0 > 10 -
Antineoplastic
medical drugs, - - - - + -
hormones (estrogen)
Narcotic drugs - - + - - -
NOTE: + irrespective the concentration of harmful substance at the air of a working zone working condition
should be carried to the given class;
* - excess of specified level for substances with sharply directed mechanism of action can lead to sharp
poisoning of workers.
Tab. 4. Classes of working conditions depending on level of noise and vibration at the working
place (excess of maximum permissible level (MPL), how many times)
Occupational factor, unit Class of working conditions
Admis- Harmful - 3 Dange-
sible rous
2 3.1 3.2 3.3 3.4 4
NOISE:
Sound level, dBA; < MPL up to 85 86-95 96-105 106-115 > 115
Equivalent level of sound,
dBA
VIBRATION LOCAL,
equivalent corrected level < MPL up to 115 116-118 119-121 122-124 > 124
of vibro-speeds, dB
VIBRATION GENERAL,
equivalent corrected level
of vibro-speed, dB
axis X
axis Y, X < MPL up to 113 114-119 120-125 126-131 > 131
< MPL up to 122 123-128 129-134 135-140 > 140
Tab. 5. Classes of working conditions on the basis of separate indicators of microclimate for
premises of industrial enterprises and open territories at warm season
(excess of maximum permissible level (MPL), how many times)
Microclimate Class of working conditions
indicators Admissible Harmful - 3 Dange-
rous
2 3.1 3.2 3.3 3.4 4
Temperature of According to > 0.1-3.0 >3.1-6.0 > 6.1-9.0 >9.1-12.0 -
air, 0С S S N*
3.3.6.042-99
Speed of air According to up to 3 > 3 times - - -
movement, m/s SSN* times
3.3.6.042-99
110
Relative humidity, % According to up to 1-25 > 25 - - -
S SN*
3.3.6.042-99
Thermal radiation, up to 140 141-1500 1501- 2001-2500 2501-3500 >3500
Watt/m2 2000
Tab. 6. Classes of working conditions on the basis of separate indicators of microclimate for
premises of industrial enterprises and open territories at cold season
(excess of maximum permissible level (MPL), how many times)
Microclimate Class of working conditions
indicators Admissible Harmful - 3 Dange-
rous
2 3.1 3.2 3.3 3.4 4
Temperature of air, According to up to 2.0 2.1-4.0 4.1-6.0 6.1-8.0 -
0
С S S N*
3.3.6.042-99
Speed of air According to up to 3 > 3 times - - -
movement, m/s SSN* times
3.3.6.042-99
Relative humidity, According to up to 1-15 > 15 - - -
% S SN*
3.3.6.042-99
Thermal radiation, up to 140 141-1500 1501- 2001-2500 2501-3500 >3500
Watt/m2 2000
NOTE: * SSN 3.3.6.042-99 "State Sanitary Norms of occupational microclimate in the industrial premises».
Tab. 7. Classes of working conditions by severity of work

№ Indicators of Class of working conditions
heaviness of work
Optimum Admissible Harmful
(easy physical (average physical (heavy work)
work) activity)
1 degree 2 degree
1 2 3.1 3.2
1. Physical dynamic loading, expressed in terms of mechanical work for change, kg m
111
1.1 At the regional loading
(with primary
participation muscles of
hands and humeral belt)
 at cargo moving on the
distance
to 1 m:
- For men up to 2500 up to 5000 to 7000 >7000
- For women up to 1500 up to 3000 to 4000 >4000
1.2 At the general pressure

(with participation
muscles of hands,
cases, feet):
 At cargo moving on the
distance from 1 to 5 m:
- For men up to 12500 up to 25000 to 35000 > 35000
- For women up to 7500 up to 15000 to 25000 > 25000
 At cargo moving on the
distance more than 5 m:
2. Weight of cargo which
rises and moves
manually, kg:
2.1 Lifting and moving

(single) cargoes, at
alternation with other
work (2 times at one
hour):
2.2 Lifting and moving

(single) cargoes
constantly during a
labor shift:
- For men up to 5 up to 15 up to 30 > 30
- For women up to 3 up to 7 up to 10 > 10
2.3 Total weight of a cargo,

moved each hour on the
labor shift extent:
From a working
surface:
 - For men
- For women up to 250 up to 870 up to 1500 >1500
From a floor: up to 100 up to 350 up to 700 >700
 - For men
- For women up to 100 up to 435 up to 600 >600
up to 50 up to 175 up to 350 >350
112
3 Stereotypic working
movements
(quantity for change)
 At local pressure (with up to 20000 up to 40000 to 60000 > 60000
participation muscles of
brushes and fingers of
the hands)
At regional pressure up to 10000 up to 20000 to 30000 > 30000
 (with participation
muscles of hands and a
humeral belt)
4 Static pressure
Size of static pressure
for change at cargo
deduction, kg·s
One hand:
 - For men up to 18000 up to 36000 to 70000 > 70000
Two hands:
 - For men up to 36000 up to 70000 to140000 >140000
With participation of
the muscles of a trunk
 and feet
Continuation of tab. 7
№ Indicators of Class of working conditions
heaviness of work
(easy physical (average physical (heavy work)
work) activity) 1 degree 1 degree
1 2 3.1 3.2
5. Working pose Free Periodic finding in Periodic finding in Finding in the
convenient an inconvenient the inconvenient or inconvenient or
pose, pose pose (the trunk is fixed pose to 50 % fixed pose more
change turn, an of time change; than 50 % of time
"sitting- inconvenient finding in the change; finding in
standing" is arrangement of compelled pose the compelled
possible. finitenesses) and / from 10 % to 25 % pose more than 25
Finding in a or in the fixed of time change. % of time change.
pose pose to 25 % of Finding in a pose Finding in a pose
"standing" time change. "standing" from 60 "standing" more
to 40 % of Finding in a pose % to 80 % of time than 80 % of time
time change. "standing" to 60 % change. change.
of time change.
6. Case inclinations
(more than 300), up to 50 51-100 101-300 > 300
quantity for change
7. Moving on a space
(the transitions
caused by
technological
 process of change),
km up to 4 up to 8 up to 12 > 12
Across: up to 2 up to 4 up to 8 >8
113
 On a vertical:
Tab. 8. Classes of working conditions by the intensity of work

№ Indicators of intensity of Class of working conditions
work
Optimum Admissible (intensity Harmful
(intensity of easy of average degree) (intensive work)
degree) 1 degree 2 degree
1 2 3.1 3.2
1. Intellectual pressure There is no Decision of simple Decision of Creative
necessity of tasks according to difficult activity,
 The maintenance of making decision the instruction tasks on decision of
work algorithm difficult tasks
at the absence
of algorithm
 Character of performed Work under the Work under the Work in the Work in the
work individual plan established schedule conditions conditions of a
with possibility of its of a time time deficiency
updating deficiency with high
responsibility
for result
2. Touch pressure
 Duration of a
concentrated
supervision
 (in % from change time) up to 25 25-50 51-75 > 75
Density of signals (light,

sound) for 1 business
 hour on the average
up to 75 75-175 176-300 >300
Quantity of the
simultaneous
supervision objects up to 5 5-10 11-25 > 25
3. Monotony of loading
 Quantity of elements,
necessary for realization > 10 9-6 5-3 <3
of a simple task or in the
operations, repeating
repeatedly
№ Indicators of intensity Class of working conditions

of work
(intensity of (intensity of (intensive work)
easy degree) average degree) 1 degree 2 degree
1 2 3.1 3.2
 Monotony of
industrial conditions
(time of passive
supervision over < 75 76-80 81-90 > 90
technological process
in % by change time)
114
4. Regimen of work
 Actual duration of a 6-7 8-9 10-12 > 12

working day (hours)
 Work in shifts One-shift work 2-shift work 3-shift work Irregular working
(without a night (without a night (work in a in shifts with work
shift) shift) night shift) at night
Presence of the Breaks are Breaks are Breaks are Breaks are absent
 regulated breaks, their regulated, regulated non-regulated
duration sufficient Insufficient Insufficient
duration: 7 % duration: from 3 % duration: to 3
and more of to 7 % of time % of time
change time change change
8. LITERATURE:
8.1. The basic:
8.2. Additional:
8.2.2. "Hygienic classification of work by indicators of hazard and danger of an
industrial environment factors, weight and intensity of work" № 248, Order Ministry of
Public Health of Ukraine from 08.04.2014 year.
Appendix 1
Estimation of severity and intensity, hazard and dangerous of work by
„ Hygienic classification of work”
Class of severity,
Characteristic of Exceedance
№ Occupational factors intensity, hazard and
factors MAC dangerous of work
1. Industrial environment:
1.1. Noise 85 dBA + 5 dBA ІІІ class 2 degree
2. Severity of work:
2.1. Cargo weight 35 kg + 5 kg ІІІ class 1 degree
3. Mental loading:
3.1. Duration of focused 80 +5 ІІІ class 1 degree
observations (% of a given shift)
Standard answer
At the estimation of occupational factors by „Hygienic classification of work”, working
conditions of the worker concern: by noise – to ІІІ class 2 degree, by severity ІІІ class 1 degree
(cargo weight), by mental loading – ІІІ class 1 degree (duration of focused observations (% of a
given shift).
Finaly, working conditions concerned to ІІІ class 2 degree (by noise level), carried out to...
(specify possible changes in the body of worker).
115
In order to preserve workers ' health director of the enterprise should carry out preventive
measures as well as... (enumerate basic hygienic actions focused on the improvement working
conditions).
Theme of independent out-of-class work № 3. Hygiene of labor protection medical

staff in the treatment-and-prophylactic establishments.
1. PURPOSE: research basic harmful and dangerous occupational factors, which
negatively influence to the medical workers, and develop preventive measures to
improvement of working conditions of the basic professional groups of medical
workers.
2.1.1. Phisiological-hygienic features of working conditions of the basic
professional groups of medical workers.
2.1.2. Features of professional-caused and professional disease of the basic
professional groups of medical workers.
2.1.3. Main directions of improvement working conditions at the medical-
preventive establishments.
2.2.1. Carried out preventive measures in order to improve working conditions
of medical staff, taking into account typical working conditions.
3.1. Phisiological-hygienic features of working conditions of surgery medical
workers.
3.2. Phisiological-hygienic features of working conditions of therapeutic
medical workers.
3.3. Phisiological-hygienic features of working conditions of stomatological
medical workers.
3.4. Professional-caused and professional disease of the basic professional
groups of medical workers.
3.5. Professional disease of the basic professional groups of medical workers
with chemical etiology.
3.6. Professional disease of the basic professional groups of medical workers,
caused by physical factors.
3.7. Professional disease of the basic professional groups of medical workers,
caused by severity and intensity of work.
3.8. Professional disease of the basic professional groups of medical workers
with bacterial etiology.
3.9. Hygienic actions of improvement working conditions of medical workers.
3.10. Legislative actions of protection work of medical workers (reduced
working day, increase of official salaries, and additional holidays for work with
harmful working conditions and for a special kind of work).
Out-of-class work is spend as an inderpendent work of the student. Control of
initial level of knowledge is spent by the test control or interrogation on the theme.
Students receive situational problems and perform practical work on the estimation of
116
professional diseases. Students make out the conclusion and discuss results. Work is
made out by the report.
5. LITERATURE:
5.1. The basic:
Vinnytsya: Nova Knyha publishers, 2009. – P. 288-297, 358-364, 365-370.
5.2. Additional:
5.2.2. SSaN&N 2.0.003-74. Harmful and danger occupational factors. Classification.
5.2.3. "Hygienic classification of work by indicators of hazard and danger of an
industrial environment factors, weight and intensity of work" № 248, Order Ministry of
Public Health of Ukraine from 08.04.2014 year.
Appendix 1
Hygienic characteristics of occupational hazards
medical staff of various profiles
Hazards occupational factors surgical department doctors are the following:
- quantity of surgical interventions - up to 150 per year for general surgery practice, 170 per year –
for otorhinolaryngology department, 370 per year – in obstetrics and gynecology departments;
- uncomfortable body position with a trunk bent forward and prolonged static tension muscles of a
shoulder girdle, back, arms stretched forward;
- heating microclimate with high radiative heat flows from source of artificial light (shadowless
lamp);
-ionizing radiation for radiological department, especially in traumatology, vascular surgery,
neurosurgery;
- toxic impact of anesthesia (nitrous oxide, halothane, chloroform, diethyl ether) and anesthetics;
- high mental, nervous and emotional stress associated with complexity, duration of surgery,
possible complications arising, responsibility for life of a patient.
Among occupational diseases surgery department doctors with temporary total disability, the
most prevalent diseases as well as nervous system, circulatory system, digestive diseases, acute
respiratory diseases. Among chronic diseases are the following – disease of circulatory system,
neurasthenia, which are associated with high emotional and physical stresses, angina, hypertension,
dystonia, neurasthenia.
Common diseases associated with prolonged standing for a surgical table: sciatica,
osteoarthritis, psoriasis, varicose veins of lower extremities.
Temporary total disability surgeons at more than 60-80% of doctors was explained by their
point of view to changed profession, caused by chronic intoxication of drugs and anesthetics, 11-
20% - by infectious diseases, 9-10% - by physical and nervous overload.
Hygienic characteristics working conditions and health of therapeutic department doctors
depend on service of patients. For outpatient, precinct servicing a key role belongs to excessive
physical activity, which depends on the season of a year (quantity of cases), size of a therapeutic
department, type of building (single high-rise buildings, presence/absence of elevators). These
professions are also characterized by psychoemotional stress, adverse effects of physical factors, x-
ray radiation, microwave, ultrasound, laser and other diagnostic and therapeutic instrumental
measures of treatment, chemical hazard, pharmacological agents.
Occupational diseases doctors of a therapeutic department, primary, TB specialists,
infectious disease specialists, dermato-venereologists, lab technicians as well as bacteriological,
virological, helminthological laboratory concerned infectious disease, typical for these department;
117
for radiologists – dermatities, eczema, toxicoderma, melanoma, leukemia, skin cancer, radiation
sickness; for psychiatrist –psychoneurosis, etc.
Occupational hazards of dentists are forced body position (standing, with tilt and turns of a
body), which leads to prolonged static voltage corresponding muscle groups, noise and vibration
from drills, eye strain, blinding effect of photopolymer lamp, getting into a breathing area of
mercury carried out from mercury amalgams, evaporation of solvent polymeric materials, danger of
infection from patient with diseases of an upper respiratory tract in the incubation stage,
convalescence, while performing manipulations, involving contact with mucous membranes, blood
of patient.
Enumerated hazards should cause postural disorders (34-45 %), varicose veins of lower
finiteness (19-49 %), vibration disease (paresthesias, loss of temperature, tactile sensation of hands,
Dupuytren's contracture).
Visual analyzer overloading could cause spasm of accommodation, so-called false myopia,
eye pain.
Through saliva, tissue of gums, an open wound could transmit AIDS, prion disease, hepatitis
B and hepatitis C.
Measures for improvement working conditions worker staff
One of the main conditions focused on protection medical staff and successful treatment of
patients is planning & architectural measures carried out for medical institutions, in accordance with
Building Norms and Rules (BN&R 2.2-10-2001 “Public health care bodies”). These standards
provides major requarements to the premises of a hospital, department, their localization, squar,
specific requirements towards size, walls and floors of the x-ray, radiology, physical therapy
departments. Typical planning & architectural rules and requirements carried out for infectious,
tuberculosis departments of the hospital.
In accordance with SSaN&R and ISO 12.1.005 – 88 "Sanitary-hygienic requirements for air
of a working zone", if the medical staff has made a timely request for a hearing on a denial of
compensability as required by the based on one or more reports of examinations conducted pursuant
to this subsection and the staff attending physician or nurse practitioner authorized to provide
compensable medical services does not concur with the report or reports, the staff may request an
examination to be conducted by a physician selected by the director from the list described in (List
of authorized providers and standards of professional conduct for providers of independent medical
examinations). If the medical staff has been terminated for violation of work rules or other
disciplinary reasons, the insurer or self-insured employer shall cease payments pursuant when the
attending physician or nurse practitioner authorized to provide compensable medical services.
Well – spread measures of a personal protection medical staff as well as individual sanitary
protective actions carried out for a body, eyes, respiratory and other organs.
Basic protection towards ionizing and non-ionizing electromagnetic radiation provide
mainly technological antirradiation actions such as decrease power of radiation sources, distance,
time, shielding, in accordance with legislative, organizational and technical directions.
Therefor, maximum permissible dozes of irradiated staff carried out in hygienic standards
"Radiation Safety Standard of Ukraine RSSU – 96" and (OSPU – 01), etc.
Legislative measures focused on medical staff protection, working in the hazardous working
conditions are the following:
- 4-hour’s labor activity – for medical staff, working with open sources of radionuclides;
- 5-hour’s labor activity – for medical staff, working with closed sources of ionizing
radiation (gamma, x-ray), for pathologists, forensic doctors, anatomists;
- 5.5-hour’s labor activity – for medical staff, as well as tuberculosis, psychiatric clinics,
physiotherapists, dentists;
- 6-hour’s labor activity – for medical staff of the infections, tuberculosis, psychiatric,
balneological, radon, laboratory departments.
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Occupational disease is any chronic ailment that occurs as a result of work or occupational
activity. It is an aspect of occupational safety and health. An occupational disease is typically
identified when it is shown that it is more prevalent in a given body of workers than in the general
population, or in other worker populations. Occupational hazards that are of a traumatic nature
(such as falls by roofers) are not considered to be occupational diseases.
Under the law of workers' compensation in many jurisdictions, there is a presumption that
specific disease are caused by the worker being in the work environment and the burden is on the
employer or insurer to show that the disease came about from another cause. Diseases compensated
by national workers compensation authorities are often termed occupational diseases. However,
many countries do not offer compensations for certain diseases like musculoskeletal disorders
caused by work. Therefore the term work-related diseases is utilized to describe diseases of
occupational origin. This term however would then include both compensable and non-
compensable diseases that have occupational origins.
Occupational lung disease. Occupational lung diseases include asbestosis among asbestos
miners and those who work with friable asbestos insulation, as well as black lung (coalworker's
pneumoconiosis) among coal miners, silicosis among miners and quarrying and tunnel operators
and byssinosis among workers in parts of the cotton textile industry. Occupational asthma has a vast
number of occupations at risk.
Bad indoor air quality may predispose for diseases in the lungs as well as in other parts of
the body.
Occupational skin diseases and conditions are generally caused by chemicals and having
wet hands for long periods while at work. Eczema is by far the most common, but urticaria, sunburn
and skin cancer are also of concern.
High-risk occupations include: hairdressing, catering, healthcare, printing, metal machining,
motor vehicle repair, construction.
Occupational lung disorders caused by exposure of organic dust
Professional disease Etiology
Bagassosis Moldy bagasse (sugar cane)
Byssinosis Cotton dust
Bird fancier’s, breeder’s, or handler’s lung Avian droppings or feathers (including
parakeets, chickens, turkeys and pigeons)
Cheese washer’s lung Moldy cheese
Coffee worker’s lung Coffee beans
Farmer’s lung Moldy hay, grain, silage
Fish meal worker’s lung Fish meal
Humidifier or air conditioner lung Contaminated water in humidification and air
conditioning systemsSilicosis, silicatosis,
carboconiosis, metalloconiosis, pneumoconiosis,
Pneumoconiosis caused by organic dust, mixed dust, etc.
Substantial module 4. Hygiene of children and adolescents.

Concrete purposes:
 Know factors and conditions of environment, which are influence on the
forming of children and adolescents health.
 Give differential estimation of the main criterias of children and adolescents
health and know methods of complex estimation health status of children and
adolescents.
 Use methods of hygienic estimation physical development of children and
adolescents in the organized collective of children.
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 Use positive factors of environment for treatment and prevention negative
influence of environment to the state of health, physical, psychological and
intelectual development of children and adolescents.
 Use organization measures of teachering and educational process at the
preschool institutions and schools of different type to resistant children and
adolescents health.
 Know hygienic features of planning and operation preschool and school
buildings, and their separate premises (classes, offices, masterful, etc.) for
maintenance appropriate conditions among pupils.
 Know and use in medical practice sanitary legislation on the branch of hygiene
of children and adolescents.
Тheme № 10. Analyses state of health children and adolescents.

1. PURPOSE: research techniques of complex estimation health status of children
and adolescents.
2.1.1. Definition "health"; indicators of health and health group’s criteria of
children and adolescents.
2.1.2. Indicators of health of a person; population; health index, distribution of
children by health groups; incidence, disease prevalence, demographic and health
indicators.
2.2.1. Calculate and estimate parameters of the children population health.
2.2.2. Carry out estimation criteria of children’s health.
3.1. Health as indicator, which integrally characterized influence of biological factors
and environment on the organism of children and adolescents.
3.2. Methods of statistical research indicators on the basis of medical examinations:
– indicators of pathological defeats;
– structure of pathological defeats.
3.3. Instrumental research basic anthropometric indicators:
– physiometrics (functional): vital capacity; muscle strength in the arms;
– somatometrics (musculoskeletal system, shape of a spine, chest, legs, posture).
1. Standard legislative regulations and hygienic conclusion towards analyses state of
health children and adolescents, in accordance with a scenario – based task.
2. Instrumental measurement basic anthropometric indicators (in accordance with
teachers’ instruction and given tasks, item 3.3).

1. Give the definition: "health".
2. Among numerous factors, forming health of children and adolescents and
having most significant impact on a growth and development of the child's body, are
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favorable or wellness factors and unfavorable or risk factors. What factors are related
to favorable factors (wellness)?
3. What factors are related to unfavorable or risk factors?
4. Enumerate main criteria carried out by family doctors, pediatricians, doctor –
hygienist of educational institutions at the complex assessment health status of
children and adolescents.
5. What criteria carried out distribution of children on health groups?
6. Specify, and characterized groups of health among children and adolescents.
7. Which pathology should reveale distribution of children by health groups?
8. What is the basis for identifying risk factors of an environment, educational
process and other conditions in childcare preschool institutions and comprehensive
schools with preventive actions?
9. Indicators of an individual health.
10. Indicators of population health.
11. Criteria of social welfare (WHO).
12. Concept of a health index.
13. Methods of research morbidity.
14. Hygienic prenosological diagnostics; concept "psycho-physiological state",
"norm".
15. Concept "disease"; "primary morbidity".
16. Concept common incidence, prevalence of disease, morbid.
17. Concept "pathological affection".
18. Concept "disability, "special needs".
19. Enumerate demographic and health indicators.
20. Concept: attributable risk, relative risk, potential risk, real risk.
21. Concept "injury", "environmental monitoring".
with Standard legislative regulations at the given theme. Then students receive
scenario – based tasks and should write protocol, carried out analyses state of health
children and adolescents in the copybook (Appendix). Student should demonstrate
practical assessment selectively carried out by the teacher’s task (issue 4). At the final
part of the practice teacher estimates students educational activity on the given theme,
signed protocols.
Early childhood is a stage in human development. It generally includes toddlerhood and
some time afterwards. Play age is an unspecific designation approximately within the scope of early
childhood. Some age-related development periods and examples of defined intervals are: newborn
(ages 0–5 weeks); infant (ages 5 weeks – 1 year); toddler (ages 1–4 years); preschooler (ages 4–7
years); school-aged child (ages 6–13 years); adolescent (ages 13–19).
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Physical growth and development. In this phase there is significant synaptic growth and
myelination of neural fibers in the brain, especially within the frontal lobes. For example, between
the ages 2 and 6, the brain increases from 70% of its adult weight to 90%. The growth of the brain
is followed by a surge in cognitive abilities. Around the age of five, children start speaking properly
and master their hand to eye coordination.
It is optimal that an environment is provided that encourages physical development and
allows the children to explore and try out new things. The physical development in children follows
a pattern. The large muscles develop before the small muscles, the large muscles are used for
walking and running and other physical activities, these are known as gross motor skills. Small
muscles are used for fine motor skills such as picking up objects, writing, drawing, throwing and
catching.
Cognitive growth and development. Called the preoperational stage, this is the stage during
which the child repeatedly asks "Why?", and is used to build relationships with the child. The child
can't yet perform the abstract thinking operations. The child has to be able to see what is being
talked about, because they do not understand the concepts of logic, betrayal, contemplation, etc.
This means that they think literally: if a child is told that they have to go to bed because "night is
falling", they will ask how can the night (literally) fall from the sky. They also see the human
characteristics in every object, e.g. the table "is bad" if they accidentally hit it with their foot and it
hurts. They also exhibit egocentrism; not to be confused with egoism; that being said, they do not
comprehend that the other person has beliefs and the children at this age think that what they think,
everybody thinks. There is also a matter of perceptive centration, which causes the children to
primarily see what is visually most prominent on someone/something, e.g. if a man has long hair,
the child will think he's a woman.
Social-emotional growth and development. This includes children understanding a sense of
'self', relationships with others and sociability. The emotional development includes
expressions,attachment and personality. Children manifest fear of dark and monsters and around the
age of three notice whether they are a boy or a girl and start acting that way. Boys are usually more
aggressive, whilst girls are more caring. However, aggression is manifested in two different ways:
boys are more physically aggressive, while the girls are more socially aggressive (name-calling and
ignoring). In this stage the individual differences become more prominent.
Physical development
Gross motor skills. Between ages 2 and 3 years, young children stop using the awkward,
wide-legged robot-like stance that is the hallmark of new walkers. As they develop a smoother gait,
they also develop the ability to run, jump, and hop. Children of this age can participate in throwing
and catching games with larger balls. They can also push themselves around with their feet while
sitting on a riding toy. The period of the most rapid development of motor behaviors is the period
between 2 and 6 years (also known as the preschool years). Skills that appear are basic locomotor,
ball-handling, fine eye–hand coordination, walking leads to running, jumping, hopping, galloping,
and skipping, climbing evolves from creeping.
Fine motor skills. There are several developmental expectations for children to reach by the
time they reach the age of 2. Children are expected to be able to draw simple shapes such as circles,
squares and triangles. They should also be able to cut out such shapes as these. By doing such
activities as these develops the children's fine motor skills, by strengthening there fingers and
developing there finger control. Fine Motor Skill.
Early childhood education. Infants and toddlers experience life more holistically than any
other age group. Social, emotional, cognitive, language, and physical lessons are not learned
separately by very young children. Adults who are most helpful to young children interact in ways
that understand that the child is learning from the whole experience, not just that part of the
experience to which the adult gives attention.
The most information learned occurs between birth and the age of three, during this time
humans develop more quickly and rapidly then they would at any other point in their life. Love,
affection, encouragement and mental stimulation from the parents or guardians of these young
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children aid in development. At this time in life, the brain is growing rapidly and it is easier for
information to be absorbed; parts of the brain can nearly double in a year. During this stage,
children need vital nutrients and personal interaction for their brain to grow properly. Children's
brains will expand and become more developed in these early years. Although adults play a huge
part in early childhood development, the most important way children develop is interaction with
other children. Children develop close relationships with the children they spend a large period of
time with. Close relationships with peers develop strong social connections thst can be transferred
later in life, even children at an early age have a preference of whom they want to interact with or
form friendships with. There are distinctive characteristics of friendships, for infants, toddler and
pre-school aged children.
Allocation of children to health groups allows to reveal people who have risk factors,
concerning development of pathological deviations, children with initial forms of diseases and
functional deviations and, based on received results to work out complex measures for protection
and strengthening of childen’s health, prevention of chronic diseases appearance.
Primary, these measures should be directed on children, concerning to the second health
group (children – reconvalescents, children, which are frequently ill during long – period, with
dysharmonicity of physical development, overweight or underweight children without endocrine
pathology, flat feet, children with functional deviations of cardiovascular system, myopia, caries, II
stage of palatine tonsils hypertrothy, allergic diseases, thyreoid gland enlargement I, II stages,
asthenic syndrome, etc.
Criteria for assessment children’s resistance: morbidity rate with temporal disability and
exacerbation of chronic diseases during previous and current years, incidents of nonspecific
resistance (X – chromatine and geretochromatine content in cheek mucous membrane epithelium,
glicigen content in neutrophils, activity of alkaline and acid phosphotase in neutrophils,
dehydrogenase in lymphocytes, lesozyme and lactatedehydrohynase in saliva, level of skin
bactericidal action, etc.
There are favourable (sanitary, health – improving) and un favourable (risk factors) factors,
which are forming health and significantly influence to the physical growth and development.
Favourable (sanitary, health – improving) are the following:
- rational regime of daily activity;
- adequate and balanced nutrition;
- correspondence of environment to hygienic standards;
- optimal motor activity;
- tempering;
- healthy lifestyle and following hygienic personal assignments.
Unfavourable (risk – factors) are the following:
- disturbance regime of daily activity;
- disadvantages in organization of nutrition;
- hygienic isssues focused on the requirements to the games, educational process,
extracurricular and labor activity;
- insufficient or excess of motor activity;
- harmful habits and ignorance of hygienic personal assignments.
Table. Clasification children of early and preschool age by groups of health
Group Signs of health Criteria of health group
1 2 3
І group Chronic pathology Should be absent
deviations should be Functional condition of vital Deviations should be absent
absent systems and organs
Resistance and organism Morbidity carried out during medical
activity examination, rare and easily current
cases of acute diseases or their absent
Physical and psychical Normal, correspond to the age
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development
Chronic pathology Should be absent
Functional condition of vital Functional deviations at
ІІ group systems and organs 1 y.o. children - burdened midwifery
functional deviations anamnesis (toxicity, other pathology of
pregnancy, complicated course of birth
and family history, multiple pregnancy,
prematurity, without any signs of
prematurity, dysfunctional early
neonatal period, caries of teeth -
subcompensated stage, anomaly bite
Resistance and organism Morbidity –long-term acute illness
activity with prolonged reconvalescence period
of weakness, irritability, disturbance of
sleep and appetite, fever, etc.
Physical and psychical Disharmonious physical development,
development hypotrophy or obesity II stage. Normal
or slight deviation of neuro-
psychological development
Chronic pathology Presence of chronic diseases,
congenital malformations of organs
and systems
ІІІ group
Functional condition of vital Presence of functional abnormalities in
compensation stage
systems and organs the diseased system, body without
clinical manifestations of functional
disorders on the other systems and
organs. Caries, decompensatory form
Resistance and organism Morbidity is rare, not severe origin
activity exacerbations of basic chronic diseases
without significant disturbance
common condition and well-being.
Rare intercurrent disease
development hypotrophy or obesity II or III stage,
low growth. Psychological
development is normal or behind
normal standards.
ІV group Chronic pathology Presence of functional abnormalities in
subcompensation stage pathologically altered organs and
systems, other organs and systems
Functional condition of vital Presence of functional abnormalities in
systems and organs pathologically altered organs and
Resistance and organism Morbidity is severe current of the basic
activity chronic diseases, rare or frequent acute
illness with impaired common
condition and well-being after acute or
prolonged reconvalescence period of
an intercurrences disease
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development hypotrophy or obesity I or II stage,
low growth. Neuro-psychical
development is behind hygienic
standards.
V group Chronic pathology Presence of severe chronic pathology

decompensation stage or severe birth defect, that cause
disability of the child
Functional condition of vital Expressed functional abnormalities in
systems and organs pathologically altered organs and
Resistance and organism Morbidity – often and severe acute
activity exacerbation of main chronic diseases,
frequent acute illness
development hypotrophy or obesity II or III stage,
low growth. Neuro-psychical
development is behind normal
standards.
Health groups of adolescents and schoolchidren

Group Criteria
І (healthy Healthy children with normal physical and mental development without
children) morphological and functional abnormalities. Chronic diseases are absent, while
medical examination abnormalities should not found. From time to time suffer
from acute illness.
ІІ risk – group Healthy children with risk of chronic diseases, having morphological and
functional abnormalities or reduced resistance. Pathological or biochemical
abnormalities (premorbid state), effects of disease should be absent. Often
suffer from acute illness (more than 3 times per year). Presence of risk factors.
ІІІ Patients with chronic diseases in the stage of compensation with preserved
functional abilities. Exacerbation for year should be absent.
ІV Patients with chronic diseases, 1-2 exacerbations per year, with congenital
malformations in the stage of subcompensation, or reduced functional abilities
of the organism.
V Patients with severe chronic diseases or severe malformations in the stage of
decompensation, carried out to the common disability; persons with disabilities
caused by illness.
Criteria of complex assessment of children and adolescent’ health is well-
spread in the practice of doctor – hygienist, doctor of the pediatrition department,
focused on the school diseases and family doctors:
- presence or absence of chronic diseases during medical examination;
- functional state vital systems of organism;
- organism resistance towards unfavorable impact of an environmental factors;
- individual level of nervous and psychological development as well as harmonic
physical development.
8 LITERATURE:
8.1. The basic:
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8.2. Additional:
Appendix 1
Scenario – based task: "Analyses state of health children and adolescents"
In the comprehensive school 784 pupils have been studied. Medical examination in 2013 have
revealed: 55 pupils have disharmonious physical development (30 pupils have considerable
deficiency of weight of body, 25 - superfluous weight of body), 70 children having infringement
(11 –scoliosis І degrees, 5 - scoliosis ІІ degrees), 90 pupils - myopia of weak degree. Other 78
pupils suffer from chronic diseases (38 pupils - vegetal-vascular dystonia. Throughout a year 104
schoolboys did not address for medical service.
During medical examination in this school in 2014 (780 children) it was revealed:
disharmonious physical development of 60 schoolboys (45 - with considerable deficiency of body
weight, 15 - superfluous weight of body), having infringement - 82 pupils (scoliosis І degrees - 20,
ІІ degrees - 9). Severe infringement was revealed at 103 pupils, among them myopia was diagnosed
at 11 pupils. Other chronic diseases were revealed at 115 children, i.e. vegetal-vascular dystonia -
75 schoolboys. Throughout a year 64 pupils did not address for medical service.
Tasks.
Carry out calculations indicators state of health for children on the basis of the given scheme
by the following indicators:
Scheme of calculation indicators of children and adolescents health:
1. Frequency of diseases:
common examined children - all revealed (on separate diseases)
1000 examined - х revealed
2. Structure of disease schoolboys - percent of separate diseases:
common diseases - 100 %
separate disease – х
3. Carry out hygienic conclusion, by the results of the given scenario – based task:
A. Specify, which diseases carried out often and/or seldom.
B. Specify, which have the greatest percent and/or a small amount.
C. Compare indicators of disease at the schoolboys in 2013 and 2014 years.
D. What are the main reasons of a high incidence, or separate diseases reduce.
E. What document is used in order to research health of children and adolescents at
the routine medical examinations collective of children?
F. Provide hygienic recommendations doctor – pediatritian, carried out medical
examination in the comprehensive schools in order to reduce children’s
morbidity.
Standard answer.
А. First place takes defects of locomotor posture, diseases of eye analyzer among
schoolchidren.
B. The greatest percent among all diseases belongs to the defects of locomotor apparatus
C. Comparing all diseases in the dynamics carried out their increasing from 2013 to 2014.
D. Possible causes of high morbidity, related to the musculoskeletal system, was closely
connected with school furniture (desks shouldn’t responsible for its hygienic requirements; height
of seat doesn’t correspond to the height of table, etc.). Distance of a seat should be positive, not
negative, carried out to the scoliosis, left side or right side, or to the "round back".
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Decrease visual acuity associated with insufficient natural and artificial lighting, as well as a
wrong posture of the pupil at the schooldesk.
At the process of school training pupils have considerable static load, which caused forming of
a wrong working posture. Origin of working posture depends on the type of physical activity.
Mainly, carried out written work 80% of time pupils should have immobility, at the other
activities 55-70%. While writing or reading the most comfort position is enclosure tilted forward,
the distance from eye to the notebook should be from 25-26 cm to 30-35 cm. Risk factors,
associated with furniture, i.e. desks, tables and chairs, which didn’t correspond to the hygienic
requerements and towards their discrepancy between sizes and anthropometric indicators of pupils.
E. "Methodological recommendations complex assessment of children and adolescents health
at the medical examinations" and "Methodological recommendations for medical health care
services, provided to the children – rural inhabitants by general practitioner / family doctor".
F. Recommendation of general practitioner / family doctor:
1. Teacher staff of the comprehensive school should pay attention to the pupils, i. e. their working
posture at the school desk.
2. Provide lectures for schoolchildren, related to the comfort position at the school desk, in
accordance with hygienic standards.
3. School furniture should be marked and correspond to the pupils anthropometric indicators.
4. Carried out natural lighting: light should fall on the left side of a workplace.
5. Standard level of artificial lighting should be not less than 48 Wat/m2 of the floor square.
Тheme № 11. Hygienic estimation organization teaching &educational training in

the preschool institutions and comprehensive schools.
1. PURPOSE: research methods of hygienic estimation teaching &educational
training and daily routine of children and adolescents in the preschool institutions and
comprehensive schools.
2.1.1 Daily routine of children and adolescents, its physiological substantiation.
2.1.2 Issues of daily routine leisure and work time for children of different age
groups.
2.2.1. From hygienic point of view should estimate teaching &educational training
in the classes.
2.2.2. Carry out hygienic assessment school schedule collective of children
different age groups.
3.1. Teaching &educational training as health – forming factor at the children
and adolescents.
3.2. Basic hygienic – focused parameters, carried out for group & games,
classrooms, gymnasium (gym), workshop, and their hygienic assessment:
- microclimate indicators as well as comfortable and admissible (air
temperature, humidity, speed of air movement);
- correction means of microclimate (ventilation, heating);
- insolation of classrooms and methods of its correction.
3.3. Methods of instrumental research basic indicators carried out for
group & games, classrooms, gymnasium (gym), workshop:
- microclimate indicators as well as comfortable and admissible (air
temperature, humidity, speed of air movement);
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- coefficient of natural illumination and light coefficient;
- comfort insolation and orientation of windows in the premises.
1. Standard legislative regulations and hygienic conclusion towards organization
teaching &educational training in the preschool institutions and comprehensive
schools, in accordance with a scenario – based task.
2. Instrumental measurement basic anthropometric indicators in the premises of
group & games, classrooms, gymnasium (gym), workshop (in accordance with
teachers’ instruction and given tasks, item 3.3).
1. What means "early childhood"?
2. What means "dynamic stereotype"?
3. Specify basic hygiene issues of educational training in an early childhood?
4. What means "daily routine"?
5. Which elements of educational training carried out in an early childhood?
6. Specify features of organization teaching &educational training for 6 y.o.
children; school maturity, methods of its determination.
7. Which medical criteria concerned to the definition "school maturity"?
8. Which psychophysiological criteria concerned to the definition "school
maturity"?
9. Enumerate testimony carried out deferral admission to school 6 y.o. chidren.
10. What skills related to a personal hygiene of children?
11. From what age carried out skills of selfcare a child?
12. Specify standard useage various technical training in the classroom.
13. Specify maximum duration of computer games for preschool age children.
14. What changes happened in the modern comprehensive schools?
15. What are the basic principles of hygienic standardization teaching
&educational training?
16. What hygienic requirements carried out for lessons, schedule?
17. What hygienic requirements carried out for breaks, rotation of classes,
holidays, duration of training quarters?
18. What hygienic requirements carried out for technical training in the
classroom?
19. What hygienic requirements carried out for illumination and microclimate in
the group & games, classrooms, gymnasium (gym), workshop?
20. Hygienic estimation to the school furniture in the classroom and workshops.
21. What hygienic requirements carried out for a daily routine as well as
learning activities, leisure time, dreams, etc.?
scenario – based tasks and should write protocol, carried out hygienic estimation
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teaching &educational training and daily routine of children and adolescents in the
preschool institutions and comprehensive schools in the copybook (Appendix).
Student should demonstrate practical assessment carried out by the teacher’s task
(issue 4). At the final part of the practice teacher estimates students educational
activity on the given theme, signed protocols.
School age -is life period when influence of biological factors decreases for a state of health
children and teenagers and increases social factors to which concern a mode and training
organization.
Sensitivity of children's organism to environmental factors is considerably above, than at
adults. The raised temperature and humidity of air, bacterial impurity, increased maintenance of
organic substances, change of ionic structure of air sharply change state of health and mood of
schoolboys.
Therefore, decrease in exhaustion and preservation of health schoolboys are promoted by
rationally made schedule of subject matters, observance of hygienic requirements to the
organization of a mode teaching and educational process.
Hygienic requirements to the organization of teaching and educational process at school
Studying of organization teaching and educational process at school is spent by such criteria:
 quantity of educational changes;
 schedule of lessons;
 duration of occupations, quantity of breaks;
 week academic load;
 duration of educational week, quarter, year.
For a hygienic estimation of the schedule of lessons Grebnjak and Sivkov standards are used.
Leading component of teaching and educational process is the lesson, at which influence of
different environmental factors is considered. Character of classes construction impact to the mental
and physical state of pupils.
Structural unit of educational activity at the comprehensive school is 45 minute lesson.
Mental capacity schoolboys at weekly days are unequal. Level of mental capacity should
increase in the middle of week and should be lowest on Monday and Friday.
Academic load distribution should be highest on Tuesday or Wednesday.
In these days of week (Tuesday, Wednesday) in school schedule should be included the most
difficult subjects.
At the correctly made schedule of lessons the greatest quantity of points by the sum of all
subjects should be on Tuesday and on Wednesday, Thursday is an easy day.
At an arrangement of subjects in the schedule of lessons on Monday (period of working
capacity is lowest), mathematics should not be carry out 4 lessons after physical education. On
Monday difficult disciplines as well as physics, algebra, geometry, which cause high loading in the
beginning of week are not recommended.
Incorrectly made schedule of lessons: on Friday mathematics carried out after physical
education, or coupled lessons of labor, maximum loading was on Thursday, and minimum on
Wednesday, these schedule didn’t abide hygienic recommendations.
Difficult subjects: physics, algebra and geometry at the wrong schedule of lessons carried
out on Wednesday, Thursday and Friday on 5 and 6 lessons. On Friday physical education carried
out on the 1- st lesson.
Scientific researches proved that optimum intellectual capacity of schoolboys should be
carry out from 10 a.m. till 12 a.m.
For preservation of overloading breaks should be carry out between lessons, their duration is
important. According to hygienic recommendations, distribution of breaks for one day is the
following: 10-30-10-10 or 10-20-20-10 minutes.
129
The total sum of time carried out for regulated breaks makes 80 minutes. Reduction of
general time of breaks till 65 minutes is insufficient for enough restoration of working capacity.
Leisure activity during breaks should be carrying out on a fresh air, organization of breaks – on
gymnasium. The best way of leisure activity is outdoor games.
Lacks of organization school-educational process at the modern comprehensive schools:
 on the ground areas of school there is so functional zones: rest zone, educational zone,
gymnasium;
 lessons of physical education, biology, natural sciences should be spent on a fresh air;
 an insufficient sizes of ground areas;
 architecturally-planning decisions of school building mismatch hygienic norms;
 insufficient sizes of educational premises impact on the localization of school furniture and
quality of air in the premises;
 specific area in the premises should be less than 2,0 m2 per one pupil occurs rise temperature
and relative humidity of air that leads to the premature development of exhaustion and
decrease working capacity of pupils;
 parameters of temperature and relative humidity of air in the school exceed specifications in
cold and warm periods of year;
 during cold period of year air temperature in classes should be 24,1-25,0оС, relative
humidity of air - 78,2-88,0 %;
 during warm period of year air temperature in classes should be 22,9-23,3оС, relative
humidity of air - 82,2-85,5 %;
 disadventages of architecturally-planning actions (an insufficient area) and adverse modes of
heating and ventilation in the class premises.
Social adaptation of the child to training at school, concept «school maturity»
Condition of mental health of a child provides its social adaptation at school, influences
on physical, somatic and reproductive health. The raised mental vulnerability of the child at
training at school leads to deterioration of physical health. Relative density of "school-unripe"
children at the age of 6-year-old, functional not ready to training at school, makes 29,5-31,6 %,
that is each three children of ten.
It is proved, that physical development of 6 y.o. children at the different regions of
Ukraine for last 20 years has worsened:
-quantity of children with disharmonious and sharply disharmonious physical
development (from 13,7 to 23,6 %) has increased;
- quantity of children with backlog of biological age from calendar (from 12,2 to
31,2 %) has increased.
Among 1 class pupils 30% practically healthy children are registered, but by the moment of
their leaving school there are no more than 6 %.
Thus, for maintenance of social adaptation of a child for pupils of 1 class’s class and game
rooms, a room for the day dream is equipped.
Hygienic estimation of educational process at school:
 Architecturally-planning decisions of the ground areas, buildings of school and indicators of
microclimate of educational classes for majority of schools don’t correspond to the hygienic
requirements «State sanitary rules and norms on the device, maintenance of general
educational institutions and the organisation of teaching and educational process»
№5.5.2.008-01.
 At the educational institutions infringement of organization teaching and educational
process, irrational schedule of lessons are registered.
 Increase in admissible common weekly loading and insufficient duration of breaks in the
majority of schools carried out.
«State sanitary rules and norms on the device, maintenance of general educational
institutions and the organisation of teaching and educational process» №5.5.2.008-
01
130
1.1.1 1. Major premises equipment
Тable 1.
------------------------------------------------------------------
|Height |Group of furniture, | Classes |
group | their color | |
| | |-----------------------------------|
| | | 1| 2| 3| 4| 5| 6| 7| 8| 9|10|11|12|
|-------+--------------------+--+--+--+--+--+--+--+--+--+--+--+--|
|to 115 |1 orange | +| | | | | | | | | | | |
|-------+--------------------+--+--+--+--+--+--+--+--+--+--+--+--|
|to 130 |2 purple | +| +| +| | | | | | | | | |
|-------+--------------------+--+--+--+--+--+--+--+--+--+--+--+--|
|130-145|3 yellow | | +| +| +| +| +| | | | | | |
|-------+--------------------+--+--+--+--+--+--+--+--+--+--+--+--|
|146-160|4 red | | | | +| +| +| +| +| +| +| +| +|
|-------+--------------------+--+--+--+--+--+--+--+--+--+--+--+--|
|161-175|5 green | | | | | | | +| +| +| +| +| +|
|-------+--------------------+--+--+--+--+--+--+--+--+--+--+--+--|
|175 |6 blue | | | | | | | | | +| +| +| +|
Hygienic assessment of organization training and education at school consists of the major
parts as well as daily routine, school schedule, organization of lessons. Control of school schedule
includes quantity of hours at the classes, duration of lessons, breaks between lessons and sections,
correspondence of classes to the curriculum during school year and week. School year begins on 1 –
st of September and finished on 1 – st of July in all types of comprehensive schools in Ukraine.
School year duration for pupils of the primary school should not be less than 175 working days, for
pupils of general educational establishments II – III level – less than 190 working days. Structure of
school year (by terms, half year, semester, etc.) and duration of school week should detemined by
curriculum.
Data concerning allowable total quantity of hours (lessons) per week are presented in table
2.
Table 2.
1.1.2 Standard quantity of hours (lessons), carried out weekly loading of students
-------------------------------------------------------
|Class Standard total quantity of hours (lessons)at the|
| | structure of curriculum in the comprehensive
schools
| |-----------------------------------------------|
| | 5-days working | 6-days working |
| | week | week |
|-----+-----------------------+-----------------------|
| 1 | 2 | 3 |
|-----+-----------------------+-----------------------|
| 1 | 20,0 | 22,5 |
|-----+-----------------------+-----------------------|
| 2 | 22,0 | 23,0 |
|-----+-----------------------+-----------------------|
| 3 | 23,0 | 24,0 |
|-----+-----------------------+-----------------------|
| 4 | 23,0 | 24,0 |
|-----+-----------------------+-----------------------|
| 5 | 28,0 | 30,0 |
|-----+-----------------------+-----------------------|
| 6 | 31,0 | 32,0 |
|-----+-----------------------+-----------------------|
| 7 | 32,0 | 34,0 |
|-----+-----------------------+-----------------------|
| 8 | 33,0 | 35,0 |
|-----+-----------------------+-----------------------|
| 9 | 33,0 | 36,0 |
|-----+-----------------------+-----------------------|
|10-12| 33,0 | 36,0 |
131
1.1.3 Estimation of lesson schedules, methodology carried out by Hrebniak N.P. and
Mashynistov V.V. (1993). According to this method every subject has a different point
of complexity:
---------------------------------------------
| Subject |Degree of points|
|---------------+----------------|
|Geometry | 6 |
|---------------+----------------|
|Algebra | 5,5 |
|---------------+----------------|
|Foreign language 5,4 |
|---------------+----------------|
|Chemistry | 5,3 |
|---------------+----------------|
|Physics | 5,2 |
|---------------+----------------|
|Biology | 3,6 |
|---------------+----------------|
|Ukrainian language 3,5 |
|---------------+----------------|
|Ukrainian literature 1,7 |
|---------------+----------------|
|History | 1,7 |
Таble 3.
1.1.4 Standard useage of various technical training in the classroom
-------------------------------
|Class| Time- period |
| | (min.) |
| |-----------------------|
| |movies |TV-Programs |
|-----+----------+------------|
| 1-2 | 15-20 | 15 |
| | | |
| 3-4 | 15-20 | 20 |
| | | |
| 5-7 | 20-25 | 20-25 |
| | | |
| 8-12| 25-30 | 25-30 |
| | | |
-------------------------------
State sanitary rules and norms on the device, maintenance of general educational institutions
and the organisation of teaching and educational process №5.5.2.008-01
Rank Scale of difficulty of school subjects after Sivkov
Name of subject Level of difficulty in points
Mathematics, Russian for national schools 11
Foreign languages 10
Physics and chemistry 9
History 8
Native language and literature 7
Geography and biology 6
Physical training 5
Drafting 4
Labor 3
Drawing 2
Singing 1
and the organisation of teaching and educational process №5.5.2.008-01
Rank Scale of difficulty of school subjects after Agarkov
132
Mathematics 8
Russian for national schools 7
Biology 6
Russian literature 5
History 4
Drawing and music 3
Labor 2
Physical training 1
Rank Scale of difficulty of school subjects after Grebeniak
Geometry 6
Algebra 5.5
Foreign languages 5.4
Chemistry 5.3
Physics 5.2
Biology 3.6
Ukrainian language 3.5
Ukrainian literature 1.7
History 1.7
For hygienic estimation of the school schedule Rank Scale of difficulty of school subjects on
days of week in classes is used.
At the correctly made schedule of lessons the greatest number of points in day is necessary
on Tuesday or Wednesday.
For pupils of younger and average school age to distribute week loading is necessary
maximum on Tuesday and Wednesday, but moderately on Thursday.
At the incorrectly made schedule of lessons the greatest number of points in day is necessary
on Monday and Friday, or at the identical score in all working days.
and the organisation of teaching and educational process №5.5.2.008-01 order by Ministry of
Public Health of Ukraine
Height of the bench Differencia
Number of the school sm Number of the school sm
desks desks
VI 31.5 VI 20.5
VII 34.0 VII 22.0
VIII 38.0 VIII 24.0
IX 41.0 IX 27.0
X 44.0 X 29.0
XI 46.5 XI 30.0
XII 48.0 XII 31.0
and the organisation of teaching and educational process №5.5.2.008-01 order by Ministry of
Public Health of Ukraine
Color marks of school furniture
Group of school furniture Pupil’s height Color mark
(ring with D=25 mm or strip
with width 20 mm)
A up to 130 sm yellow
133
B 130-145 sm red
C 145-160 sm blue
D 160-175 sm green
E 175 cm and more white
Marks are put on the back edge of the desk table and back of the chair with such designation:
groups of school desks (numerator) and pupil’s height (denominator), for example:
B___ or D___
131-145 more than 175
Evaluation: School desks are provided only for the equipment of educational premises for I – IV
classes.
State sanitary rules and norms safety of toys and games for children`s health №5.5.6.012-98
order by Ministry of Public Health of Ukraine
1. Toy characteristic
1.1. The name of a toy and its short description.
1.2. The sizes, weight (weight of a toy for children of 3th years should not exceed 100 gram,
for 7th years - is no more 400 gram and for children of 10 years - 800 gram).
1.3. The toy coloring.
1.4. The material (basic and additional), on what parts.
1.5. The form and a design.
1.6. Durability and accuracy of manufacturing.
1.7. Presence of easy branch of small details, prickly, cutting, poorly protected and other
details dangerous for a children's traumatism.
2. Sanitary characteristic of the material
2.1. Impurity of a material (raw materials), use of old breakage.
2.2. Durability of fixing of dye (the paint is located on a surface by an equal layer, rough,
has cambers, cracks, defects of coloring, durability of a film).
2.3. Especial and special sanitary signs.
3. Esthetic and educational characteristic of the toy (develops initial movements and
perception, acquaints children with elements of a science and techniques, promotes art and musical
development of children, displays subjects and samples of an external world).
4. Organoleptic estimation of the toy (level of a smell of toys for children of 3 years - is no
more 1 point, from 3 till 7 years - 2, for 7 years and older - are more than 3 points).
5. Chemical analysis of the toy.
6. Sanitary-and-hygienic estimation and recommendations.
Definition intensity of toys’ smell

Estimation intensity of smell, Hygienic Intensity of smell
degree of points characteristics
1 Smell is absent Notable smell should be
absent
Very weak smell Smell is severe
2 Weak smell Smell is severe, if to
pay attention
3 Notable smell Smell is easily felt and cause
unpleasant sensations
4 Accurate smell Smell pays attention to
everybody and cause
unpleasant sensations
5 Very strong smell Smell is such strong, that
134
causes unpleasant sensations
Hygienic assessment of school textbooks and manuals: sanitary examination of the

polygraphic design of school texbooks and mannuals, i.e. general information about edition,
characteristics of paper (colour, type of surface, showthrough), font (type, height of main strokes,
weight, distance between stokes), composed type (distance between letters and words (aprosh) and
lines (line spacing), line length, margin width, uniformity of type, presence of bolder and italic, type
density), print (definition quality, intensity, evenness and peculiarities of typographic paint) and
external appearance (weight, sizes, format, binding, setting), data of appropriative laboratory
research (wood content of the paper, microbial contamination of textbook, etc.).
135
Hygienic requirements to the printed matter for children №13 order 18.01.2007 year by Ministry of Public Health of Ukraine
School Font set Size of Height of Thickness Thickness Length Edition Format of a Interlines Aproshes Aproshe
textbooks font small of the of of a format, half-axis of between s
letter „n”, basic connecting line, mm a set, mm words, between
mm strokes, strokes, mm mm letters,
mm mm mm
Abc-books Alphabet New 8,0-6,0 1,5 1,2

Journal letters 130 130х172
48, 36 4,5-3,5 0,5 0,5
Basic text Not less
28-20 168х215 2.8 4-11
I class Alphabet 16
Journal 2,8 0,5 0,45
18 0.5
126 126х176
ІІ class School 14 2,5-2,3 0,3 0,15 126
Literary 16
ІІІ-ІУ School 14,12 2,3-2,0 0,3 0,15 126 168х215 126х172 3
Literary 126х176
V- VІІ School 10 1,75 0,25 0,15 113 143х215 113х180 Not less
Literary 143х200 113-167 2.7 2
108 143х200 108-162
VІІІ-Х School 10 1,75-1,7 0,25 0,15 98 128х200 98-162
(ХІ) Literary
Criteria of functional readiness of a child to training at school
Kern – Irasik tesk includes three tasks: 1) draw a man; 2) redraw a short 3 – 4 word phrase;
3) redraw a group of dots. Each task is assessed in points (the best – 1 point, the worst – 5 points).
Sum of the data of performed separate tasks is the general research result.
Kern – Irasik test
First task means that the child has to draw a man without any directions from researcher,
second one – the child copies a short phrase from an example prepared, as well as "He ate the soup"
or "She drank the juice", third one – the child looks at the stencil during 1 minute and then tries to
represent arrangement and number of dots on the sheet of paper. Criteria of general assessment of
test results are the following: good level of readiness to training at school – up to 5 points, normal
level of readiness – 6 – 10 points, low level of readiness – above 11 points.
Hygienic assessment of daily routine
Methods of questionnaire, interview and time – keeping observation are carried out hygienic
assessment daily routine of children and adolescents. During these researches the following
information should be received: presence and duration of the basic daily routine elements as well as
sleeping, education at school, dietary patterns, leisure time and phycal activity, preparing home
classes, household duties, etc. Carried out daily routine, it should be pointed the beginning and
finishing each of daily routine elements, i.e. awakening, etc.
Hygienic principles of the pupil’s leisure time optimization:
 taking into account psychological and physiological peculiarities of an individual organism,
primary formation and development of psychological and physiological functions at the
adolescents age;
 issues of individual, chronological and biological characteristics of the organism;
 increasing mobile activity during leisure time – to optimal hygienic values;
 presence of conceptual model of leisure time (application of the optimal movable activity;
usage of traditional and non – traditional forms of physical training; usage means of
psychological and physiological influence on the pupils organism; providing independent
training at leisure time) and adequate methods of purposive influence on development
process of an individual during out – of – school activity (psychological and physical
training; psychotechnical games; traditional forms of physical education, occupational and
applied physical education; exercises of non-traditional forms of physical education, i.e.
exercises for increasing cerebral circulation, visual, isometric and asymmetric exercises),
etc.
Medical contraindications carried out for 6 y.o. children for readiness to school
І. Disease carried out at the recent year:
- infectious hepatitis;
- pyelonephritis, diffuse glomerulonephritis;
- non-rheumatic myocarditis;
- meningitis epidemic, meningoencephalitis;
- tuberculosis;
- rheumatism in the active phase;
- disease of blood system;
- acute respiratory viral infections (4 or more times per year).
ІІ. Chronic diseases in the sub - and decompensation stage:
- vegetative-vascular dystonia of hypotonic (arterial blood presure 80 millimeters of mercury)
or hypertensive type (arterial blood presure 115 millimeters of mercury);
- heart disease (congenital or rheumatic);
- chronic bronchitis, bronchial asthma, chronic pneumonia (acute or absence of remission per
year);
- peptic ulcer and 12 - duodenal ulcer, chronic gastritis, chronic gastroduodenitis (in the acute
stage, with frequent relapses and partial remission);
- anemia (Hb = 10.7 - 8.0 gram%);
- adenoid vegetation of III degree, chronic adenoids;
- hypertrophy of palatine tonsils III degree;
- tonsillitis chronic (toxico-allergic form);
- endocrinopathies (goiter, diabetes, etc.);
- neurosis (neurasthenia, hysteria, logoneurosis, etc.);
- mental retardation;
- infantile cerebral paralysis;
- trauma of a skull, transferred in the current year;
- epilepsy, epileptic syndrome;
- enuresis;
- eczema, neurodermatitis (common skin lesions);
- progressive myopia (more 2,0 D).
Temporary contraindications, carried out for children with biological evolution below
normal level:
- growth below М - 1 (by local standards of physical development);
- increase in growth over last year (less than 4 cm);
136
- absence of teeth permanent dentition.
Hygienic assessment of organization and carring out lessons in the comprehensive schools
№ Scheduling options Hygienical & rational parameters of schedule
1. Beginning of the classes The best time to start classes 830 - 900 in the first shift.
and their shifts Second shift should beginning in the premises after the 1st
shift in 30-40 minutes after the 1 –st, with previous
ventilation (not less than 15-30 minutes). It is advisable to
start lesson in 2- shift at 1400.
2. Small and large breaks Small breaks should not be less than 10 minutes. The
duration of large breaks is 20-30 minutes. It is better to
have two large breaks 20 minutes, with their location after
2 or 3 lessons.
3. Daily and weekly load of Daily and weekly load should correspond to the admissible
schoolchildren hours in a curriculum. Weekly admissible standard hours
should correspond to the hygienic norms
4. Distribution by classes of Subjects should be located during the day, in accordance
subjects depending on with dynamics of schoolchildren health. Heavier lessons
their complexity should be located in the 1 – 2 classes on 1-3 lessons.
5. Distribution subjects of Subjects should be distributed in accordance with weekly
different complexity dynamics of schoolchildren health. Heavier lessons could
according to the days of be submitted in the days with highest capacity of children.
the week Most high mental capacity of children (I – 2 classes) is
observed on Tuesday and Wednesday - 100%, on Monday
and Thursday - 90-95%, and lowest on Friday (75-80%)
and Saturday (80-85%).
6. Double lessons of the In 1 -2 classes double lessons of the same subject should
same subject be carried out on the schedule whould not recommended,
cause of overloading of students.
7. Place of physical Physical education relieves mental fatigue of pupils and
education and school maintains their efficiency at a stable level. Therefore, these
schedule, daily and items should be placed on Thursday, Friday, or on 3 – 4
weekly lessons.
8. Loading of students in Loading of students in accordance with school schedule
accordance with school should be as follows: Tuesday and Wednesday 4 lessons (1
schedule class) and up to 5 lessons (classes 2-4) with common sum
25-27 points (1 class), up to 29 points (3-4 classes).
Monday - 4 lessons with common sum up to 20 points (1-2
classes) and 22 points (3-4 classes). Thursday - 4 lessons
with common sum 15 - 16 points (1-2 classes) and up to 17
points (4 class). Friday - 4 lessons with common sum up to
18 points (1-2 classes) and 20 points (3-4 classes).
Saturday - 4 lessons with common sum up to 20 points (1
and 2 classes) and up 22 points (3-4 classes).
9. Lightweight of a school In order to carry out optimum dynamics of mental capacity
day during week should be provided lightweight day in a schedule, located
in the middle of week as well as on Thursday. Lightweight
day is carried out by reducing duration of lessons, and by
location two or three easy lessons, in accordance with
hygienic standards.
137
№ Scheduling options Hygienical & rational parameters of schedule
10. Mode of study the first In order to facilitate adaptation 1 class pupils whould be
classes pupils reduce lessons in the first week of the study. The best way
to abide daily routine of children is the following scheme:
1st quarter: 3 lessons for 30 minutes, 2nd quarter: 4
lessons for 30 minutes, 3rd and 4th quarter 4 lessons for 30
minutes.
8. LITERATURE:
8.1. The basic:
8.2. Additional:
Appendix 1
Scenario - based task № 1: "Hygienic estimation organization teaching &educational training
in the preschool institutions and comprehensive schools"
Comprehensive school № 215 schedule is represented in a table. Pupils of 2 class study in
the first shift.
Monday: Tuesday: Wednesday:
1. Reading 1. Reading 1. Music
2. Mathematics 2. Mathematics 2. Reading
3.English language 3. Physical education 3. Ukrainian language
4. Ukrainian language 4. Ukrainian language 4. Mathematics
5. Health bases
Thursday: Friday:
1. Ukrainian language 1. Mathematics
2. English language 2. Reading
3. Mathematics 3. Labour training
4. Physical training 4. Labour training
5. Fine arts
Tasks.
1. Carry out hygienic estimation of schedule for pupils of the second class which study in the
first change at school.
2. Specify etiological factors and-or risk factors for health of pupils of the second class.
4. Recommend hygienic actions for optimization of lessons.
Standard answer.
1. Schedule of lessons at 5- day week is made incorrectly: the greatest loading is on
Thursday, instead of Tuesday and Wednesday (maximum period of working capacity of
schoolboys), the point of difficulty for subjects after Sivkov, Grebeniak, Agarkov is 29.5
on Monday, but 35.5 on Thursday, 28.5 on Tuesday, 30.5 on Wednesday.
138
2. Risk factor for schoolboys is chronic loading, cause of incorrectly made schedule of
lessons.
3. State sanitary rules and norms on the devise, maintenance of general educational
institutions and organization of teaching and educational process № 5.5.2.008-01 order by
4. Reduce duration of lessons in 2 classes till 40 minutes, liquidate coupled lessons. For
preventive maintenance of chronic exhaustion reconsider schedule of lessons: heavy
lessons arrange on Tuesday and Wednesday at 2 and 3 lesson; on Thursday, Monday and
Friday must be easy subjects.

The kindegarden was provided by 5 toys, weight of each toy is 200 gram, length is 30 sm,
their noise level is 40 dB A, power energy is 25 Volt. Toys were made from fabric-fur materials
which easily separated. The toy has an extraneous smell, 1 point. The material caused salivation and
irritation of upper airways.
Tasks.
1. Carry out hygienic estimation of the given toy.
2. Specify etiological factors and-or risk factors for children.
4. Recommend plan of hygienic actions in order to improve quality of toys.
Standard answer.
1. The toy on some parameters mismatches hygienic norms: weight is 200 gram, instead of 100
gram (for 3-6 y.o.); has easily separating details, high level of cry, made from fabric-fur
materials, which course salivation. The toy is not suitable for use of children at the age of 3-
6 years.
2. Risk factors: toys weight is more than in 2 times exceeds norm, that can lead to the child`s
traumas, the toy has easily separating small details, that can injure children (to get to
respiratory ways, an ear).
3. State sanitary rules and norms safety of toys and games for children’s health №5.5.6.012-98.
4. For prevention traumas of children is necessary to decrease weight of toy to 100 gram and
develop details, which are not separate from the toy.

Textbook for second class has such characteristics as well as weight is 410 gram, a smooth
paper, paper of pages is white, sunlight is passes through the paper. The font is not appeared
through the page, the size of font is 16, spaciousness of the font is 6.4 on 18 mm of a line, lengths of
a line is 126 mm, color of paint is black, headings are color, separate strokes of letters are erased by
dry wadded tampon. Quantity of pictures in these textbook is 25%. Quantity of carryings over 6.8
on 1 page.
Tasks.
1. Carry out hygienic estimation of the given textbook.
2. Specify etiological factors and-or risk factors for children.
4. Recommend plan of hygienic actions in order to improve quality of textbook.
Standard answer.
1. Textbook for 2 classes mismatches hygienic norms on such indicators: textbook weight is
410 gram exceeds hygienic norm (300 gram) on 110 grams, i.e. 36%, separate strokes of
letters are erased by dry wadded tampon, quantity of carryings over 6.8 on 1 page, insteade
of standard 3-4 on 1 page.
139
2. Risk factors: textbook weight exceeds admissible more than on 36 %, that with other
textbooks for 1 educational day exceeds 1.5-2 kg (for I-III classes) and leads to the
infringement of bones system.
3. „Hygienic requirements to the printed matter for children” order by Ministry of Public
Health of Ukraine №13 from 18.01.2007 year.
4. For preventive maintenance of infringements of bones system lower weight of the textbook
for 2 classes to standard for this age - 300 gram.
Theme of independent out-of-class work № 4. Hygienic principles of rational

organisation physical education and labour training at the children and
adolescents. Scientific bases carrying out of medical-professional consultation.
1. PURPOSE: research methods of hygienic control lesson of physical education and
labor at school; provide technique of determining suitability of adolescents; research
methods of medical-professional consultation, proffesional orientation of schoolboys.
2.1.1. Hygienic requirements towards organization lessons of physical
education.
2.1.2. Methods of research body functionality, their reaction to different
standards of physical education, hardening factors.
2.1.3. Basic organizational forms of labor training and education of children and
adolescents.
2.1.4. Main legislative standard documents on the organization and
implementation labor education and training of children and adolescents.
2.1.5. Objectives of vocational guidance, medical consultations and professional
selection of adolescents, psychological, anatomical and physiological characteristics
of the teenagers’ organism's reaction as well as impact of occupational factors.
2.1.6. Legislative framework, guidance and national documents on labor
protection and medical examination of adolescents.
2.2.1. Carry out control for sanitary conditions premises of a gymnasium, sports
equipment, inventory, medical observation of children in order to carry out them into
groups of physical education.
2.2.2. Carry out current sanitary supervision for regime and conditions of labour
training at the children and adolescents, appoint sanitary conclusion according to the
results of sanitary supervision research, and recommend hygienic measures on
optimization lessons of labor training.
2.2.3. Carry out sanitary characteristics professions, recommended for teenagers
as well as in the industrial enterprised, which are served by sanitary &
epidemiological station.
2.2.4. Apoint a standard list of medical contraindications carried out for hiring or
training of adolescents with different deviations of health (according to the data of
clinical examination).
2.2.5. Implement professional selection and prediction successful professional
activity of students.
140
3.1. Basic principles of physical education training. Types, means and forms of
physical education in the modern educational institutions.
3.2. Hygienic estimation premises of physical education in the pre-school
establishments and school.
3.3. Hygienic requerements to the physical education training.
3.4. Medical supervision, carried out organization of physical education and
hygiene aspects of medical support physical education of children and adolescents.
3.5. Physiological-hygienic issues of control over labor training at the children
and adolescents.
3.6. Professional orientation as main hygienic problem.
3.7. Providing medical professional selection and medical professional
counseling of adolescents.
3.8. Scientifical basis of medical-professional consultation. Concept
"proffesional orientation".
Carrieng out-of-class work teacher pays attention of students to the methods of
organization lessons of physical education and labor training, including catering
services in children's collectives. Students work independently. Self – Stude Material
carried out by the questions for self-preparation (issue 3). Students get acquainted
with Standard legislative regulations at the given theme. Students should estimate
physical education and labour training in the comprehensive schools and pre – school
establishments, in accordance with scenario – based tasks and should write protocol
in the copybook (Appendix). Teacher should control out-of-class activity of students
in the final modular control.
5. LITERATURE:
5.1. The basic:
5.2. Additional:
Appendix 1
Scenario - based task № 1: "Hygienic principles of rational organisation physical culture and
labour training at the children and adolescents. Scientific bases of carrying out medical-
professional consultation"
Дать гигиеническую оценку режима дня для школьника 5-го класса, который учится в
I смену общеобразовательной школы:
Carry out hygienic estimation daily routine 5 – class pupil, carried out lessons in the
comprehensive school on I shift:
1. Awakening 700
2. Breakfast 700-730
3. Road to school 730-830
141
4. Lessons at school 830-1330
5. Extracurricular activity 1330-1430
6. Road from school 1430-1500
7. Lunch 1500-1530
8. Preparation of homework 1530-1830
9. Watching television 1830-2000
10. Supper 2000-2030
11. Preparation befor before falling asleep 2030-2200
12. Sleeping 2200-700
Tasks:
1. What allowed quantity of hours should be carried out for night sleep of 5 class pupils (Appendix
2)
2. How many lessons carried out in 5 classes, according to SSR&N 5.5.2.008-01?
3. How many hours should be provided for extracurricular activities, according to hygienic
requirements (Appendix 2)?
4. How many hours should be carried out for preparation of homework in 5 classes, according to
SSR&N 5.5.2.008-01?
5. How many hours should be carried out for watching television in 5 classes, according to SSR&N
5.5.2.008-01?
6. Which elements of daily routine are absent in the given daily routine (Appendix 2)?
Standard answer.
Quantity of hours, carried out for sleep at night in 5 classes should be 9 hours. According to
SSR&N 5.5.2.008-01 sleep of a pupil in a daily routine takes 10 hours, i.e. child of this class had
not enough sleeping in 1 hour less than recommended, which leads to the fatigue and exhaustion.
In the 5 class quantity of lessons shouldn’t correspond to SSR&N 5.5.2.008-01.
Extracurricular activities (1 hour) correspond to SSR&N 5.5.2.008-01 (Appendix 2). Preparation of
homework should take 2 hours. In the given task 5 class pupil watched TV program 1.5 hours per
day, moreover, pupil shows TV programs before dinner, before falling asleep.
In accordance with SSR&N 5.5.2.008-01, 5 classes schoolchildren chould watch TV 25
minutes per day. Infringement of timetable promotes fatigue of schoolboy, night's sleep chould not
be deep, restless, which leads to the fatigue and exhaustion.
Disadventages of the daily routine of 5 class’s children are the following:
a) in the given timetable was absent such element as a school breakfast (second breakfast);
b) after lunch leisure time in a fresh air (walking) was absent, which promote good health of
choolchildren. This element needs for optimal level of physiological functions and health, in order
to prevent ultraviolet failure. Stay outdoors in a daytime affects phosphorus-calcium metabolism.
c) absence of a key element of daily routine as well as self-service – 2 hours per day
(Appendix 2).
Scenario - based task № 2: "Hygienic principles of rational organisation physical culture and
labour training at the children and adolescents. Scientific bases of carrying out medical-
professional consultation"
A 16 y.o. girl, after graduating 9 class of a comprehensive school, gets a job in the building
company as a plasterer pupil. During medical examination was revealed: complaints on the health
were absent. Objectively: body length 166 cm, weight – 51 kg, chest circumference 76 cm, formula
of puberty development Ах2Р2М22Ме correspond to 14 years old girl. Functional characteristics:
dynamometry of a right hand – 22 kg, left - 21kg; vital capacity of lungs - 2500 ml. Skin is clean,
pale pink, pharynx is pure, multiple palpable cervical and submandibular lymph nodes.
In the lungs was percutere pulmonary sound, vesicular breathing. Borders of the heart: left -
1.5 cm on the left side, in a middle line, right – 0.5 cm on the right side, in a sternum, upper – II
intercostal space. Muffled heart sounds, systolic murmur at the apex and Botkin area. The heart rate
142
was 78 beats/min, rhythmic. Arterial blood presure - 110/60 millimeters of mercury. The abdomen
is soft. Liver shouldn’t palpate from the ribs, painless on palpation.
Lab analysis of blood: erythrocytes – 3.0 × 1012/liter, hemoglobin - 105 gram/liter, colour
index – 0.7, leukocyte - 7.5× 109/liter, erythrocyte sedimentation rate - 15 mm/hour. Urine analysis:
pathological changes shouldn’t reveal. ECG: sinus rhythm, right, a slightly lower spike T. Chest x-
ray: mitral configuration of the heart. Anamnesis: over last year carried out respiratory disease 3
times, moved varicella and at 12 y.o. was suffered from rheumatism in the active phase, after which
was formed mitral valve insufficiency; in 13 y.o. underwent surgery of chronic tonsillitis, 3 years
takes anti-relapse treatment; at 15 y.o was removed from dispensary observation.
Tasks:
1. Estimate professional suitability of children.
2. Specify etiological factors or/and risk factors for health.
3. Determine necessary standard document, and carry out hygienic estimation.
4. Provide program towards consultation activity for children.
Standard answer.
For hygienic assessment of a given task carried out "Guidelines for comprehensive health
assessment children and adolescents at the collective medical examinations". At this period a girl
couldnt work as a plasterer pupil in the building company. The girl needs a complex examination,
which includes an electrocardiogram and ultrasound examination heart muscle, examination of
lymph nodes, their biopsy. Consultation of specialist, hematologist and cardiologist is primary
importance. Etiological factors and risk factors for pupils’ health are the following: a) hypothermia;
b) physical activity; c) drafts.
The future profession of schoolchildren should be answered by anatomical and physiological
peculiarities of his body, it’s necessary to carry out all activities in order to correct definition of
professional suitability. These issues are addressed by conducting orientation and medical
professional advice. Teachers should systematically carry out professional orientation with each
child and with whole classes.
143
Appendix 2
Daily routine of schoolchildren
Hours
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
1
Classes
6
10
11
Lessons at school Extracurricular activity Self-service
Preparation of homework Working on a fresh air

Sleeping
Substantial module 5. Radiation hygiene.
Concrete purposes:
 Know basis and biological action sources of ionising radiation, its use in
medicine, science, power and other areas.
 Give hygienic conclusions concerning the radiating control on working
conditions with closed and open sources of ionising radiation and protection
against its adverse action by legislative, organizational methods and the
techniques based on physical laws of an indulgence of radiations.
 Estimate actions of radiation protection of the personnel and radiating safety of
patients in the radiological divisions of medical institutions.
Тheme № 12. Laws of formation irradiation loading of a person in the

residential apartments, its hygienic estimation and issues to decrease. Radiation
danger and antiradiation protection on the objects with radiation-nuclear
technologies.
1. PURPOSE: propose actions focused on minimisation level of the population
irradiation from ionising radiation, based on a quantitative estimation possible
radiating impact.
2.1.1. Physical characteristic and sources of ionising radiation.
2.1.2. Biological action of ionising radiation and conditions, on which it
depends.
2.1.3. Concepts towards «absorbed dose», «absorbed in an air dose»,
«equivalent dose», «capacity of equivalent dose».
2.1.4. Features of formation and preventive maintenance of adverse action
radiating loading on the population at carrying out of radiological procedures.
2.2.1. Carry out measurements capacity of an equivalent dose of gamma
radiation in accordance with dosimeter RKSB-104.
2.2.2. Carry out hygienic estimation capacity of an absorbed dose, absorbed in
air dose, equivalent dose, by the scenario – based task.
3.1. Concept of radio-activity. Hygienic characteristic sources of an environmental
contamination by radioactive substances.
3.2. Basic characteristics and units of ionising radiation.
3.3. Types of radiating impact (external and internal irradiation) of an organism;
conditions of their occurrence.
3.4. Characteristic of biological action of ionising radiation. Classification of clinical
effects of their damage action on a human body (stochastic, non-stochastic) and
conditions of their occurrence.
3.5. Methods and means of protection against an external irradiation, based on
physical laws (protection by quantity, time, distance, shielding).
3.6. Principles of hygienic regulation radiation safety in accordance with Radiation
Safety Standard of Ukraine -97 (RSSU-97).
4.1. Standard legislative regulations carried out hygienic assessment of radiation
safety residential environment, by the data of the scenario – based tasks.
4.2. Instrumental methods of determining equivalent dose at the assessment radiation
characteristics of building materials, residential environment, foodstaff and drinking
water.
4.3. Instrumental methods of determining effective dose.
1. Concept and origin of radioactivity. Specify activity unit in the International Units
System (IUS).
2. Enumerate types of nuclear transformations and characterize them?
3. Which types of radiation sources do you know? Provide their comparative
description.
4. Enumerate qualitative and quantitative characteristics of ionizing radiation?
5. Specify ways of interaction towards ionizing radiation and substances?
6. Define terms "absorbed dose", "exposure dose". Specify their values in IUS units.
7. What means equivalent and effective dose? Specify their links to each other?
8. What types of irradiation of a body do you know?
9. Specify types of radiation effects of a human body? Give examples.
10. Which control parameters carried out for assessment effectiveness of ventilation?
11. Which sanitary legislation provides system of the radiation-hygienic regulations?
12. How many groups of radiation-hygienic regulations do you know? Specify their
characteristics.
13. Which categories of persons are determined by RSSU-97? Enumerate limits of
effective doses for each category.
14. Carry out comparative characteristic towards practical assignments, their
procedure.
15. On which main principles based antiradiation protection towards practical
assignment.
16. In which case an individual monitoring is required?
17. Which limitations carried out irradiation of pregnant women and women at the
reproductive age, classified to category A, according to RSSU-97?
get acquainted with Standard legislative regulations on the given theme. Then
students receive scenario – based tasks and should write protocol carried out
hygienic assessment towards radiation safety of residential environment, in the
copybook (Appendix). Student should demonstrate practical assessment selectively
carried out by the teacher’s task one of the given factors of residential environment
146
Radioactivity - spontaneous transformation of the atomic nuclei of chemical elements with
change in their chemical nature or energy state of the nucleus, which is accompanied by nuclear
radiation.
Quantitative measure of radioactive decay - activity (A) - amount of decays per unit of a
time. Unit activity in IUS system - becquerel (Bq) - one decay per second.
Ionizing radiation is carried out qualitatively by:
- type of radiation: - corpuscular (α, β, n0), electromagnetic (γ, x);
- radiation energy measured in dzoules (Dz);
- penetrating ability (length of run) - distance, which takes place in an environment;
- ionizing - amount of ion pairs that are formed along the length of run.
Quantitative characteristics of ionizing radiation are doses:
Absorbed dose - amount of ionizing radiation energy, absorbed by unit mass of irradiated
environment. The unit of absorbed dose – Gray.
Absorbed dose in the air - measure of an amount of ionizing radiation, which is absorbed by
air. Recent notion of ionizing dose in the air - an exposure dose, which refers the density of air
ionization. The unit is X-ray exposure dose (X-ray).
Equivalent dose (H) - any type of dose ionizing radiation which causes biological effect as a
standard (reference) X-ray radiation with energy of 200 keV.
In order to calculate an equivalent dose of radiation significant factor should be taking into
account relative biological effectiveness different types of ionizing radiation Unit of dose equivalent
is Sivert (Sv).
Effective dose - sum of equivalent doses, received by individual organs and tissues with
non-uniform irradiation of a body, multiplied by the tissue narrowing factors:
Values of significant factors of tissue (wT)
Tissue or organ wT
Gonads 0,20
Red bone marrow, colon, lung, stomach 0,12
Bladder, mammary glands, liver, esophagus, thyroid 0,05
Skin surface of the bone 0,01
Other organs 0,05
Exposure - exposure of humans to ionizing radiation from sources, outside the body
(external radiation), carried out from sources inside the body (internal radiation).
Radiation effects of human exposure
deterministic stochastic
genetic somatic-stochastic
Deterministic effects (non stochastic) - effects of radiation exposure, depends on the

received dose (acute and chronic radiation sickness, local radiation injuries).
Stochastic effects – non – deterministic effects any dose of ionizing radiation, provide
severity of manifestations carried out an exposure dose.
Genetic effects: dominant and recessive gene mutations, chromosomal aberrations.
Somato-stochastic effects: decline of life expectancy, increasing general morbidity,
malignant neoplasms.
RSSU-97 is the main national standard document, carried out system of radiation-hygienic
regulations in order to ensure acceptable levels of exposure both an individual and society at whole.
Purpose of RSSU-97 is the basic requirements as the following:
• protection of human health from possible hazard as well as result of the exposure ionizing
radiation sources;
• safety appointment of the ionizing radiation sources;
• environmental protection.
147
RSSU-97 provides two fundamentally different issues in order to radiation protection:
• For all types of practice assignment towards normal values of the industrial and medical
sources of ionizing radiation;
• While intervention, associated with accidental exposure of population, as well as chronic
exposure due to technologically-enhanced naturally occurring sources.
Practical assignment carried out the following issues: production of radiation sources,
using of radiation sources and radioactive substances in medical research, industry, agriculture, etc.,
production of nuclear energy, i.e. fuel and energy cycle elements, storage and transport of ionizing
radiation sources. Radiation safety and antiradiation protection towards practical assignment should
carry out the following basic principles:
1 Principle of justification: any practical activity, followed by exposure of people, shouldn’t
carry out unless its great benefit irradiated individuals or society, compared with its hazard;
2 Principle of limitation: levels of exposure all significant types of practices should not
exceed established limits of doses.
3 Principle of optimization: levels of individual doses or amount of exposed individuals in
order to each source of radiation should be achieved in the lowest level, taking into account
economic and social factors. Intervention - type of human activity, aimed by reducing and
preventing an uncontrolled and unpredictable exposure and significant exposure in the emergency
exposure situations (acute, short-term or chronic) and chronic exposure carried out from hand –
made sources of natural origin.
RSSU-97 includes four groups of radiation-hygienic regulations:
First group - regulations in order to control practical activities, a key purpose focused on the
control irradiation level of a staff and population, as well as maintaining an acceptable radiation
environment and technology of radiation-nuclear facilities. This group includes limits of doses.
Second group – sanitary regulations, aimed at limiting of the human exposure from medical
sources.
Third group – sanitary regulations, focused on intervention doses of irradiation in the
radiation accident.
Fourth group – sanitary regulations, focused on intervention doses of irradiation in the
technologically-enhanced natural occurring sources.
Radiation Safety Standards established the following categories of irradiated people:
Category A (staff) – persons, which are permanently or temporarily working with the
sources of ionizing radiation (effective dose limit LDE 20 mSv / year).
Category B (staff) – persons, which should not directly engaged in a work with the sources
of ionizing radiation, could be additional irradiated because of their workplaces location in the
premises and industrial sites facilities, provided radiation-nuclear technologies (2 mSv / year).
Category C – whole population (1 mSv / year).
Individual monitoring in specific amounts for each case should be applied for individuals
with annual effective dose over 10mZv/year.
According to issue 5.6., RSSU-97 carried out limitation for irradiation pregnant women and
women of reproductive age, concerned to the category A: average equivalent dose of external local
irradiation any of two recent months should not exceed 1 mSv. In this case, LDE should not exceed
2 mSv towards the whole period of pregnancy.
Evaluation of radiation protection would be carried out as well as the following ways:
1 Definition case of a human body irradiation with ionizing radiation
2 Specify groups of radiation-hygienic regulations (RSSU-97)
3 Definition categories of the irradiated persons.
4 Enumerate indicators of the given radiation case (indicators, carried out state an
environment and (or) LDE of an irradiated person.
5 Carry out hygienic conclusion towards LDE of an irradiated person.
148
8. LITERATURE:
8.1. The basic:
8.2. Additional:
8.2.1. Law of Ukraine "Protection of population towards ionizing radiation".
8.2.2. Radiation Safety Standards of Ukraine (RSSU-97). – Order MHU №62 from
01.12.1997.
8.2.3. Common Sanitary Rules of Radiation Safety of Ukraine. – Order MHU from
02.02.2005.
8.2.4. State hygienic specification – 97 "Admissible level of maintenance
radioisotopes Cs137 and Sr90 in the foodstuff and potable water". – Kyiv, 1997.
Appendix 1
Instruction
towards measurement an absorbed dose of gamma radiation in the air by dosimeter RCSB-
104
Radiometer RKSB-105 provide in order to measure an equivalent dose of gamma radiation
(H) from 0.001 to 99 mcSv / hour and carried out calculation of the flux density and specific
activity. In order to carry out level of absorbed dose gamma radiation in the air in the premises, you
should primary switch radiometer (upper left button) in the top position; correspond to value "x
0.01". Installing range and mode, you should taking radiometer by the hand and moving a black
switch to the issue "on". Secondly, on a scoreboard display four numbers "0 0 0 0" carried out.
Finaly, while listen to the intermittent beep sounds, you should record a final result, as well as "17 0
0" in a scoreboard. Carry out conclusion, you should specify, that in the given case an absorbed
dose of gamma radiation – 0.017 mcSv / hour. Radiometer keeps data of measurement 10 seconds,
when automatically starts working. Data of research should compare with their standard permissible
levels, according to RSSU-97.
Appendix 2
Admissible level of maintenance radioisotopes Cs and Sr in the foodstuff and potable
137 90
water
(State hygienic specification)
Values of admissible levels radioisotopes Cs137 and Sr90 in the foodstuff and potable water
(Bk/kg, Bk/l)
№ Name of the foodstuff Cs137 Sr90
1. Bread, bakeries 20 5
2. Potato 60 20
3. Vegetables (sheet, root crops, greens) 40 20
4. Fruit 70 10
5. Meat and meat products 200 20
6. Fish and fish products 150 35
7. Milk and dairy products 100 20
8. Eggs 6 2
9. Water 2 2
10. Milk condensed and concentrated 300 60
11. Milk dry 500 100
12. Fresh wild-growing mushrooms and berries 500 50
13. Dried up wild-growing mushrooms and berries 2500 250
14. Herbs 600 200
149
15. Other products 600 200
16. Special products of a children's food 40 5
Appendix 3
Scenario – based task № 1: "Laws of formation irradiation loading of a person in the
residential apartments, its hygienic estimation and issues to decrease. Radiation danger and
antiradiation protection on the objects with radiation-nuclear technologies"
On the basis of Law of Ukraine «About status and social protection of victims owing to
Chernobyl accident citizens» in one of settlments radioisotopes Сaesium-137, Strontium-90
research of milk and potato from local manufacturing is carry out. Following results are received:
level of activity caesium-137 in the milk made 315 Bk/kg, in the potato - 98 Bk/kg; level of activity
of strontium-90 in the milk made 62 Bk/kg, in the potato - 51 Bk/kg.
Tasks.
1. Find necessary specifications and technical documentation for a hygienic estimation of the
situation.
2. Carry out hygienic estimation and make hygienic conclusion about conformity results of
measurement of activity caesium-137, strontium-90 to admissible levels and suitability of
products to the use.
Standard answer.
1. Admissible level of maintenance radioisotopes 137Cs and 90Sr in the foodstuff and potable
water (State hygienic specification).
2. Level of activity caesium-137 in the milk exceeds admissible in 3.15 times (admissible level
is 100 Bk/l, in the potato exceeds admissible in 1.6 times (admissible level is 60 Bk/kg); level of
activity of strontium-90 in the milk exceeds admissible in 3.1 times (admissible level is 20 Bk/l,
in the potato exceeds admissible in 2.5 times (admissible level is 20 Bk/kg).
Тheme № 13. Hygienic estimation of antiradiation protection medical staff and

radiating safety of patients at the radioactive substances application and other
sources of ionizing radiation in the health care facilities.
1.PURPOSE: propose radiation actions at applying sources of ionising radiation in
the health care facilities in order to estimate possible radiating impact on the staff and
patients organism.
2.1.1. Ways of application sources of ionising radiation in the health care
facilities with diagnostic and treatment purposes.
2.1.2. Issues of radiation risks during working with ionising radiation and other
sources of irradiation in the health care facilities.
2.2.1. Measure and estimate parameters, which characterise radiation situation in
the workplaces and other premises and individual doses irradiational staff during
working with sources of an ionising radiation.
2.2.2. Carry out determination of permissible parameters irradiated patients with
diagnostic and treatment purposes.
3.1. Types of ionizing radiation, their useage for practical assignment.
3.2 Features of radiation risks and radiation protection (X-ray research, diagnostics
with applying radiation therapy) in the structural departments of health care facilities.
150
3.3 Characteristic of X-ray radiation hazard for diagnostic research and conditions on
which it depends. Requirements carried out planning and sanitary equipment of X-
ray.
3.4 Methods and means of radiation control. Ways of reducing radiation exposure of
the staff and patients, carried out in the health care facilities.
4.1. Standard legislative regulations carried out hygienic assessment antiradiation
measures applying ionizing radiation sources in the health care facilities, by the data
of scenario – based tasks.
4.2. Estimation of individual exposure patients and medical staff in order to provide
further treatment, diagnostic or rehabilitation actions (by individual task of the
teacher).
1. What means medical exposure and which principles of radiation protection?
2. What actions (procedures) should contain medical exposure and which sources of
radioactivity cause irradiation of a particular person?
3. Which categories of population could be exposed to radiation in the
implementation of medical practice?
4. What means "recommended exposure levels (regulations of the second group)" and
who carried out them?
5. Which categories of patients carried out during radiological procedures?
6. Which "recommended limit of medical exposure" established by Ministry of
Health of Ukraine for various categories of patients?
7. What are the limits of medical exposures carried out for routine patients,
volunteers?
8. Which limits of medical exposures apply for pregnant women?
9. To which categories of irradiation concern medical staff of the radiological and X
– ray departments in the health care facilities, specify LDE for these categories?
10. What means "reference levels" and how they correspond to LDE of a human
person?
11. What means "individual monitoring" and to which categories of staff should they
apply?
12. Specify, how to carry out measurement, recording and keeping results of research
an individual monitoring medical staff, irradiated from external sources of radiation?
13. Which dangerous and harmful factors impact on a medical staff (category A) of X
–ray premises?
14. Specify requirements to X – ray departments planning in the residential
apartments, polyclinics, medical care facilities.
15. Which set of premises should include X-ray department, specife requirements for
their interior decoration?
16. Which requirements carried out to parameters of microclimate and ventilation
system?
17. What rules should be followed while placing in the health care facilities X-ray
tube?
151
18. What groups of radiation protection measures applied in X-ray department,
enumerate them?
19. What means radiation control, its types in health care facilities?
20. Specify control toward medical staff health, working in X-ray departments before
and at the process of work.
21. Which basic requirements provide for the patients and population radiation
safety?
get acquainted with Standard legislative regulations on the given theme. Then
students receive scenario – based tasks and should write protocol carried out
hygienic assessment towards radiation safety of residential environment, in the
copybook (Appendix). Student should demonstrate practical assessment selectively
carried out by the teacher’s task one of the given factors of residential environment
Medical exposure carried out at the result of medical examination, investigation or
treatment. Medical exposure should be associated with such activities:
- X-ray preventive examinations;
- X-ray screening;
- X-ray diagnostic research;
- Diagnosis research applying radiopharmaceuticals drugs;
- Radiation therapy;
- Irradiation for research purposes.
Radiation protection at the medical exposure bases on the following principles:
- Irradiation should be reasonable and designed by doctor in order to achieve useful
diagnostic and therapeutic effects which could not be obtained by other methods of diagnosis and
treatment (principle of justification);
- Collective dose applied population carring out X-ray and radiological procedures, should
be as low as possible taking into account economic and social factors (principle of optimization);
- Amount of radiation dose carried out by physician individually for each patient, based on
clinical indications, in order to prevent occurrence of deterministic effects in healthy tissues and the
whole body (principle of limitation).
Category of irradiated population at the medical practice such as the following:
- Medical staff (categories A and B);
- Patients (patients - category C).
Dose limits for medical irradiation purposes shouldn’t determined, therefore a certain
radiological or radiological procedure carry out by the doctor’s medical indications as well as
recommended levels of medical exposure, which was established by Ministry of Health of Ukraine
Order.
Category AD:
- Patients, which were diagnosed with cancer, or precancerous diseases;
- Patients carried out differential diagnosis of congenital cardiovascular disease and vascular
congenital malformations;
152
- Persons carried out examination in emergency practice (i.e. trauma) by vital indicators.
Recommended limits of irradiation (effective dose) - 100 mSv / year.
Category BD:
- Patients whose investigation is carried out according to clinical indications towards somatic
(non-cancer) diseases, in order to clarify diagnosis and / or choice of treatment.
Category CD:
- Patients from risk – group, i.e. worker staff, enterprises working with harmful and danger
occupational factors during routine medical examinations;
- Patients after surgical treatment oncological diseases, during routine medical
examinations.
Category DD:
- Persons who are all kinds of preventive examinations;
- Persons who are examined in health programs recommended limits for exposure (effective
dose) - 1 mSv / year.
Placement of X-ray equipment should be carried out so that primary radiation flux was
directed towards main wall, behind which located premises for permanent residence of the staff and
patients. Direct stream of radiation shouldn’t send in the direction of control premises window.
While X – ray premises situated on the first floor, the distance between residential and office
apartments should be less than 30 meters, windows of procedural premises would be shielded with
protective shutters 2 m height above the floor.
Stationary radiation protection equipment of X-ray department (walls, floor, ceiling,
security doors, viewing windows, shutters, etc.) should provide attenuation of X-rays irradiation to
limit doses (LD) for categories of irradiated persons.
Calculation of radiation protection is determined by multiplicity fixed means of weakening
X-ray radiation dose rate at the given point of the premises to permissible dose, carried out in an
absorbed dose unit. On the basis of calculated values, should be determining appropriate lead
equivalent elements appointed for the protection means. Major construction and special protective
materials have their own protective characteristics (lead equivalents) corresponding to the sanitary
rules. Towards fixed protection could be used any building materials, with necessary structural and
protective characteristics and relevant environmental and sanitary requirements.
Mobile radiation protection equipment:
- Large protective screen for staff with window (one, two, three-sided), carried out in order
to protect whole body in a standing position;
- Small protective screen, carried out in order to protect lower part of the body in a sitting
position;
- Small protective screen, carried out in order to protect lower part of a body;
- Swivel protective screen, carried out in order to protect individual organs of a patient
standing, sitting and lying.
Personal radiation protection means: protective cap, goggles, collars, capes, aprons and
skirts of various lengths, vests, and plates in order to protect both male and female gonads.
Effectiveness of protection mobile and personal radiation protects means towards staff and
patients, expressed in a value of lead equivalent, shouldn’t be less than sanitary rules values. All
remedies should have stamps or labels, indicating their lead equivalent and date of inspection. All
personal protective equipment, containing lead, should be shrouded, and mobile - coated with paint
in order to prevent lead contamination of an environment and human body.
Radiation control (RC) is carried out at the daily activity of X-ray premises, as well as the
following types:
- Periodic;
- Current;
153
- Unscheduled (emergency).
Periodic RC is carried out by the regional health care facilities X – ray departments and
SES, and should be held not less than 1 time per 2 years.
Current RC includes:
- Control doses of irradiation workplaces of the staff, in the premises and territory of
neighboring premises;
- Individual irradiation monitoring of the staff, patients and those, who periodically involved
in the special radiological examinations (surgeons, anesthesiologists, etc.).
In order to work with X-ray equipment should allowed 18 y.o. persons with a document
towards training, coaching and recent examination, in accordance with radiation safety rules.
Manager of health care facility should organize a preliminary (at employment) and routine periodic
medical examinations staff, which concerned to category A, and those persons who didn’t have
medical contraindications.
Carring out numerous medical contraindications towards working with X – ray equipment,
whould be a serious reason for temporary or permanent transfer these persons to another working
condition without contact with irradiation, i.e. separately carried out for each case individually.
For pregnant employees manager of health care facility should create necessary conditions
in order to prevent irradiation exposure.
Basic requirements carried out irradiation protection of the patients and population:
1 Radiological procedure should be provided by specialist as well as reasonable clinical
indications.
2 Patients should be covered with complete information towards expected or received doses
and possible consequences.
3 Patient has right to refuse from medical X-ray examinations, except preventive purposes,
carried out for identification of infectious diseases.
4 Doctor – radiologist is responsible for X-ray examination, provided final conclusion
towards type of examination, its justification.
5 Radiologist has the right to refuse a patient towards X-ray examination, if last one
shouldn’t background (absence of diagnosis, numerous medical contraindications, etc.), therefore,
doctor whould fix his motivation in the medical case history of the given patient (medical
sertificate).
6 Radiologist should register a value of individual effective dose in an ambulatory patient
card.
7 While cumulative dose of diagnostic irradiation of the patient whould be over 100 mSv, it
is necessary to limit irradiation and carried out patient to the medical examination.
8. LITERATURE:
8.1. The basic:
8.2. Additional:
01.12.1997.
8.2.3. Common Sanitary Rules of Radiation Safety of Ukraine. – Order MHU from
02.02.2005.
Appendix 1
Scheme of sanitary inspection radiological department in the health care facilities
1. Name and the hospital address, office placing (the case, floor, adjacent premises).
154
2. Presence and condition of conducting documentation (magazine of dosimetry, instruction,
etc.).
3. Office planning (premises, their squares).
4. Type of X-ray device, pressure and force in a current X - ray tube.
5. Appointment of X-ray device (diagnostic, therapeutic, fluorographic). Worker bunch is
motionless, unidirectional.
6. Presence and ventilation type in procedural, top and bottom exhaust channels. Natural and
artificial illumination.
7. Protection means X-ray irradiation of the doctor-radiologist workplaces (protective screens,
lead glass, walls, doors, windows, individual protection frames). Calculation efficiency of
their protection.
8. Presence and type of X-ray dosimeters, individual dosimeters, check of devices.
Appendix 2
Scenario – based task: "Hygienic estimation of antiradiation protection medical staff and
radiating safety of patients at the radioactive substances application and other sources of
ionizing radiation in the health care facilities"
In radiological department of hospital at the operation room of computer tomography, which
was the source of X-ray and gamma radiations, with increase of level of ionizing radiation in the
working zone of the personnel has been established. The radiologist has received an annual
individual equivalent dose of the irradiation at level of 50 mZv.
1. Find necessary specifications and technical documentation for a hygienic estimation of the
situation.
2. Carry out hygienic estimation and give hygienic conclusion about conformity of the
irradiation to admissible levels. For a hygienic estimation find the basic dose border for a
year of individual irradiation, established for the given category of irradiated persons.
3. Specify limit of an effective dose for a year for category A (persons who constantly or
temporarily work with the sources of ionising irradiations) according to Radiation Safety
Standard of Ukraine (RSSU-97).
Standard answer.
1. Individual equivalent dose received by doctor-radiologist, work with closed sources of γ -
and Х- ray radiation exceeds an annual limit of dose for category A (personnel directly
contacting to radioactive sources) in 2.5 times ( standard is not more than 20 mSv/year).
2. Risk factors for health of doctor-radiologist are: increase of stochastic effects, including
malignant diseases of the irradiated bodies; immunity defects that promotes occurrence of
infectious and somatic diseases.
3. Radiation Safety Standard of Ukraine (RSSU-97).
4. Strengthening of individual radiation control behind radiation sources; reduction of
operating time with ionising radiation sources; protection in distance; use of filters
(materials containing lead) for separate parts and all body of the doctor at carrying out of
procedures.
5. Individual equivalent dose received by doctor-radiologist for category A (personnel
directly contacting to radioactive sources) exceeds standard limits in 2.5 times.
Theme of independent out-of-class work № 5. Hygienic aspects of residing

population in the territories with high radioactive pollution levels as a result of
Chernobyl accident.
1. PURPOSE: research system of actions in order to prevent infringements of
population health, inhabitants of the high radioactive pollution levels territories, as a
result of Chernobyl disaster.
155
2.1.1. Characteristic of radiation hazards in the territories, contaminated after
Chernobyl nuclear disaster.
2.1.2. Theoretical background prevention harmful effects, carried out from the
sources of external and internal exposure population, living in the contaminated
territories.
2.2.1. Carry out preventive actions in order to restrict harmful impact of an ionising
radiation on the population in the contaminated territories, after Chernobyl nuclear
disaster.
3.1. Features of irradiation population, living in the territories, contaminated after
Chernobyl nuclear disaster.
3.2. Zoning of surrounding territory around Chernobyl Nuclear Power Plant ,
depending on pollution levels.
3.3. Additional irradiation impacts on a human body adaptive capabilities for
different age categories.
3.4. Psycho-emotional reactions population, living in radiation-contaminated areas
and their role in forming population health.
3.5. Main directions of antiradiation protection population, living in areas of
increased radiation contamination (therapeutic, preventive, organizational, etc.).
3.6. Ways of contamination foodstaff with radionuclides. Role of food products at the
increasing an internal exposure.

Student should research given materials, carried out in modern educational
literature (textbooks, manuals, etc.), recommended in the higher medical
establishments. For further research of theme student should read scientific literature
(monographs and articles). In order to search professional literature, student used list
of questions and references, in accordance with guideline. At the Self-Study training,
student could get advice from the teacher. Self-Study preparation of students should
be carrying out on the final module control.
5. LITERATURE:
5.1. The basic:
5.2. Additional:
01.12.1997.
5.2.3. "State sanitary rules and regulations towards protection of the population from
electromagnetic radiation impact" SSanR&N-239-96.
156
Appendix 1
Law of Ukraine "On the status and social protection citizens irradiated after Chernobyl
disaster"
Depending on landscape and geochemical characteristics of the soil, excess of natural pre-
accident background level of environmental irradiation, i.e. possible negative impact on the
population health, requirements for implementation radiation protection, taking into account
industrial and social activities, irradiated territories, which were under an impact of Chernobyl
disaster, divided into zones as well as the following:
1) exclusion zone - territory, carried out evacuation of local population in 1986;
2) obligatory resettlement zone - territory, contaminated with a long period of
radioactivity radionuclides, polluted soil by cesium isotopes 15.0 Kuri /km2 and above
background pre-accident level, strontium 3.0 Kuri /km2 and above background pre-accident
level, or plutonium 0.1 Kuri /km2 and above background pre-accident level. Calculated
effective equivalent dose of human exposure, taking into account coefficients of radionuclide
migration into the plants, etc. should exceed 5.0 mSv (0.5 Ber) per year above background pre-
accident dose.
3) guaranteed voluntary resettlement zone – territory of soil contamination density
by cesium isotopes from 5.0 to 15.0 Kuri /km 2 and above background pre-accident level,
strontium from 0.15 to 3.0 Kuri /km 2 and above background pre-accident level, or plutonium
from 0.01 to 0.1 Kuri /km2 and above background pre-accident level. Calculated effective
equivalent dose of human exposure, taking into account coefficients of radionuclide migration
into the plants, etc. should exceed 1.0 mSv (0.1 Ber) per year above background pre-accident
dose.
4) strict radiological & ecological control zone – territory of soil contamination
density by cesium isotopes from 1.0 to 5.0 Kuri /km 2 and above background pre-accident level,
strontium from 0.02 to 0.15 Kuri /km2 and above background pre-accident level, or plutonium
from 0.005 to 0.01 Kuri /km2 and above background pre-accident level. Calculated effective
equivalent dose of human exposure, taking into account coefficients of radionuclide migration
into the plants, etc. should exceed 0.5 mSv (0.05 Ber) per year above background pre-accident
dose.
Lands of exclusion and obligatory resettlement zones withdrawn from agricultural and other
needs, limited from neighboring territories and transferred to category of radiation-dangerous lands.
In the exclusion and obligatory resettlement zones should be prohibited:
- permanent residence of citizens;
- marketable activity without special permissible from Ministry of natural disasters of Ukraine;
- export without special permissible from Ministry of natural disasters of Ukraine building
materials, soil, wood, natural resources, machinery and equipment, treatment plants,
mushrooms, berries, etc. for any purposes, exept scientific purposes;
- agricultural, forestry, industrial and other activities, as well as construction, without special
permissible from Ministry of natural disasters of Ukraine;
- destroy areal of a grazing wildlife, sports and commercial hunting and fishing;
- distilled animals, timber rafting. Enter and exit from territory of these zones is carried out by
special pemission with obligatory dosimetric control citizens and transport. Transit all types of
transport carried out by special pemission from administration of the zone;
- another activity without providing of radiation safety;
- residence of persons, having medical contraindications towards contact with sources of ionizing
radiation or persons with special needs caused by Chernobyl accident.
In the zones of exclusion and obligatory resettlement specialized staff carried out
obligatory measures, such as the following:
157
- radionuclides transeffing prevention from territory of the given zones, i.e. radioactive
contamination of an environment;
- monitoring of the natural environment and biomedical monitoring;
- providing territories with high – quality sanitary and fire-safe condition;
- application methods of immobilization radionuclides in the contaminated places.
All types of activities should be carried out with restriction collective dose of irradiation,
as well as limiting of involved persons.
In the guaranteed voluntary resettlement zone should be prohibited:
- building of new enterprises, expansion of the current businesses, which are not directly
related to the radio & ecological, social protection, as well as life and work activities;
- any type of activity, which degrades radioecological situation;
- natural resources useage, which doesn’t correspond to the requirements of radiation
safety;
- applying of pesticides and herbicides without special pemission bodies, represented
Cabinet of Minister of Ukraine;
- children, pupils and students activities, which caused negative impact on their health.
In order to reduce risk of morbidity and decreasing doses of radiation exposure in the
territory of guaranteed voluntary resettlement zone provided by government such types of
activity:
- voluntary resettlement of people from the zone;
- conversion of a current industry into ecologicaly safety products;
- well – spread monitoring radioactive contamination of the soil, water, air, foodstaff,
natural resources, residential and industrial apartments, as well as medical, biological and radio-
ecological monitoring;
- carring out an annual medical examination of the population in order to provide early
symptoms of diseases;
- appointment of the population with high quantity and enough quantity medication,
drinking water, clean foodstaff, i.e. having radioprotective properties as well as
removal radionuclides from a human body;
- specialized staff carry out dezactivation of the territory, at a vital importance;
- providing gasification of the settlements and road building with asphalt and concrete
materials;
- residents of the given territories should be supported with benefits and compensation,
in accordance with Law of Ukraine "On the status and social protection citizens
affected by Chernobyl disaster".
In a strict radiological & ecological control zone are prohibited:
- building of the sanatoriums, pioneer camps, health care facilities, new enterprises,
which have negative impact on a human health and an environment;
- any type of activity, which degrades radioecological situation;
- natural resources useage, which doesn’t correspond to the requirements of radiation
safety;
- applying of pesticides and herbicides without special pemission bodies, represented
Cabinet of Minister of Ukraine;
- children, pupils and students activities, which caused negative impact on their health.
In order to reduce risk of morbidity and decreasing doses of radiation exposure in the
territory of strict radiological & ecological control zone provided by government such types of
activity:
- conversion of a current industry into ecologicaly safety products;
- constant monitoring radioactive contamination of the soil, water, air, foodstaff, natural
resources, residential and industrial apartments, as well as medical, biological and
radio-ecological monitoring;
158
- carring out an annual medical examination of the population in order to provide early
symptoms of diseases;
- appointment of the population with high quantity and enough quantity medication,
drinking water, clean foodstaff, i.e. having radioprotective properties as well as
removal radionuclides from a human body;
- specialized staff carry out dezactivation of the territory, at a vital importance;
- providing gasification of the settlements and road building with asphalt and concrete
materials;
- residents of the given territories should be supported with benefits and compensation,
in accordance with Law of Ukraine "On the status and social protection citizens
affected by Chernobyl disaster".
Substantial module 6. General questions of hygiene and ecology.

Concrete purposes:
 Know principles of hygienic rationing, methods and means of hygienic
researches, their use in carrying out of precautionary and current sanitary
inspection in different areas of national economy, treatment-and-prophylactic
and improving establishments.
 Know basic concepts about biosphere, factors of environment and their influence
on the organism and population health.
 Analyze and use in practical profession physician favorable (improving) factors
of environment (solar radiation, climate, weather, other physical, chemical,
biological factors and conditions).
Theme № 14. Influence anthropogenesis components of biosphere on the
population and individual health. Hygienic estimation potential risk of
environmental factors impact on a human body and population health.
1. PURPOSE: research influence of environmental factors on the population
health; scheme of estimation health risks impact on the population health.
2.1.1. Basic concepts carried out risk assessment methodology.
2.1.2. Major risk assessment issues focused on the environmental factors impact on
the population health.
2.2.1.Identify harmful factor and carry out a qualitative assessment of adverse health
effects.
2.2.2. Justify a scheme of risk assessment issues, focused on the environmental
factors impact on the population health.
3.1. Environment, its components. Common regularities an environment impact on
the human body and health.
3.2. Air pollution and its impact on a human health.
3.3. Soil pollution and its impact on a human health.
3.4. Water objects pollution and its impact on a human health.
3.5. Public health as an integral indicator of environmental pollution. Indicators,
characterized population health.
3.6. Schemes of research environmental factors impact on the population health.
159
3.7. Epidemiological method of research environmental influences on the population
health. Main ways of its implementation.
3.8. Risk assessment methodology towards an impact of environmental factors on the
population health. Basic concepts.
3.9. Key issues of risk assessment methodology (identification of harmful factor (s),
assessment of exposure, dependence "dose - effect"; risk characterisation).
3.10. Risk assessment and risk management, their relation. Risk management and
hygienic norms.
1. Standard legislative regulations and hygienic conclusion towards environmental
factors impact on the population health, in accordance with a scenario – based task.
2. Carry out estimation of correlation coefficient towards an individual environmental
factor and one of the population health indicators.
5.1. Which indicators used in order to characterize the population health?
5.2. What means individual health from theoretical point of view?
5.3. What means individual health from actual point of view?
5.4. What is a complex approach of the health assessment as well as statistical
indicator?
5.5. Specife objective of the first stage complex assessment the population health.
5.6. From which sources should get information about indicators of the population
health?
5.7. Specife objective of the second stage complex assessment the population health.
5.8. What criteria of classification adult population in health groups?
5.9. Enumerate persons, who concerns to I and II health groups?
5.10. Specife objective of the third stage complex assessment the population health.
5.11. Which issues provides a qualitative analysis of an environment?
5.12. Whould it possible to "predict" changes in the level of population health?
5.13. Enumerate stages in a scheme, focused on identifying the relationships between
environmental factors and population health?
5.14. Specify, which issues whould provide the correlation analysis?
5.15. How to estimate level of relationship between separate environmental factors
and individual health?
5.16. Specify, which criteria should be carry out in order to choose observation zone?
5.17. What are the differences towards the environmental factors impact on the
population health?
scenario – based tasks and should write protocol in the copybook, carried out
hygienic estimation focused on the estimation degree of pollution atmospheric air, in
accordance with permissible concentration of harmful substances in an atmospheric
160
air of cities (Appendix). Student should demonstrate practical assessment carried out
by the teacher’s task (issue 4). At the final part of the practice teacher estimates
students educational activity on the given theme, signed protocols.
Systematic activities to prevent or cure health problems and promote good health in humans
are undertaken by health care providers. Applications with regard to animal health are covered by
the veterinary sciences. The term "healthy" is also widely used in the context of many types of non-
living organizations and their impacts for the benefit of humans, such as in the sense of healthy
communities, healthy cities or healthy environments. In addition to health care interventions and a
person's surroundings, a number of other factors are known to influence the health status of
individuals, including their background, lifestyle, and economic, social conditions, and spirituality;
these are referred to as "determinants of health." Studies have shown that high levels of stress can
affect your health.
Health is the level of functional or metabolic efficiency of a living organism. In humans, it
is the general condition of a person's mind and body, usually meaning to be free from illness, injury
or pain (as in "good health" or "healthy").The World Health Organization (WHO) defined health in
its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not
merely the absence of disease or infirmity." Although this definition has been subject to
controversy, in particular as lacking operational value and because of the problem created by use of
the word "complete," it remains the most enduring. Other definitions have been proposed, among
which a recent definition that correlates health and personal satisfaction. Classification systems
such as the WHO Family of International Classifications, including the International Classification
of Functioning, Disability and Health (ICF) and the International Classification of Diseases (ICD),
are commonly used to define and measure the components of health.
The term «population health» extended among hygienists and epidemiologists, in a
translation from english (population) associates with health of a certain group of persons.
From the biological point of view population - the group of live individuals which differ
signs of disconnexion and genetic relationship and capable freely to be crossed among themselves.
That is, in scientific researches it is necessary to prove, that the certain group of people is
population.
The term «health as recourse» – is the medico-social resource and potential for society
promoting national safety define as the important economic and social potential of the country
caused by influence of life way of the population and factors of environment.
The term «health of the nation» – is the medico-demographic and social category defining
physical, mental and social well-being of people, carrying out the ability to live within the limits of
social duties.
«Нealth of the nation» includes two concepts: somatic and reproductive health.
Reproductive health - is the condition of full physical, mental and social well-being, and not
just absence of diseases of reproductive system or frustration of its function.
The term somatic health allows to reveal accurately a consequence of adverse influence of
negative factors of environment, and to eliminate their influence on ability to live of the person.
The term «somatic mutagenesis» (used in medical genetics) designates damage of the
genetic material to somatic cages that leads to occurrence of tumors, and «mutagenesis in
reproductive cages» which consequence is bareness, or birth of the child with genetically caused
pathology.
Using the term population health, as health of separate groups of inhabitants, is meant
complex of the indicators describing demographic condition of population, disease and physical
inability, physical development of the population.
Basic indicators, recommended by WHO, carried out environmental factors impact on the
population health
161
Indicator – parameter, which gives the information about the investigated phenomenon.
Groups of indicators (WHO 2000), according to communication of quality of environment
and population health:
- state of health - death rate (carried out 65 death causes), disease and prevalence of
diseases (about 25 indicators);
- physical environment - security habitation, potable water and water drain, quality of
potable water, atmospheric air and air in premises, the condition of water objects, noise,
radiation;
- working conditions - influence of occupational factors on the organism;
- health protection - standard maintenance of quality of foodstuff, etc.
Lowest observed adverse effect level (LOAEL) - the least (minimum) concentration of
organisms of the same kind, factors of environment not moving to influence.
No observed adverse effect level (NOAEL) - the greatest (maximum) concentration of
organisms of the same kind, under the set conditions of influence of the factor of environment.
Safety – is the high probability of absence of harmful effects.
Health of the person connected with influence of environmental factors, is defined by safe
action of physical, chemical, biological, social and psychological factors of environment.
Influence of polluting substance is the contact between the person or group of people and
one or several factors of environment throughout certain time.
Environmental factors action should be the following:
 combined;
 complex;
 additive.
Ways of harmful substances receiption to the organism:
- aerogene: at inhalation of harmful substances from atmospheric air or air in premises;
- alimentary: through the gastroenteric path at the use of the polluted foodstuff and
potable water;
- intercutaneous: through the skin at contact to air, water, soil, etc.
Basic indicators of Health & Environmental Objects Estimation (WHO, 2000)

Indicator type Influence Effect Action
Quality of Mid-annual Death rate from Participation in the
atmospheric air concentration respiratory illnesses at 1 international arrangements on
NO2, PM10, SO2. month’s children, 1y.o. environment.
children, in all age Introduction of an effective
groups. Death rate from policy on smoking influence.
cardiovascular
pathology in all age
groups.
Quality of air in The percent of The death rate connected Estimation and introduction of
premises population living in with internal factors norms on maintenance with
conditions, not (traumas on the house, habitation.
answering to hygienic poisoning) at 5 y.o. Estimation and introduction of
standards. children. norms on land tenure in
settlements.
Potable water Percent of population Death rate of 5 y.o. Introduction of hygienic
using potable water, children from diarrhoeia. specifications and actions for
corresponding Disease of 5 y.o. children potable water clearing.
162
specifications of with diarrhoeia.
WHO.
The percent of
population using
favorable drinking
water.
Safety of food Influence of potentially Quantity of flashes Monitoring of foodstuff
dangerous chemical diseases with microbes’ quality.
substances, in etiology.
monitoring of Diseases of food
foodstuff. poisoning.
Noise Percent of population Introduction of hygienic
suffering from sources absent specifications and actions for
of noise. struggle against noise.
Industrial wastes Percent of children Estimation of dangerous waste.
and polluted soils with lead level in blood absent Percent of house with
above 10 mkg/dl. centralised water drain.
Radiation Percent of population Annual disease of skin Percent of the companies with
receiving cumulative cancer (International permission to use and
dose of irradiation Classification of recycling of radioactive
above 5 mSv/year. diseases-X). substances.
Recreational Excess of Quantity of flashes of Introduction of hygienic
water specifications on intestinal diseases with specifications and actions for
microbiological water etiology. sewage treatment.
parametres.
Quantity of pollutant substance, operating to the organism or body, is characterized by
concept of „dose”.
 general dose – quantity of pollutant substance, contacting to the organism from all
environments (air, water, products);
 internal (absorbed) dose - quantity of pollutant substance, absorbed by the organism
(fabrics, bodies) at breath, swallowing and-or contact to a skin and mucous membranes;
 biologically effective dose - quantity of pollutant substance, making direct harmful
impact as the certain part of pollutants will be neutralized by organism systems
(transformed and deduced from organism).
Hygienists use concepts of maximum-permissible dose - the maximum quantity of substance
which action on the human body does not cause negative changes in its organism and at its
descendants (See tables 1, 2, 3).
Maximum permissible level - the maximum level or concentration of the harmful factor
which action on the organism throughout certain period of time shouldn’t cause infringements of
health throughout whole life, and at its descendants.
Table 1. Scale of changes population health, depending on degree of atmospheric air pollution
Excess of maximum concentration Expected state of health
limit
1 Negative changes of state health are absent
2-3 Changes of state health by functional indicators
4-7 Expressed physiological shifts
8-10 Increasing of disease
100 Sharp poisonings
1000 Deadly poisonings
Table 2. Scale of danger for population health chemical substances in the soil
163
Expected state of health Pollution level
(maximum admissible concentration)
Changes of state health by functional 4 MAC
indicators
Expressed physiological shifts 4-10 MAC
Increasing of disease 20-120 MAC
Chronic poisonings 120-190 MAC
Sharp poisonings 200-900 MAC
Deadly poisonings 1000 MAC
Table 3. Scale of danger chemical substances in water objects for population health
Degree of cleanliness Pollution level
(maximum admissible concentration)
admissible 1 MAC
average polluted 2-3 MAC
much polluted 4-10 MAC
very much polluted 100 MAC
Methodological issues of risk estimation, caused by influence of environmental factors on

the population health
Risk - event (result) which meets at contact of the person to the environment containing
polluting substances in certain concentration throughout certain time.
Conditions of occurrence risk for individual health:
 risk source in an environment (ecological risk);
 excess of MAC, MSL ecological risk factor;
 susceptible organism of a human body;
 ways of receipt risk factors to the human body.
Environmental /ecological risk the potential for adverse effects on living organisms
associated with pollution of the environment by effluents, emissions, wastes, or accidental chemical
releases; energy useage; or the depletion of natural resources.
Health Risk Assessment (HRA) – a document that identifies risks and quantities of possible
adverse health effects that chould be result from exposure emissions of toxic air contaminants.
Health Risk Assessment cannot predict specific health effects; it only describes the increased
possibility of adverse health effects, based on the best scientific information available.
Health groups criteria should be the following:
1. Presence or absence of chronic diseases;
2. Resistance of the body;
3. Level of physical development;
4. Morpho-functional parameters.
First group – healthy people.
Second group – healthy people with functional and some morphological deviations.
Third group – patients with long-term chronic diseases while maintaining functionality of
the body (compensated stage).
Fourth group – patients with long-term chronic illness or persons with physical disabilities,
developmental disabilities, resulting of injuries, with reduced functional abilities of an
organism (subcompensated stage).
Fifth group – seriously sick patients (asthma, etc.).
Distribution of adult population in accordance with health groups
Health group Percent of population in the group, %
Men Women
I 27-28 20-21
164
Health group Percent of population in the group, %
Men Women
II 20-21 16-17
III 39-40 47-48
IV 11-12 14-15
V 1 0.8
SCHEMES OF HYGIENIC RESEARCH

"ENVIRONMENTAL FACTORS IMPACT ON THE INDICATORS OF HEALTH"
Observation zones – given territories (experimental and control), which are characterized by
identical inhabitant conditions and activities of the population, but differ by orientation, distribution
and intensity of exposure etiological factors of environment, limited by necessary quantity persons
under the observation.
Scheme of hygienic research "factor – indicator of health"
Select limiting hazard factor in the environment
Hygienic estimation factors (prevalence, impact, duration and conditions of exposure)
Carry out adequate sensitive indicator of health and group of adult population
Data collection for calculation indicator of health
Indicator of health calculation
Estimation of link between prevalence of factor & indicator of health
Development and implementation preventive recommendations, their effectiveness
Scheme of hygienic research "factor – complex indicators of health"

Select limiting hazard factor in the environment
Hygienic estimation factors (prevalence, impact, duration and conditions of exposure)
Carry out adequate sensitive indicators of health and group of adult population
Data collection for calculation indicators of health
Indicators of health calculation
Integration of the given health indicators into a health index, definition of health groups
Estimation of links between prevalence of factors & indicators of health
In order to research these groups should be selected the most vulnerable groups, having the
greatest influence of research factors. In the territories of observation whould be examined sanitary
situation, laboratory and instrumental research intensity of all factors impact.
In the territories, selected for research of public health, carried out such methods as
epidemiological, sanitary-statistical research, medical examinations, clinical observations and
165
natural epidemiological experiment. Influence of environmental factors on the health should be
provided by five schemes of research.
Scheme of hygienic research "comlex of factors – indicator of health"
Enumeration etiological factors of the environment
Hygienic description prevalence of selected factors

(quantification, identification of ways, duration and conditions of exposure to the organism)
Identify sensitive indicator of health for research group of population
Data collection for calculation special indicator of health
Evaluation of multivariate links between different etiological factors & health indicators in
accordance with mathematical modeling
Scheme of hygienic research "comlex of factors – complex indicators of health"

Enumeration etiological factors of the environment
Hygienic description prevalence of selected factors

(quantification, identification of ways, duration and conditions of exposure to the organism)
Enumeration adequate health indicators and selection of research population group
Data collection for calculation special indicators of health, determination index of health
Evaluation of multivariate links between different etiological factors & health indicator in
accordance with mathematical modeling

Inversion approach carried out research influence of environmental factors on population
health
Estimation level of public health
Substantiation "normalized" forecast changes level of health
Establishing list of priority environmental factors
Development and implementation preventive recommendations
Estimation effectiveness of preventive measures in order to improve health

8. LITERATURE:
8.1. The basic:
8.2. Additional:
166
Appendix 1
Scenario - based task on the theme №14: Influence anthropogenesis components of biosphere
on the population and individual health. Hygienic estimation potential risk of environmental
factors impact on a human body and population health
In city Dnipropetrovsk having about 980 thousand of population, 7 areas of supervision had
been chosen by different level of atmospheric pollution. For the control of atmospheric air pollution
data of stationary posts of supervision (daily average tests) were used. Data for 2009 were resulted
in the table:
Region of the city General disease of
Substances children's
dust SO2 CO NO2 population
(Р‰ ±mp)
Lenin 0,133 0,017 1,250 0,045 1613±5,9
Industrial 0,130 0,016 1,350 0,045 1883±7,4
October region 0,100 0,007 1,000 0,028 1651±6,8
Amur-dniprovsky 0,160 0,013 1,800 0,028 1553±6,4
Kirovsky 0,470 0,011 3,000 0,060 2094±11,0
Krasnogvardejsky 0,316 0,009 2,000 0,038 1649±10,1
Babushkinsky 0,120 0,009 1,300 0,023 1491±6,3
1. Define effect of additive action for substances and calculate it in the regions of the city.
2. Carry out hygienic conclusion about level of pollution atmospheric air and degree of health
hazard (according to State sanitary rules №201-97) one of the areas (by instructions of the teacher).
3. Establish character and force of communication between level of pollution of atmospheric air
concrete polluting substance (on the instructions of the teacher) and the general disease of the
children's population (using the method of pair correlation) and make the conclusion.
Procedure of statistics
1. Factor of correlation is calculated by the formula:
Studied signs Ranks d d2

X Y X Y (X-Y ranks)
(substances) (general disease of (substances) (general disease
children's of
population) children's
population)
Σ
Estimation of correlation factor:
Character of links is expressed by a sign “+” - positive links, “-“ - negative links;
Force of links is expressed by ratio: 0 - absence of links, up to 0.3 - weak links; up to 0.7 - average
links; up to 1.0 - strong links.
Theme of independent out-of-class work № 6. Hygienic estimation influence

natural components of biosphere on the person and population health.
1. PURPOSE: research technique of estimation influence of weather and climate on
the human body; acquire preventive maintenance methods (permanent, seasonal,
urgent) of reactions healthy and sick person on the climatic changes.
167
2.1.1. Physiology of thermoregulation and adaptation of the person.
2.1.2. Medical classifications of weather.
2.1.3. General and applied medical classifications of a climate.
2.2.1. Define indicators which characterise climatic and weather conditions of
district, and give hygienic estimation.
2.2.2. Apply preventive maintenance methods (permanent, seasonal, urgent) of
reactions healthy and sick person at different diseases on the climatic changes.
3.1. Weather, its definition. Factors which form and characterise weather.
3.2. Laws of atmospheric circulation. Formation of different types of
weathers.
3.3. Basic temperature and atmosheric pressure processes. Temperature
inversion.
3.4. Meteorological reactions of the person, its definition, mechanism of their
occurrence.
3.5. Medical classifications of weather, value of indicators which lay in their
basis.
3.6. Influence of meteorological conditions on dynamics of atmospheric air
pollution.
3.7. Influence of weather on the person health through distortion of dynamics of
atmospheric pollution. Temperature inversion.
3.8. Medical forecasting of weather, principles and preventive maintenance
methods of meteorological reactions.
3.9. Climate. Definition. Factors which form and characterise the district
climate.
3.10. Classification and the hygienic characteristic of climatic belts.
Climatic zones of Ukraine.
3.11. Features of the climate in different natural-geographical regions.
3.12. Acclimatisation. Basic hygienic questions of acclimatisation on the North,
South and in the conditions of high mountains.
3.13. Hydrometeorological service, technique of processing and value of
meteorological supervision for medical-hygienic estimation of climatic conditions.
3.14. Use of climatic factors with improving and preventive purpose, sanatorium
treatment at different diseases. Climatic resorts of Ukraine.
For independent out-of-class work of the student 1 academic hour is carried
out. Student should receive at the teacher scenario – based task on the given theme,
corresponding to methodical instructing, and additional literature. During
independent training student should receive consultation of the teacher. After self –
study of the theoretical material, student carries out self-checking by decision of the
scenario – based task, offered by the teacher. At the final part of the practice teacher
estimates students educational activity on the given theme, signed protocols.
5. LITERATURE:
5.1. The basic:
168
Theme of independent out-of-class work № 7. Hygienic value of solar radiation

and use its components for preventive diseases of the person and sanitation of
air, water and subjects.
1. PURPOSE: research methods of organization ultra-violet (UV) irradiation for
prevention human diseases and technique of purification air, water and objects of the
environment by UV-irradiation.
2.1.1. Hygienic meaning of UV-irradiation, its using in the practical medicine.
2.1.2. Infringement of the health and diseases, connected with insufficient or
superplus of UV-irradiation.
2.1.3. Methods and instruments for measurement intensity of UV-irradiation.
2.2.1. Use UV-irradiation for preliminary and secondary profilactice different
diseases at the medical-preventive establishments and child’s care centers, on the
industrial enterprises and for purification of air, water and objects of the environment.
2.2.2. Use UV-irradiation for purification of air in the premises and other
environmental objects, estimate it’s effective.
3.1. Origin of solar irradiation, it’s main elements.
3.2. Spectral composition of UV-irradiation in the border with atmosphere and
on the surface of Earth (regions A, B, C). Biogeneous and abiogeneous action of UV-
irradiation.
3.3. Artificial sources of UV-irradiation, their physical and hygienic
characteristic.
3.4. Kinds of biological action of UV-irradiation, specifications of spectral parts
of UV-irradiation.
3.5. Methods and units of measurement intensity of UV-irradiation.
3.6. Concepts of erytemic, physiological and preventive doses of UV-
irradiation, their quantitive determination by the different methods of UV-irradiation
estimation.
3.7. Infringement of health and diseases, connected with insufficiency of UV-
irradiation.
3.8. Main symptoms of "solar insufficiency" and principles of prevention UV-
irradiation.
3.9. Using of UV-irradiation for preliminary and secondary prevention of
different diseases.
3.10. Types of artificial sources of UV-irradiation, their action, basic technical
characteristic.
3.11. Superplus solar irradiation of the person by the Sun and artificial sources
of UV-irradiation. Methods of prevention superplus action of UV-irradiation.
3.12. UV-irradiation as occupational harmlessness.
169
5. LITERATURE:
5.1. The basic:
Theme of independent out-of-class work № 8. Scientifical basis of medical

biorhythmology and chronohygiene.
1. PURPOSE: research theoretical background towards biological rhythms,
their meaning for psychohygiene and psychoprofilactice.
2.1.1. Principles of medical biorhythmology as the science and its
psychohygienic meaning.
2.1.2. Hygienic characteristic and classification of the biological rhythms.
2.1.3. Reasons and main clinical symptoms of desinchronoses at the medical
establishments.
2.2.1. Determine different types of daily curves of the biological rhythms, kinds
of daily capacity and calculated biological rhythms.
2.2.2. Use at the organization of educational and labor process at free time
biorhythmological principles of rational organization daily activity of the person.
3.1. Biological rhythms and health status of the person. Conception about
biological rhythms. Principles of biorhythmology as the medical science.
3.2. Hygienic characteristic of biological rhythms (level, period, amplitude,
acrophase, form of day curve, etc.).
3.3. Classification of the most popula biological rhythms.
3.4. Technique of determination different types of daily curve of biological
rhythms.
3.5. Methods of determination types of daily capacity of the person.
3.6. Methods of determination calculated biological rhythms of the person.
3.7. Conception of desinchronoses as the main type of chronopathology, medical
and hygienic categories. Types of desinchronoses.
3.8. Biorhythmological principles of rational organization daily activity of the
person. Chronohygiene as the main prevention principle of desinchronoses.
170
5. LITERATURE:
5.1. The basic:
Substantial module 7. Hygiene of extreme situations.

Concrete purposes:
 Explain necessity and urgency of medical, fire-prevention and other kinds of
help suffered from disasters different genesis (natural, technogenic, social).
 Distinguish the international and national organizational structures on help
granting suffered from different kinds of disaster and liquidation of their
consequences.
 Plan medical service by victim in the accidents, other cataclysms, their life-
support (placing, water supply, food, stress removal).
 Know principles of the organisation and sanitary inspection for carrying out
placing in field conditions, water supply, food, working conditions liquidators
of consequences of accidents and other extreme situations.
 Plan actions of the organisation medical maintenance in the conditions of
extreme situations.
Theme of independent out-of-class work № 9. Sanitary inspection for
organization of nutrition and water supply in the conditions of accidents.
1. PURPOSE: estimate physiological and hygienic, moral-psychological values of
water supply and balanced diet of formations in the field conditions at liquidation of
consequences extreme situations. Study methods of medical control over full value
and safety of water supply and food of formations in the field conditions at extreme
situations.
2.1.1. Concept "balanced diet", conditions of its maintenance.
2.1.2. Infringement of health and diseases, which can arise at non-observance of
water supply and balanced diet.
2.1.3. Methods of preventive maintenance alimentary, infectious diseases,
helmintoses, food poisonings, defeats through water and food poisonous substances,
radioactive substances, bacteriological substances.
171
2.2.1. Estimate food staff of formations by different methods:
- settlement, behind an apportion of products (menu-apportion);
- studying of the set of products in a daily diet, conditions of their
storage, culinary processing, realisation;
- control-weight method (weighing of products at loading in a copper,
ready portions and dishes);
- studying of the food status of an organism of staff formations (for
somathoscopic, somathometric, physiometric, biochemical, clinical indicators);
- express (by means of devices) and laboratory analysis of products and
ready food.
2.2.2. Organise and carry out medical control over water supply and full value of
food staff formations (and the suffered population) and necessary preventive actions
of its maintenance.
2.2.3. Carry out medical actions at occurrence of alimentary, infectious intestinal
diseases, helmintoses, food poisonings, defeats through water and food strong
poisoning, radioactive substances to investigate the reasons of their occurrence, carry
out preventive maintenance.
3.1. Rational (high-grade) food, conditions of its maintenance. Physiological
norms of food as a basis of its full value and adequacy to needs of the organism.
3.2. Organisation of water supply and food of military and civil formations in
the field conditions at extreme situations and during war, its form (collective, group,
individual). Food points, types of field-kitchens, other means.
3.3. Military rations rations of formations civil defence, their hygienic
characteristic.
3.4. Water supply and food in the conditions of infection districts and objects by
food strong poisoning, radioactive substances at an application of weapon of mass
defeat.
3.5. Food concentrates, dry rations, survival diets as means of food staff of
formations during the sharp period of accidents and other extreme situations.
3.6. Duties of medical service, methods and means of the hygienic control over
full value and safety of food and water supply staff of formations and the suffered
population in the field conditions at extreme situations.
3.7. Methods of the estimation food status of the organism (somathoscopic,
somathometric, physiometric, biochemical, clinical, etc.).
3.8. Health infringement, diseases, connected with quantitative and qualitative
inadequacy of daily diet, diet infringement, discrepancy of quality of products and
dishes to fermental possibilities of digestive system.
3.9. Infectious diseases with alimentary mechanism of transfer, helmintoses,
food poisonings, methods of their investigation and preventive maintenance in the
field conditions at extreme situations and during war.
172
Appendix 1
State sanitary rules and norms "Hygienic
requirements to drinking water, intended for
human consumption" # 2.2.4-171-10
Epidemic Safety of Drinking Water Indicators

№ List of Indicators Units Standards for drinking water
Tap water, Water from Bottled
water from points wells water
of the spill and
pump rooms
1. Microbiological indicators
1 Microbic number CFU/ cm3 < 100 should not < 20
t 37 С
0
defined
2 Microbic number CFU/ cm3 should not should not < 100
t 22 С
0
defined defined
3 Coliforms CFU/ 100cm3 absence <1 absence
4 E. Coli CFU/ 100cm 3
absence absence absence
5 Enterococci CFU/ 100cm3 absence should not absence
defined
6 Pseudomonas aeruginosa CFU/ 100cm3 should not should not absence
defined defined
7 Pathogenic enterobacteria should absence absence absence
contain in 1
dm3
8 Coliphaged CFU/ dm3 absence absence absence
9 Enteroviruses, adenovirus, should absence absence absence
rotavirus antigens, reovirus, contain in 10
hepatitis A virus (HAV) etc. dm3
2. Parasitological indicators
10 Pathogenic intestinal cells, cysts absence absence absence
protozoa: oocysts of in 50 dm3
cryptosporidia,
spores Giardia, dysentery
amoebae, balantine
intestinal etc.
11 Intestinal helminthes cells, eggs, absence absence absence
larvae
in 50 dm3
173
Appendix 2
State sanitary rules and norms "Hygienic requirements to
drinking water, intended for human consumption" # 2.2.4-171-
10
Table 1
Sanitary-chemical indicators of drinking water Safety & Quality
№ List of Indicators Units Standards for drinking water
Tap water Water Bottled water,
from wells water from
points of the
spill and pump
rooms
1. Organoleptic indicators
1 Smell points <2 <3 < 0 (2)4
t 200С <2 <3 < 1 (2)4
t 60 С
0
2 Color quantity degrees < 20 (35)1 < 35 < 10 (20)4

3 Feculence NUF < 1,0 (3,5) 1
(1 NUF = < 2,6 (3,5)1 – for < 3,5 < 0,5 (1,0)4
0,58 mg/dm 3)
underground
water source
4 Taste and aftertaste points <2 <3 < 0 (2)4
2. Physico-chemical indicators
а) inorganic components
5 pH pH 6,5 – 8,5 6,5 – 8,5 6,5 – 8,5
6 Carbon dioxide % should not should not 0,2 – 0,3 – for

defined defined weakly
carbonated
0,31-0,4 –
medium
carbonated
0,41-0,6 –
highly
carbonated
7 Iron mg/dm3 < 0,2 (1,0)1 < 1,0 < 0,2
8 General hardness mmol/dm3 < 7,0 (10,0)1 < 10,0 < 7,0
9 General alkalinity mmol/dm3 should not should not < 6,5
defined defined
10 Iodine mcg/dm3 should not should not < 50
defined defined
11 Calcium mg/dm3 should not should not < 130
174
defined defined
12 Magnesium mg/dm3 should not should not < 80
defined defined
13 Manganese mg/dm3 < 0,05 (0,5)1 < 0,5 < 0,05
14 Copper mg/dm3 < 1,0 should not < 1,0
defined
15 Polyphosphates (PO43-) mg/dm3 < 3,5 should not < 0,6 (3,5)4
defined
16 Sulfates mg/dm3 < 250 (500)1 < 500 < 250

17 Dry residue mg/dm3 < 1000 (1500)1 < 1500 < 1000
18 Residual chlorine free mg/dm3 < 0,5 < 0,5 < 0,05
19 Chlorides mg/dm3 < 250 (350)1 < 350 < 250
20 Zinc mg/dm3 < 1,0 should not < 1,0
defined
b) organic components
21 Residual chlorine mg/dm3 < 1,2 < 1,2 < 0,05
associated
3. Sanitary-Toxicological indicators
а) inorganic components
22 Aluminum mg/dm3 < 0,20 (0,50)2 should not < 0,1
defined
23 Ammonium mg/dm3 < 0,5 (2,6)1 < 2,6 < 0,1 (0,5)4
24 Chlorine dioxide mg/dm3 < 0,1 should not should not
defined defined
25 Cadmium mg/dm3 < 0,001 should not < 0,001
defined
26 Silicon mg/dm3 < 10 should not < 10
defined
27 Arsenic mg/dm3 < 0,01 should not < 0,01
defined
28 Molybdenum mg/dm3 < 0,07 should not < 0,07
defined
29 Sodium mg/dm3 < 200 should not < 200
defined
30 Nitrates (NO3) mg/dm3 < 50,0 < 50,0 < 10 (50)4
31 Nitrite mg/dm3 0,5 (0,1)3 < 3,3 < 0,5 (0,1)5
32 Ozone residual mg/dm3 0,1 – 0,3 should not should not
defined defined
33 Mercury mg/dm3 < 0,0005 should not < 0,0005
defined
34 Lead mg/dm3 < 0,010 should not < 0,010
defined
35 Silver mg/dm3 should not should not < 0,025
defined defined
36 Fluorides mg/dm3 climate zones: climate zones:
IV < 0,7 IV < 0,7
III < 1,2 < 1,5 III < 1,2
II < 1,5 II < 1,5
37 Chlorite mg/dm3 < 0,2 should not should not
defined defined
175
b) organic components
38 Polyacrylamide residual mg/dm3 < 2,0 should not < 0,2
defined
39 Formaldehyde mg/dm3 < 0,05 should not < 0,05
defined
40 Chloroform mcg/dm3 < 60 should not <6
defined
c) integral indicator
41 Permanganate oxidation mcg/dm3 < 5,0 < 5,0 < 2,0 (5,0)4
_________________
1
Standard, specified in brackets, carried out in separate cases in coordination with Chief State Sanitary Doctor-
Hygienist on the relevant administrative territory.
2
Standard, specified in brackets, carried out for drinking water, treated with aluminum reagents.
3
Standard, specified in brackets, carried out for clean drinking water.
4
Standard, specified in brackets, carried out for bottled drinking water, drinking water from points of the spill and
pump rooms.
5
Standard, specified in brackets, carried out for non-carbonated drinking water.
Classes and methods of processing of water. Basic schemes of waterpipes

Water of underground sources І class completely answers representations about good-
quality potable water, specifications of its quality completely correspond to that for drinking
water agree to ISO 4808: 2007 "Sanitary and technical requirements and rules of selection".
Therefore it can be directly presented the population without processing. The waterpipe
scheme in this case has the following appearance:
1 2 3 4 5 6 7
where: 1 - an underground source of water supply (pressure head or not pressure head waters);
2 - an artesian borehole;
3 - the pump І lifting;
4 - disinfecting;
5 - the tank of pure water;
6 - pump station ІІ lifting;
7 - water supply system.
Water of underground sources ІІ class can contain hydrogen sulphide of mineral origin,
much more iron and manganese. It worsens it organoleptic properties and compels to apply special
methods of processing (aeration, aeration with the further filtration). Besides, underground waters ІІ
class can have raised oxidability and coli-index that are certificate of epidemic danger of water and
demands its disinfecting before giving to consumers. Under these conditions the waterpipe scheme
has the following appearance:
1 2 3 4 5 6 7 8
where: 1 - an underground source of water supply;

2 - an artesian borehole;
3 - the pump І lifting;
4 - special methods of processing;
5 - disinfecting;
176
Water of underground sources ІІІ class can have raised feculence, increased chromaticity,
much more maintenance of iron, manganese, hydrogen sulphide. Some underground sources
contain excessive quantity of fluorine (to 5 mg/l). Coli-Index can reach 1000. For reduction of
feculence and chromaticity of such water is necessary to spend clarification and discoloration by
filtering with preliminary upholding. Hydrogen sulphide, iron and manganese delete by the method
of aeration with the further filtration. In case of the fluorine raised, maintenance of such water is
necessary to make defluorination. And for maintenance of epidemic safety water is necessarily
disinfect.
Water of superficial sources І class. Superficial reservoirs with absence of feculence and
less of water color, which does not have a smell, containing insignificant quantity easily oxidized,
including organic substances which has slight increase of the maintenance of iron and rather low
level of microbes, are carried to І class. Such water can be processed on good-quality drinking by
filtering without coagulation or with application of small doses of coagulant substances and
disinfecting.
Water of superficial sources ІІ class. To ІІ class of water sources belong water with
more muddy and painted water which has a notable natural smell, contains slightly more
than easily oxidized, especially organic substances, higher maintenance of iron, rather high
level of bacterial pollution and contains significant amounts of plankton. Traditional
methods of processing are comprehensible, to clearing of such water used: for removal of
plankton - microfiltration, for clarification and discoloration - coagulation with upholding
and the further filtering, coagulation with two-level filtering, contact clarification and
obligatory disinfecting. The basic scheme of such waterpipe looks like:
1 2 3 4 5 6 7 8 9 10 11 12
where: 1 - a superficial source;

2 - a ladle (a water intaking construction);
3 - a coastal water reception well;
4 - pump station І lifting;
5 - the chamber of clearing of a pressure which simultaneously carries out functions of the
amalgamator of water with coagulant solution;
6 - the reaction chamber;
7 - a sediment bowl;
8 - the fast filter;
9 - disinfecting;
To III class of the superficial sources which quality of water mismaches requirements of
ISO 4808: 2007, by means of traditional methods of clearing concern water of such reservoirs: very
muddy, intensively painted in yellowy-brown colour for the account of organic substances, has a
strong natural smell, contains many easily oxidized, especially organic substances, the considerable
maintenance of iron, high level of bacterial pollution and contains a lot of plankton (100000 kl/sm3).
Except traditional methods of processing, additional steps of clarification, application are necessary
for clearing of such water oxidising and sorbent methods, more effective disinfecting.
Technique of sanitary inspection of water supply sources
Sanitary inspection includes three basic positions:
 Sanitary-topographical inspection of its environment;
 Sanitary-engineering inspection of the condition of an equipment of water source.
 Sanitary-and-epidemiologic inspection of area placing of water source.
177
The important practical value has definition of water quantity in the source of water and it
debit (productivity).
For example, in a well with concrete rings quantity of water define under the formula:
V = π R2 h,
where: V – quantity of water in a well, m3;
π - 3.14;
R - ring radius, m;
h - thickness of sheet of water, m.
Calculation of necessary quantity of chloric with any percent (% ) of active

chlorine for disinfection of wells
Water volume in a well makes 1 m3 (or any other volume, you can see in the situational
task), at the concentration of active chlorine … % (see to the situational task) for water disinfecting
is necessary to calculate chloric exhaust quantity (P), by such formula:
E (m3) · C (100 mg/dm3) · 100
Р= H (%) = … gram, were
E – volume of water in well, m , 3
C – given concentration of active chlorine in water well, gram/ m3,

H – content of active chlorine in disinfection, %,
100 – constant coefficient number.
Example.
1m3 х 100 mg/dm3 х 100
Р= 25 % = 400 gram, where
E – volume of water in well, ( 1 m3),
C – given concentration of active chlorine in water well, (100 gram/ m3),
H – content of active chlorine in disinfection, (25 %),
100 – constant coefficient number.
Technique of sampling water for laboratory analyses
At sampling of water from the superficial reservoir, or mine well take its temperature by
means of the special thermometer (fig. 1) or the usual chemical thermometer which tank will wrap
up gauze bandage in some layers. Temperature define directly in a water source. The thermometer
lower in water for 5-8 minutes, then quickly extend and remove indicators of temperature of water.
Fig. 1. The thermometer for measurement of temperature of water in reservoirs, wells (a),
bathometer for water sampling on the analysis (b).
178
Sampling of water from superficial reservoirs and wells is spent with the bathometers of
different designs which are provided with a double twine: for device lowering to the set depth and
for opening of a vessel on this depth (fig. 1).
For sampling of water from flowing reservoirs (the river, stream) is designed bathometer
with the stabilizer which directs a mouth of a vessel against the current.
Test of water from the water crane or equipped well mine select:
 for bacteriological analysis, after preliminary sterilization an exhaust outlet of the
crane waters throughout not less than 10 minutes, in a sterile bottle in capacity of 0.5 l, with the
gauze stopper, wrapped up from above a paper cap. Not to presoak a gauze stopper, the bottle fill
approximately on three quarters so that under a stopper there were 5-6 sm of air space. Ware with a
gauze stopper in advance sterilize at 1600 during 1o'clock;
 for sanitary-chemical analysis (organoleptic indicators, the basic indicators of
chemical compound and indicators of chemical pollution) select to one litre in chemically-pure
ware, preliminary having rinsed its selected water (for the full sanitary-chemical analysis select 3-5
l of water).
During test selection make the covering letter in which mark: the kind, name, location,
address of a source of water (the superficial reservoir, an artesian borehole, a mine well, the water
crane, a water folding column); its short characteristic; the condition of weather during selection of
test and throughout the last 10 days; the reason and the sampling purpose (planned inspection, an
adverse epidemic situation, complaints of the population to deterioration of organoleptic properties
of water); laboratory where test goes; the necessary volume of researches (the short, full sanitary-
chemical analysis, the bacteriological analysis, definition of pathogenic microorganisms) is marked;
date and time of selection of test; results of the researches executed during selection tests
(temperature); who selects test (the surname, post, establishment); the signature of the official who
has selected this test.
Tests are delivered in laboratory as soon as possible. Bacteriological researches should be
begun throughout 2 hours after selection of test or under condition of storage in a refrigerator at
temperature 1-8°С - not later than in 6 hours. The physical and chemical analysis spend throughout
4 hours after a capture of test or under condition of storage in a refrigerator at 1-8°С - not later than
in 48 hours. At impossibility of carrying out of researches in the specified terms of test should be
preserved (except tests for organoleptic and bacteriological researches, and also definition of coli-
index, which is necessarily carry out in the terms resulted above). On the selected test apply the
accompanying form in which specify the address, the kind of a source of water where test goes, the
analysis purpose, date and time of selection of test, the signature of the official selecting this test.
Appendix 1
Scenario – based task for self-preparation: "Sanitary inspection for organization of
nutrition and water supply in the conditions of accidents"
In settlement N. population use potable water from well, which is filled with water from
soil horizon depth on 15 m. Well of mine type. Outside there is a cover with hatch and canopy
is arranged. Water lift by a public bucket. The territory round a well is equipped by the clay
lock. Protections are not present. Depth of mine well - 15 m. Height of standing of water in a
well is 1.5 m3. At the sanitary inspection of well were established unsatisfactory technical
conditions: internal walls have damages, the hatch of cover and canopy with numerous
cracks. Last repair was spent 5 years ago. Laboratory researches of test of water from a well
are following:
Investigated indicator Maximum Result of research
concentration limit
1. Feculence (by standard scale) Not more > 1.5 3.2
2. Color quantity, degree Not more > 20 0
35
3. Smell, points Not more > 2 4 (wooden)
4. Taste and aftertaste, points Not more > 2 3 (bitterish)
5. Nitrates, mg/dm3 Not more > 45 22.5
179
6. Coli-index, in 1 dm3 Not more > 10 15
Tasks.
1. Give hygienic estimation of water from well by results of laboratory researches.
2. Define etiological factors and-or risk factors for health population.
3. Offer necessary hygienic actions for maintenance population with qualitative potable
water.
4. Calculate necessary quantity of chloric with 25 % of active chlorine for well
disinfection.
Standard answer.
1. Sanitary-engineering condition of well mismatches sanitary rules. Annual preventive repair
was not spent for 5 years, round a well there is no fencing, an external part of well has
unsatisfactory condition. All it promotes deterioration of organoleptic properties (taste,
smell, feculence, color quantity), increasing of nitrates and intestinal stick.
2. Risk factor for health of water users are unsatisfactory epidemic indicators of water from
well, promoting flashes of intestinal infections among the population.
3. Carry out repairs of external part of well, its clearing and replacement of sand from a well
bottom; spend preventive disinfection of well by chloric; spend sampling of water for
laboratory researches for definition efficiency of the spent actions; forbid the population to
use potable water from well before performance of all actions.
4. Water volume in a well makes 1.5 m3, at concentration of active chlorine 25 % for water
disinfection is necessary chloric exhaust quantity:
1.5 m3 х 100 mg/dm3 х 100
Р= 25 % = 600 gr of chloric with 25 % of active chlorine have to be taken
for disinfection of water in a well.
5. LITERATURE:
5.1. The basic:
Theme of independent out-of-class work № 10. Organization and sanitary

inspection of working conditions liquidators of accidents consequences.
1. PURPOSE: estimate working conditions of staff military and civil rescue
formations at the liquidation of consequences accidents and other extreme situations.
Familiarise with forces and means of medical service military and civil formations on
the hygienic maintenance of work liquidators of accidents consequences. Research
methods of medical control over state of health and working capacity liquidators of
accidents consequences.
2.1.1. Value of hygienic maintenance working conditions of military and civil
formations at the extreme situations.
2.1.2. Prominent features of working conditions at the extreme situations
depending on their origin.
2.1.3. Harmful and dangerous factors, which accompany accidents and other
extreme conditions, their influence on health and work capacity liquidators of
accidents consequences and the suffered population.
2.1.4. Clinical and psychophysiological methods of estimation work capacity,
weariness and state of health liquidators.
180
2.2.1. Find out harmful and dangerous factors, which arise at different kinds of
extreme situations and can influence on the state of health and work capacity
participants of liquidation their consequences.
2.2.2. Find out clinical, psychophysiological signs of decrease work capacity,
infringements of health participants of liquidation accidents consequences.
2.2.3. Study staff to methods and means of preservation health and work
capacity at the liquidation of accidents consequences and others heavy times, use
individual protection frames (respirators, gas masks, overalls), dopes, psychotropic
preparations, etc.
2.2.4. Own accessible and expedient in the conditions of accidents methods and
means of medical control over weight, intensity of work, psychophysiological,
physical condition liquidators of accidents consequences and suffered population.
3.1. Classifications of accidents and extreme situations by natural, technogenic,
social origin.
3.2. Harmful and dangerous factors, which operate on the liquidators of
accidents and other extreme situations by natural origin (earthquakes, flooding,
brown, shifts and other).
accidents and other extreme situations by technogenic origin in the chemical, oil and
similar enterprises.
radiating failures and accidents (on an example of Chernobyl accident).
3.5. Psychoemotional pressure and stress, which develop at liquidators of
accidents and other extreme situations, methods and means of their preventive
maintenance and treatment.
3.6. Preventive word meaning, commands, use of dopes, psychotropic
preparations for the purpose of overcoming stresses, psychoemotional reactions at
liquidators of accidents consequences, suffered population.
3.7. Hygienic characteristic of individual protection frames, which are used by
liquidators at fires, flooding, others heavy times.
3.8. Features of the mode and working conditions, its weight, intensity, duration
and intensity at liquidation of accidents consequences and other extreme situations,
methods of their revealing and estimation in the conditions of accidents.
Scenario – based task for self-preparation: "Organization and sanitary inspection of
working conditions liquidators of accidents consequences"
181
1. Enumerate methods and means of hygienic estimation weight, intensity of work. Define which
physiological and psychophysiological methods should be used in the conditions of accidents and
other extreme situations.
2. In the apartment houses, destroyed by earthquake, because of destruction of gas networks, short
circuit of electric systems there were fires owing to dust, smoke content, air gassed condition have
complicated salvage operations. In the houses there are many lost, injured inhabitants blocked by
blockages.
Specify, which requirements and recommendations you should offer for liquidators of
consequences with the purpose to maintenance their health and working capacity.
3. Because of mass destruction of the population around explosion on the chemical plant (about
15000 victims) in many participants of formations, which profits liquidators of accident
consequences, have arisen stress, psychoemotional reactions, which sharply lowered their working
capacity.
Your recommendations for stress removal, restoration (increase) of working capacity.
Physical hazards at the extreme situations
Occupational microclimat – is the complex of physical factors (convection and radiation
temperature, air humidity and the velocity of air movement), determining the thermal status of the
worker’s organism.
Table 1. Hygienic standartization of occupational microclimate at the extreme situations
Heaviness Energy Class of work conditions*
of work losses, W Optimal Admissible Harmful
1 level 2 level 3 level 4 level
1a up to 139 21.0-23.4 23.5-25.4 25.5-26.6 26.7-27.4 27.5-28.6 28.7-31.0
1b 140-174 20.2-22.8 22.9-25.8 25.9-26.1 26.2-26.9 27.0-27.9 28.0-30.3
2a 175-232 19.2-21.9 22.0-25.1 25.2-25.5 25.6-26.3 26.3-27.3 27.4-29.9
2b 233-290 18.2-20.9 21.0-23.9 24.0-24.2 24.3-25.0 25.1-26.4 26.5-29.1
3 >290 17.0-18.9 19.0-21.8 21.9-22.2 22.3-23.4 23.5-25.7 25.8-27.9
- by WBGT-index (complex evaluation of occupational microclimate)

Table 2. Hygienic standartization of occupational noise at the extreme situations
Kinds of activity and working Levels of sound pressure (dB) in octave lines with Levels
places average geometrical frequencies (Hz) of sound
31.5 63 125 250 500 1000 2000 4000 8000 (dBA)
Creative labour work of scientists 86 71 61 54 49 45 42 40 38 50

and students, medical activity,
laboratories
Administrative work, work with 93 79 70 63 58 55 52 50 49 60
measurement and analytic works,
control works
All kinds of work (at the 107 95 87 82 78 75 73 71 69 80*
expense of above listed) on the
constant working places in
production premises and on the
territory of industrial
enterprises
* MSL for non-constant sound: equivalent level makes 80 dBA and maximum level – 110 dBA.
Occupational noise – is the complex of sounds with various intensity and frequency, has
irregular character and causes unpleasant feeling.
Classification of occupational noise:
182
 by the spectrum:
- wide-frame (the spectrum is more than an octave);
- tonal (having discrete tones);
 by the time characteristics:
- constant (level up to 5 dBA);
- non-constant (level more than 5 dBA):
discrete (has stable intervals with constant noise level);
impulse (consist of some sounds signals);
 by the frequency:
low-frequency (up to 350 Hz);
average- frequency (up to 800 Hz);
high frequency (more than 1,000 Hz).
Industrial dust – is the gas-dispersed system with solid phase.

Classification of industrial dust
 According to the origin:
aerosols of condensation: condensed steams of metals, etc.;
aerosols of disintegration: organic, mineral (non-organic), mixed dust.
 By the particle size of dust:
high dispersed;
average dispersed;
low dispersed.
Physical factors of dust:
Dispersity.
Form and consistence.
Solubility.
Electrical charge.
Radioactivity.
Influence of dust to the human at the extreme situations:
Direct influence:
- irritative: mechanical irritation of mucous leading to inflammative processes;
- toxic: toxic dust results chronic and acute poisoning;
- mutagenic;
- teratogenic;
- carcinogenic;
- specific (fibrogenic) – it’s typical for silica dust;
- photodynamic: dust can sensibiliser skin cells to solar UV radiation;
- biological – aerogenic transport of disease agents (anthrax);
- allergic;
- radioactive.
Indirect influence:
- decreasing of the negative-charged ions in the air;
- forming of fogs in humid air;
- lead to overheating microclimate.
Hygienic measures:
 Hygienic standartization of occupational factors at the extreme situations (chemical,
physical, biological): MAC, MSL, RSLA, etc.
 Sanitary-technological measures.
 Architectural-planning measures.
 Sanitary-technical measures.
 Planning measures.
 Individual protection.
183
 Medical-biological actions.
6. LITERATURE:
6.1. The basic:
Hygiene and ecology: study guide\ Rublevska N.I., Shevshenko O.A., Kramarova
Y.S. at al. – Dnipro, 2017. -183p.
184

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Rublevska N.I., Shevshenko O.A., Kramarova Y.S.

Recommended by the Academic Council of State Establishment “Dnipropetrovsk

Reviewed by: I.V. Zavgorodniy, Doctor of Medical Sciences, Professor, Director of

Adapted and translated by Bachelor of Arts (Philology), PhD Hrygorenko L.V.,

Responsible-Editor: Head of Hygiene and ecology Department, MD, professor

Substantial module 1. Municipal hygiene.

Тheme № 1: Hygiene of water and water supply of settlements. Sanitary

Geochemical endemic Reasons Geochemical provinces Clinical symptoms

Polychlorinated Natural waters: Usho (oil illness) Nausea, vomiting, bronchitis,

Lead Undeg. waters-0.001-0.1mkg/l Saturnism Paralyses, infringements of

Mercury Undeg. waters-0.001-0.1mkg/l (Methyl-mercury) Frustration of mentality,

where С1, С2, Сn — actual concentration of chemical substances in water, mg/l;

Water purification for human consumption purposes consists in the

The drawbacks of chlorination are:

Investigated indicator Result of research

Scenario – based task: "Hygienic requirements to water supply sources"

Investigated indicator Average values

Indicator of water quality Above of the city D. Maximum concentration Class of

Coli-phage 90 Plaque forming unit Not more 100 in 1dm3 -

Standard ability of EQC:

where C -value of chemical substances (1-2 class of danger);

Theme № 2: Sanitary protection of atmospheric air. Hygiene of planning in the

6. STRUCTURE AND OCCUPATION MAINTENANCE:

Quantity indicators of estimation atmospheric air pollution

Тheme № 3: Sanitary protection of soil and clearing of the settlements.

Investigated indicator Result of research

Scenario – based task № 2: "Sanitary protection of soil"

Тheme № 4: Hygiene of the residential and public buildings and facilities.

5. QUESTIONS FOR SELF-PREPARATION:

Residence time carried out in the microenvironment, hours per day

Residential premises 12 12 19,5

Transport – 1,5 0,5

Public buildings & establishments 8 9 2

Atmosphere air 4 1,5 3

2. Area for 1 person - residential - 17.5 m2 (minimum 9 m2)

3. Required set of outbuildings Front (corridor), kitchen (kitchen & dining room),

4. Zoning of residential space (spatial and Carried out by an apartment (cottage)

Vital importance in hygiene focused on an air temperature and horizontal adjustment

Тheme № 5: Features of hygienic requirements towards planning, functioning of

Transient microflora sanation Hygienic antiseptics

Transient microflora sanation and decreasing an amount of Surgical antiseptics

Hygienic demands to hospital environment

Operating room 22 20% 2 500 1000 0 <4 VP

Scenario – based task № 2: "Features of hygienic requirements towards planning, functioning

Тheme of independent out-of-class work №1. Hygienic meaning of physical

Date Signature Name

Hygienic standardization of municipal noise

Levels of constant noise and

Maximum level of non-

constant noise (dBA)

Apartment premises 7.00-23.00 63 52 45 39 35 32 30 28 40 55

Cafes, restaurants 7.00-23.00 75 66 59 54 50 47 45 43

Fig. 1. Luxmetre U-116.

Lighting method of research of natural illumination in premises - definition of factor of

Тheme № 6. Nutrition in the preventive medicine. Organization of the treatment-

Rational nutrition - (lat. rationalis - clever) is a physiologically balanced diet of healthy

№4 Chlorinated hydrocarbons, arsene, tellurium, mercury compounds

Food packages, nutrients and energy value treatment-and-prophylactic rations

Hygienic estimation of Body Mass Index (BMI)

II 1.6 18-29 2800 77 42 78 448

Professional Coefficient Vitamins

Daily needs of vitamins for different professional groups of population (women)