Geneal Hygiene

.Introduction
Topic: Concepts and etymology of Hygiene
Hygiene as a science. Its place among medical sciences.
Classification
Main objectives of Hygiene
Environment and Health
Branches of Hygiene. Environmental Health. Sanitary
Methods used in Hygiene

Etymology of Hygiene
Hygieia is the Ancient Greek goddess of health, the daughter of the god of healing Asclepius
Hygieinos means healthy
Hygiene
an area of medicine that studies the impact of living and working conditions on human health
and develop measures (sanitary norms, rules, etc.) to prevent their adverse effects, to ensure
optimum living conditions, promote health and prolong life
Medical Sciences (hygienistics), which study the influence of environmental factors on human
health, its performance and life expectancy, develops the standards, requirements and sanitary
measures aimed at improving the settlements, living conditions and human activities -
Environmental Health
Two main objects of the Hygien
Environmental factors  Non ionizing  Parasites
 Chemical electromagnetic waves  Insects
 Biological  Microclimate ( air  Antibiotics
 Factors of human temperature, humidity, ect)  Others
activity Chemical factors Factors of human activity
 Social  Chemical elements  The day mode
Physical factors and compounds  Severity and intensity
 Vibroacoustics (noise, thereof: of labor
vibration, ultra-,  Metals (lead,  Other
infrasound) mercury, etc.) Social factors
 Dust (aerosols of  Pesticides, fertilizers  Culture
predominantly fibrogenic  Organic compounds  Poverty
actions)  Complex of chemicals  Politics
 Illumination Biological factors  Economics
 Ionizing radiation  Microogranisms  Others
Contribution of Environmental
factors to morbidity Globally, an estimated 24% of
the disease burden (healthy life years lost) and an
estimated 23% of all deaths (premature mortality)
was attributable to environmental factors. Among
children 0–14 years of age, the proportion of deaths
attributed to the environment was as highas 36%.

Branches of Hygiene – Food Hygiene, Nutritiology, Dietology

• General Hygiene • Occupational Hygiene
• Communal Hygiene: • Ionizing Radiation Hygiene
– Air Hygiene, Water Hygiene, Soil Hygiene, • Rural Hygiene
• Hygiene of Children and Adolescents • Hospital Hygiene
• Military Hygiene • Resort Hygiene
• Sport Hygiene • Psychohygiene
Public Buildings Hygiene • Personal
• Transport Hygiene • Hygiene
• Nutrition Hygiene:
 Sanitary
Practical implementation of hygienic measures In simple words:Making our environment healthier and
safer Methods used in Hygiene
 Sanitary and Hygienic methods
 Epidemiological methods
 Physiological methods
 Clinical methods
 Physical methods
 Chemical methods
 Others
Prevention
 •Primordial prevention
 •Primary prevention
 •Secondary prevention
 •Tertiary prevention
Topic 2: Water and Health
Plan
• Water distribution
• Sources of water
• The physical and chemical characteristic of water
• Physiological role of water
• Hygienic importance of water
• Epidemiological role of water
• Economic role of water
• Influence of chemical structure of water on a body
• Protection of water sources
Water you are not only necessary for life, but you are life; you`re the unparalleled wealth Earth, you`re the
most delicate, the most pure, you`re the soul of Earth.
Water, you have no taste, no colour, no odour; it’s impossible to describe you, people enjoy using you, not
knowing, what you are. It is impossible to tell, that you are necessary for life: you are life. You fill us with a
gratification that exceeds the delight of the senses. The forces left us come back to us with you. Dried up
springs of our heart begin rages again
Antoine de Saint Exupery. Wind, Sand, and Stars, 1939
H2O with isotopes of H (deuterium D, tritium T) and O (O17, O18)
– 42 isotopes of water
A dispersion system (water + mineral salts, colloids, gases, organic
substances, alive organisms)
Physical and chemical properties of water.
Physiological role of water.

Hygienic importance of water

• It is necessary for the sanitary and household purposes, i.e.:

• Maintenance of a body in cleanliness in a life and manufacture
• Maintenance of cleanliness of clothes etc. things of personal use improvements of physiological
functions of a skin, and improvement of thermal balance, clearing of the animal parasites
• to keep dwellings and environment in cleanliness
• to reduce indoor air pollution (dwellings, manufactures)4
• to use air conditioning

Hygienic importance of water

• In clinics: There is large dependence on volume of consumed

water
• Prevention of hospital infections
• Water is applied with the medical purpose
• In the enterprises of a food-processing industry
• Maintenance of high sanitary cleanliness
• For technical process
In health promotion and sports (in swimming pools)
Role of water in economy
For satisfaction of drinking needs
For improvement of working conditions For needs in agriculture, industry, electric power industry & transport
Water and health
• Direct impact of water on health:
• infectious diseases, invasions, intoxications and epidemic diseases of a noninfectious nature
• Indirect effect of water on health:
when water causes unpleasant impressions so sometimes people refuse from the use of such water
Sources of Water Pollution
Suburban development
Wastewater treatment plant
Water & sanitation-related disease
 Water-borne diseases:
Bacterial(Cholera) , viral (Hep.A), some protozoa (Giardiasis), helminths (Ascariasis)
 Water-washed diseases:
Scabies, skin sepsis and ulcers, yaws, trachoma, Lice and typhus
 Water-based diseases:
Protozoa: Filariasis, schistosomiasis, Bilharziosis, Dracunculosis
Helmints: Threadworm
 Water-related insect vector diseases:
Malaria, Yellow fever, Dengue fever, Bancroftian filariasis, Onchocercosiasi
Bacteria
Campilobacter (Yeuni), Esherichia (Coli), Salmonella (typhus, paratyphus etc.), Shigella, Cholera vibrions,
leptospira, Yersinia (enterocolitica, tularensis), agents of pseudomonas, Brucellosis, Antrax, Erisepiloides,
tuberculosis, Far East fever and other infections.
Viruses
Adenoviruses (poliomielitis, Coxaki, ECHO), enteroviruses, Hepatitis A, E viruses, Norvolkvirus, rotaviruses, fine
round viruses.
Protozoa
Entaemoeba histolytica, Hiardia intestinalis, Criptosporidium parvum, Dracunculus medinensis, Naegleria
fowleri (primary amoeba meningoencephalitis), Acanthomoeba spp. (amoeba meningoencephalitis),
Shistosomiasis (Bilharziosis), Balantidium coli.
Helmints
Fasciola, Fasciolopasis, Echinococcus, Spirometram, Ascaris, Trichurism, Toxocara, Necetor, Ancilostoma,
Strongiloides, Taenia solium
Toxins in water
Cyanobacteria's toxins:
• hepatotoxins, i.e. microcistin LR:R, causing death during 24ч after intake with food or water as result of
a vascular shock and extensive hemorrhagic defeats of a liver
• neurotoxins
• lipopolysacharines
Chemical content of water and health
• Water-nitrate methaemoglobinaemia
• Nitrosamines of water
• Fluorides, Iodine, Strontium in water (biogeochemical provinces)
• Lead in water
• Synthetic superficially active substances (SSAS)
• Pesticides and mineral fertilizers, petroleum
Guideline Values for Nitrate and Nitrite in Drinking Water
Sources of Fluoride and Its Health Impact
Lead
•Intellectual impairment in children
•Cerebral changes in adults
•No threshold health effects have been identified
Organic pollutants in water
Halogenated aliphatic (chain) hydrocarbons:
Trihalomethanes are formed during disinfection of drinking water; other compounds are
used as solvents for decaffeinated coffee, general solvents and in products such as propellant,
degreasers, spot removers and dyes
Aromatic (ring) hydrocarbons:
Many of them derived from fossil fuels, also as additives in petrol, moth balls, adhesives
and cigarette smoke
Chloro- and nitro-aromatic hydrocarbons:
Fungicides and explosives
Phthalates:
Phthalates are added to plastic to make them flexible; found in rain wear, footwear,
shower curtains, children's toys
Organic pollutants in water
Halogenated ethers:
Used in production of plastics and resins and in research laboratories
Phenols:
Fungicide; wood preservative; Chloro-dichloro-, trichloro-phenols are by-products in the production of
pentachlorophenol
Organochlorines:
DDT, lindane, aldrin and chlorodane are examples of the extremely persistent organochlorine pesticides
widely used in 1950s-60s
The Breakdown of Organic Compounds
Entre water from a variety of sources including:
Human/animal wastes
Plants
Soil erosion
Industrial wastes
Generally unstable, may be oxidised to stable and relatively inert end
products, e.g. CO2, NO3, H2O
Oxidation: loss of electrons to an oxidising agent such as oxygen or chlorine which accepts electrons
Oxidation of organic compounds occurs in aerobic or anaerobic conditions
Quantity of organic materials and the quantity of oxygen needed to oxidise it estimated by using:
Biochemical oxygen demand (BOD)
Permanganate value (PV)
Chemical oxygen demand (COD)
Wellhead protection zones
 Drinking water quality
Hygienic requirements to drinking water quality
Drinking water must be safe in epidemiological and radiological
aspect, harmless in chemical aspect and have favorable organoleptic
properties.
Drinking water must meet hygienic standards before it flows into
pipes and at destination points.
The drinking water safety is determined by its compliance with
requirements on microbiological, parasitological, chemical,
organoleptic and radiological indices
Organoleptic standards Radiological water standards
Indices Measure units Standards, no
more than Indices Measu Stand Harmfulnes
Smell Marks 2 re ar s
units ds indicator
Taste Marks 2
Color Grades 20(35) General a- Bc/l 0.1 radiological
Turbidi Units of turbidity, 2.6 (3.5) / 1.5 radioactivity
ty or mg/l (2) General p- Bc/l 1.0 radiological
radioactivity
Microbiological standards
Standards of chemical compounds of rinking

Indicators Units of measure Standards Indi Measure Permissib

ces units le limit
Thermotolerant Number of bacteria in No present
Coliform 100 level
bacteria ml1 General indices
General Coliform Number of bacteria in No present pH Units of pH 6-9
bacteria 100 General Mg/l 1000 (1500)
ml
mineralization
General number of Number of bacteria No more
bacteria forming colonies in 1 than General Hardness Mmol/l 7.0 (10.0)
ml 100 Oxidation Mg/l 5.0
Coliphagus Number of units in 100 No present Oil products Mg/l 0.1
ml Superficial active Mg/l 0.5
Spore of Number of spores in 20 No present substances
Clostridium ml Phenolic index Mg/l 0.25
reducing sulphid
Cists of Lamblia Number of cists in 50 ml No present
water
Water treatment
Water treatment
 Need to treat all surface waters and some groundwaters
 Contamination may be microbiological, chemical or physical
 Microbiological contamination is most important as it causes highly infectious disease with
short-term impacts
 Chemical contamination tends to have longer term effects on health
 Suspended solids affect microbial survival and the acceptability of water
 Always disinfect water supplies and maintain a residual in the water for protection against
contamination during distribution and storage.
Water treatment processes The Multiple Barrier Principle of Water Treatmen

UpfIow-Downf Iow Рrefilter Horizontal Flow Prefilter

Coagulant Dosing: Al2(SO4)3 – alumina, FeCl3

– chloric iron, Fe SO4 – iron sulphat Flocculator
Filtration
A purification instrument to remove solids from liquids
• Screens
• Sand Filtration:
• Slow Sand Filtration
• Rapid Sand Filtration
• Cross Flow Membrane Filtration:
• Micrifiltration (0.1-1.5 microns, removing
suspended solids, bacteria) i
• Ultrafiltration (0.005-0.1 microns, removing salts,
proteins)
• Nanofiltration (0.0001-0.005 microns, removing viruses, pesticides and
herbicides)
• Reversed Osmosis (up to 0.001 microns, metal ions, fully removing
aqueous salts)
 • Cartridge Filtration
Slow Sand Filter
Rapid Sand Filter
Disinfection
The purpose is killing the present undesired microorganisms in the water
• Chemical: chlorination, treatment of water with silver and ozone
ions
• Physical: ultrasound, ultraviolet light, boiling, etc.
Biological: bacteriologic filters
Chlorination
Chlorination with normal doses Chlorination with preammonization Superchlorination,
postchlorination
Chlorine preparations: chlorine lime, chloramines, chlorine dioxide, etc.
Chlorine lime is a mixture of a calcium hypochlorite (Ca(OCl)2), slaked lime (Ca(OH)2), Calcium
chloride (CaCl2). Ca(OCl)2 – the most active part of the chlorine lime
Chemical reactions during chlorination:
Ca(OCl)2 + H2O = Ca(OH)2 + 2HClO - H2O + Cl2 2HClO = H2O + O +Cl2
Effectiveness of chlorination
The effectiveness of chlorination is evaluated by the quantity of residual chlorine. The residual
chlorine should be within 0.3-0.5 mg/l
Ozone and UV light
OZONE
 Since 1906, Nice France UV LIGHT
 Kills all pathogens  Expensive
 Fewer by-products  Used in water with low
 Reacts with bromide ions and forms bromate turbidity
(carcinogen)
 Expensive
 Requires addition of chloramines to have a
residual disinfectant
Portable methods of disinfection
Solar water disinfection
Ultraviolet disinfection
Demineralized water
 Increases diuresis
 Increases elimination of electrolytes
 Decreases K+ in blood serum
 Increases the risk from toxic metals due to
increase of leach of them from pipes

 Increases the risk of bacterial contamination

Demineralized water
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• Increases diuresis
• Increases elimination of electrolytes
• Decreases K+ in blood serum
• Increases the risk from toxic metals due to increase of leach of them from pipes
Increases the risk of bacterial contamination

Further readings
• Protecting surface water for health. Identifying, assessing and managing drinking- water quality risks
in surface-water catchments. WHO.-2016.
• Preventing disease through healthy environments: a global assessment of the burden of disease
from environmental risks / Annette Prüss-Üstün … [et al]. WHO.- 2016
• WHO seminar pack for drinking-water quality. -WHO.- 2000
• Hygiene, Environmental Sanitation and Water
www.un.org.np/publications/unicef/handbook_e/hygiene.htmCombating Waterborne Diseases at the
Household Level (PDF). World Health Organization. 2007. Part 1. ISBN 978-92-4-159522-3.Water for Life:
Making it Happen (PDF). World Health Organization and UNICEF. 2005. ISBN 92-4-156293-5.Nwachcuku N,
Gerba CP (June 2004). "Emerging waterborne pathogens: can we kill them all?" (PDF). Current Opinion in
Biotechnology 15 (3): 175-80. doi:10.1016/j.copbio.2004.04.010. PMID 15193323.
Dziuban EJ, Liang JL, Craun GF, Hill V, Yu PA et al. (22 December 2006). "Surveillance for Waterborne Disease
and Outbreaks Associated with Recreational Water — United States, 20032004". MMWR Surveill Summ. 55
(12): 1-30. PMID 17183230.

Topic 4-5
Air Hygiene
A pasture of life
“While I’m breathing I’m hoping”
Daily, human breaths 9 kg of air
Direct and indirect role of air
O2, CO2, and N2
O2 – 16%, 159 mm Hg at 0 m, 110 mm Hg at 3000 m above sea
level
O3 absorbs the most of UV (short waive light)
CO2 – 0.03% Sources: processes of fuel burning out In metropolies
– 1% Safe CO2 level – 0.07 (K. Flugge) and 0.1% (M.Pettenkofer)
N2 from organic compounds to atmosphere High biological role
Inhaled (atmospheric) and exhaled air

Compound and partial pressure of oxygen and carbon dioxide in different mediums
Positive:
breathing, body hardening, etc
Negative, unfavourable: Unfavourable
climate conditions, significant changes in
chemical content, dusts, etc can break
normal relationships between our body and
the environment; therefore it can lead to
different diseases and their complications
Physical properties of air
Temperature
Humidity
Velocity
Pressure
Ionization
Radioactivity
Air temperature, humidity and velocity
• Combined effect
• Chronic cooling or superheating →immunological disturbance
• 17-19oC,
• Humidity and virulence of bacteria
• Skin diseases
• 30-65%,
• Ventilation, bracing stimulus for a body
• 0.2-0.4 m/s
Wind rose
Air pressure
• 760 mm Hg or 100 000 Pa (1000 gPa)
• Daily AP altitude – 4-5 mg Hg, annual altitude – 20-30 mm Hg
• People sensitive to AP changes: with rheumatism, hypertension,
ischemic heart disease
• In normal conditions, hemoglobin’s saturation by oxygen is 94-97%,
at 2 km high it is 92%, 4 km – 82-85%
Hypoxia
The state, which occurs in the organism with the inadequate supply of
tissues and organs by oxygen or during the breakdown
of the oxygen utilization in them in the biological oxidation process
• Exogenous hypoxia
• Endogenous hypoxia
High atmospheric pressure
During diving or caisson work
Pressure is higher than atmospheric on 1 atm by every 10 m
sinking
Caisson sickness: When the blood “boils”
Ionization of air
• Negatively and positively charged air ions
• Favourable effects of “-” ions
• 3000-4000 ions/cm3 – therapeutic effect
• 800-1000 ions/cm3 – in rural air
• 100-400 ions/cm3 – in city air
• 30-50 ions/cm3 – in city offices
• Chizhevsky chandelier
Air pollution sources

Air pollution & their sources

Health impact of air pollution

Effects of air pollution on respiratory system

Indoor air pollution

Indoor air pollution

Indoor air pollution

Indoor air pollution

Primary sources of indoor air quality problems (NIOSH, USA)
• Inadequate ventilation 52%
• Contamination from inside building 16%
• Contamination from outside building 10%
• Microbial contamination 5%
• Contamination from building fabric 4%
• Unknown sources 13%
Radon

Health effects of indoor air pollution

Topic 6 Hygiene of Soil
Soil
Soil content and its properties
Soil is superficial layer of ground with 2 cm-2 m of
thickness.
Soil consists of mineral and organic part, humus, live
organisms, air and water

Properties of soil
• Air permeability
– Increases biochemical oxidation processes in soil
• Water permeability
– Effects on formation of soil water and ground
water
• Water capacity
– Conditions air permeability and wetness of soil and
possibility of constructions of building on it
• Capillarity of soil
– Causes wetness of buildings
Geochemical and toxicological role of soil
9 essential microelements: Fe, I, Cu, Cr, Co, Mo, Mg, Zn, Se
Less essential microelements: F, Ni, V, As, Si, Li, B and Br
Toxic elements: Al, Cd, Pb, Hg, Be, Ba, V and Tl
Indifferent and inert elements: Tn, Pl, Au and Ag
Surplus and insufficiency of them can cause diseases
Biogeoendemic diseases
Goitre, fluorosis, caries, molybdenosis, Hondro- and osteodistrophia (Sr), Encephalitis (Pl),
Selenium toxicosis
Molybdenum
• Antagonist of Cu in biological tissues
• Activates a few of enzymes
• 15 enzymes (aldehydroxidase, xanthinoxidase & sulphitoxidase), consist Mo
• Xanthinoxidase catalyzes formation of urine acid (defect in Purina exchange → Ksantinuria,
Xanthin
stones in renal canals)
• Sulphitoxidase makes sulphates from sulphites in our body (Defect in sulphiteoxidase → brain
anomaly, idiotism, ectopia of the eye crystalline lens, increased excretion of sulphites, tiosulphates
by urine)
• Surplus of Mo → Mo-gout, accumulation of urine acid in joints
Boron
Regulates activity of parathyroid hormone, and therefore, Ca, P and cholecalciferoli exchange. In
our body, there is ≈ 20 mg of B
Surplus of Boron in soil → Boron enteritis, increase of anaemia and respiratory diseases
Boron acid is cumulated in our brain, liver and adipose tissue (acute boron intoxication →
involvement CNS)
Bromine
Distributed in all tissues equally, but mostly it is concentrated in thyroid and kidneys
Selectively influences on braking processes in neurones of the cerebral cortex
Increase in Br intake of chlorides → increase of bromine excretion
Chronic increased intake of Br → allergic or measles-like rash, brown colouration of mouth mucous
membrane, conjunctivitis and bronchospasms
Soil contamination
Technogenic biogeoendemic provinces
High concentration of Pb, As, F, Hg, Cd, Mn, Ni and other elements, benz(a)pyren, pesticides, etc.
If transport load of the road is up to 10 000 cars per day, concentration of iron is 1000 mg/kg in
superficial soil layer, Zn – 20 mg/kg, Pb - 10 mg/kg and 0.2 mg/kg of Cd
They present real danger of direct and indirect impact on a body through food chain
Soil borne human diseases
A human diseases resulting from any pathogen or parasite, transmission of which can occur from
the soil, even in the absence of other infectious individuals
Euedaphic pathogenic organisms (EPOs), being potential pathogens which are true soil organisms,
i.e. their usual habitat is the soil
Soil transmitted pathogens (STPs) are organisms which, while they may be able to survive in soil
for extended periods of time, are not true soil organisms, but rather are obligate pathogens who
must infect a host in order to complete their life cycles
Soil borne infectious diseases
Virulence of some pathogenic microbes
Other non-infectious soil associated diseases
• Silicosis
• Geophagia (pica associations)
Self-purification of soil

Sanitary evaluation of soil

Epidemiological role of wastes

Reference
• S. Jeffery, W.H. van der Putten. Soil Borne Diseases of Humans (2011). Luxembourg: Publications
Office of the European Union. doi:10.2788/37199
• Communicable diseases. Control of schistosomiasis and soil-transmitted helminth infections. WHO
54th WHA. 30/03/2001
• Baumgardner DJ. Soil-Related Bacterial and Fungal Infections. J Am Board Fam Med.
2012;25(5):734-744
• Park’s Textbook of Preventive and Social Medicine. Chapter 13

Topic 7
Hygienic bases of illumination
Learning outcomes
After lecture you should know:
• Physical bases of visible light
• Biological, physiological and hygienic role of visible, ultraviolet
and infrared waves
• Factors effecting the level of indoor illumination
• Hygienic norms of indoor illumination
• Health effects of insufficiency of illumination
• The role and norms of room Insolation
• Hygienic assessment of natural and electric room illumination
Physical bases of visible light
• A radiation energy causing a sense of light
• 360-760 nm
• Our eyes are most sensitive to the middle part of the optical
spectrum and have the maximal sensitivity to wave length 555
nm (yellow-green part)
• The capacity of this radiation is called a light stream (F, lumen)
• A light exposure (e) is a ratio of a light stream to a surface
square: e= F/S (lux)
• A coefficient of natural light exposure is a ratio of indoor light
exposure level to outside light exposure measured at the same
height level and time (Ce, %)
Biological, physiological and hygienic role of visible light
• More than 80% of information from the outer world
• Effects on all body organs and systems very favourably
• Stimulates metabolism, improves a general functional status
of a body, emotional mood, and increases workability
• Has a thermal effect
• Leader of the biological rhythm of life
• Improper and insufficient light affects negatively on functions
of the vision organs, increases fatigability of vision organs and
the CNS in general.
• Insufficient illumination decreases work efficiency
(productivity) of labour, promotes growing occupational
traumatism
Ultraviolet wavesb 100-400 nm UVL of 100-290 nm do not reach the Earth surface The most active
part of light in connection to the biological activity of UVL “Nothing to do for a doctor where sun
looks” The UVL affects on our skin not only by local changes of cellular and tissue proteins but on all
our body through the extra and intra receptors of skin Biological properties of the UVL depend on
the wave’s length.

The UVL deficiency & surplus

• The UVL deficiency → Rachiotis, decreasing general resistance, upset of metabolic processes
• The UVL surplus →provocation of chronic diseases (tuberculosis, ulcer, rheumatism, etc)
• The UVL surplus → mutagenic and carcinogenic effects.
Illumination in a room
The natural illumination of premises is created by light passing the windows and lanterns and light
reflecting ceiling, walls, floor etc.
General light environment is formed as a result of interaction of direct and reflected light in a
premise.
• Height of the sun stand (day time, season of a year, geographical latitude)
• Character of cloudiness (weather)
• Transparency of the atmosphere
• Condition of a terrestrial cover
• Smoke and air pollution
• Near buildings or trees and their outside decoration
• Heights of a floor, height of the windows, their shape, types and cleanness of window’s glasses
• Interior decoration and furniture and the height of ceiling
Standardization of Illumination
• Lateral (through windows)
• Top (through lanterns) and
• Combined (through windows and lanterns)
• coefficient of natural light exposure (еmin %) at system of lateral illumination, at systems of the
top and combined illumination (еave)
• In living rooms, hospital wards emin should be not less than 0.5%. in classes it should be > 1%. It
means that the indoor light exposure should be not less than 1 % of outside level
Hygienic assessment of illumination
• emin, % - 1-1.5%
• Light coefficient, CoL, shows how many square meters of a floor we have
per 1 square meter of windows’ glass. It should be no more than 1:4, 1:6
• Angle of incidence, o BAC - 27o
• Opening angle, o EAC - 5o
Insolation regime
Vision impairment due to irrational illumination
Overfatigue of sight
Due to insufficient light exposure, intense visual work on close distance, often re-adaptation, and
presence of stroboscopic effect. Pain in area of forehead, eye apples, deterioration of visibility,
hyperemia of eye apples, swollen eyelids, epiphora, and sometimes conjunctivitis
Short-sightedness (myopia)
At long work on close distance, it is necessary to consider
weakness of accommodation
Basic hygienic requirements to electric illumination
• Favorable spectrum of radiation and continuous light flow of a
light source.
• Sufficient light exposure of working surfaces and premises.
• Uniform distribution of brightness on working surfaces and in
working premises.
• Absence of glares in a field of sight of workers.
Standards of electric light exposure
Depending on types of light source (bulbs, tubes, diodes)
• Living rooms, general hospital wards – at least 75 lux
• Study rooms, children rooms – at least 100 lux
• Operation hall – at least 200 lux
Reference
• Eric E. Richman. Requirements for Lighting Levels.
https://www.wbdg.org/pdfs/usace_lightinglevels.pdf
• Lighting. 1915.82. General Working Conditions. Occup. Safety and Health Standards for Shipyard
Employment.
https://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=190

Topic 8
Ionizing Radiation and Health
Learning outcomes
After lecture you should know:
 Physical bases of ionizing radiation
 Measurement units for activity and exposure doses
 Environmental and medical sources of ionizing radiation
 Acute and chronic health effects of ionizing radiation to human body
 Principles of protection from ionizing radiation
Ionizing radiation is radiation with enough energy so that during an
interaction with an atom, it can remove tightly bound electrons
from the orbit of an atom, causing the atom to become charged or
ionized
Alpha particles
Alpha decay: a nucleus ejects an alpha particle which is identical to
an ionized helium nucleus
Beta particles
Beta minus decay happens when a neutron within an atom's
nucleus transforms into a proton and an electron and an
antineutrino are ejected out of the nucleus of an atom. For a beta
plus decay a proton transforms to a neutron and a positron (similar
to an electron
but with a positive charge) and a neutrino are ejected out of the
nucleus
Neutrons
The neutron is an indirectly ionizing particle. It is indirectly ionizing
because it does not carry an nelectrical charge.
X rays and gamma waves
Longer wave lengths, lower frequency waves (heat and radio) have less energy than shorter wave
length, higher frequency waves (X and gamma rays)
Isotopes
Atoms with the same number of protons and different number of neutrons are called ISOTOPES. An
isotope may be defined as one or two or more forms of the same element having the same atomic
number (Z), differing mass numbers (A), and the same chemical properties
Activity
The activity of a radioisotope is simply a measure of how many atoms
undergo radioactive decay per a unit of time. The SI unit for measuring the rate of nuclear
ransformations is the becquerel (Bq). The becquerel is defined as 1 radioactive disintegration
per second.
The old unit for this is the curie (Ci), in honour of Pierre and
Marie Curie who discovered radium and polonium. The curie is
based on the activity of 1 gram of radium-226, i.e. 3.7 x 1010
radioactive disintegrations per second.
Why is ionizing radiation dangerous?
When atoms in living cells become ionized one of three things
usually happen – the cell dies, the cell repairs itself, or the cell
mutates incorrectly and can become cancerous. Not all cells are
affected by
ionizing radiation in the same way. The cells that reproduce the
most and are the least specialized are the most likely to be affected
by ionizing radiation, for example those in a forming fetus.
Health effects of Ionizing radiation
• Acute health effects:
 Acute radiation syndrome (ARS) or radiation poisoning
 Acute radiation burns (cutaneous radiation syndrome)
• Chronic health effects:
 Chronic radiation syndrome (CRS)
 Cancer
Non-stochastic effects: effects that can be related directly to the radiation dose received
Stochastic effects: effects that occurs on a random basis independent of the size of dose.
Ionizing radiation and Health
Ionizing radiation can produce tissue damage directly by striking a vital molecule, such as DNA, or
indirectly by striking a water molecule and producing highly reactive free radicals that chemically
attack vital molecules. The effects of radiation can kill cells, make them unable to reproduce, or
cause onlethal mutations, producing cancer cells or birth defects in offspring. The radiosensitivity of
normal tissues or cancer cells increases with their rate of cell division and decreases with their rate
of cell specialization. Highly radiosensitive cells include lymphocytes, bone marrow hematopoietic
cells, germ cells, and intestinal epithelial cells. Radiosensitive cancers include leukemias and
lymphomas, eminoma, dysgerminoma, granulosa cell carcinoma, adenocarcinoma of the gastric
epithelium, and squamous cell
carcinoma of skin, mouth, nose and throat, cervix, and bladder. Harmful effects of radiation include
serious disturbances of bone marrow and other blood-forming organs, burns, and sterility. There
may be permanent damage to genes, which results in genetic mutations. The mutations can be
transmitted to future generations. Radiation also may produce harmful effects on the embryo or
fetus,
bringing about fetal death or malformations. Long-term studies of groups of persons exposed to
radiation have shown that radiation acts as a carcinogen; that is, it can produce cancer, especially
leukemia. It also may predispose persons to the development of cataracts.
Ionizing radiation units
The roentgen (R) is a unit of exposure dose applicable only to x-rays and gamma rays. It is the
amount of radiation that produces 2.58 Ч 10−4 coulomb of positive and negative ions passing
through 1 kilogram of dry air. The rad is a unit of absorbed dose equal to 100 ergs of energy
absorbed per 1 g of absorbing material; the absorbed dose depends both on the type of radiation
and on the material in which it is absorbed. The rem is a unit of absorbed dose equivalent that
produces the same biologic effect as 1 rad of high-energy x-rays. For beta and gamma radiation, 1
rem is approximately equal to 1 rad; for alpha radiation, 1 rad is approximately 20 rem.
Only the amount of energy of any type of ionizing radiation that imparted to (or absorbed by) the
human body can cause harm to health.
To look at biological effects, we must know (estimate) how much energy is deposited per unit mass
of the part (or whole) of our body with which the radiation is interacting.
The international (SI) unit of measure for absorbed dose
The gray (Gy), which is defined as 1 joule of energy deposited in 1 kilogram of mass. The old unit of
measure for this is the rad, which stands for "radiation absorbed dose." - 1 Gy = 100 rad.

Radiation units (From Bushong, 2001 )

Equivalent dose
The biological effect depends not only on the amount of the absorbed dose but also on the intensity
of ionisation in living cells caused by different type of radiations.
Neutron, proton and alpha radiation can cause 5-20 times more harm then the same amount of the
absorbed dose of beta or gamma radiation.
The unit of equivalent dose is the sievert (Sv). The old unit of measure is the rem. - 1 Sv = 100 rem.
Coefficients of relative biological effectiveness - RBE
Sources of Radiation Exposure
Radiation is permanently present throughout the environment, in the air, water, food, soil and in all
living organisms.
Large proportion of the average annual radiation dose received by people results from natural
environmental sources.
Each member of the world population is exposed, on average, to 2.4 mSv/yr of ionizing radiation
from natural sources.
In some areas (in different countries of the world) the natural radiation dose may be 5 to 10-times
higher to large number of people.
Effects of radiation dose to the entire body
• 0 – 5 rem received in a short period or over a long period is safe—we don’t expect observable
health effects.
• 5 - 10 rem received in a short period or over a long period is safe—we don’t expect observable
health effects. At this level, an effect is either nonexistent or too small to observe.
• 10 - 50 rem received in a short period or over a long period—we don’t expect observable health
effects although above 10 rem your chances of getting cancer are slightly increased. We may also
see
short-term blood cell decreases for doses of about 50 rem received in a matter of minutes.
Effects of radiation dose to the entire body
• 50 - 100 rem received in a short period will likely cause some observable health effects and
received over a long period will increase your chances of getting cancer. Above 50 rem we may see
some changes in blood cells, but the blood system quickly recovers.
• 100 - 200 rem received in a short period will cause nausea and fatigue. 100 - 200 rem received
over a long period will increase your chances of getting cancer.
• 200 - 300 rem received in a short period will cause nausea and vomiting within 24-48 hours.
Medical attention should be sought.
• 300 - 500 rem received in a short period will cause nausea, vomiting, and diarrhea within hours.
Loss of hair and appetite occurs within a week. Medical
attention must be sought for survival; half of the people
exposed to radiation at this level will die if they receive no
medical attention. Effects of radiation dose to a smaller area of
the body
• 40 rem or more locally to the eyes can cause cataracts.
• 100 rem - 500 rem or more can cause hair loss for a section
of the body that has hair.
• 200 rem or more locally to the skin can cause skin reddening
(similar to a sunburn).
• 1,000 rem or more can cause a breakdown of the intestinal
lining, leading to internal bleeding, which can lead to illness and
death when the dose is to the abdomen.
• >1,500 rem or more locally to the skin can cause skin reddening
and blistering.
We are radioactive
0.012% of our body’s potassium is radioactive
We expose ourselves to 40 mrem each year due to the decay of
naturally occurring radioactive isotopes in our bodies
We are exposed to 5 mrem of radiation each time we fly roundtrip
If you eat a banana a day for a year you are exposing yourself to
about 3.6 mrem Smoking a half a pack of cigarettes per day adds
500 mrem/day

Radon
Inert radioactive gas.
Escapes easily from rocks and soils into the air and tends to concentrate in enclosed spaces.
Soil gas infiltration is recognized as the most important source of residential radon.
Exposure to Radon
Exposure to radon in the home and workplace is one of the main risks of ionizing radiation causing
tens of thousands of deaths from lung cancer each year globally
Radiation Protection
Penetrating capacity of different types of radiation (Ignatavicius and Workman, 2002)

Penetrating and Ionizing capacity of different types of radiation

ALARA Principle
“As Low As Reasonably Achievable” means making every reasonable effort to maintain exposures to
ionizing radiation as far below the dose limits as practical, consistent with the purpose for which the
licensed activity is undertaken, taking into account the state of technology, the economics of
improvements in relation to state of technology, the economics of improvements in relation to
benefits to the public health and safety, and other societal and socioeconomic considerations, and
in relation to utilization of nuclear energy and licensed materials in the public interest.
Distance
Increasing distance from the radiation source reduces the dose according to the inverse-square law
for a point source. Distance can sometimes be effectively increased by means as simple as handling
a source with forceps rather than fingers. This could reduce erythema to the fingers, but the extra
few centimeters distance from the body will give little protection from acute radiation syndrome
Time
The longer that humans are subjected to radiation the larger the dose will be.
"Quickly putting or dumping wastes outside is not hazardous once fallout is no longer being
deposited. For example, assume the shelter is in an area of heavy fallout and the dose rate outside
is 400 roentgen (R) per hour enough to give a potentially fatal dose in about an hour to a person
exposed in the open. If a person needs to be exposed for only 10 seconds to dump a bucket, in this
1/360 of an hour he will receive a dose of only about 1 R. Under war conditions, an additional 1-R
dose is of little concern.« (C Kearny)
Shielding
Low atomic number materials are recommended to shield beta particles High atomic number
materials are very effective in shielding photons Shielding is of special importance when time and
distance cannot be completely utilized as safety factors. In such instances lead, which is an
extremely dense material, is used as a protective device. The walls of diagnostic x-ray rooms are
lined with lead, and lead containers are used for radium, cobalt-60, and other radioactive materials
used in radiotherapy. Monitoring devices such as the film badge, thermoluminescent dosimeter, or
pocket monitor are worn by persons working near sources of radiation.
Reduction of incorporation into the human body
Where radioactive contamination is present, a gas mask, dust mask, or good hygiene practices may
offer protection, depending on the nature of the contaminant. Potassium iodide (KI) tablets can
reduce the risk of cancer in some situations due to slower uptake of ambient radioiodine. Although
this doesn't protect any organ other than the thyroid gland, their effectiveness is still highly
dependent on the time of ingestion which would protect the gland for the duration of a twenty-four
hour period. They do not prevent acute radiation syndrome as they provide no shielding from other
environmental radionuclides.
Fractionation of dose
If an intentional dose is broken up into a number of smaller doses, with time allowed for recovery
between irradiations, the same total dose causes less cell death. Even without interruptions, a
reduction in dose rate below 0.1 Gy/h also tends to reduce cell death. This technique is routinely
used in radiotherapy. The human body contains many types of cells and a human can be killed by
the loss of a single type of cells in a vital organ. For many short term radiation deaths (3 days to 30
days), the loss of two important types of cells that are constantly being regenerated causes death.
The loss of cells forming blood cells (bone marrow) and the cells in the digestive system (microvilli
which form part of the wall of the intestines) is fatal.
Reference
• Feynman, Richard; Robert Leighton; Matthew Sands (1963). The Feynman Lectures on Physics,
Vol.1. USA: Addison-Wesley. pp. 2–5.
• European Centre of Technological Safety. "Interaction of Radiation with Matter" (PDF). Radiation
Hazard. Retrieved 5 November 2012.
• Fundamental Quantities and Units for Ionizing Radiation (ICRU Report 85)". Journal of the ICRU 11
(1). 20
• Prasad KN. Handbook of Radiobiology, 2 nd ed. New York : CRC Press, Inc.; 1995.
• Donnelly EH, Nemhauser JB, Smith JM; et al. (June 2010). "Acute radiation syndrome: assessment
and management". South. Med. J. 103 (6): 541–6.

Topic 9
Hospital Hygiene
Learning outcomes
 After this lecture the students should know:
 Hygienic requirements to the placement and territory of hospitals in a settlement
 Type of hospital building systems
 Hygienic requirements to hospital wards and chambers depending on type of the hospital
section
 Hygienic requirements to the hospital environment for patients
Basic systems of building hospitals
  decentralized,
 centralized and
 hybrid
Decentralized (pavilion) system
 Consists of a series of separate, relatively small, low-rise buildings (pavilions) with different
medical departments
 Good isolation between hospital departments:
 It facilitates the therapeutic and protective treatment
 It prevents the occurrence of nosocomial infections
Centralized system of hospitals
 All medical establishment is in one high-rise building
 It lowers construction costs
 Facilitates easier operation of sanitation services, reduced path of movement of patients
and medical staff from individual offices to the diagnostic and physiotherapy room
A mixed or hybrid system of hospitals
 It aims at integrating somatic hospital departments, medical diagnostic rooms, laboratories,
a centralized admission in one main building
 There are separately placed outpatient clinic, infectious and maternity wards, sectional and
economic courtyard
 Provides centralization of medical processes and the use of equipment,
 Implements the principle of the isolation of individual medical offices.
 Enables to combine functionally homogeneous sub-systems and create the appropriate
complexes (surgical, sterilization unit, X-ray diagnostic unit, laboratory, etc.)
Hygienic requirements to the placement of hospitals in a settlement
 Sufficient size and landscaping
 With less noise, dust, cleaner air and greater comfort →on thewindward side, and at a
considerable distance from the source of noise and air pollution facilities
 Level of noise on the territory during the daytime should not exceed 45 dB, and at night - 35
dB
 Well insolated and ventilated area, preferably near the water mains, sewer
communications, water supply sources
 A small sloop of the land surface
Hygienic requirements to the placement of hospitals in a settlement
 To bring medical assistance closer to the population, outpatient clinics should be placed in
the center of the service area
 A general hospital with hospital and clinic are often located within a residential area
 Tuberculosis, psychiatric hospitals or rehabilitation centers that are not related to
outpatient care, are often built in suburban area, even outside of the city
Hygienic requirements to the land of hospitals
 Size of area (depending on number of beds and the system of hospital building)
 Distance to water supply, sewage, industrial and transport source of noise and air pollution
 Aeration and insolation conditions
 Level of drain water
 Properties of soil
 Sloop
  Ratio of area of 1:2 (3:4)
Size of area for construction of hospital (ha)

Zoning of the hospital area

• Area of medical buildings for non-infectious patients
• Area of infectious unit
• Area of maternity departments
• Area of outpatient clinics
• Radiology and pathology zone,
• Zone of garden and parks
• Household zone
• Zone of Morbid Anatomy Department
Plan of a city hospital (hybrid system)
1 – main corps
2 – outpatient
clinic
3 – obstetrics and
gynecology unit
4 – infectious
disease unit
5 – kitchen
6 – admin and
household corps
7 – pathological
anatomy corps
Requirements to the area of hospitals
 Building area of hospitals should
be 12 15% of the land,
 The green area is not less than
60% (the rate of 25 m2 per bed),
 Pedestrian and road carriageways take the rest of the area
 The outside protective green strip – 15-30 m of width
 Strips of green space should be between the functional areas of hospitals and make 15
meters
 Between the walls of buildings with the windows of the chambers -2.5 heights of the
building opposite, but not less than 25 m
  Between the buildings with the chambers and pathologic housing, admission unit and
kitchen - not less than 30 m
 Between the radiological and other housing - not less than 25 m
Requirements to the area of hospitals
 Cleaning the gap between the medical corps and kitchen, pathologic housing and protective
strip of green spaces should not be less than 30 m
 Pathological Anatomy Department should be placed in an isolated place, which is not visible
from the windows of the hospital
 A courtyard with a central boiler, cleaning, disinfection plant, garages, warehouses,
vegetable store should be placed on the leeward side of and below the terrain at a distance
of 30-40 m from the hospital buildings
 The minimum distance between trees and the walls of buildings should be not less than 5
m, the bushes and the building - 1.5 m
The general hospital structure
 Admission unit
 Hospital, which consists of therapeutic, surgical and obstetric-gynecological units, children
unit, infectious disease unit, office for blood transfusions with blood and blood bank,
radiology unit etc.
 Outpatient clinic
 Medical diagnostic subsections: department of functional diagnostics, radiology,
physiotherapy, rehabilitation and physical therapy
 Pathological anatomy section with morgue
 Support services: nutrition unit, laundry, fumigator, the central sterilization department,
workshops for the repair of medical equipment, garage, vegetable storehouse etc.
 Administrative & household part: stationery, medical archives, libraries etc.
Ward section
 Ward section is designed for 30 beds, in particular one-bed (9 m2), two- and four-bed (7 m2
per bed) chambers
 In wards, the most comfortable when beds are placed in parallel to the light-carrying wall
 The distance between the beds should be not less than 0.8-1.0 m
 The beds pose no closer than 0.9-1.0 m from the external wall
 The post of duty nurse (4-6 m2), a doctor's office (10 m2), procedural (13-18 m2), enema (8
m2), dining room (18 m2), the place of day care patients (15 m2) and bathroom
 The width of the corridor should be not less than 2.4 m, which allows free deployment of
beds or stretchers
 If the department consists of several ward sections, the head office (12 m2), the room for
senior nurses and sister-hostess (10 m2), and storage space for mobile equipment (12 m2),
wheelchair parking (5 m2), two staff rooms, a room for specialized rooms (their
appointment depends on the profile of the department), for example, in the surgical
department - dressing (22 m2) are placed between the ward section of the housing office
 Lounge and dining room can be shared between two adjacent sections
 The wards for intensive care, semi-box and boxes, a chamber-biotron, "sterile" chamber
Surgery unit
 25-45% of hospital beds in modern multidisciplinary hospitals
 Consists of the wards and the operating unit
  Ratio of surgical table is 1 per 25-30 beds
 The operating unit usually consists of a sterilizer (6-12 m2), preoperative (10-20 m2),
operating (25-35 m2) with anesthetic (20-30m2), gypsum (20 m2), tool (10 m2) and other
(operating-pressure chamber)
 The operation unit of several surgical departments are merged into one operating complex
 A sterile, especially pure and clean zones of the operating unit
 I - the highest aseptic requirements to the room, surgical and sterilization equipment
 II - premises directly related to the operating: preoperative and anesthetic
 III - a room for the storage of blood and portable equipment, protocol, the surgeon &
nurses offices, laboratory of express analyzes, clean zone of bathing and delousing space
 The operating area should be not less than 45-50 m2, the height – not less than 3.5 m
Operating unit
 Windows of operating hall should be oriented to the Northern rumba.
 The light ratio should be 1:3 to 1:4.
 Two doors: one - for the import of patient for the surgery, and the second, in the side wall, -
for export of operated
 Persons with septic wounds and any pustular skin contamination cannot be allowed to
enter the operating room
 Smooth & shiny walls, easy to clean
 Walls and ceiling paint is recommended light matte oil paint, which reduces light
reflections, and does not tire the eye surgeon
 All types of wiring and heating appliances are installed in the wall
 The floor should be decorated by tiles with a slight slope to the ramp
Infectious disease clinic
 A separate house
 Two entrances: one for patients, and the second - for the staff, delivery of food and clean
things
 Boxes and semi-boxes
A Semi-box
1 – Ward
2 – WC
3 – Gateway
One entrance from the
corridor
A Box
A – Entrances from outside
and inside and gateways
B – Box
D – Restroom
The area of a box is 22 m2
per 1 bed, and 27 m2 for 2-
bed box. Chamber area
should be 7.5 m2 per bed
Children’s ward
 Wards for children up to one year are calculated on 24 beds
 For children over the age of one year - to 30 beds
  They consist of:
 One - (9 m2/bed), two- (7 m2/bed) and four-bed chambers (4 m2/bed),
 Post of duty nurse, and procedural
 Dining room,
 Rooms for mothers,
 Playroom,
 Facilities for day stay of children,
 Washrooms and toilets.
Area of wards of pediatric hospitals

Environment in hospital wards

Natural Illumination
 Light ratio should be:
 1:5 to 1:6 in the wards, rooms for day-stay patients, in the offices of physicians, treatment
 1:4 - 1:5 - in the operating room, maternity, surgical dressings,
 1:6 - 1:7 - in coffee shops, waiting rooms.
 Natural light ratio (ce%) in the wards should not be less than
 In the wards – 0.5%
 In doctor’s offices – 1%
 In operating halls – 2%
 The depth of the chamber does not exceed 6 m,
 The ratio of the depth of the room (the depth-to-width ratio) is less than two (width - not
less than 2.9 m).
Electric Illumination
By fluorescent lamps should be:
in general operating halls - 400-300 lux
dental laboratories and libraries -300 lux
doctors' offices - 200 lux
wards, manipulation rooms, boxes, nurse on duty - 150 lux
bathrooms - 100 lux , hallways, aisles, bathrooms - 75 lux.
Lighting by incandescent lamps - 2 times less.
Local illumination during the the patient examination or performing medical procedures should be
300 (minimum) - 1000 (optimal) lux.
General lighting in intensive care units should ensure illumination of not less than 500 lux.
Recommended height of installation of wall lamps with direct & diffused light on each bed - 1.6-1.8
m above the floor.
Orientation of windows of hospital rooms on latitude southern 45 0

Note. * Allowed orientation of windows in chambers, the total number of beds of which is not more
than 10% of the total number of beds in wards
Microclimate in wards
 Air temperature should be:
 in the general wards - 20 oC
 in intensive care, burns, post partum wards and wards for children - 22 oC
 in doctors' offices and procedurals - 20 C
 Relative humidity - 35-60%
 Air velocity - 0.2-0.3 m/s.
Indoor air temperature of hospital premises

Air exchange in wards

 Air ventilation – through air vents, transoms supply and exhaust channels
 In hospitals for 100 beds or more - exhaust mechanical ventilation
 Operating and maternity hospitals should have individual supply & exhaust ventilation with
the advantage of high supply or be airconditioned
 Air exchange rate should be%
 in general wards - 2-3 times per hour,
 in maternity and operating rooms, recovery rooms and intensive care units
-up to 10 times per hour
Permissible levels of microbial contamination
Further reading
1. Wenzel RP (1997). Prevention and control of nosocomial infections, 3rd ed. Baltimore, MD,
Williams & Wilkins.
2. Rutala A (1995). Chemical germicides in health care. Morin Heights, Canada, Polyscience.
3. Boyce, J.M., Pittet, D. (2002) Guideline for Hand Hygiene in Healthcare Settings:
Recommendations of the Healthcare Infection Control Practice Advisory Committee and the
HICPAC/SHEA/APIC/IDSA Hygiene Task Force.
4. Puchkova Oxana. Indoor climate in hospitals. What are the risk factors for patients?
Bachelor’s Thesis Building Services Engineering.
5. https://publications.theseus.fi/bitstream/handle/10024/54446/Final%20version%20Oxa
na29.01.20013.pdf?sequence=1
6. Good lighting for health care premises.
http://www.licht.de/fileadmin/Publikationen_Downloads/h07_engl.pdf
7. Light for Health and Care.
https://www.zumtobel.com/PDB/teaser/en/AWB_Health_Care.pdf

Topic 10
Nutrition Hygiene
Learning outcomes
After this lecture the students should know:
• What is healthy diet
• What are body energy needs
• How to find your energy expenditure
• How to assess your diet
• How to find dietary recommended intake
• What is globesity
Healthy diet – what is it?

• Fresh food
• Organic food
• No fast food
• Food with vitamins
• Plenty vegetables
• Plenty fruits
• Less or no meat
• More fish
• Low fat
• Lots protein
• Less salt
• No food additive
What US Americans eat? Annual intake:
•French fires 29 pounds

•Pizza 23 pounds

•Ice cream 24 pounds

•Soda 53 gallons

•Sodium 2.7 pounds

•Average calorie intake: ≈ 2700
Sources: FDA, USDA, CDC
http://cdc.gov/nchs/nhanes/wweia.htm

What is a Healthy Diet?

•Healthy
diets are characterized

by

adequacy

and

balance
•There are
many types
of healthy
diets

•There is no good or bad food, only diets that are healthy or unhealthy
•There are dietary guidelines. In USA, there are “Dietary guidelines for Americans” and the “Choose
MyPlate”:
•Dietary Guidelines address issue of dietary balance
•Choose MyPlate focuses on food choices for meals to comprise adequate diets
•DGA – for people age 2 and over
What is a Healthy Diet?
•Adequacy, balance and variety are key characteristics of a healthy diet
•Healthy diets contain different food that provides calories and nutrients in amounts that promote the optimal
functioning of the body
•Variety of food is required to obtain all of the essential nutrients we need in our diet
•What is important is that the contributions of a variety of individual foods add up to an adequate and balanced
diet
Adequate diets
•Variety of foods provide sufficient levels of calories and essential nutrients
•Amount of calories to maintain healthy body weight
•Essential nutrients in intake levels from the Recommended Daily Amounts and Ais
•Following tools such as the MyPlate guidelines helps meet needs for essential nutrients and other beneficial
dietary components
Essential Nutrients
Carbohydrates
•Proteins
•Fats
•Vitamins
•Vitamin A
•B-vitamins
•Vitamin C
•Vitamin D
•Vitamin E
•Vitamin K
•Choline
•Minerals
•Macro minerals
•Calcium, Phosphorus, Potassium, Sodium, Iodine,
etc
•Trace minerals
•Fluoride, Iodine, Iron, Manganese, Selenium,
Zinc, etc
•Water
Dietary Reference Intakes (DRIs)
•Recommended intake levels of essential nutrients and other biologically active components of food
•Recommended daily levels of intake that not only meet the nutrient needs of almost all healthy people (97-
98%), but also promote health and help reduce the risk of chronic disease
•The DRIs are developed by experts. Example:
http://www.iom.edu/Activities/Nutrition/SummaryDRIs/-/media/Files/Activity%20Files/Nutrition/DRIs/S-
Summary%20Table%20Tables%201-4.pdf
Balanced Diets
•Provide calories, nutrients, and other components in the right proportion
•Diets that provide more calories than needed to maintain a healthy body weight are also out of balance

Acceptable
Macronutrient
Distribution Range
•Carbohydrate 45-65%
total calories
•225-325 grams for 2000 calories diet
•Protein 10-35% total calories
•50-175 grams for 2000 calories diet
•Fat 20-35% total calories
•44-78 grams for 2000 calories diet
Carbohydrate
•Derived primarily from plant based foods
•Composed of carbon, hydrogen, and oxygen molecules (CHO)
•The body’s preferred source of energy (calories)
•Contain 4 Cal/g
•Include sugars, starches, and fiber
•Main dietary sources: grains, fruits, vegetables, beans, dairy food, sucrose, high fructose corn syrop
Protein
•Chains of 20 amino acids (9 essential)
•Composed of carbon, hydrogen, oxygen, and nitrogen
•Structural component of tissues and organs
•Makes up enzymes and hormones
•Growth, maintenance and repair of tissues
•Can provide energy – 4 Cal/g
•Food sources: animal food, dairy food, beans, legumes, nuts, grains, etc
Fats
•Concentrated source and storage form of energy (9 Cal/g – 3,500 per pound)
•Carry essential fatty acids, fat-soluble vitamins, and healthful phytochemicals
•Dependent on type and amount in the diet, can have positive and negative health effects
•Part of lipids chemical group:
•Includes sterols (cholesterol)
•95% of fat in our diets and body is in the form of triglyceride (glycerol molecule and 3 fatty acids)
•Food sources: oil, dairy foods, butter, high fat meats, fried foods, baked goods, nuts…
First Dietary Guidelines, 1894
Farmers’ Bulletin, W.O. Atwater:
“Unless care is exercised in selecting food, a diet may result which is one-sided or badly balanced – that is, one
in which either protein or fuel ingredients (carbohydrate and fat) are provided in excess… The evils of
overeating may not be felt at once, but sooner or later they are sure to appear – perhaps in an excessive amount
of fatty tissue, perhaps in general debility, perhaps in actual disease”.
Evidence based guidelines
•Balance calories with physical activity to manage weight
•Stress consumption of nutrient-dense foods, balancing caloric intake and output, and increasing physical
activity
•Recommend to consume more of certain foods and nutrients such as fruits, vegetables, whole grains, fat-free
and low-fat dairy products, and seafood
•Recommend to consume fewer food with sodium (salt), saturated fats, trans fats, cholesterol, added sugars,
and refined grains
•Should be updated regularly
Key term definition “Nutrient Dense”
Nutrient-dense foods and beverages:
•Provide vitamins, minerals, and other beneficial substances and relatively few calories without
•Solid fats in the food or added to it
•Added sugars
•Added refined starches
•Added sodium
•Retain naturally occurring components, such as dietary fiber
•All vegetables, fruits, whole grains, seafood, eggs, beans and peas, unsalted nuts and seeds, fat-free and low-
fat dairy, and lean meats and poultry are nutrient dense when prepared without solid fats or sugars
Nutrient Density
•Adequate diet includes food that is good source of a number of nutrients and is low in calories
•Food that provides multiple nutrients in appreciable amounts relative to calories is considered nutrient-dense
•Food that provides calories and low- amounts of nutrients is called empty-calorie food
•It is easier to build an adequate diet around nutrient-dense foods than around empty calorie foods

Nutrient Dense Foods (1-100 scale)

•Raw leafy green vegetables 100 •Refined oils 1
•Solid green vegetables 97 •Refined sweets 0
•Non-green, non-starchy
vegetables 50
•Means/legumes 48
•Fresh fruits 45
•Starchy vegetables 35
•Whole grains 22
•Raw nuts and seeds 20
•Fish 15
•Fat-free dairy 13
•Wild meat and fowl 11
•Eggs 11
•Red meat 8
•Full-fat dairy 4
•Cheese 2
•Refined grains 2
Energy Density
•Energy density (calorie-density)
•Number of calories in a gram (given volume)
•Number of calories in a portion of food divided by the food’s weight in grams
•Example:
•1-7 calories in 20 grams of potato chips
•107/20=5.4
•Associated with overeating, weight gain, obesity, type 2 diabetes
•Fried pork chop 2.7
•Energy-dense foods tend to be nutrient poor
Energy Density
Higher energy-dense food cal/g •Fried fish 2.2
•Bolonga 3.1 •Fried rice 1.6
•Fried chicken 2.8 •Potato salad 1.4
•Fried pork chop 2.7 •Frozen strawberries 1.1
•Cheeseburger 2.7 Lower energy-dense food cal/g
•Fried fish 2.2 •Sliced turkey breast 0.9
•Fried rice 1.6 •Grilled chicken 1.7
•Potato salad 1.4 •Bean burrito 1.9
•Frozen strawberries 1.1 •Boiled potato 0.9
Lower energy-dense food cal/g •Broiled fish 1.2
•Sliced turkey breast 0.9 •Rice 1.3
•Grilled chicken 1.7 •Tossed salad with dressing 1.1
•Bean burrito 1.9 •Fresh strawberries 0.3
•Boiled potato 0.9
•Broiled fish 1.2
•Rice 1.3
•Tossed salad with dressing 1.1
•Fresh strawberries 0.3 Energy Density

Higher energy-dense food cal/g

•Bolonga 3.1
•Fried chicken 2.8
•Fried pork chop 2.7
•Cheeseburger 2.7
What to choose?
•Make most of your food choice high in nutrient density and low in energy density
•Higher fiber foods tend to be higher in nutrient density and lower in energy density
•High fat foods tend to be lower in nutrient density and higher in energy density
•Water content also lowers energy density
Obesity trendsWorldwide obesity

•WHO:

http://www.who.int/gho/ncd/risk-
factors/obesity_text/en/index.html
•International Association for the Study

of Obesity: Interactive World map of Obesity: http://www.iaso.org/resources/world-map-obesity/A

Balancing Calories to Manage Weight
•Prevent and/or reduce overweight and obesity through improved eating and physical activity behaviors
•Control total calorie intake to manage body weight. For people who are overweight or obese, this mean
consuming fewer calories from foods and beverages
•Increase physical activity and reduce time spent in sedentary behaviors
•Maintain appropriate calorie balance during each stage of life-childhood, adolescence, adulthood,
pregnancy and breastfeeding, and older age.
Body Needs Energy
•Basal metabolism uses 60-80% of total calories for:
• breathing
•Beating of the heart
•Maintenance of body temperature
•Renewal of muscle and bone tissue
•Ongoing activities to sustain life and health
•Growth is component of basal metabolism
•Calories for basal metabolism are highest during growing years
Basal Metabolic Rate
•Estimate calories for basal metabolism by quick formula:
•For men: Multiply body weight in pounds by 11
•For women: Multiply body weight in pounds by 10.1 (10)
•A man of 170 pounds needs 170 x 11, or 1870 Cal/day
•A 135-pound woman needs 135 x 10, or 1350 Cal/day
•Formula estimates basal metabolism for gender and weight
•Other factors affect how efficiently the body uses calories:
•Physical activity level
•Muscle mass, height
•Health status
•Genetic traits
•Results from quick formula may be 10 to 20% lower or higher than the true number required for basal
metabolism
Basal Metabolic Rate
•Estimate calories for basal metabolism by quick formula:
•For men: Multiply body weight in pounds by 11
•For women: Multiply body weight in pounds by 10.1 (10)
•A man of 170 pounds needs 170 x 11, or 1870 Cal/day
•A 135-pound woman needs 135 x 10, or 1350 Cal/day
•Formula estimates basal metabolism for gender and weight
•Other factors affect how efficiently the body uses calories:
•Physical activity level
•Muscle mass, height
•Health status
•Genetic traits
•Results from quick formula may be 10 to 20% lower or higher than the true number required for basal
metabolism
Activity level estimate…
•Inactive (30% BMR)
•Sitting most of the day; less than 2 hours of moving about slowly or standing
•“Average” (50% BMR)
•Sitting most of the day; walking or standing 2-4 hours; no strenuous activity
•Active (75% BMR)
•Physically active 4 or more hours each day; little sitting or standing; some strenuous activity
Calories for Thermogenesis
•Some energy expenditure is for chewing and swallowing foods, digesting foods, absorbing and utilizing
nutrients, and transporting nutrients into cells
•Some energy involved in these activities escapes as heat
•Processes are dietary thermogenesis
•Calories for dietary thermogenesis are about 10% of sum of basal metabolic and physical activity calories
Maintenance Calorie Needs Examples Be able to estimate calorie needs if know gender, weight and
activity level
130 pound sedentary female 1859 Cal
•BMR: 130 x 10 = 1300 calories •Total 1859 Cal/day inactive female
•Activity calories: + 30% 390 Cal; 1300 + 390 = •± 10% = 1675-2044 Cal/day
1690 Cal 170 pound active (average) male
•Thermogenesis : +10% 169 Cal; 1690 + 169 = •BMR: 170 x 11 = 1870 calories
•Activity calories: + 50% 935 Cal; 1870 + 935 =
2805 Cal
•Thermogenesis : +10% 280 Cal; 2805 + 280 =
3085 Cal
•Total 3085 Cal/day inactive female
•± 10% = 2785-3395 Cal/day
Determine calorie needs…
Elena, 32 years old, 150 pounds, commutes 45 minutes to work, parks beside building, takes elevator to 4th
floor, computer based work, 1-2 meetings a day in conference room down the hall, relaxes with TV in the
evening
Chandran, 27 years old, 190 pounds, racquetball twice a week for an hour, waiter in upscale restaurant 3 nights
a week (6-10 pm), much of free time at computer with online graduate program
Further reading
•Payne-Palacio, June R. and Canter, Deborah D. (2014). The Profession of Dietetics. Jones & Bartlett
Learning. pp. 3, 4
•History of the Study of Nutrition in Western Culture (Rai University lecture notes for General Nutrition
course, 2004)
•Carpenter, Kenneth J. (1994). Protein and Energy: A Study of Changing Ideas in Nutrition. Cambridge
University Press.
•Mahan, L.K. and Escott-Stump, S. eds. (2000). Krause's Food, Nutrition, and Diet Therapy (10th ed.).
Philadelphia: W.B. Saunders Harcourt Brace.
•Smith, Richard (24 January 2004). "Let food by thy medicine...". BMJ 328 (7433): 0–g.
doi:10.1136/bmj.328.7433.0-g.
•Walter C. Willett and Meir J. Stampfer (January 2003). "Rebuilding the Food Pyramid". Scientific American
288 (1): 64–71. doi:10.1038/scientificamerican0103-64.
•Willett, Walter C. with Skerrett, Patrick J. (2005) [2001]. Eat, Drink, and be Healthy: The Harvard Medical
School Guide To Healthy Eating. Free Press (Simon & Schuster). p. 183.
•Jenkins, David; Jenkins, Alexandra L.; Wolever, Thomas M.S.; Thompson, Lilian H. and Rao, A. Venkat
(February 1986). "Simple and complex carbohydrates". Nutritional Reviews 44 (2): 44–49. doi:10.1111/j.1753-
4887.1986.tb07585.x.
International dietary recommendations
Learning outcomes
After this lecture the students should know:
• What is healthy diet
• What are body energy needs
• How to find your energy expenditure
• How to assess your diet
• How to find dietary recommended intake
• What is globesity International Dietary
Guidelines
• http://fnic.nal.usda.gov/dietary-
guidance/myplatefood-pyramid-
resources/ethniccultural-food-pyramids
• http://www.mayoclinic.com/health/healthy-
diet/NU00190
• most healthy-diet plans emphasize the
following:
• Eat more plant foods, including fruits,
vegetables and whole grains
• Choose lean protein from a variety of sources
• Limit sweets and salt
• Control portion size
• Be physically active Mediterranean Diet
• WHO developed guide in 1994 to help
popularize a diet associated with reduced risk of
heart disease and cancer
• Emphasizes olive oil, breads, whole grain
cereals, nuts, fish, dried beans, vegetables, and
fruits; and wine in moderation
• Intake of red meat is limited to monthly, and sweets and poultry to weekly intake
Latin American Diet
• Emphasis on fruits and vegetable ,fish and healthful fat consumption
• Some moderate alcohol consumption
Asian Diet
• Shares a number of elements with the Mediterranean Diet Pyramid
• Separates food into monthly, weekly, and daily intakes
• Focuses on plant foods and reduced intake of red meat, eggs, poultry products
• Developed from results of studies on more than 10000 families in China and Taiwan
Japanees Food Spinning Tool
Pakistani Diet

Philippine Diet
 Emphasis on fruit and vegetable, lower fat, lower sugar, less sodium.
French Diet Guide
WHO
www.who.int/dietphysicalactivity/diet/en/index.html
Improving dietary habits is a societal, not just an individual problem. Therefore, it demands a
population-based, multisectoral, multidisciplinary, and culturally relevant approach. These
recommendations need to be considered when preparing national policies and dietary guidelines,
taking
into account the local situation.
• Achieve energy balance and a healthy weight
• Limit energy intake from total fats and shift fat consumption away from saturated fats and
towards the elimination of trans-fatty acids
• Increase consumption of fruits and vegetables, and legumes, whole grains and nuts
• Limit the intake of free sugars
• Limit salt (sodium) consumption from all sources and ensure that salt is iodized
Foodborne diseases. Food poisonings
Learning outcomes
After this lecture the students should know:
•Classification of foodborne diseases
•Classification of food poisonings

•Main causes of
food poisonings
•Main symptoms of
food poisonings
•Prevention of food
poisonings
•What is Codex

Alimentarius?

Foodborne
illness: I. Food
Transmitted
Infections
Foodborne illness
(foodborne
disease) is
any

illness resulting from the food spoilage of contaminated food, pathogenic bacteria, viruses, or
parasites that contaminate food, as well as chemical or natural toxins such as poisonous
mushrooms, or cause allergic reactions.
They include food poisoning
 •Vibrio

vulnificus

•Yersinia
Foodborne illness: I.

Food Transmitted Infections enterocolitica and Y. pseudotuberculosis

Bacteria: Viruses::
•Campylobacter jejuni •Enterovirus
•Clostridium perfringens •Hepatitis A
•Salmonella spp •Hepatitis E
•Escherichia coli O157:H7 •Norvovirus
•Bacillus cereus •Rotavirus
•Listeria monocytogenes
•Shigella spp.
•Staphylococcus aureus
•Staphylococcal enteritis
•Streptococcus
•Vibrio cholerae, including O1 & non-O1
•Vibrio parahaemolyticus
Foodborne illness: I. Food Transmitted Infections
•Platyhelminthes:
•Diphyllobothrium sp.
•Nanophyetus sp.
•Taenia saginata
•Taenia solium
•Fasciola hepatica
•Tapeworm and Flatworm
•Nematode:
•Anisakis sp.
•Ascaris lumbricoides
•Eustrongylides sp.
•Trichinella spiralis
•Trichuris trichiura
•Protozoa:
•Acanthamoeba and other free-living amoebae
•Cryptosporidium parvum
•Cyclospora cayetanensis
•Entamoeba histolytica
•Giardia lamblia
•Sarcocystis hominis
•Sarcocystis suihominis
•Toxoplasma gondii
 Foodborne Illness. II. Food allergies
•90% of food allergies are caused by:
•Milk
•Egg
•Peanuts
•Tree nuts
•Wheat
•Soybeans
•Fish
•Crustacean
shellfish
Foodborne illness. III. Food poisonings
Food poisoning is acute (rarely chronic) disease resulting from eating food massively
contaminated by microorganisms or containing toxic substances of microbial or non-
microbial nature.
Food poisonings
1. Microbial foodborne poisonings:
•Toxicoinfections
•Toxicosis (intoxications):
•Bacterial toxicosis
•Mycotoxicosis
•Mixt
3. Foodborne poisonings of unknown etiology
2. Non-microbial foodborne poisonings:
•Poisoning by food poisonous by its nature:
•plant origin
•animal origin
•Poisoning by food toxic under certain conditions:
•plant origin
•animal origin
•Poisoning impurities chemicals
Food poisonings
1. Microbial foodborne poisonings:
•Toxicoinfections
•Toxicosis (intoxications):
•Bacterial toxicosis
•Mycotoxicosis
•Mixt
2. Non-microbial foodborne poisonings:
•Poisoning by food poisonous by its nature:
•plant origin
•animal origin
•Poisoning by food toxic under certain conditions:
•plant origin
•animal origin
•Poisoning impurities chemicals
3. Foodborne poisonings of unknown etiology

Microbial food poisonings

Toxicoinfections
•Escherichia coli (E. coli saprophytic),
•Bacteria Proteus (mirabilis et vulgaris),
•Enterococci (Sfr. faecalis var. liguefaciens et zymogenes),
•Cl. Perfringens,
•B. Cereus (diarrheal form),
•Vibrio paragemoliticus
•Emerging foodborne pathogens (Citrobacter, Hafnia, Klebsiella, Eolwarolsiella, Yersinia,
Pseudomonas, Aeromonas, and others)
Bacterial toxicosis
•Enterotoxigenic Staphylococcus aureus;
•Cl. Botulinum;
Mycotoxicosis
•Aspergillus,
•Fusarium: F. Sporofrichiella var. Sporotrichioides, F. Graminearum,
•Ergot (Clauceps purpurea)
Mixt toxicosis
•B. Cereus + Enterotoxigenic Staphylococcus aureus

Examples: toxicoinfections – Campylobacter jejuni toxicosis – Clostridium botulinum

Campylobacter jejuni
•Campylobacter jejuni is the leading cause of gastroenteritis in the US and probably world-
wide.
•In India - over 2.4 million persons annually, or 0.8% of the population
•Grossly underreported
•In developed nations the incidence of infection peaks is in early adulthood and higher in
males. In developing nations, the infection is hyperendemic among young children.
•The principal route of transmission in developed countries is by eating and consuming
chicken; the greatest risk may come from eating chicken prepared outside the home
•Other potential sources of infection include unpasteurized milk, other foods of animal
origin, contaminated water, and pets such as dogs and cats.

Campylobacter jejuni
Properties of the organism
•Curved s-shaped gram (-) rods, motile with a single polar flagellum at one or both ends.
•Defined "viable but not culturable" state.
•respiratory metabolism, microaerophilic.
•Grow with 10% CO2 / 5% O2 . Some species / strains require additional H2 in the
atmosphere
•C. jejuni will grow at 42o C and this is used as a selection criterion.
•The organism is unusually thin (0.2 - 0.9 )

Campylobacter jejuni

Campylobacter jejuni
Reservoirs and epidemiology
•Human cases are associated with:
•Poultry - especially eating chicken out
•Pets - especially young puppies
•Water supply
•Raw milk

•Most cases occur in the summer months -- late spring to early autumn

Campylobacter jejuni
Pathogenesis and Disease Characteristics
–
Low

infectious dose
–Two disease entities:
•Diarrhea
•Dysentery
–Associated with Guillaine-Barrè syndrome
Campylobacter jejuni
Virulence factors
•Cj can invade intestinal epithelial cells.
•Cj secretes a number of novel proteins upon
cultivation with enterocytes: CiaB
•pVir, present only in some strains of Cj
appears to be important for invasion.
•Microtubule mediated endocytosis occurs
•Cj apparently stays within vacuole
•Adenyl cyclase activating cholera toxin-like
enterotoxin
•Cytotoxin
Campylobacter jejuni
Virulence factors
 •Microtubule mediated endocytosis occurs and microfilament mechanism may be involved
too
•Microtubules aggregate into finger-like protrusions with C.j. at the tips
Campylobacter jejuni
Virulence factors
– Cytolethal Distending Toxin
• Irreversable cell cycle arrest
• All three CDT genes need to be expressed for activity
– Adenyl cyclase activating enterotoxin (?)
Campylobacter jejuni
Guillaine-Barrи Syndrome
– Ascending muscle weakness or paralysis, rapidly progressing
– 40% of GBS patients have evidence of Campylobacter infection
– Penner 1,2,8,17,19,41 are disproportionately represented
– LPS oligosaccharides structurally related to human motor neuron gangliosides
Clostridium botulinum
• Gram positive rod
• anaerobic
• spore former
• seven types based on serologic specificity of neurotoxin named A through G
• A, B, E and sometimes F --> causes of human botulism
• C and D ---> animal botulism, contaminated feed.
• G ---> no clear association with disease
Food Sources

Disease Characteristics:
• Symptoms hit 12-36 hours after ingestion (sometimes sooner, sometimes weeks later!)
• nausea and vomiting (B and E)
• visual impairment: blurred, ptosis, dilated pupils
• loss of mouth and throat function (A and B)
• dry mouth, throat, tongue, sore throat
• fatigue and loss of coordination
• respiratory impairment
• abdominal pain and either diarrhea or constipation
Infant Botulism:
• constipation --- days to week after onset
• generalized weakness and a weak cry
• poor feeding and sucking reflex
• lack of facial expression
• floppiness
• respiratory arrest may occur although death is rare.
Virulence Factors
Neurotoxin (BoNT)
 water soluble
  produced as a single polypeptide --- 150,000 MW (progenitor)
 cleaved by a protease to form two polypeptides which then become S-S bonded : 100,000 and
50,000 MW
 There are differences in serotypes:
A=dimer, trimer, and can be larger
E= monomer and dimer
 B= dimer
 A,B,E, F are chromosomally encoded
C, D are phage encoded
G is plasmid encoded
Architecture of the motor end plate
Motor end plate of the muscle cell
Prevention of food toxicoinfections
• Strict veterinary &sanitary supervision of
the state of animals for slaughter & the rules
of the process at slaughter
• Strict veterinary & sanitary inspection of
meat processing & dairy enterprises
• Sale of only cooked eggs of waterfowl birds
• Careful monitoring of the health of persons
working in food factories & catering
• Strict compliance with rules governing the
storage of perishable foods
• Effective thermal processing of foods
• The basic measure of prevention is the
organization of laboratories carrying out
sanitary inspection of foods
Poisoning by food poisonous by its nature
Plant origin
• Poisonous mushrooms (pale toadstool,
gyromitra, satanic mushroom and others)
• Conditionally edible mushrooms that
has not undergone proper cooking (morels,
etc.).
• Wild and cultivated plants (datura,
henbane, milestones poisonous hemlock,
belladonna, aconite, elder, etc.).
• Weed cereal with poisonous seeds
(trihodesma, heliotrope, pagoda, and others.)
Animal origin
• Caviar and roe of some fish species
(Marina, Sevan cisco, barbel, puffer and other
reef fish)
• Some endocrine glands of slaughtered animals (adrenal glands, pancreas)

Poisonous plants causing defeat of nervous system

Aconite contains alkaloids aconitine and zongorine in all parts of plants.

Belladonna contains alkaloids atropine, giosciamine, scopolmanie in all parts of the plant including berries
Cicuta virosa contains cicutoxin in its root
Poisonous plants causing defeat of digestion system

Daphne mezereum-contains glycosides daphnine, daphnetoxin, mezerine and flavonoid c-tosterine in all
parts of the plant
Meadows-affron (Colchicum) contain alkaloids colchicine, colchamine in seeds and bulbs
Castor oil plant (Palma Christi, Ricinus communis) contain glycoprotein ricin and alkaloid ricinine in seeds
Poisonous plants causing defeat of cardiac system
Digitalis purpurea has glycosides (cardenolydes), flavonoids, steroid saponines in leaves
Hellebore (Veratum luteum) contains alkaloid veratrin in roots
Lily of the valley (Convallaria majalis) contain saponine
convallarin and few cardiac glycosides (convallamarin and
convallatoxin) in berries.
Poisonous plants causing defeat of liver
Groundsel contains alkaloids of pyrrolysin structure:
platiphylline, seneciphylline, sarrecin in all parts of the plant,
esp. in roots
Prevention of poisons by toxic plants
• Health education, particularly in kindergarten and schools
• Prevention of contacting children with these plants
• Burning of all toxic plants on the territories in public places
and recreation areas
Poisonous weeds and technical plants

Poisonings by mushrooms
3 groups: edible, conditionally edible, and toxic mushrooms
Poisonous mushrooms consist of proteins that destroyed into toxic nitrogen substances. That is why you can
be poisoned not only by toxic mushrooms but edible but not fresh. The most dangerous are death-cup,
gyromitra, toadstool, and false honey agaric
Poisonous mushrooms
Gyromitra
Consists of gyromitrin that cause heavy toxicosis. To prevent
poisoning, it is necessary to blanch and boil it, and take out of the
broth. The broth is not usable because gyromitrin is water-soluble.
Poisonous mushrooms
Death-cup (destroying angel mushroom) contains amanitoxin (LD50
α-amanitine - 0.1 мг/кг) , amanitohemolysine, phalloidine. These
toxins stop protein synthesis and lead to destroying cells (citolysis).
Gyromitra contains toxin muscarin in the content of 0.02 %.
Muscarin syndrome: salivation, heavy sweating, vomiting, diarrhea, bradycardia, collapse, pulmonary edema
and myosis
Conditionally edible mushrooms
Morchella esculenta
Grows in Europe. Considered as delicates. Fried mushroom is used
Prevention of poisonings by mushrooms
• Sale of mushrooms only in allowed places
• Not sure – do not touch, do not taste, do not eat
• Do not collect not fresh mushrooms
• Morchella, saddle fungus and other mushrooms should be chopped and boiled twice with changing broth
• Many mushrooms require require pretreatment - soaking in a
strong salt solution and subsequent boiling;
• Do not to collect around the highways and in environmentally
disadvantaged areas
• Health education about the kinds of mushrooms and their
external
features
Technical plants: Manioc (Cassava) Cianogenic glucosides
(linamarin and lotaustralin). They, on hydrolysis, release
hydrocianic acid (HCN).
Selection of manioc is quite important.
Bitter manioc must be treated and prepared properly.
Poisoning by animal food poisonous by its nature
Fish blaasop (Japanese Fugu are by
Hawaiian islands. They contain toxin tetradotoxin in different organs, that
has no antidot
Organs of several fishes(marinka, barbel, poisonous shark)
Endocrine glands of animals (adrenal and pancreas)
Poisoning by food toxic under certain conditions
Plant origin
• Bitter kernel of stone fruit (peach, apricot, cherry, almond, etc.)
containing amygdalin
• Beech nuts, tung, ricin
• Beans raw beans containing fazin
• Germinated (green) potatoes containing solanine
• Cottonseed oil containing gossypol
Animal origin
• Liver, caviar and roes of certain fish species (pike, burbot, tench, erch,
mackerel) during the spawning season, mussels
• Honey bees when collecting nectar from poisonous plants
Poisoning by food toxic under certain conditions

Poisoning by chemical impurities

• Coming from the equipment, packaging materials (melamine, copper, zinc, lead, arsenic, etc.)
• Organic mercury and arsenic entering the seed grain during its treatment - pickling (granosan, mercuran et
al.)
• Food additives added in excessive amounts (nitrates, dyes, preservatives, antioxidants, fragrances,
emulsifiers, etc.).
• Pesticides (trace amounts are present in products in excess of the established norms)
Poisoning by chemical impurities
Chemical poisoning impurities may be associated with the inclusion of these substances in the "food chain"
and the accumulation in the food as foreign substances or their food intake in the course of its processing and
as a result of migration from the equipment, containers and packaging materials
Poisoning by chemical impurities and their prevention
• Pb - MPC in tin cans - 0.04%, in tinning pots and glazes -1%
• Cu - copper utensils just for jams
• Zn - zinc utensils just for water
• Hg – prohibited. Minamata disease
• The content of monomers of 0.03 - 0.07%
• Pesticides: lindane MPC of 2.0 mg/kg - in green vegetables, meat and fats, to 0.1 mg / kg - in eggs of grain,
potatoes; organic mercury and geksahlorbenzolic pesticides are prohibited in foods
• Nitrites, nitrates and nitrosamines
• Nitrates - MPC 200 mg/kg for potatoes, 150-400 mg/kg of cucumbers, 60-90 mg/kg for melons and 2000
mg/kg for leafy crops
• Nitrite MPC 3-5 mg /kg in sausages
• Food additives
Melamine
Organic base, trimer of cyanamide, structure based is
1,3,5-triazine. It is a colorless crystals.
Melting point is 354 °C; practically insoluble in cold
water and most of organic solvents.
Forms salts with acids (C3H6N6 ×ЧHCl), decomposing
by heating.
Melamine is made from urea CO (NH2)2 at 350-450
°C and pressure of 50-200 MPa.
Application of melamine
Used in the production of melamine-formaldehyde
resins (plastics, adhesives, paints), ion exchange resins,
tanning agents, hexachlormelamine that used in the
manufacture of dyes and herbicides. Melamine is used
in the production of fertilizers, as well as non-protein
nitrogen source for livestock. However, in 1978 it was concluded that ”melamine is unacceptable as a
non-protein nitrogen source, as it is slowly and incompletely hydrolyzed as compared to other - for
example, urea." Melamine is used by some unscrupulous producers in food production to improve the
analysis of the measured protein concentration: the analysis by the Kjeldahl method. Such adulteration of
food is dangerous to health of consumers.
Melamine
Melamine plastic is a real danger when used for the
production of pottery. On contact with the fluids, especially
hot, it begins to actively emit formaldehyde contained in
the material. The emission of formaldehyde in food continues
all the
time of the use of the pottery, as its content in the plastic is
very large. Additionally, cracks and scratches on the surface
of the dish increase emissions. Certain hazard is a picture
printed on
the bowl, as paints with a high content of heavy metals
(lead, cadmium, manganese) are used for printing, and color
fastness is questionable.
The list of materials, products and equipment for contact
with food products approved by the
Ministry of Health should not consist of
melamine. The public health bodies should
issue sanitary-epidemiological conclusions
on melamine products (mostly decorative -
bowls, trivets, candlesticks, etc.), in which
they will stamp: "Not intended for contact
with food."
Polytetraflouridethylene (Teflon)
PTFE, Teflon (-C2F4-)n is
tetrafluoroethylene resin (PTFE), a plastics that has a rare physical and chemical properties and widely used in
engineering and in everyday life.
The word "Teflon®" is a registered a trademark of DuPont. Generic name of the substance - "PTFE" or
"fluoropolymer”
Properties of Teflon
Physical: Teflon is a white, transparent material in a thin layer, resembles paraffin or polyethylene. It has
high heat and frost resistance, remains flexible and elastic at temperatures ranging from -70 to +270 °C. It
is an excellent insulating material. PTFE has a very low surface tension and adhesion, and is not
wetted either with water or fats, or most organic solvents.
Chemical: By their chemical resistance, it exceeds all known synthetic materials and precious metals. It
does not collapse under the influence of alkalis, acids and even mixtures of nitric and hydrochloric acids.
It
decomposes by melts of alkali metals, fluorine and chlorine trifluoride.
Hazard of Teflon
Teflon is very stable and inert under normal conditions. However, when heated above 200 ° C, PTFE
decomposes to form toxic products. Furthermore, in the production and degradation of the polymer, the
formation of perfluorooctanoic acid (PFOA) is possible, the latter is still used in the production of Teflon
coatings. However, the firm DuPont, the only producer of PFOA in the United States has agreed to remove the
remains of the reagent from their enterprises up to 2015, although not committed to completely eliminate its
use. Recently, Teflon became associated with increased levels of cholesterol and triglycerides in humans. In
animals changes in the volume of the brain, liver and spleen, while collapsing the endocrine system, increase
the risk of cancer, infertility and underdevelopment are noticeable. It is proved that the C-8,entering the body
of laboratory rats causes the grows of malignant tumors, can lead to mutations in the offspring, and immune
system disorders.
Teflon cookware is harmful to health. People using cookware with non-stick coating are more likely to have
thyroid
problems. This conclusion made by British researchers from the University of Exeter. All because of the
coating
itself, which contains the harmful substance - perfluorooctanoic acid. During their study, researchers
measured the level of this acid in the body of young Americans (20 y.o.) for 7 years - from 1999 to 2006. It
was found that the common thyroid problems were in the most of them, which had exceeded level of the
acid.
Pesticides
Pesticides are synthetic & chemical substances used in agriculture to protect food crops from weeds, pests
and diseases, as well as to stimulate growth.
Pesticides are classified by:
Its nature and chemical structure:
• Organic (organophosphate, organochlorine, organic mercury, carbamates)
• Vegetable origin (pyrethrum, anabasine, lindane)
Toxicity:
• Highly toxic substances LD50 up Ho 50 mg/kg
• Toxic - LD50 50-200 mg/kg
• Low toxic - LD50 1000 mg/kg.
Application:
• Insecticides – to kill insect, mite,
acaricides,
• herbicides – to eliminate weeds,
• fungicides – to kill fungi
• defoliants – to eliminate leaves
• deflorants - to destroy the flowers and
ovaries
Prevention of poisonings by pesticides
 • Control is based on strict compliance with agricultural
practices of the use of pesticides
• Control of residual components of pesticides in food
• Using the low- and middletoxic pesticides
Food poisonings of unknown etiology
• Alimentary paroxysmal-toxic myoglobinuria (Haff, Yuks,
Sartland diseases)
• Laker fish of some areas of the world in some period of year

• International “Food Law” or “Food Code”

• Developed in 1962
• Subsidiary of Food and Agriculture Organization (FAO), United Nations (UN)and World Health Organization
(WHO)
• Joint venture between FAO and WHO to formulate internationally accepted food safety standards for
protection of human health and to ensure fair trade practices
Purpose of the Codex Alimentarius
The purpose is to protect consumer health and economic
interests and to secure fair trade practices in the food industry
Upgraded standards for manufacturing, processing, safety and
quality throughout world
Codex Alimentarius
• Ensures that products complying with Codex standards can be
bought and sold on the international market without
compromising health or interests of consumers
• Codex standards ensure product is safe internationally
• Review of member laws based in internationally accepted
scientific and technological standards
“Food” under the Codex:
• “any substance, whether processed, partly processed or
raw, which is intended for human consumption and includes
drink, chewing gum and any substance which has been used in
the manufacture, preparation or treatment of food but does not
include cosmetics, tobacco or substances used solely as drugs
Codex Standards
• Food requirements intended to provide consumers with a
sound, wholesome food product free from adulteration,
correctly labeled and presented.
• Explicitly quantifies and specifies in acceptable form,exactly
what is considered to be in compliance with regards to certain commodities
Recommended literature
• Chapter 2. Foodborne Hazards in Basic Food Safety for Health Workers" (PDF). World Health Organization.
Retrieved August 12, 2007
• Aflatoxins. Center for Food Safety & Applied Nutrition. Retrieved August 12, 2007.
• Riemann, Hans P.; Cliver, Dean O. (2006). Foodborne Infections and Intoxications. Academic Press.
• Smith, James L. (2005). Fratamico, Pina M.; Bhunia, Arun K.; Smith, James L., eds. Foodborne Pathogens:
Microbiology And Molecular Biology. Horizon Scientific Press.
• http://www.codexalimentarius.org

Hygiene of Children
and Adolescents
Learning outcomes
After this lecture the students should know:
• What is hygiene of children and adolescents
• Features of physical development of children and adolescents
• Methods of assessment of their physical development
Hygiene of Children and Adolescents
• This is the section of preventive medicine, which:
• studies environmental conditions of life and activities of children, their impact
on health and functional condition of the growing organism,
• develops scientific bases and practical measures aimed at children health
promotion, support for the optimal level of function and beneficial development of them
• It is the science of protecting and promoting the health of the younger generation,
of educating a person with a harmonious spiritual and physical development.
• It is a discipline that integrates health standards and experience of health protection
services in relation to the growing body takin into account its capabilities and needs at this
stage of ontogenesis
Hygiene of Children and Adolescents
• Study subject - Health care of children and adolescents, because they spend a long
time in a sort of environmental conditions.
• Aim of the study is to substantiate and develop hygienic conditions for education
and training, a complex of recreational activities which promote health and physical
development of children and adolescents
• Objectives:
• To effect the education of a healthy person by favorable environment, without
disturbing the nature of the growing organism,
• To promote functional and physical abilities of the growing organism
Issues of Hygiene of Children and Adolescents
• Health and physical development of children and adolescents
• Hygiene of the study process in children and adolescents’ establishments
• Hygienic bases of physical education of children and adolescents
• Hygiene of work activity of children and adolescents
• Sanitary well-being in children and adolescents’ establishments
Modern trends
•Decease in mortality
•Improvement in demographic indicators in developed countries
•Increase in morbidity rate (adolescents -10%, children – 18%)
•Decrease in well-being of the population
•Decrease in psychological development
•Increase in allergic pathology
•Decrease in infectious diseases
Health of the population
•Package of medical and demographic indices (death/birth rates)
•Indices of morbidity (acute/chronic)
•Indices of disability
•Level of physical development and its harmony
Health of an individual
•Multi-dimensional dynamic process of adaptation of a body to constantly changing
environmental conditions
•A state of the structure, functions and adaptive reserves, which provide a human a life at
a given time in a given environment.
•A form of life, which provides the necessary quality of life and its maximum duration in
given conditions
Health determinants
•Life style - 50%
•Environment - 23%
•Genetics – 17%
•Health care – 10%
•Biological:
•Mother’s age
•Mother’s health
•Deviations (ante-, intra-, postnatal)
•Weight
•Social:
•Living conditions (home, etc)
•Family income
•Education of parents
•Daily mode
Physical development of children
•It is a combination of morphological and functional properties
of the body characterizing the process of growth and
development
•It is the process of altering the morphological and functional
properties of the organism in the process of development of
the individual.
•Indicators of physical development of children and
adolescents reflect the level of welfare of the people and serve
as an objective criterion for the health of children and
adolescents reflecting reserves of physical strength, endurance
and ability of the organism.
Physical development
•Biological development
•Dynamics of
growth process
•Body building &
weight
•Muscle strength
& workability
•Presence of fat
tissues
•Sexual
development
•Motoric
development
•Social conditions
of life
•Nutrition &
environment
•Genetics and
quality of health
care services
Regularities of physical development
•As younger an organism as more intensive its growth and development
•Growth and development processes flow irregularly; each age period
has own certain anatomic and physiological features
•Process of growth and development according to
gender (two crosses in girls and boys)
Regularities of physical
development
•Endogenity (the growth and
development according to inherited genetic
program)
•Irreversibility
•Cyclical (periods of activation and
inhibition of growth)
•Gradualness
•Synchrony (the growth and
aging are made with respect to time)
Acceleration and deceleration of physical development
•Acceleration - accelerating the pace of growth and development of children & adolescents
compared to previous generations
•Deceleration – slowdown in the growth & development of the younger generation,
especially in height and weight

Anthropometric study
•Carrying out in the 1st part of the day
•The use of standardized and carefully checked instruments
•Following anthropometric points
•Somatometric indices:
•Height, weight, circumferences
•Somatoscopic indices:
•Status of skin and mucosa layers, adipose
tissues, musculoskeletal system, level of sexual
development
•Physiometric indices:
•Vital capacity, muscle strength, pulse rate, BP
•Health status
Somatometria
•Height measurement:
•Wooden stadiometer
•Metallic anthropometer
•Pedobaromacrometer
•Error must be not above 0.5 cm
Somatometria. Weighing
•Weighing
•Weighing on an empty stomach and
without cloth and shoes

•Circumference
of thorax

is

Somatometria. Circumferences
•Steel tape-measure
•Centimeter tape-line
measured in rest state, maximal inspiration and expiration
Somatoscopic signs. Fat deposition
•Stoutly compass
•Measuring the thickness of fat folds on the abdomen and under the shoulder blade.
•Mean thickness of fat deposition is considered as 1 to 2 cm.

Somatometric signs. Skeleton

3 types:
•Thin (narrow shoulders and chest, the small size of the hands)2)
•Chunky (strongly-built: broad shoulders and chest, big hands)
•The interim
Somatoscopia. Shape of the chest
•Cylindrical (even development of the upper and lower sections,
rounded shape of infrasternal corner with magnitude close to 90o,
the front chest line is rounded.)
•Conical (narrowing at the top, extended at the bottom, the
broader and protruding lower section compared with the upper,
infrasternal angle greater than 90o, the front chest line is straight
at the top and round at the bottom, the ribs have a horizontal
arrangement)
•Flat (elongated and flattened chest, infrasternal angle is
narrowed, less than 90o, the ribs obliquely downward, the
front chest line is straight)
•Mixed
•Rachitic
•Barrel-like
Somatoscopia. Spine

•Normal: In sagitale it has S shape. Cervical and lumbar curvature is faced

forward, the chest bulge is faced back
•Lordotic (small neck & pronounced lumbar bending,
jutting stomach, upper body is tilted back)
•Kyphotic (increased cervical and lumbar bend, spin is round, slumped shoulders, the head bent forward
•Stooping (increased depth of cervical bending, but smoothed lumbar, head is bowed, shoulders are down)
•Straightened (smoothing both bends).
Somatoscopia. Spine deformations
•Right and left-side scoliosis of different degree
•1st degree - mild asymmetry shoulder & blades
•2nd degree - sustainable bending to the right or to the left, the
availability of compensatory muscle rollers
•3rd degree - deep curvature accompanied by the chest
deformation
Somatoscopia. Legs’ shape
•Normal
•X-shaped (valvus)
•O-shaped (varus)
Somatoscopia. Shape of feets. Methods of two lines
Method
•Point A – in the middle of the heel
•Point B - in the middle of the base of the thumb
•Point C - between the thumb and second finger
•Wire 2 lines: 1 - between A and B; 2 - between A and
C.
Evaluation:
•If two lines do not go beyond the footprint, it is a
normal foot
•If the lateral line is located on the edge of the print,
and the medial is beyond it, it is flattened foot
•If two lines are located on the footprint. It is flatfoot.

Somatoscopia. Method of Stritter

Plantography
•Normal (arch): Isthmus of up to 50%
•Flattened: Isthmus of 50-60%
•Flatfoot: Isthmus 60%
Assessment of puberty
•Boys of 10-11 years
•The sequence of development of sexual characteristics:
•Changes in voice
•Body hair pubis
•Increase in the thyroid cartilage of the larynx
•Body hair armpits and face
•Girls of 9-10 years
•The sequence of development of sexual characteristics:
•The development of mammary glands
•Body hair pubis
•Body hair armpits
•Menstrual function
Physiometria. Vital capacity
•Water spirometer
•Gas spirometer
Physiometria. Muscle strength
•Muscle strength of hands:
•Hand dynamometer
•The strength of back (the force of the back extensors):
•Back dynamometer
Physiometria. BP
•Heart rate: on the pulse per 1 min
•BP: Scipione Riva-Rocci apparatus (Tonometer)

Comprehensive assessment of physical development. Evaluation criteria

•Nervous and mental state
•Chronic diseases
•Resistance
•State of main organs and systems
Comprehensive assessment of physical development. Methods
Generalizing (cross-sectional)
•This massive study of physical development of large groups of children in a relatively short period of time
(body check)
•Statistical analysis of the data to determine mean values of the physical development of each age-sex group
and the average age that will serve as standards of physical development
Individualized (longitudinal)
•The systematic monitoring of individuals for a long time.
•Reveals the characteristics of growth and development of the individual associated with the concrete
conditions of life (diet, past illnesses), allows to study the rate of physical development throughout the
growth period
Methods of assessment of physical development
•Method of standard deviations with the graphic representation of the profile of physical development
•Regression scale method
•Centile method
•Comprehensive assessment of physical development
•Comprehensive health assessment
Method of standard deviations
•The bottom line is compared to the physical development of the individual's physical development of the
group, of which he is a member
•The main development index (F) is compared to the mean of these features (M) corresponding to the age-
sex groups and divided by sigma (standard deviation)
•The disadvantage: each feature is evaluated in isolation, without correlation with other signs.
Method of standard deviations

Regression scale method

• Make correlation array to determine closeness of the relationship of:
 Height with body weight
 Height with thorax circle

• Height determines the level of physical development

• Weight and thorax circle determine harmony
• Low, below average, average, above average, high
• 1  - harmonic physical development
• 1-2 - disharmonic physical development
• 2-3 - very disharmonic physical development
Comprehensive assessment of physical
development
• Definition of the level of biological development (biological age) based on height, annual growth rate,
number of permanent teeth, the level of development of secondary sexual signs and the term of menses in
girls Comparison of an individual development data with standards (tables), definition of the accordance of
biological age to passport age (acceleration or retardation)
• Definition of morphologicl and functional status of the body using the regression scale and age standards
for somatometric and physiometric indices Morpho-functional status of an organism
1st degree - well-balanced
2nd degree - deteriorated and disharmonious
3rd degree - poor and disharmonious
4th degree - total delay of physical development
5th degree - advanced physical development
Recommended literature
• Kail, Robert V (2011). Children and Their Development (6th Edition) (Mydevelopmentlab Series).
Englewood Cliffs, N.J: Prentice Hall.
• Bronfenbrenner, Urie (1979). The ecology of human development: experiments by nature and design.
Cambridge: Harvard University Press.
• Cole, Michael; Vygotskiĭ, L. S. (1978) [Published originally in Russian in 1930]. Mind in society: the
evelopment of higher psychological processes.
Cambridge: Harvard University Press.
• Berk L (2005). Infants, Children, and Adolescents. Boston: Allyn & Bacons.
• Woolfolk, A., & Perry, N. E. (2012). Child and adolescent development.
Upper Saddle River, NJ: Pearson Education.

Occupational Hygiene Occupational Hazards

OCCUPATIONAL HAZARDS
• Physical hazards
• Chemical hazards
• Biological hazards
• Mechanical hazards
• Psychosocial hazards
ROUTE OF EXPOSURE
• Inhalation
• Ingestion
• Skin absorption

Eating, Smoking

Gas, Vapour,
Aerosol, Dust,
Fume, Smoke,
Mist, Fog Primary irritants, Allergy,
Systemi toxicity
FOUR TYPES OF SITUATION AT WORK
• Diseases only occupational in origin (pneumoconiosis)
• Where occupation as one of the causal factors
(bronchogenic carcinoma)
• Occupation as a contributory factor (chronic
bronchitis)
• Occupation aggravating pre-existing condition
(asthma)
PHYSICAL HAZARDS
• Dusts and Fibers
• Noise
• Corrosives
• Microclimate (Temperature, Humidity and Air velocity
Extremes)
• Ionizing Radiation
• Non-Ionizing Radiation (Illumination, glare, contrast, EMF)
OCCUPATIONAL DISEASES DUE TO PHYSICAL
AGENTS
• Heat - Heat stroke, Burns
• Cold - Frost bite
• Light - Miners Nystagmus, Cataract
• Pressure - Caisson disease, Air embolism

OCCUPATIONAL DISEASES DUE TO PHYSICAL

AGENTS
• Noise - NIHL, Hypertension, Irritability
• Vibration - Neuromuscular diseases, Peripheral
vascular diseases
• Radiation - Leukemia, Aplastic anaemia
• Mechanical - Injuries, Accidents
• Electricity - Electric shock, Burns

CHEMICAL HAZARDS
• Metals (lead, mercury, arsenic, cadmium,
chromium, zinc, beryllium, tin, silver, etc)
• Carbon compounds (organic solvents)
• Benzene, Toluene, Xylene
• Phenol, Nitrate, Naphthalene, Isocyanates, Carbon
tetrachloride, Carbon disulphide, Vinyl chloride
monomer, etc
• Pesticides & toxic gases (ammonia phosgene,
carbon monoxide)
CHEMICAL HAZARDS
• Irritants
• Asphyxiates
• CNS Agents
• Specific organ agents
• Genetic activity

Acute versus Chronic

Irritants
• Respiratory
• Skin
• Eye
• Primary/Secondary
• Primary – at source of contact
• Secondary – travels through
blood to another area
• Reversible/Irreversible
• Sensitization
• Irritant that has a delayed
reaction on subsequent
exposure

ASPHYXIATES
• Simple Asphyxiates • Dilute air so oxygen
• N2 content is low
• CO2 • Chemical Asphyxiates
• He • CO
• CH4 • HCN
• H2S
• Interact at cellular leveltoinhibitoxygenuptake.

CENTRAL NERVOUS SYSTEM DEPRESSANTS

• Narcotics
• Anesthetics
• Depressants
• Aliphatic Hydrocarbons
• Increased chain length enhances effect
• Addition of an alcohol group (i.e. ethanol)
• Addition of a halide group enhances the effect

SPECIFIC ORGAN ATTACK

• May be reversible or irreversible
• Blood - Hemotoxic
• Liver – Hepatotoxic
• Lungs – Pulmonotoxic
• Kidneys – Nephrotoxic
• Skin – Dermatotoxic
• Nerves & Brain - Neurotoxic
GENETIC ACTIVITY
• Typically is irreversible
• Causes cancer – Carcinogen
• Causes chromosome damage – Mutagen
• Causes birth defects – Teratogen
• Causes damage to reproductive system Reproductive Hazard
OCCUPATIONAL DISEASES DUE TO CHEMICAL
AGENTS
• Gases - CO, CO2, HCN, H2S,CS2
• Dusts - Pneumoconiosis
• Metals - Lead, Mercury, Chromium, Manganese
• Chemicals - Acids, Alkalines
• Solvents - Benzene, Trichloroethylene

ANTICIPATION OF CHEMICAL HAZARDS

• Consider the following:
• Raw materials
• Intermediates formed
• Final products
• Disposal of used products

• Maintenance materials
• “Cradle to Grave” thought process

ANTICIPATION OF CHEMICAL HAZARDS

• Occupational Safety and Health Administration (OSHA) has established Permissible Exposure
limits
• They are defined in time weighted average, TWA, for most working conditions. Short Term
Exposure Limits, STEL, for 15 minute exposure. Ceiling, C, for maximum allowable concentration.
• Industrial Hygienists have established Threshold Limit Values, TLV.

BIOLOGICAL HAZARDS
• Pathogenic organisms
• Five levels of classification
• 1 least dangerous
• 5 most dangerous
• Pathogenic organisms are typically not found in a chemical processing facility
• Possible biological hazards in an industrial setting
• AIDS
• Hepatitis B

BIOLOGICAL HAZARDS
• Industries with possible biological hazards
• Pharmaceutical Manufacturing
• Food processing or agricultural products
• Typically hazards are well contained

OCCUPATIONAL DISEASES DUE TO BIOLOGICAL

AGENTS

• Hepatitis B, Rabies, AIDS, Leptospirosis…,

• Occupational Cancers
• Cancer of Skin, Lungs, Bladder
• Occupational Dermatosis
• Dermatitis, Eczema
• Psychosocial Diseases
• Neurosis, Peptic ulcer, Hypertension

NEW PATHOLOGIES
• AIDS
• Stress
• Geriatrics
• Space Medicine
• Genetic Aberrations (longevity!)
• Cancer
• Robotics-related Injuries
• Migrant Global Workers
DUSTS AND FIBERS
• Concerned about particle size and penetration into pulmonary track
• D > 0.5 micron – does not reach lungs (but may ingest)
• 0.2 < D < 0.5 micron – respirable and gets stuck in lungs
• D < 0.2 micron – are exhaled
LUNG DISEASES CAUSED BY DUST
• Depends on chemical composition, particulate size, concentration, shape, specific gravity &
body‟s reaction
• Pneumoconiosis
• Asbestosis
• Silicosis
• Coal workers pneumoconiosis
• Lung diseases caused by dust of organic origin
• Byssinosis (exposure to cotton dust)
• Mushroom workers lung
• Suberrosis (Cork dust)
• Bird breeders lung (chickens, parrots, pigeons)
• Man made fibers
• Occupational asthma
• Flour insects and pollens: linseed, soya beans, teak wood, hair, fur, etc: isocyanates, poly
urethane, amines, metals

DID YOU KNOW?

• About 30 million workers are exposed to hazardous noise on the job
• Noise-induced hearing loss is the most common occupational hazard for workers globally
• Hearing loss from noise is slow and painless; you can have a disability before you notice it
• If you must raise your voice to speak with someone only 3 feet away, you are in high (hazardous)
noise.
• It is 100% preventable

SOUND
Sound is a sensation of acoustic waves, a
disturbance that propagates through a medium
having properties of inertia ( mass ) and elasticity.
The medium by which the audible waves are
transmitted is air. Basically sound propagation is
simply the molecular transfer of motional energy.
Hence it cannot pass through vacuum. Speed of sound 344 m/s
THE HUMAN EAR
Outer Ear: Pinna and auditory canal
concentrate pressure on to drum Middle
Ear: Eardrum, Small Bones connecting
eardrum to inner ear Inner Ear: Filled with
liquid, cochlea with basilar membrane
respond to stimulus of eardrum with the
help of thousands of tiny, highly sensitive
hair cells, different portions responding
different frequencies of sound. The
movement of hair cells is conveyed as
sensation of sound to the brain through
nerve impulses Masking takes place at the
embrane; Higher frequencies are masked
by lower ones, degree depends on freq.
difference and relative magnitudes of the
two sounds
WHAT IS NOISE?
• Sound is a sensation of acoustic waves disturbance/pressure fluctuations setup in a medium)
• Noise is any unpleasant, unwanted, disturbing sound
• By-product of many industrial processes, e.g. operating machinery
• Exposure to high levels of noise may lead to hearing loss and other harmful health effects
 HEARING LOSS
•Temporary Hearing Loss
- results from short term exposure to noise
- hearing returns when away from the noise
•Permanent Hearing Loss
- results from exposure to a moderate or high level of noise over a
long period of time
- hearing loss is PERMANENT
- Permanent damage or destruction of hair cells in the ears
- Hearing cannot be restored
NOISE HAZARD RECOGNITION
• Need to shout
• Ringing sensation
• Degraded hearing after work
• Auditory testing
NOISE HAZARD
• Sound level measurement
L = 10 * Log (I/I0)2

L = Sound intensity, decibels (dB)

P = Sound pressure, rms (Pa)
I0 = Reference sound pressure, rms (20  Pa)

OSHA SOUND LEVEL PEL‟S

NOISE CONTROL
• ENCLOSE EQUIPMENT
• ENCLOSE OPERATOR
• SLOWER ROTATIONAL SPEED
• INTAKE/EXHAUST MUFFLERS
• PADDED MOUNTINGS
SELECTION OF HEARING PROTECTION DEVICES
• Hearing protection devices are selected according to:
• Employee comfort
• Level of noise exposure
• NRR of device
• Type of work being performed
• Environmental conditions
• Employee may select hearing protection from a variety of suitable hearing protectors provided by
employer.
TYPES OF HEARING
PROTECTION DEVICES
• Ear muffs
• Foam insert earplugs
• Semi-aural earplugs

EAR MUFFS

Disadvantages

Advantages • Higher cost

• Eye glasses can interfere
• More protection at higher with ear muff seal
frequencies than earplugs • May be uncomfortable in hot
• Various NRRs available environments
• Durable, long lasting • Must be cleaned before use
• Can be fitted on hard hat by another worker
• Reusable

FOAM INSERT EARPLUGS

Advantages
• More protection at lower Disadvantages
frequencies than muffs
• Various NRRs available • Hands must be cleaned
• Inexpensive; disposable before inserting
• Can be custom molded earplugs
for individual worker • Improper insertion
• Reusable plugs are reduces NRR value
available

SEMI-AURAL CAPS

Advantages
• Various NRRs available
• Easy to insert
• May be used several times
• Ideal for people going in and out of noisy areas
Disadvantages

• Improper insertion reduces

effectiveness
• More expensive than ear
plugs
• Typically have lower NRRs
than plugs or muffs

AUDIOMETRIC TESTING

• Monitors employee‟s hearing over time

• Baseline audiogram must be performed within first 6 months of work
exposure ( 8 hour TWA ≥ 85 dBA)
• Annual audiograms are required each year after baseline audiogram
• Employer must pay for the cost of each required audiogram

VIBRATION

VIBRATION EXPOSURE
Contact with Vibrating Machine:
• Segmental Vibration
„Segment of body‟ such as hand-transmitted vibration (known
as hand-arm vibration or HAV)

• Whole Body Vibration

Vibration transmitted through the seat or feet (known as
whole-body vibration or WBV).

HAND ARM VIBRATION

• WHAT IS HAV?
HAV is vibration transmitted from work processes into workers‟
hands and arms. It can be caused by operating hand-held power
tools such as road breakers, hand-guided equipment such as
lawn mowers, or by holding materials being processed by
machines such as pedestal grinders.

• WHEN IS IT HAZARDOUS?
Regular and frequent exposure to high levels of vibration can lead
to permanent injury. This is most likely when contact with a
vibrating tool or process is a regular part of a person‟s job.

HAND ARM VIBRATION

• WHICH JOBS AND INDUSTRIES ARE MOST LIKELY TO BE AFFECTED BY HAV?
Jobs requiring regular and frequent use of vibrating tools and equipment are
found in a wide range of industries, for example:
• Building and maintenance of roads and railways
• Concrete products
• Construction
• Forestry
• Foundries
• Heavy engineering
• Mines and quarries
• Plate and sheet metal fabrication
• Public services
• Public utilities

HAND ARM VIBRATION

WHAT SORT OF TOOLS AND EQUIPMENT CAN CAUSE VIBRATION INJURY?
• Chainsaws
• Concrete breakers/road drills
• Hammer drills
• Hand-held grinders
• Hand-held sanders
• Nut runners
• Pedestal grinders
• Power hammers and chisels
• Powered lawnmowers
• Riveting hammers and bolsters
• Strimmers/brush cutters
• Swaging machines.
HAND ARM VIBRATION
Moderate vibration High vibration
• impact wrenches
• carpet strippers
• chain saws
• percussive tools
• jack hammers
• scalers
• riveting or chipping hammers
• grinders
• sanders
• jig saws
HAND ARM VIBRATION - CAUSES & EFFECTS
WHAT INJURIES CAN HAV CAUSE?
Regular exposure to HAV can cause a range of
ermanent injuries to hands and arms including
damage to the:
• Blood circulatory system (e.g. vibration white
finger)
• Sensory nerves
• Muscles
• Bones
• Joints

HAND ARM VIBRATION - CAUSES & EFFECTS

• HAV Symptoms
• Attacks of whitening (blanching) of one or more fingers when exposed to cold/wet
• Tingling and loss of sensation in the fingers
• Loss of light touch
• Pain and cold sensations between periodic white finger attacks
• Loss of grip strength
• Bone cysts in fingers and wrists
HAND ARM VIBRATION - CAUSES & EFFECTS WHAT EFFECTS DO THESE
INJURIES
HAVE ON PEOPLE?
• Painful finger blanching attacks (triggered by cold or wet conditions)
• Loss of sense of touch and temperature
• Numbness and tingling
• Loss of grip strength
• Loss of manual dexterity
• Unable to work in cold/wet conditions
• Unable to do leisure activities such as fishing, golf, swimming
• Need to avoid further exposure to vibration, or cold and wet
сonditions
• Have difficulty handling tools and materials and with tasks requiring
fine finger manipulation

HAND ARM VIBRATION MANAGEMENT & CONTROL

• Identify those at risk from occupational vibration
• Assess the risk involved:
• The level, type and duration of exposure
• Any effects concerning the health and safety of workers at particularly sensitive risk
• Any indirect effects from interactions between vibration and the workplace/other work
equipment
• Information provided by the manufacturers of work equipment
• The existence of replacement equipment
• Specific working conditions such as low temperatures
• Appropriate information obtained from health surveillance
• Prevent and/or control the risk
HAND ARM VIBRATION MANAGEMENT & CONTROL
WHAT CAN I DO TO CONTROL THE RISK?
• Look for alternative ways of working which eliminate the vibrating equipment altogether
• Make sure your employees use the most appropriate equipment for each job
• Minimize the time individuals use the equipment
• Break up periods of continuous equipment use by individuals
• Design the job so that poor posture is avoided.
• Construct jigs to hold materials or tools.
• Maintain tools to the manufacturer’s specifications to avoid worsening vibration for example:
• Replace vibration mounts before they are worn out;
• Ensure rotating parts are checked for balance and replace them if necessary;
• Keep tools sharp.
• Get advice from your trade association on best practice.
• Get advice from the equipment manufacturer on safe use of the equipment.
• Mechanize or automate the work or change the way of working
• Ask the manufacturer to add anti-vibration mounts to isolate the operator from the vibration
source
• Provide tool support to take the weight of the tool allowing the operator to reduce grip and feed
force
• Introduce a purchasing policy specifying low vibration performance for new equipment
HAND ARM VIBRATION – MANAGEMENT & CONTROL
Workers can reduce the risk of hand-arm vibration syndrome (HAVS) by following safe work
practices:
• Employ a minimum hand grip consistent with safe operation of the tool or process.
• Wear sufficient clothing, including gloves, to keep warm.
• Avoid continuous exposure by taking rest periods.
• Rest the tool on the work piece whenever practical.
• Refrain from using faulty tools.
• Maintain properly sharpened cutting tools.
• Consult a doctor at the first sign of vibration disease and ask about the possibility of changing to a
job with less exposure
HAND ARM VIBRATION MANAGEMENT & CONTROL
Employee Information and Training

• Potential sources of hand-arm vibration

• The health effects of hand-arm vibration;
• Risk factors (e.g. high levels of vibration, daily length/regularity of exposure);
• How to recognize and report signs of injury;
• Ways to minimize risk, including:
• Changes to working practices to reduce vibration exposure;
• Correct selection, use and maintenance of equipment;
• How to use tools to reduce grip force, strain etc.;
• Maintenance of good blood circulation at work, e.g. by keeping warm, exercising fingers and not
smoking.

Employees should also have access to a proactive health surveillance program

HAND ARM VIBRATION MANAGEMENT & CONTROL

Employees should also have access to a proactive health surveillance program.
Regular Employees Checks:
• Have your fingers gone white on exposure to cold?
• Have you had any tingling or numbness in your fingers after using vibrating equipment?
• Are you experiencing any problems with muscles or joints in your hands or arms?
• Do you have any difficulty picking up small objects such as screws or nails?
• Is it difficult to tell if something is hot or cold to the touch? If the answer to any of these
questions is „yes‟, assume that there is a risk from HAV to your employees.You should refer the
employee to a doctor and take action to reduce exposure.

OCCUPATIONAL VIBRATION
CONTROL STANDARDS
• National regulation
• For Hand Arm Vibration:
• The daily exposure limit value standardized to an eight-hour reference period shall be 5 m/s 2.
• The daily exposure action value standardized to an eight-hour reference period shall be 2,5 m/s 2.

MICROCLIMATE AT WORK
Temperature Extremes
• Heat Stress
• Heat Stroke
• Heat Exhaustion
• Cold Stress
• Frostbite
• Hypothermia

Heat Stress
• Body’s Energy Balance
• Metabolic rate
• Radiation
• Convection
• Sweating
• External Conditions
• Temperature
• Humidity
• Air movement
• Radiation
In a typical healthy individual the internal core body
temperature may rise as much as 3°C during heat stress
Cold Stress
• Less Common in Industrial Situations
• Cold climates
• Refrigerated space
• Wind chill
• Responses to Cold Stress
• Body core temperature is typically 37°C
• Shivering when body Tc < 36°C
• Lose Consciousness at Tc < 34°C
Temperature Stress Control
• Hot Stress
• Air movement
• Periodic rest
• Remove to cooler location
• Cold Stress
• Limit exposure time
• Protective clothing
ELEMENTS OF OCCUPATIONAL HEALTH SERVICES
• Medical treatment
• Assessment and control of work environment
• General preventive health measures
• Preventive medical examinations
ELEMENTS OF OCCUPATIONAL HEALTH SERVICES
• Medical treatment
• Assessment and control of work environment
• General preventive health measures
• Preventive medical examinations

MEDICAL MEASURES
• Pre-employment medical check up
• Periodic medical examination
• Health promotion
• Health education
• Specific protection
• Assessment of risk by supervision of working environment

PRE-EMPLOYMENT MEDICAL EXAMINATION

• To determine the physical and emotional capacity of the individual to perform the job.
• To provide base line health data for epidemiological and legal purposes.
• To counsel the person for correction of diseases / habits which may harm later.
• Assessment of pre-existing toxicity / impairment due to past exposure, if any.

PRE-PLACEMENT MEDICAL EXAMINATION

HAZARD UNDESIRABLE CONDITIONS
Lead Anaemia, Hypertension, Peptic
ulcer
Dyes Asthma, Skin & Kidney disease
Solvents Liver & Kidney disease,
Alcoholism
Silica Tuberculosis, Chronic lung
disease
X rays / Radium Blood diseases

PERIODIC MEDICAL EXAMINATION

• Evaluation of general health status.
• Earliest detection and prevention of work related disorders.
• Early detection, control and prevention of any health disorder which may affect the ability to
perform the job.
• To detect deviation in health status from base line data.
• Detection of infectious / communicable diseases which may affect others.