Basic hygiene and sanitation

Useful for MLT and D.Radiogarphy

1. Basic Hygiene and Sanitation 1.Water and health 2.Air pollution 3.Noise pollution 4.Housing and ventilation 5.Water purification 6.Sterilization

2. Hygiene “Hygiene is defined as the practice of keeping oneself and ones surrounding clean in order to prevent disease.” Sanitation “Sanitation is defined as the arrangements to protect public health and the provision of safe and clean drinking water and proper disposal of sewage.”

3. Water Water is vital resource for living being.It constitutes two atom of hydrogen and one atom of oxygen.it occupies 71% of the earth’s surface.However only 3% water is usable and 97% water remains in the sea in the form of saline water.

4. Safe and wholesome water It is defined as free from pathogenic microorganisms harmful chemical substances pleasant to taste i.e. odourless and usable for domestic purpose. Uses of Water 1.Domestic purpose 2.Industrial purpose 3.Agricultural purpose 4.Public purpose 5.Power generation 6.Carrying away waste

5. Water requirement The basic physiological requirement of water have been estimated about 2 liters per head per day . It is just for survival 150-200 lit required for domestic purpose. Human health and water Water borne diseases: 1 .Caused by presence of Infective agent Viral :Viral hepatities A,Hepatities E,poliomyelitis,Rotavirus diarrhoea. Bacterial :Typhoid,Para typhoid fever,bacillary dysentery E.coli diarrhoea,cholera.

6. Protozoal :Amoebiasis,giardiasis Helminthic:Roundworm ,Hydatic diseases Snail:Schistosomiasis 2.Water washed disease: Occur in case of personal diseases. Suffer due to lack of insufficient water eg:trachoma,conjunctivities,scabies 3.Water based disease: Aquatic animals that form a necessary part of life cycle of infecting agent. 4.Water related diseases: Induced by insects that breed in water. eg: malaria , filariasis

7. 5.Sources of contamination of water: Solid waste & sewage/garbage Industrial waste Harmful chemical substance Physical pollutant Eg:Excreta harmful gases (CO2, SO2, N etc)

8. Human heath and water Diarrhoea: Poor water quality continues to pose a major threat to human health. Diarrheal disease alone is responsible for the death of 1.8 millions people every year (WHO 2004). It was estimated that 88% of the burden is attributable to unsafe water supply and sanitation.

9. Improvement in drinking water quality through household water treatment such as chlorination lead to reduction of diarrhoea. Malaria 1.3 million people die of malaria each year 90% of whom are children under five. Intensified irrigation dams and other water related projects contributes importantly to this disease burden.

10. Trachoma 6 million are visually impaired by trachoma. The disease is strongly related to lack of face washing, often due to absence of safe water. Improving access to safe water sources and better hygiene practices can reduce the morbidity by 27%. Intestinal helminthes (Ascariasis,Hookworm) 133 million people suffer from high intensity intestinal helminthes infections which often leads to severe consequences such as cognitive impairment,masssive dysentery or anaemia.

11. These disease causes around 9400 deaths every year. Access to safe water can reduce the morbidity. Japanese Encephalitis 20% of clinical cases of J.E and 35% suffer permanent brain damage. Improved management for irrigation of water resources reduces transmission of disease. Hepatitis A There are 1.5 million cases of clinical hepatitis A each year.

12. Air Air is the invisible gaseous substance surrounding the earth, a mixture mainly of oxygen and nitrogen. Pollution is the main source for addition of unwanted substance which adversely alters natural or anthropogenic environment. Air pollution Air pollution can be defined as the presence of toxic chemicals or compounds (including those of biological origin)in the air, at levels that pose a health risk . According to WHO 2014 report, air pollution in 2012 caused the deaths of around 7 million people worldwide.

13. Sources of air Pollution Automobiles Agriculture produce chemical Gases(co2,co,no2,so2 etc) Open burning Coal mining Electricity gas, steam Municipality garbage Hospital waste Incinerators Dust

14. Effects of air pollution on health Acute and chronic effects on health. Lungs cancer and other cardiopulmonary morbidity and mortality. Ambient air pollution causes about 5% trachoma, bronchus and lungs cancer 2% of cardio respiratory infections mortality and about 1% of respiratory infections mortality globally. Asthma, chronic bronchitis and emphysema.

15. Prevention and control of air pollution Focus more on walking and bicycle rather than automobiles. Shifting to less polluting automobile engines. Shifting to less polluting fuels, especially solar produce hydrogen gases. Giving financial assistance to automobile for each low or less pollution automobiles. Requires vehicle inspection routinely over the time. Making of legislation for controlling.

16. Current scenario of air pollution in Nepal Air pollution has become a serious environmental concern and a public health risk in Kathmandu Valley. Studies show that the concentration of particulate matter less than 10 microns (PM10) in the Valley’s ambient air is already several times higher than WHO safer limit and Kathmandu is one of the most polluted cities in Asia with regards to PM10 and PM2.5level (WHO, 2014b; CAI-Asia, 2006).

17. Although levels of gaseous pollutants such as oxides of nitrogen, oxides of sulphur , and ozone have not been found to be very high, they may increase in the future with increasing motorization. Furthermore, levels of toxic chemicals such as polyaromatic hydrocarbons (PAH) may also be high due to combustion in brick kilns and diesel vehicles (MOEST, 2005).

18. According to Environmental Pollution Index 2014 published by Yale University, Nepal ranked second last after Bangladesh in terms of air quality and its effect to human health. Nepal is the fastest urbanizing country in South Asia and Kathmandu Valley is the fastest growing metropolitan area in the region (World Bank, 2012).

19. The valley is especially vulnerable to air pollution due to haphazard urbanization, rapid motorization, valley centric industrialization and its topography. RESPONSEs TO AIR POLLUTION Government initiative Policies and standards: Interim constitution 2007 has guaranteed every person the right to live in a clean environment as a fundamental right and mandate state to make necessary arrangements to maintain clean environment.

20. Environmental Protection Act introduced in 1997 make legal provision to maintain clean and healthy environment by minimizing adverse impacts as far as possible. Climate Change Policy 2011 has aimed at moving in low carbon development path, which provide co-benefits for reducing the air pollution. National Ambient Air Quality Standard (NAAQS) was introduced in 2003 and updated in 2012.

21. Nepal Vehicle Mass Emission Standard (NVMES) was introduced in 2000 and revised in 2012. Now all vehicles except for heavy equipment vehicles imported to Nepal require compliance with EURO III emission standard. Euro III Standard Fuel: Nepal Oil Standard started supplying EURO III standard of fuel since 2010.

22. Emission standards for in-use and new diesel generators (DG) sets, industrial boilers, cement industries and crusher industries were introduced in 2012. Ambient Air Quality Monitoring System: Vehicle Inspection and Emission Testing: Ban on polluting vehicles: Ban on the heavily polluting Movable Bull Trench Kiln: Pollution tax on fuel: The government started to collect pollution tax of NRs. 0.5 from each liter of petrol and diesel sold in the Kathmandu Valley in 2007.

23. Road improvement, footpaths and cycle lanes: The government has initiated road expansion campaign to improve the traffic flow, and has built sidewalks and cycle tracks to promote walking and cycling. ii. Private initiative Public transport: The public transport service in Kathmandu Valley is exclusively provided by the private sector. Although it is not efficient it still provides its services to thousands of people, as 28 % of the travel in Kathmandu is on public transport. Operation of electric vehicles: Around 600 electric three wheelers (SAFA Tempos) are currently operating in Kathmandu Valley in 17 routes

24. iii. Initiatives from non governmental institutions Some of the key organizations working on air pollution related issues are Clean Energy Nepal, Clean Air Network Nepal, Nepal Forum of Environmental Journalists (NEFEJ), Environment and Public Health Organization (ENPHO), International Centre for Integrated Mountain Development (ICIMOD), and LEADERS Nepal. . Academic institutions such as Kathmandu University, Tribhuwan University and Pokhara University conducts research on air pollution related issues.

25. Noise pollution Noise pollution means an unwanted or undesirable sound that leads to physical and mental problems. Noise pollution is dependent on the loudness and frequency of the sound. In fact, when the sound exceeds its limit, it becomes fatal for human and other organisms. The noise intensity is measured in decibels or dB. A person can bear the noise up to 85 decibels, after which his hearing power can be damaged. According to the World Health Organization, sound levels less than 70 dB are not damaging to living organisms, regardless of how long or consistent the exposure is. Exposure for more than 8 hours to constant noise beyond 85 dB may be hazardous. If you work for 8 hours daily in close proximity to a busy road or highway, you are very likely exposed to traffic noise pollution around 85dB.

26. Sources of noise pollution Industries Residential areas Transportation noise Construction noise Public works Military noise Domestic noise

27. Effects of noise pollution Hearing loss Sleeping interference Decreased work performance Speech interference Hypertension Child development: Children appear to be more sensitive to noise pollution, and a number of noise-pollution-related diseases and dysfunctions are known to affect children, from hearing impairment to psychological and physical effects. Also, children who regularly use music players at high volumes are at risk of developing hearing dysfunctions. In 2001, it was estimated that 12.5% of American children between the ages of 6 to 19 years had impaired hearing in one or both ears

28. Various  cardiovascular dysfunctions . Elevated blood pressure caused by noise pollution, especially during the night, can lead to various cardiovascular diseases. Psychological dysfunctions  and noise annoyance. Noise annoyance is, in fact, a recognized name for an emotional reaction that can have an immediate impact.

29. Control and prevention of noise pollution Factories, which mainly produce noise pollution, should be established far away from settlements, forests, reservoirs and hilly areas. Settlements should not be located at least within 20 kilometres from mining areas, and airports. With proper maintenance of vehicles, along with the restriction of high sound horns, the use of advanced technology silencer should be used inevitably.

30. Use of horn in public places (hospital, teaching institutes etc.) should be banned. The sound of musical instruments should be controlled to desirable limits. The use of sound amplifiers of high power, DJ, etc should be banned in religious, social, political events. The use of sound absorber acoustic tiles should be encouraged in the construction of multi- storeyed buildings.

31. In industrial, commercial and hospital buildings, adequate soundproof systems should be installed. Planting green trees along the road side reduces the intensity of noise pollution. Protective tools (ear plugs etc.) should be provided for workers. Limits should be set on noise and control over noise pollution by legal provisions. Adequate health education on pollution should be provided through government agencies and voluntary institutions.

32. Housing and Ventilation Physical structure that human uses and the environs of the structure including all necessary services, facilities,euipment and devices needed or designed for health of individual or family is known as housing. Goals of housing 1.Shelter:The house should provide a sanitary shelter(basic need)

33. 2.Family life: The house should provide adequate for family life and related activities. Such as preparation of food ,meeting, sleeping individual activities and other basic activities. 3.Access to community facilities: Accessibility to community services and facilities,schools,shopping areas. 4.Family participation in community life: Family is part of the wider community. Community is very important to family in many ways. it can offer help in times of need, it is the important source of friends.

34. Criteria for healthful housing An expert community of the WHO recommended the following criteria for healthful housing. Healthful housing provides physical protection and shelter. Provides adequately space for cooking eating, washing and excretory functions. It is designed,constructed,maintained and used in a manner such as to prevent the spread of communicable diseases.

35. It provides for protection from hazards of exposure to pollution. It is free from unsafe physical arrangements due to construction or maintenance and from toxic or harmful materials. It encourages personal and community development, promotes social relationship.

36. Housing Standard-: Social and economic characteristics such as family income, family size and composition, standard of living,lifestyle,stage in life cycle, education and cultural factors are taken into account. Because of cultural diversity and other factors such as climate and social traditions, standard of housing varies from country to country and from region to region.

37. In short-there cannot be rigid, uniform standards. Site-: - should be elevated from its surroundings - should have an independent access to a street of adequate width should be away from breeding places of mosquito and flies should be away from nuisances such as dust,smoke,smell,excessive noise, and traffic. should be in pleasant surrounding soil should be dry and safe for founding the structure and should be well drained. The sub-soil water should be below 1o feet.

38. Set Back-: It is the open space all around the house which allows proper ventilation and lightening - In rural areas it is recommended that the built-up area should not exceed one third of total area. - In urban areas it is allowed up to two-third of total area. The set back should be such that there is no obstruction of lighting and ventilation.

39. Floor-: -Should be Pucca and satisfy the following criteria: should be impermeable ,so that easy to clean and dry must be smooth and free from cracks and crevices to prevent the breeding of insects and harbourage of dust it should be damp-proof the height of the plinth should be 2-3 feet.

40. Walls-: - reasonably strong should have a low heat capacity weather resistance unsuitable for harbor of rats and vermin. Roof-: -Should not be less than 10 feet in the absence of air-conditioning for comfort.

41. Rooms-: should not be less than two,atleast one of them can be closed for security the other may be open on one side if that side is a private courtyard Number should be increased as per the family members Floor Area-: - should be at least 120 sq ft for more than one person and at least 100 sq ft for single person. Floor area per person should not be less than 50 square per person.

42. Cubic Space: the height of the room should be at least 500 cubic ft per person preferably 1000 cubic ft Windows: every living room should be provided with at least 2 windows and one of them should open directly on to an open space the windows should be placed at a height of more than 3 feet(1 m) above the ground in living rooms windows area should be 1/5th of the floor area doors and windows combined should have 2/5th the floor area.

43. Ventilation: Cubic space fresh air supply 300 to 3000cubic feet per hour per person and sufficient space for air exchange. Lighting-: the daylight factor should exceed 1 % over half the floor area. Kitchen-: Must have a separate kitchen.Must be protected against dust and smoke, adequately lighted, provided with water supply, provided with a sink for washing utensils and fitted with arrangements for proper drainage.

44. Privy-: A sanitary privy is a must for every house, belonging exclusively to it and readily accessible. Garbage and refuse-: Should be removed from the dwelling at least daily and disposed of in a sanitary manner. Bathing and Washing-: house should have facility for bathing and washing belonging exclusively to it and providing proper privacy Water Supply-: House should have a safe and adequate water supply available at all times.

45. RURAL HOUSING-: Minimum standard suggested-: - There should be at least two living rooms Ample verandah space may be provided - The build-up area should not exceed one-third of total area There should be a separate kitchen with a paved sink or platform for washing utensils The house should be provided with a sanitary latrine. The window area should be at least 10% of the floor area . There should be a sanitary well or a tube well within a quarter of a ample from the house

46. It is insanitary to keep cattle and livestock in dwelling house. Cattle sheds should be at least 25 feet away from dwelling houses. A cattle shed should be open on all sides an area 8ft×4ft is sufficient for each head of cattle There should be adequate arrangement for the disposal of waste water, refuse and garbage.

47. Housing and Health Poor housing is associated with the following health conditions-: Respiratory Infection Skin infection Rat infestation Arthropods Accidents Morbidity and Mortality Psychological effects

48. Overcrowding It refers to the situation in which more people living within a single dwelling than there is space for, so that movement is restricted, privacy secluded, hygiene impossible rest and sleep difficult. Overcrowding is a health problem in human dwelling. It may promote the spread of respiratory infections such as TB,Influenza and Diphtheria. Overcrowding refers to the situation in which more people living within a single dwelling than there is space for, so that movement is restricted, privacy secluded, hygiene impossible rest and sleep difficult. Overcrowding is a health problem in human dwelling. It may promote the spread of respiratory infections such as TB,Influenza and Diphtheria.

49. Three criteria have been used commonly for judging the presence of “overcrowding” 1. PERSONS PER ROOM CRITERION The number of persons in the household is divided by the number of rooms in the house. The criteria for counting of persons for assessment of sufficiency of living area are as follows: • An infant (a child under 12 months of age) is not counted. • Children aged 1–10 years are counted as half a person each. • All those above the age of 10 years are counted as one person each. The accepted standards are given in the following Table Table: Persons per Room Criteria for Assessment of Overcrowding in a Household

50. PERSONS PER ROOM TABLE

51. 2. FLOOR SPACE CRITERION • Measure the length (L) and breadth (B) of all the rooms. Calculate the floor area of each room by the formula: Floor area = L × B • Add up all the room area to calculate the total area. • Calculate the number of occupants in the same manner as in the previous case. • Divide the total area by the number of persons residing in the house. • This will give the floor space per person. • The accepted standard of floor space per person is given in the following Table

52. The minimum standard for floor area per person has been set as 50 sq feet (5 sq m).

53. 3. SEX SEPARATION CRITERION According to this criterion, overcrowding is considered to be present if two persons, above 9 years of age, of opposite sexes, not husband and wife, must sleep in the same room. ‘Must sleep in the same room’, means that there is no other option but to share the room.

54. Major problems due to lack of sanitation Poor sanitation is linked to transmission of diseases such as cholera, diarrhoea , dysentery, hepatitis A, typhoid and polio. Inadequate sanitation is estimated to cause 280 000 diarrhoeal deaths annually and is a major factor in several neglected tropical diseases, including intestinal worms, schistosomiasis , and trachoma. Poor sanitation also contributes to malnutrition. Diarrhoea remains a major killer but is largely preventable. 

55. Options for improving sanitation and hygiene by water purification and sterilization. Water purification Purification of water can be done by two methods: 1.Large scale purification 2.Small scale purification Large scale purification : Done by 3 main process 1. Sedimentation(storage) Water pumped from the source (river, lake or dam) is allowed to stand in large tanks, called settling tanks, for a few hours. Mud, sand and other suspended particles settle down. The water over the sediment layer is more or less clean.

56. This is natural process which takes place in 3 ways Physical: The quality of water is proved more by storage. About 90%of suspended particle or impurities settle down in 24 hours and then the water become clear. Chemical: Certain chemical changes also takes place during storage. The aerobic bacteria oxidize the organic matter with the help of dissolved oxygen free ammonia content is reduced.

57. Biological: helps to reduce pathogens in water. After 5-7 days in storage the bacterial count in river water is reduced by 90%.If it is stored too long, vegetable growth may occur. The optimum period of storage of water is 10-14 days.

58. 2.Filtration It is quite important because 98%-99% of bacteria are removed by filtration, apart from other impurities. There are two types of filters commonly used: Slow sand or biological filter Rapid sand or mechanical filter

59. Slow sand or biological filter In this process of filtration, water is drawn from the river, streams or lakes into the filter bed. Essentially slow sand filtration consist of raw water, a bed of graded sand,an under drainage system and a system of filter control. The raw water which has to be purified is first stored in settlement tanks for 1-2 days. Then water is sent through a bed of sand or small stones. This sand works as a biological filter.

60. Advantages 1.No need to add chemical in water 2.Simple equipment needed 3.Suitable land is easily available 4.Supervision is simple Disadvantage 1.A large area is required 2.Filtration is open so possibility of contamination should be more 3.Less feasible(less practicable) to operate 4.Sedimentation has to take place before the process of filtration

61. Rapid sand or mechanical filter Rapid sand filters work faster than slow sand. There are two main types. Gravity type(Paterson’s filter) Pressure type(Candy’s filter) The following steps are involved in rapid sand filtration: Coagulation: Raw water is treated with chemical substance at first such as alum to remove turbidity and color. Amount of alum used is 5-40 mg/liter depending on how dirty the water is.

62. Mixing: After the addition of alum. The water is subjected to violent agitation in mixing chamber for a few minutes. This process thoroughly mixes alum with water. Flocculation: Water is than passes into the flocculation chamber, where it is slowly agitated for about 30 minutes. This results in the formation of a thick precipitation of aluminum hydroxide.

63. Sedimentation:The coagulated water is now led into sedimentation tanks, where it is kept for 2-6 hours. The precipitation of aluminum hydroxide along with impurities settle down and the water now looks much clearer in appearance. Filtration: It is the last steps of rapid sand filtration. The purified water from rapid sand is over 99% purifies.

64. Advantages 1.can deal raw water directly, no need to store 2.Filter occupies less space 3.Filtration is rapid,40-50 times that of slow filtration 4.Washing of the filter is easy 5.There is more flexibility in operation

65. 3.Chlorination Kills pathogenic bacteria, no effect on spores and certain viruses. Also oxidizes iron, manganese and hydrogen sulphide , destroys some taste and odor producing constituents Also controls growth of algae and slime organisms and aids coagulation.

66. PRINCIPLES OF CHLORINATION Water to be chlorinated should be free of turbidity • Chlorine demand should be estimated: Chlorine demand = Amount of chlorine added – residual chlorine Point at which chlorine demand is met is called break point chlorination • Contact period of at least one hour • Minimum recommended concentration of free chlorine : 0.5mg/L for one hour • The sum of chlorine demand of specific water plus the free residual chlorine of 0.5mg/L constitutes the correct dose of chlorine to be added.

67. METHODS OF CHLORINATION • Chlorine Gas • Chloramine • Perchloron ADVANTAGES • Low cost • Easy of application • Kills almost all bacterial contaminants DISADVANTAGES • Formation of halogenated compounds which are suspected carcinogens.

68. Purification of water in small scale This is also called household purification of water in an individual and domestic scale. The method can be used singly or in combination. This includes boiling,chemical,disinfectionand filtration. Boiling Boiling is the best method of purifying water for household purpose. To be effective, the water must be brought to a rolling boil for 10-20 min. It kill bacteria,spores,cysts and ova. Boiling also removed temporary hardness of water. The taste of water is altered but it is considered harmless. Water should be boiled in the same container in which it is to be stored to avoid contamination during storage .

69. Chemical disinfection Bleaching powder Chlorine solution Iodine Potassium permanganate

70. Bleaching powder Bleaching powder or chlorinated lime is a white amorphous powder with a pungent smell of chlorine. It is an unstable compound. On exposure to air, light and misture,it’s rapidly loses its chlorine content. But stabilized bleach. Bleaching powder should be stored in dark,cool,dry place in close container that is resistant to corrosion.

71. Chlorine solution It may be prepared from bleaching powder if 4kg of bleaching powder with 25% chlorine is mixed with 20liters of water,it will give a 5% solution. Readymade chlorine solution in different strength and name are available in market i.e.high test hypochlorite (60-70% available chlorine)chlorine tablets (0.5g=20liter of water), piyush and water guard(3drops/liter of water) etc

72. Piyush can be used by putting 3 drops/liter of clean water, shake well and drink after 30 minutes. water guard can be used as 2 ml in 10 liters of clean water ,stir with clean spoon and drink after 30 min. Iodine: Iodine may be used for emergency disinfection of water in which 2 drops of 2 % ethanol solution of iodine is used in one liter of clean water. A contact time 20-30 minutes is needed for effective disinfection.

73. Potassium permanganate: Once widely used it is no longer recommended for water disinfection. Although a powerful oxidizing agents, it is not satisfactory agents for disinfecting water. It may kills cholera vibrios,but is of little use against other disease organism. It alter the color ,smell and taste of water.

74. Filtration Water can be purified on a small scale by filtering through different types of filter i.e. charcoal filter ,kanchan arsenic filter,barkefeld filter and chamber land filter. Charcoal filter Collect 3 pots and make holes at the bottom of the pot with sharp instrument Place pebbles sand and charcoal in another pot to make a filter which is set on top of a second pot. Pour water into top filter and collect drinking water from the collecting pot in the bottom.

75. Kanchan Arsenic filter It is used to remove arsenic,pathogens,iron,odor and some other contaminants in drinking water. It can filter 15liter water/hour. Barkefeld: It consist of candle made of prcelain.It does not require pressure Chamber land filter : It has porous tube made of unglazed; it kills bacteria by mechanical action.