ABSTRACT

LEARNING OBJECTIVES By the end of this course, the

student will be able to: 1.Identify the nature,
health effects, and sources of environmental risks
2.Build a model explaining the environmental
background of human diseases 3.Define health-
related activities relevant to prevention and/or control of
these risks Explain methods for monitoring the quality
of water Describe principles of waste management
in the community and in health care settings

[Author name]
Dr. Ezzadin Franka
ENVIRONMETAL
HEALTH
Air , WATER, Food, Housing
 ENVIRONMETAL HEALTH
LEARNING OBJECTIVES
By the end of this course, the student will be able to:
 Identify the nature, health effects, and sources of environmental risks
 Build a model explaining the environmental background of human
diseases
 Define health-related activities relevant to prevention and/or control of
these risks
 Explain methods for monitoring the quality of water
 Describe principles of waste management in the community and in health care
settings
Introduction to Environmental Health

Definition of Environment
 The environment is the frame in which man lives affecting him and
'affected by him in a reciprocal relationship.
 The term environment captures the notion of factors that are external to the
individual as opposed to internal factors, e.g. genetic makeup of an
individual.
 The term environment implies all external conditions, circumstances and
factors- living and non-living - which surround man and affects him and
the growth and development of his community.

Definition of Environmental Health

 The term is used to refer to the science and art of identifying, assessing,

1
 correcting, controlling, and' preventing those exposures in the
environment including physical, chemical, biological and mechanical -
which may potentially harm the human health of present and future
generations.
 It is thus the study of how human health is affected by environmental
exposures and how to manage, control and prevent those hazardous
exposures in order to avoid potential harm to human health. Being a
sector of public Health, it is principally a preventive discipline.
Importance of studying Environmental Health
 Explain the role of the environment as an important determinant of health
and
disease as the epidemiological triad illustrates.
 Highlight the fact that environmentally induced ill health is controllable
and
preventable if correct environmental measures are applied.

Compartments of the environment:

1. The natural environment 2. The man- made environment
1. The natural environment:

It includes all various facets that comprise our planet and its surroundings.
The natural environment includes the following components:

a) The Atmosphere, which is the layer of gases that surrounds the earth.
b) The Hydrosphere, which is made up of oceans, lakes, rivers and
other bodies of water on earth.
c) The Geosphere, which consists of a central core surrounded by an

2
 outer layer of the earth's crust.
d) The Biosphere which is the narrow zone where different types of
living
organisms live on earth i.e. the zone of earth where life is found
which is a little above and below the surface of land and in water
and air.

2. The man -made environment:

It includes all what humans invented during the course of their civilization.
The man -made environment includes the following components:
a) The physical infrastructure; It includes all what was invented and built by man
as buildings, cultivated land, bridges, paved streets, transportation means, etc... Which
constitutes all physical achievements of human civilization. Forms of environment
include urban environment, rural environment, work environment, home environment,
refugee camps environment, etc.

b)The socio-cultural environment: It includes the social and institutional

'systems which have been developed by man. It also refers to the environment created
by human culture, the social norms, relations and behaviour. Culture differs from one
country to another and even there are subcultures in the same country.

The environmental media

They are the interface between man and environment. Through them exposure
to
environmental hazards occurs. Environmental Health practice focuses
principally on safety of environmental media on a global, regional, national,
district, and local levels (at home, work, school, street, etc. ... ).

3
 Natural System Issues
Air Pollution
• Global climate change
• Stratospheric ozone
depletion
• Urban air pollution
• Acid deposition
• Outdoor pollutants
• Indoor pollutants
Water Pollution
• Sediment
• Nutrient overload
• Toxic chemicals
• Infectious agents
• Oxygen depletion
• Pesticides
• Oil spills
• Excess heat
Biodiversity Depletion
• Habitat destruction Food Supply Problems
• Habitat degradation • Overgrazing
• Extinction • Farmland loss and degradation
• Wetlands loss and degradation
• Overfishing
• Coastal pollution
• Soil erosion
• Soil salinization
Major
• Water shortages
Environment • Groundwater depletion
al Problems • Loss of biodiversity
Human Health
• Childhood diseases
• Cancer
Waste Production • Asthma
• Solid • Immune system deficiencies
• Hazardous • Reproductive system problems
• Molecular • Endocrine system disruptions
Source: Adapted from Living in the Environment, Tenth Edition, G. Tyler Miller, Jr., 1998

• Environmental media of natural environment include:

a. Air
b. Water
c. Food
d. Soil / Land.
• Environmental media of man -made environment include:
a. Consumer products and by-products
b. Wastes.

Types of Environmental Hazards I Stressors I Agents

Environmental hazards are those factors or conditions in the environment that may be
harmful to human health upon exposure to them and thus increase the risk of human
disease, injury or death. Environmental hazards may be encountered outdoors or
indoors.
Major categories of environmental health hazards include:
1. Physical hazards: noise, temperature, radiation, pressure. .'
2. Chemical hazards: toxic chemicals of synthetic or natural origin.
3. Biological hazards: infectious agents of plant or animal origin.
4. Mechanical hazards: ergonomics, repetitive and acute trauma.
5. Psychosocial hazards: discrimination, violence, stress.
There are interactions among classes of stressors. Thus, radiation, infection or
psychological stress may modify the effect of toxic chemicals upon health.
•
Environmental Risk Assessment
It is a formalized process for characterizing and estimating the magnitude of harm
resulting from some exposures and intended to provide objective information to
inform public policy decisions.
- Objectives of risk assessment process:
. Maintenance of health and safety of the general population (environmental risk

4
assessment) and health & safety of specific exposure groups as workers (occupational
health risk assessment).
. Formulating of TL Vs (threshold limit values) of exposure to various hazardous
agents.
- Risk assessment paradigm: is composed of four interrelated activities:
1- Risk research.
2- Risk assessment.
3- Risk management.
4- Risk communication.
- Risk assessment model include:
1- Issue identification.
2- Hazard identification.
3- Dose- response assessment.
4- Exposure assessment for the relevant population..
5- Risk characterization.

.
Example of how environment affects health
Many poor nations lack potable drinking water and the management of sewage is
hampered by scarce resources leading to increased burden of diarrheal diseases in
poor
communities, which is called a silent emergency leading to high infant mortality rates.
If
both quantity and quality of potable water are controlled adequately, the burden of
diarrheal diseases will markedly decrease ameliorating infant mortality markedly.
Environmental Sanitation
I

Sanitation is the science of safeguarding health. It is an operational term for the

preventive and control aspects of environmental health.
The role of primary care or family physician in Environmental Health:
1. Recognition of environmental risks in the area he or she serves.
2. Assessment of magnitude of risk of environmental hazards on human health.
3. · Contact public agencies responsible for remedial actions to encourage them
to
control environmental hazards in the area he or she serves.
4. Health education of the public regarding the healthy living practices,

Air
Composition of the air:
 Nitrogen 79 %
 Oxygen 20.96%
 Carbon dioxide & traces of other gases (H2 , methane and argon) 0.04 %
 Water vapour.

Value of the air (Function):

 Gas exchange between air & blood haemoglobin in the lung.

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  Cooling power to keep constant body temperature.
 Feeling of comfort with good performance of work
Sanitary requirements of air:
o Free from pollution.
o Optimum temperature 20-250 C
o Relative humidity 30-65 %.
o Cooling power 5-7 milli.cal/sq.cm/sec.
o Air movement 0.05-0.1 m/s

Relative humidity
Definition:
Amount of water vapour of certain volume and temperature of air 'XIOO
Amount of vapour needed to saturate the air of same volume &temp.
o The optimum relative humidity of air is between 35-65 %.
o The relative humidity can be measured by Daniel hygrometer
Effects of the relative humidity:
o Keeping moisture of the skin.
o Help in cooling power of air through the evaporation of sweat.
Evaporation ceases when the relative humidity reaches 100 %.
Adverse effects of relative humidity
 High relative humidity:
o Feeling of discomfort
o Interferes with heat loss & predisposes to heat stroke.
o Helps in spread of droplet infection as the organism can live
longer outside the body.
o Increases susceptibility to respiratory & rheumatic diseases.
 Low relative humidity:
o Dryness of skin & mucous membrane.
o Dryness of respiratory passage especially the nose.
o Feeling of discomfort
Cooling power of the air

Definition:
Cooling power of the air is the readiness of the air to accept the continuous
flow of the heat from the body. Or
The ability of the body to loose heat in the surrounding air.
Cooling power of the air can be measure by Kata thermometer.
Factors affecting the cooling power of air:
 The temperature of the air.
 The relative humidity
 The air movement
Impaired cooling power is due to Increase In relative humidity with sluggish air
movement.
Hazards of impaired cooling power:
Mild: {picture of ill ventilation in crowded places} headache, discomfort, loss of
concentration, lassitude, mental fatigue sensation.
Severe: Thermal stress {Heat related illnesses}
 Circulatory instability.

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  Heat exhaustion.
 Heat stroke.
 Heat cramps.
 Miliaria rubra (Prickly Heat) and Thermogenic anhydrosis.
 Respiratory distress.
 Ischaemic heart disease.
Air pollution
Definition of air pollution:
" Should "be applied only when the air "contains an excessive concentration of
foreign matter which adversely affects the health & the well- being of individual or
causes damage to property or to plant or animal life.
Vitiation of air:
It is any change in physical character or chemical constituents of air, which is
usually, not be harmful.
Types of air pollution
1- Physical pollution:
 Extremes of temperature
Noise
Radiation
2-Chemical pollution :
 Gases and vapour
Suspended particulate matter: as dust, fume, smoke, mist and fog
3-Biological pollution
Pathogen of infection
Allergens.
Primary pollutants
The five major pollutants accounts for 98 % of all air pollutants.
 Carbon monoxide 52 %
 Sulfur oxide 18 %
 Hydrocarbon 12 %
 Particulate matter 10 %
 Nitrogen oxide 6%
Secondary pollutants (photo chemical pollution)
They are formed in the atmosphere from precursors that may or may not harmful by
Photochemical reaction. _
Photochemical reaction between hydrocarbons and oxides of nitrogen in sunlight and
air
could produce:
 Peroxy acetyl nitrate (PAN)
 Aldehydes.
 Ozone.
Hazardous pollutants
They are pollutants to which no ambient air quality standards are applicable
 Asbestos: malignancy of the lungs .pleura & peritoneum.
 Beryllium: progressive granuloma of the lung.
 Mercury: CNS & renal toxicity
 Vinyl chloride: angiosarcoma of liver &other cancers.
 Future candidates include: benzene .arsenic, cadmium and benzypyrene.

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 I-Outdoor air pollution
Sources of air pollution
A - Natural disasters
B- Man-made contaminants
A - Natural disasters
Natural disasters are extreme, sudden events caused by environmental factors that
injure
people and damage properties. Earthquakes, windstorms, floods and diseases, all
strike
anywhere on earth, often without warning.
Earthquake:
Is a sudden rapid shacking of the earth caused by the breaking and shifting of rocks"
beneath the earth's surface. Ground shaking from earthquakes can trigger, huge
destructive ocean waves (tsunamis) ..
Volcanic Eruption:
Consist of violent explosions that blast great clouds of gas -laden debris (magma) into
the atmosphere. Volcano produce enormous amount of heat, rock, gases, chemicals
dust,
ash and steam. The volcano releases sulphur dioxide gas (S02) which reacts with
sunlight
oxygen, dust particle & water in the air to form mixture of sulphate aerosols, and
sulphuric acid. Together this gas & aerosol mixture produces a hazy atmospheric
condition known as volcano smog or "fog".
Hurricane:
Hurricanes are powerful storms that form at the sea and consist of strong wind and
rain
surround a central calm" eye" which is about 15 miles across.
Tornado:
A tornado is a violent whirlwind rotating funnel of air that extends from a cloud to
ground. These storms change direction without warning randomly destroying homes
&
power lines.
Blizzard:
Blizzard is severe storm characterized by extreme cold, strong winds & a heavy
snowfall.
If they endure for 3 hours, define a blizzard.

8
9
 B - Man-made contaminants
 Biological: pathogens of infection & allergens
 Transportation: (60 %)
 Physical: noise
 Chemical: CO, N02, S02, HC, particulate & lead
 Combustion of fuel: incomplete combustion of solid (coal) or liquid &
gaseous fuel.
Industrial process: (18 %)
 Physical: noise, extremes of temperature & radiation.
 Chemical: dust, fumes, vapours & gases.
Plants of nuclear power production.
Solid waste disposal (refuse 5 %)

Effect of air pollution

The effect depend upon:
 The general condition of the subject
 The duration of exposure
 The nature of the pollutant
 The concentration of the pollutant

The effect of air pollution may be due to:

10
  Synergistic action of air pollutant
 Production of new irritating substance
 Individual susceptibility
The effects of air pollution are
1- Human effects:
A) Respiratory system:
 Increase mortality of the vulnerable groups.
 Increase the morbidity of certain chest disease e.g. chronic obstructive
lung diseases &bronchial asthma.
 Cancer
B) Other effects:
 Eye irritation
 Nasal congestion &odour complaint
 Acid taste

2- Animal effects:
 Of particular interest is the effect of fluorine on herbivores
Advanced fluorosis in cattle is indicated by : anorexia,
diarrhoea, weight loss, low fertility &reduction in milk
production
 Lead poisoning in herbivores animal grassed in contaminated
lands.
3- Effect on vegetation:
 Deposition has the effect of reducing the rate of photosynthesis by
reducing the amount of light reaching the leaves.
 S02 is the major pollutant affecting the plants.
Oxidant gases can cause leaf collapse, growth alteration, chlorosis and
reduction of crop yields.
4 -Effect on inert material:
 CO2 in solution dissolve limestone.
 Acid corrodes most of metals.
 S02 affects leather & paper
 Ozone causes cracks of the rubber & fissuring of tires.
5- Social & economic effects:
 Cost of disease & absenteeism
 Diminished visibility &increase accidents
 Increase cost of illumination
 Increase cost of cleaning
 Damage to crops.

Prevention & control of air pollution

L-Legislation
Environmental protection agency (EPA) has adopted air quality standards for five

11
 major pollutants by studying dose response data &determining thresholds. There are
permitted levels of contamination to which nearly all people may be repeatedly exposed
day after day without developing adverse health effects.
2- Air monitoring
Monitoring networks must exist all over the country.
3- Zoning
 Residential area &industrial zone must be built after taking into account air
pollution possibility.
 Residential area must not be downwind of an industrial zone
 Large pollution sources as electric power plants must be moved out to rural areas
The following points should be considered when selecting the site of a factory:
 The nature of air contamination
 Efficiency of available control devices
 Meteorological factors
 Dispersion ability of the air at its possible sites.
 Potential effect on surrounding area
4-Prevention &reduction of pollutants
 Elimination or reduction of emission at sources by substitution of material, process or
equipment e.g.:
 Use of clean fuels with low sulphur content or deleaded gasoline
 Use of electricity instead of petrol
 Adopt low waste technology.
 Maintenance of internal combustion engines to produce less CO &hydrocarbon.
 Taking into account wind movement when spraying insecticides.
5- Control of pollutants
 Use of tall stacks which discharge exhaust gases at an elevation high
enough to put maximum concentration of exhaust gases at ground levels
within acceptable limits.
 Air cleaning methods:
 Dust: Filters, mechanical collectors, or by electrostatic precipitation.
 Gases: liquid scrubbing or gas solid adsorption (activated charcoal).
 Organic contaminants: burning or neutralizing.
2- Indoor air pollution
Building related health problems
Building related ill health:
Defined as any adverse impact on health of building users while living or working.

Causes of indoor air pollution:

 Sources that release gases or particles into the air.
 In adequate ventilation can increase indoor pollutant.
 High temperature &humidity levels can also increase concentration
of some pollutants.
Sources of pollutants in home:
=Building materials:
Radon gas from rocks (granite), asbestos from cement asbestos and ceiling
insulation. Microbial contaminant have been found in damp buildings & bathroom
walls. Toxic fungi such as Stachybotrys and penicillum present in porous products in
buildings.
=Furnishings:
Volatile organic compound and' formaldehydes from deteriorated furniture made of

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 pressed wood products and from paints and glues. Microbial contaminants have been
found in wet or damp carpet..
=Combustion sources:
Combustion products include gaseous irritants (NOx & S02), asphyxiants (CO) &
polyaromatic hydrocarbon arise from combustion sources such as oil, gas, kerosene,
coal, wood and tobacco products.
=Products of household cleaning & maintenance:
Volatile organic compounds from air fresheners, household cleaning products and
insecticides.
=Central heating or cooling systems and humidification devices:
Microbial contaminants have been found in humidifiers with stagnant water and in
condensing coils.
Outdoor air pollution:
Pollutants enter the building through the ventilation system.
NB: Building may include hazards from exposure to radiofrequency (RF)
electromagnetic radiation from appliances erected or facing buildings such as mobile
phone base station and satellite dishes, and from location of buildings near power
lines and underground cables.
Health effects of indoor air pollution:
Immediate effects:
May show up after a single exposure or repeated exposures. These include:
 Irritation of the eyes, nose, throat, headaches, dizziness and fatigue.
 Symptoms of some diseases including asthma, hypersensitivity pneumonitis
and
humidifier fever may also shown up after exposure to some indoor air
pollutants.
Long-term effects:
Occur after long period of exposure or repeated exposures. It include:
 Respiratory diseases.
 Heart diseases.
 Cancer
Building associated illness Sick building syndrome (S.B.S)
This syndrome has occurred principally in the new building with centrally
controlled ventilation system and without openable windows. The syndrome
characterized by a set of symptoms recognized recently among occupants of buildings
tightly sealed.
Aetiology:
=Ventilation design permits the accumulation of low levels of many substances:
 Formaldehyde
 Cigarette smoke
 Organic solvent
 Microbial contamination
 Fluctuation in temperature and humidity
Symptoms
Occur shortly after entering building and relieved soon after leaving.
=Headache, dizziness & fatigue. =Difficulty in concentration
-Eye, nose and throat irritation =Chest tightness (asthma like)
=Drying of skin and irritation
Treatment: - Fresh air intake.

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 Global environmental problems
. They are environmental problems which cross the international borders (i.e.
have large scale nature).
They are:
1. Ozone depletion
2. Greenhouse gases
3. Acid precipitation
4. Persistent organic pollutants (POPs)
5. Hazardous wastes ( industrial & residential)
6. Land degradation & soil loss
7. Pollution & depletion of water resources

Ozone (o3) depletion

Ozone is a gas composed of three atoms of oxygen. Ozone occurs both in the earth’s
upper atmosphere and at ground level. Ozone occurs naturally in the earth's upper
atmosphere 6 to 30 miles above the earth's surface (stratosphere) where it forms a
protective layer that protects from the sun's harmful ultraviolet rays.
Ozone at the ground level (troposphere) is a harmful air pollutant.
Definition of ozone depletion:
Declining of ozone layer thickness, which acts as a vital protective
Layer against UV - B irradiation in the stratosphere.

Causes:
 Chlorofluro carbon (Freon).
 Halogenated hydrocarbon.
 Pesticides, supersonic air craft, volcanoes.
Consequences:
Effects of UV on man:
 Sunburns, pigmentation & skin aging.
 Cancer of skin.
 Keratitis &cataract.
Effects of UV on Plants :
 Stunted growth
 Interference of photosynthesis

Small organism:
Harmful to some forms of marine life
Prevention & control
 Minimizing or preventing the use of the ozone depleting agents
(as CFCs & halogenated HCs)
 Stopping the development of supersonic aircraft.

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Greenhouse gases (Global warming)
Definition:
Increasing the building up of CO2 and other greenhouse gases such as methane, SOx
, NOx, because of combustion of coal, oil & natural gas (fossil fuel).
Mechanism:
CO2 is opaque to some wave lengths of infra-red light so increasing its concentration
in the atmosphere will decrease the rate at which the earth radiates heat to outer space
as infra-red radiation producing the 'so called global warming.

Consequences:
Melting of ice capes & rise of the sea level flooding most of the cities &
agriculture area of the world.
Floods favour water borne illnesses.
Meteorological changes lead to climatic alterations with
more heat waves & severe storms.
Higher air temperature increases the concentration of
ozone (o3) at the ground level which is a harmful
pollutant.
Heat impaired grain production &damage the crops there
by reducing food supplies & contributing to malnutrition.
Increase of heat related illnesses & of some respiratory
problems.
Increases the deaths from cardiovascular diseases among
vulnerable groups.
Exacerbation of the vector borne illnesses ego malaria, dengue fever &
encephalitis as mosquitoes proliferate faster & bite more.
Prevention &control:
Decrease CO2 building up by shifting to nuclear energy & stopping deforestation.

Acid rain
Definition:
Increase average acidity of rainfall.
Causes:
SOx also NOx emitted from combustion of fossil fuels rise high up &
dissolve. In moisture producing sulphuric & nitric acids.
Consequences:
 SOx & NOx emissions give rise to respiratory problems as
asthma, headaches, eye, and nose, throat irritation.
 Destruction of delicate aquatic ecosystems plant &tree.

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  Acid particles deposited on building & statues causing erosion.

Prevention:
Cleaning up of sulphur & nitrogen oxides.
Persistent organic pollutant (POPs)
POPs are chemical substances that persist in the environment, bio-accumulate
throughout the food web and pose a risk of causing adverse effects to human health
and environment They are used as pesticides, wood preservatives and industrial
chemicals.
The most common POPs are:
1. Polychlorinated biphenyls (PCBs) 2.Dioxin and Furans
3. Aldrin 4. DDT
5. Toxaphen 6. Endrin

Sources of POPs are:

1. Municipal waste incineration 2.Medical waste incineration
3.Cement kilns 4. Diesel fuel combustion
5. Forest fires
Human health effects:
a. Carcinogenesis: lung - liver - thyroid
b. Immune system defect: suppression of cell mediated and humoral immunity.
Developmental impact: birth defect &fetal deaths.
c. Male &female reproductive toxicity: reduced spermatic count in males &
decreased fertility in females.
d. Dermal manifestation: follicular keratosis &dry skin
,
Land degradation &Soil erosion
The term degradation describes a process. When something is degraded, its character
changed for the worse - damage is done.
Degradation of land has serious consequences for food security.

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Causes of Land degradation &soil erosion:
 Deforestation: the removal of trees for firewood, or to clear land for farming.
 Overgrazing allowing farm animals to eat all the covering vegetation until the
soil is exposed.
 Poor land management: This can be inappropriate farming methods for the
type of land; farming that is too intensive forcing the land to produce food
crops. Year after year without letting it 'rest' to build up nutrient again; using
chemical fertilizers.
 Fires: which strip the soil of the plant materials that prevents soil erosion.
 Pollution: By dumping, scrap metal, plastics and packaging & building
rubble.
 Mining: chemicals mined themselves pollute soil.
 Neglect: failing to look after local plants, tree &biodiversity.Neglect means
that the soil will not be naturally fertilized and protected, so it cannot in turn
nurture other life.
Depletion of fresh water resources
The fresh water represent only 2.5 percent of all the water on earth.
Causes of depletion of fresh water resources:
Water pollution
Caused by industrial waste, sewage contamination, agriculture practice and air
pollution.
Population growth
By the year 2025, as much as two-thirds of the world's population -predicted to have
expanded, an additional 2.6 billion people-will be living in conditions of serious water
shortage and one- third will be living in conditions of absolute water scarcity.
Increased use of irrigation
There is increasing pressure to increase irrigation despite the associated problems of
salinization and or waterlogging.
The use of fresh water in industrial and processing systems
The demand for fresh water for consumption by livestock in industrial unit and for
maintaining clean &hygienic production sites is considerable.
Ground water depletion
The volume of ground water in storage is decreasing in many areas of the world in
response to pumping.
NB:
World Water Day (22 March) every year. This day will be guided by the upcoming.
Water decade's theme water "for life"

WATER AND HEALTH

Access to safe drinking water is a required cornerstone of public health. Access to
potable water have, increased the lifespan of population worldwide.
Potable water (safe drinking water used for human consumption) should be of enough
quantity and of satisfactory quality (free from pollution, safe and clear). There are
water.
Quality and quantity challenges all over the world that caused by:
A- Population growth and urbanization.
B- Fixed sources of fresh water available whether local, regional or global.
Uses of water:
1.Drinking and food preparation purposes

17
2.Personal hygiene activities (bathing and laundering)
3.Urban irrigation and street cleaning
4.Power production from hydropower and steam generation
5.Industrial processes including bottled water and food production.
6.Agricultural purposes as irrigation and aquaculture.
7.The process of carrying away human and industrial wastes.
Sources of water in Libya:
1. In general, the underground water which comes from two types of wells:
a. Deep wells, which drilled in the ground to a depth of not less than 200 meters to
reach beneath the impermeable layer of the ground. Water raised by a
mechanical pump and distributed through a network of pipes. This is a major ' I
source in city and rural areas.

b. Shallow wells, which reaches the superficial layer of water. It is usually installed
on a private basis and a small pump raises the water. This type of well is
liable to very high contamination.
Ground waters tend to be more mineralized than surface waters. Precautions are
required to ensure wells are protected from surface water runoff by being encased
properly with the protective casing extending above the ground surface. After
construction, wells must be disinfected before being tested for water quality.
c. Desalinations this more in same city near the sea in large scales and small

Water Pollution

Definition: Water pollution is a form of environmental pollution caused by

introduction of any matter that changes the quality of water (physical, chemical or
biological) and mayor may not be harmful to health. The term water contamination
used to denote pollution that was potentially harmful to health.
Sources of water pollution:
Pollution of underground water:
I. Industrial wastewaters (trade effluents) which are the most important source.
II. Agricultural wastewaters, which are heavily polluted by pesticides and fertilizers
in
addition to sewage and trade effluents.
III. Municipal wastewaters or sewage.
IV. Shallow wells are more liable to be polluted from animal and human excreta.

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 Health problems related to water use

Health problems are related to the quality and quantity of water and may directly or
indirectly affect the health of the individuals and the community. They include:

1. General problems related to water use.

2. Problems due to Microbial contamination of drinking water.
3. Problems due to chemical contamination of drinking water.
4. Problems due to radiological contaminants in water.

1. General problems related to water use:

a) The scarcity of water in a community is related to the availability of cultivated land
and the types of food available, which would be reflected on the nutritional status of
individuals in the community.
b) On the personal level, lack of water for cleanliness and personal hygiene favours the
spread of communicable diseases starting by skin and eye infections.
c) Iodine deficiency in water results in its deficiency in the soil, crops and animals in
the area resulting in endemic goiter among the population.
d) Deficient fluorine in water results in dental caries while it's excess leads to fluorosis.
e) Water-related vectors as mosquitoes transmit several diseases as malaria, filarial, and
Dengue fever.
2. Problems due to microbial contamination of drinking water:
This may occur at the source if water is consumed without treatment, during water
transmission in the pipes or at the storage sites especially the water reservoirs on top
of high buildings if not well kept and periodically cleaned. The waterborne microbial
agents of public health significance are mainly the causative agents of diarrheal
diseases and dysentery and may be divided into three categories:

A. Bacterial Pathogens
B. Protozoan Parasites

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 C. Enteric Viruses

Biologic contamination of main sources of water supply may result in water-borne

epidemics that have the following characteristics:
1-Explosive in character affecting a large number of people in a short period of time
(primary wave).
2- All ages and all socioeconomic strata are affected.
3- The distribution of cases follow the distribution of water supply thus, it could be traced
to the source of infection.
4- The primary wave is preceded by a smaller wave of diarrhoea due to simultaneous
pollution with organisms, which cause diarrhoea with shorter incubation period,
5- The primary wave is followed by a smaller and less abrupt secondary wave of enteric
infections.
6-once the source is discovered and controlled, new cases of infection decrease rapidly
(Primary wave stops).
3. Problems due to chemical contamination of drinking water:
Chemical contamination started to be a serious.
Water is treated for biological agents but not for chemicals.
Important chemicals. That could reach the water include:
A- Heavy metals as lead, mercury, chromium, copper, cadmium, iron, and
arsenic.
B- Pesticides and fertilizers.
C- Asbestos from asbestos pipes (in same areas).
D- Nitrates and nitrites.
E- Radioactive contamination of water.
F- Persistent Organic Pollutants (POPs) which represent the most harmful group
for the ecosystem and human health include DDT, Toxaphen, Dioxin,
Dieldrin, and
Atrazine.
G- Synthetic organic chemicals (SOCs) at the nanogram to microgram per liter
concentration have been identified in drinking water supplies in United States.
These compounds result from industrial, agricultural and municipal run-off
and from the reaction of chlorine in water treatment with. Natural organics
producing tri-halomethanes.

Health problems related to chemical contamination include:

A. Chronic toxicity leading to organ affection due to cumulative effects.

b. Acute toxicity with accidental large dose.
c. Carcinogenicity (Delayed toxicity).
d. Mutagenesis and teratogenesis (congenital anomalies).

4. Problems due to radiological contaminants in water:

Radiologic contamination of public water supplies may be naturally occurring or

result from man-made activities. Man-made contamination generally affects surface
waters as a result of fallout from weapons testing and releases from nuclear power
plants (as in Fukushima Daiti nuclear power crisis in Japan, march 2011).

Naturally occurring radium contamination in drinking water is often of greater

20
 concern than man-made radioactive contamination. Radon, a daughter product of
radium, is a naturally occurring nuclide in groundwater and surveys indicate that 70%
of groundwater supplies in US have detectable radon.
 The presence of nitrites indicate fresh contamination by organic matter
(sewage).

 Determination of coliform organisms in drinking water is contamination

No coliform bacilli should be present in 100 ml water.
Food and Health
The objective of food production, processing and distribution is to provide safe and
nutritious food to the consumer. The responsibilities for accomplishing this objective
lie with every step of the food chain (the food production-to-consumption chain)
beginning with food production on the farms, and continuing through processing,
storage, distribution, retail sale and consumption.

Food security: means the availability of the right quantity and quality of food to
supply the recommended daily nutrients to maintain good health and prevent
malnutrition.
Food safety: means safeguarding food from immediate or delayed hazards to health
of consumers resulting from biological, chemical or physical contamination of food.
Common Food-borne Hazards to Health
Major hazards to health associated with food-borne disease are clearly of biological
origin. Bacterial agents are by far the leading cause of illness. They include:
1. Bacterial food-borne infections.
2. Nonbacterial food-borne infections (viral, parasitic ...).
3. Bacterial Food-borne intoxications (Refer to food borne diseases).
4. Chemical Food-borne intoxications.
5. Physical hazards as contamination with radioactive isotopes.
Chemical Food-borne Intoxications
Chemical hazards are minimally important as etiological agents of foodborne disease.
Chemicals are either naturally occurring in food or are intentionally added. They all
have tolerance limits in foods put by Food and Drug Administration (FDA). They
include:
 Pesticides, herbicides, fungicides, fertilizers, and veterinary drugs such as antibiotics
exist in most foods in addition to food additives. Their levels should usually be well
below tolerance limits put by FDA. If above limits, they may lead to illness.
 Heavy metals resulting from:
 Leaching of lead, copper, tin, zinc, or cadmium from containers in contact
with acidic foods.

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 The use of contaminated industrial wastewater for irrigation of crops or
discarding it into the sea which may contaminate both crops and fish (fish can
bio-accumulate mercury to toxic levels in their flesh).
 Fungal toxins either of microbial origin like mycotoxins (aflatoxins) produced by
fungi or associated with microscopic.molds as the toxic alkaloids present naturally in
certain wild mushrooms.

Physical food-borne hazards

Contamination with radioactive. Isotopes in case of nuclear power plants accidents
and fallout radiation may occur (as in Chernobyl in Russia in 1986 and Fukushima
Daiti in Japan I in 2011). Contamination may reach vegetation, fish, milk, meat, etc. ....
Because the half-life of radioactive isotopes is long, this kind of contamination is
dangerous and must be taken seriously. .
Control of food safety and quality standards
1- Food producers: They should follow Good Agricultural Practices as:
a) Avoid use of untreated sewage water for irrigation of crops unless proved safe,
b) Use of pesticides, chemicals and vet drugs correctly and within limits,
c) Use of sanitary animal feed devoid of microbes or toxins, and
d) A void raising fish and molluscs in water polluted by heavy metals.
e) Adequate storage of grains and nuts away from dampness and pests.
2- Food establishments: They are places producing, selling, or serving food that should
fulfil basic sanitary requirements in order to be licensed. The floors and walls should
be made of an easily cleaned material and the place must be insect and rodent proof.
The establishment must have facilities for safe storage of food, etc ..... Sanitary
facility design, sanitary equipment design, and sanitization procedures should apply.
i
3- Control of processed and imported foods:
Samples are taken from processed foods for examination. Imported foods are not
released into market until it is proved safe for human consumption. In recent years,
industry has developed a more focused approach to food quality and safety through
the Hazard Analysis Critical Control Points (HACCP) system which is a series of
actions that should be taken to ensure the safety of processed and prepared food
throughout all the steps of preparation. It is better than the traditional quality control
system based on finished product sampling and testing. . ,

Seven Hazard Analysis Critical Control Points (HACCP) Principles

1 Hazard analysis (risk assessment at each step)

-2 Identify critical control points (where hazard can be controlled)
-
3 Establish critical limits for it (to ensure safety of food)
-
4 Monitor critical control points (to ensure limits are met)
-
5 Establish corrective action
-
6 Verification (microbiological testing)
-
7 Record keeping
-
4- Food handlers: should have relevant license and are required to:
a) Have regular physical examinations to ensure that they are healthy and free

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 from organisms that can be transmitted through food.
b) Practice good personal hygiene.
c) Maintain good hygiene standards in the workplace.
d) Report any illness to management.
Infections requiring special consideration in food handlers include
1- Typhoid and paratyphoid fevers,
2- Vibrocytotoxin producing E coli (E coli 0157:H7),
3- Hepatitis A.
4- Weeping skin lesions on exposed skin (face, neck, hands, and scalp).
5- Weeping skin lesions in eyes or ears.

5- Food inspectors: Food inspectors are Ministry of Health employees responsible for
auditing food safety during all steps from production to consumption. They are one
category of sanitarians affiliated to health offices and are responsible for the periodic
inspection of food establishments, food handlers, and collection of food samples.
Inspectors have the right to close any premises that are not up to acceptable standards.
6- The consumers' role: Consumers may need health education to learn about principles
of food safety at home (Five keys to safer food by WHO).
Five keys to safer food by WHO
1- Keep clean
2- Separate raw and cooked
3- Cook thoroughly
4- Keep food at safe temperatures
5 - Use safe water and raw
Wastes and Hazards to Health

Definition
Waste is anything discarded by an individual, household, industry or
organization.

Classification of Wastes

A. According to its consistency:

1. Solid waste: contains less than 70 % water as municipal solid waste.
2. Liquid waste: contains less than 1 % suspended solids as industrial
wastewater.
3. Sludge: contains between 3 and 25 % solids as municipal sludge.

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 B. According to its hazard criteria:
1. Non-hazardous waste:
Wastes that poses no immediate effects to human health and/or the
environment, as for e.g., municipal wastes such as household
garbage and many high volume industrial wastes and non-hazardous
clinical wastes.
2. Hazardous waste:
Wastes that includes two types:
a. Substances that have characteristic hazardous properties i.e. ignitability,
Corrosively, or reactivity, as clinical chemical wastes. -
b. Substances that contain leachable toxic constituents.
3. Special waste:
Wastes, which is, regulated with waste-specific guidelines, as for e.g., mine spoils, oil
field wastes, spent oils, and radioactive wastes.

Medical Waste

All waste materials generated at health care facilities, such as hospitals, clinics,
physician's offices, dental practices, blood banks, and veterinary hospitals/clinics, as
well as medical
research facilities and laboratories.
Magnitude of medical waste in Libya:
Although there are no accurate figures, some reports describe the amount of medical
waste generated per bed per day to be about 0.5 Kg. there are about 23.000 beds

24
distributed in governmental and private health care facilities. This means that the total
medical waste is estimated to be about 12 tonnes/day, which 20-25% of them are
hazardous waste (about3.600 tones hazardous medical waste per day).
Classification:
a) Biological Infectious waste:
• All materials generated from wounds treatment contaminated with blood, serum,
faeces, urine, vomiting, and anybody excreted fluids
 Anybody intrusion element (needled sharps etc.).
 Gloves, disposable elements which come in contact with the treated body
fluids (cannulas, plastic tubing, kidney dialysis tubing etc).
b) Solid waste (similar to household waste):
 Food residues from kitchen and wards.
 General garbage items (packaging materials, etc).
 Broken furniture, non-functioning equipment items.
 Building Demolition residues.
c) Chemical waste
• Toxic chemicals as expired drugs, chemotherapeutic contaminated
containers and handling supplies, laboratory chemicals and solvents.
 Chemical containers.
 Disinfection chemicals, cleaning agents and their containers


d) Radioactive Waste:
 Body fluids from patients receiving radiotherapy.
 Expired radiotherapy units.
 Radioactive isotopes used in research experiments and contaminated
cultures.
 Methods of final treatment

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1- Incineration.
2- Compaction and sterilization.
3- Shredding and sterilization.
4- Sterilization can be carried either through:
• Chemical treatment.
• Heat treatment.
• UV Radiation.
Electronic waste (e-waste)
Definition: e-waste is defined as discarded, obsolete or broken electrical equipment
such as computers, cell phones, printers, and monitors. These devices often contain
contaminants such as cadmium, lead, mercury and flame retardants that can cause
some serious health issues and pollute the area in which they are dumped.
 Electronic Waste Hazards:
a. Environmental pollution with toxins such as: polychlorinated biphenyls
(PCBs)
mercury, cadmium, arsenic, zinc, chromium, and selenium.
b. When disposed in landfills, toxic material leach will pollute the ground water.
c. Incineration of e-waste containing PVC will produce dioxins and furans which
are
persistent organic pollutant.
d. Exporting e-waste to developing countries which intern will aggravate the
environmental
pollution in these countries.
Management of waste
Waste management is now tightly regulated in most developed countries and
includes the generation, collection, processing, transport and disposal of waste.
The major methods of waste management are:

1. Recycling-the recovery of materials from products after they have been used by
consumers.
2. Composting-an aerobic, biological process of degradation of biodegradable
organic
matter, producing compost which is a type of plant fertilizer

26
 3.Sewage treatment-a process of treating raw sewage to produce a non-toxic
liquid effluent, which is discharged to rivers or sea and a semi-solid sludge, which
is used as a soil amendment on land, incinerated or disposed of in landfill.
4. Incineration-a-process of combustion designed to recover energy and reduce the
volume of waste going to disposal.
5. Landfill-the deposition of waste in a specially designated area, which in modern
sites
consists of a pre-constructed 'cell' lined with an impermeable layer (man-made-or
natural) and with controls to minimize emissions.
6. Advanced thermal treatment, such as gasification and pyrolysis, and bio-
mechanical waste treatment which refers to a number of mechanical and
biological processes to treat waste before disposal.
7. Other methods such as sterilization of biomedical infectious waste before
disposal.

Health Hazards Related to Wastes

A. Health Hazards Related to Waste Accumulation:
I. Biological hazards
Spread of microbial pathogens in case of infectious medical waste, sewage and
municipal waste, e g Typhoid Fever, hepatitis B and A viruses, etc...
2. Chemical hazards
Chemical pollution from medical, industrial, universal and other hazardous wastes, as:
(a) Particles and gases: methane, SO2, NO2 and PM10
(b) Heavy metals: cadmium, mercury, arsenic, chromium, nickel.
(c) Organic compounds: dioxins, PCBs and PAHs.
3. Physical hazards
- Radiation from radioactive wastes
- Nuisance and bad odours
4. Mechanical hazards
- Injuries and accidents from sharp waste. .
- Accidents due to road obstruction by the accumulated waste; or during waste
collection and transportation.
5. Fire and explosion, Very important occurrence.
B. Health Hazards Related to Waste Management:
1. Biological hazards:
-Microbial pathogens are a potential source of hazard, particularly in composting
Sewage treatment and landfill.
-Insanitary landfill will produce breeding areas for flies and rodents

2. Chemical hazards:
a. Related to landfill
- Gases emitted from landfill sites, for example, consist principally of methane and
carbon dioxide, with other gases, such as hydrogen sulphide and mercury vapour
being emitted at low concentrations, and a mixture of volatile organic compounds

27
- Chemical pollution by metals, polycyclic aromatic hydrocarbons (P AH),
polychlorinated biphenyls (PCB), chlorinated hydrocarbons, pesticides, dioxins,
asbestos, pharmaceuticals and pathogens.
- Underground water pollution from leach containing toxic substances
b. Related to incineration:
- Waste incineration produces a large number of pollutants from the combustion of
sewage sludge, chemical, clinical and municipal waste, such as:
- Particles and gases.
- Heavy metals: cadmium, mercury, arsenic, chromium, nickel.
- Organic compounds: dioxins, PCBs, PAHs and PM10.
c. Others: such as odours, noise and heavy traffic, etc....
C. Occupational Health Hazards to Waste Workers
There is a large workforce employed in waste collection, sorting and disposal.
Workers may be exposed to the same potential hazards as the general population,
although the amount of exposure and risk may differ.
I

1. Occupational accidents: contusion, laceration, burn, fractures ...

2. Musculoskeletal disorders due to heavy lifting and other manual handling of
containers
3. Work related respiratory tract diseases due to VOCs, irritant gases and bio-aerosol
asthma, bronchitis, respiratory tract infections,
4. Work related gastrointestinal tract diseases: gastro-enteritis, hepatitis ...
5. Work related skin diseases: eczema, urticaria, irritant dermatitis ...
6. Infections due to exposure to infectious medical wastes or sewage
7. Increase the risk of cancer.
8. Increase the risk of birth defects among offspring of the workers.
9. Health effects due to acute and chronic exposure to radiation among workers
dealing
with radioactive waste.
10. Health effects due to exposure to heavy metals as lead, cadmium, mercury.
11.Health effects due to exposure to dioxins and furans.

Persons at Risk:
• All individuals exposed to hazardous HCW are potentially at risk of being
injured or infected. They include:
 Medical staff: doctors, nurses, sanitary staff, and hospital maintenance
personnel.
 In- and out-patients receiving treatment in HCFs as well as their
visitors. Workers in support services linked to HCFs such as laundries,
waste handling, and transportation services.
 Workers in waste disposal facilities, including scavengers.
The general public and more specifically the children playing with the items they
can find in the waste outside the HCFs when it is directly accessible to them
Checklist for handling and collecting highly infectious waste
Segregation
Highly infectious waste should be:
– kept in the medical area until it is pretreated
– segregated from other general and potentially infectious waste
– placed immediately into a leak-proof bag or container.

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Pre-treatment
Highly infectious waste should be immediately disinfected (e.g. Autoclaved or
chemically treated) before becoming mixed with hazardous health care waste from

other medical departments.

Packaging
Highly infectious waste should be packaged in yellow bags, preferably with
the biohazard symbol, and clearly marked with the words “HIGHLY
INFECTIOUS WASTE”, with a comment on whether or not it has been pretreated.

Housing and Health

Town planning _
Town planning means putting general plan and design for any city, town or
district before being established. Expected future expansion, due to progressive
growth of the population, must be taken into consideration.
Basic requirements of planning:
- Zoning of city or town into three areas: residential commercial and industrial.
- No encroachment of any zone is allowed, to protect health and comfort of inhabitants.
- Industries which may cause pollution of the environment must be sufficiently away

29
from inhabited area taking into consideration:
 The meteorological conditions.
 The nature and types of contaminants.
 Protective measures taken to prevent or minimize pollution.
-Sufficient wide streets and green areas.
-Convenient public services (transport, communications, schools, fire-extinguishing units,
first aid and emergency centers and municipal service.
-Sanitary housing.
Village planning
No planning was followed when villages were established long time ago, and so sanitary
requirements are not fulfilled. This problem could be solved by gradual setting of rural
people in modern villages and settlements, to replace the old villages which are then
demolished and reconstructed, and so on.
Poor housing:
Poor housing is defined in terms of overcrowding, damp and mould, indoor
pollutants and infestation.
Slums:
Slums are haphazardly formed, densely populated urban areas, of poor Housing
and
insanitary environment.

Causes of poor housing and slums;

1- Low socioeconomic standard and poverty.
2- Overpopulation problem "progressive increase in the population that is not
parallel with the increase in planned housing".
3- Urbanization and social instability.
4- Poor city planning.
Hazards of poor housing:-
1-Higher morbidity and
mortality:
=Overcrowding
=Increase the risk of infections and respiratory diseases
especially pulmonary
tuberculosis.
=Dampness and mould
=Increase the risk of streptococcal pharyngitis leading to rheumatic fever and
rheumatic
heart disease.
=Increase risk of respiratory problems as rhinitis, alveolitis, asthma and wheezy chest.
=Increase risk of eczema. .
=Indoor pollutant Increase risk of bronchial
asthma.
-Exposure to cold
=Decrease the body resistance to respiratory infections.
=Hypothermia. =Bronchospasm
=Increase the risk of ischemic heart diseases and myocardial
infarction.
2-Increase rates of accidents and injuries:-

30
 Home accident rate is 30% higher in slums than in well-designed and maintained
houses occupied by similar families:-
a Fires. b Electric shock.
c Falls and other mechanical injuries.
d Gas poisoning. e Elevators accidents .
. 3-Diminished physical efficiency:
=Inadequate ventilation
 Transmission and spread of air born infection “tuberculosis”, meningitis and
diphtheria" .
 Headache, loss of consciousness and lassitude.
=Inadequate illumination
 Sense of discomfort, eye strain and glare.
 Inadequate exposure to direct sunlight leading to rickets.
=Exposure to excessive noise Sense of discomfort, irritability and deafness.
=Insanitary water supply
Communicable diseases:
 Bacterial: as cholera and shigelloses.
 Viral: as hepatitis A, poliomyelitis and gastroenteritis.
 Parasitic: as amoebiasis and giardiasis.
Non communicable diseases:
a. Organic matter: diarrheal diseases.
b. Inorganic matter: lead toxicity, dental fluorosis.
c. Hazards of radioactive substances
d. Hazards of insufficient quantity of fresh safe water.
e. Hazards of bathing in polluted water.
=Insanitary disposal of sewage and refuse
1. Increase the risk of contamination of public water
supply with sewage leading to water born epidemic.
2. Breading places for flies and other insects and rodents
specially rats leading to spread of infections.
3. Social and psychological problems caused by nuisance
bad odour and disagreeable appearance.
=Inadequate spacing needed for physical exercises and
musculoskeletal development.
4- Diminished mental and psychological efficiency:
Absence of spacing needed for privacy and recreations
could increase the incidence of violence and crimes.
How to solve problem of slums?
1. Slums must be demolished, after rehousing of inhabitants, then
reconstructed on sanitary basis .
2. Establishing sanitary residential areas, for limited-income groups, either
low-rented, or owned by convenient long time terms.
3. Managing the problem of urbanization, to limit migration of rural people to
already crowded densely populated cities and towns.
4. Family planning service would help lowering of birth rate and natural
growth rate.
Rural housing: -
. Old houses are mostly primitive, made of mud bricks, and directly built on

31
ground They are characterized by inadequate ventilation and lighting, no piped water
supply insanitary latrine, if any, animal shed found within the house, baking oven
available in some house vitiates air, and fuel material is stored on top of house, with
breeding of rats, and potential risk of fire.
Modern villages and settlements provide good housing that fulfils sanitary
and social requirements.
Housing quality standards
=Site and neighbourhood:
Site and neighbourhood must be reasonably free from dangers to the health and
general welfare of the occupants like:
 Serious adverse environmental conditions (natural or man-made).
 Air pollution, smoke or dust
 Excessive noise, vibration or vehicular traffic.
Excessive accumulation of trash. 0 Rodent infestation.
Dangerous walks or steps, instability. 0 Flooding, poor drainage.
Septic tank back-ups or sewage hazards. 0 Fire hazards.
=Structure and material:
Dwelling unit must be structurally stable not threat the health and safety of the occupant
and must protect them from the environment with damp proofing foundation and
plumbing system. -
=Space and security:
 The dwelling unit must provide adequate space and security for the family.
 Special housing unit for each family (not to be shared with others).
A suitable number of rooms, according to family size, to get a reasonable" crowdness
index". The dwelling unit must have at least one bedroom for each two persons.
=Interior air quality:
 The dwelling unit must be free from any pollutions in the air at levels that
threaten the health of occupants e.g. carbon monoxide, sewer gas, fuel gas, dust
and other harmful pollutions.
 There must be adequate air circulation.
 Bedrooms and bathrooms area must have at least one openable window or other
exhaust ventilation.
=Water supply:
 Water supply must be free from contamination and served by a public or private
water supply that is sanitary and free from contamination.
=Food preparation and refuse disposal:
o The dwelling unit must have suitable accommodation for cooking and equipment
to store, prepare and serve food in a sanitary manner.
o There must be adequate facilities for the sanitary disposal of food refuse and the
kitchen must have a sink.
=Illumination and electricity:
 Each room must have adequate natural or artificial illumination provided by at
least one window in each sleeping room as well as kitchen area and bathroom in
order to permit normal indoor activities and to support the health and safety of
occupant. •
 The dwelling unit must have sufficient electrical sources so occupants can use
essential electrical appliances. The electrical fixtures and wiring must ensure
safety from fire or electric shock.

=Thermal environment:

32
 The unit must have and be capable of maintaining a thermal environment
healthy for the human body. .
There must be a safe system for heating and other one for cooling, and these
systems must be in a proper operating condition and able to provide adequate
heat or cold either directly or indirectly to each room in order to assure a
healthy living condition appropriate to the climate.
It is not acceptable to use room heaters that burn gas, oil or kerosene.

=Sanitary facilities:
 The bathroom must be located in a separate private room
The dwelling unit must have a fixed basin in proper operating condition with a sink
trap and hot and cold running water. .
The facilities must utilize an approvable public or private disposal system.
=Smoke detectors: Each unit must have a smoke detector.
=Escape system: Building must provide an alternate means of exit in case of fires
such as fire stairs.
Disinfections and sterilization
Disinfection: Destruction of the vegetative pathogenic microorganisms and reduce
them to a level which becomes not harmful to health.

Sterilization: Destruction of all forms of organisms either pathogenic or non-pathogenic

vegetative or spores.
Antiseptic: Special type of disinfectant which can be safely applied to skin and mucous
membrane but not suitable for systemic administration.
Cleaning: It is a process of removing soil, which removes many microorganisms. It is
applied in hospital environment as a necessary process before sterilization and
disinfections.

33