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Health, Hygiene & Sanitation in Remote Areas Remote Areas Emergency Medicine and Survival.

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Presentation on theme: "Health, Hygiene & Sanitation in Remote Areas Remote Areas Emergency Medicine and Survival."— Presentation transcript:

1 Health, Hygiene & Sanitation in Remote Areas Remote Areas Emergency Medicine and Survival

2 Preventative medicine Preplanning Preplanning Environment Environment Temp / terrain Temp / terrain Pathogens / vectors Pathogens / vectors Social / legal Social / legal Water Water Food Food Toilet Toilet

3 Preplanning Detailed risk assessments and planning to counter identified health threats

4 Preplanning example Bangladesh. Bangladesh. -viral illness in airport -Traffic accidents- use local drivers, use American, Toyota, Mercedes vehicles only. -Malaria- doxycycline prophylaxis, DEET, permetherin, educate on S/S -parasites- no swimming in fresh water -violence- terrorist, criminal, quasi police, food riots

5 Focus on real risks not sensationalism On a typical trip to Everest base camp traffic accidents enroute from the airport to the start of the walk are a greater risk than the climb. -Paul Auerbach, MD July 08 On a typical trip to Everest base camp traffic accidents enroute from the airport to the start of the walk are a greater risk than the climb. -Paul Auerbach, MD July 08

6 North American Wilderness Summer Minor trauma, orthopedics Minor trauma, orthopedics Contact dermatitis, sunburn Contact dermatitis, sunburn Food / water / hand washing contamination Food / water / hand washing contamination major trauma auto, quad, motorcycle, falls, logging, aircraft major trauma auto, quad, motorcycle, falls, logging, aircraft Heart attack, stroke, seizure etc… Heart attack, stroke, seizure etc… Heat/cold injury/exposure/dehydration Heat/cold injury/exposure/dehydration Drowning / technical rescue environment Drowning / technical rescue environment Penetrating trauma, logging, criminals, animals, snakebite Penetrating trauma, logging, criminals, animals, snakebite Exotic: lightning, west nile, diving, altitude Exotic: lightning, west nile, diving, altitude

7 Sources of information for international travel Local newspapers Local newspapers Missionary groups, NGO Missionary groups, NGO Local physicians Local physicians Ministry of health publications Ministry of health publications Remember to focus on regions regardless of borders. Local info is the best, sometimes local treatments may be better Remember to focus on regions regardless of borders. Local info is the best, sometimes local treatments may be better CDC Yellow book CDC Yellow book WHO essential drugs list WHO essential drugs list

8 Evacuation plans Primary Primary Alternate Alternate Contingency plans Contingency plans Emergency Emergency P air travel with visa A maritime travel or paid driver to border country. Hired medical evac service C consulate, shelter in place, local hospital E local clothes, stow away on train, boat

9 Planning on the spot Check own pulse first, often you have time Size up the whole situation Undue haste makes waste Remember where you are Vanquish fear and panic Improvise Value living Act like the locals Learn skills before the crisis, rehearse actions

10 Stinging Insects avoid or eradicate Mosquitoes: West Nile virus, Yellow fever, Malaria, Dengue Fever, Filariasis, Encephalitis, Eastern Equine Encephalitis and Japanese Encephalitis. deet Mosquitoes: West Nile virus, Yellow fever, Malaria, Dengue Fever, Filariasis, Encephalitis, Eastern Equine Encephalitis and Japanese Encephalitis. deet Sand Flies: Oroya fever, Leishmaniasis, pappataci fever virus, kala azar, Oriental sore, espundia, and bartonellosis Permetherin Sand Flies: Oroya fever, Leishmaniasis, pappataci fever virus, kala azar, Oriental sore, espundia, and bartonellosis Permetherin Tsetse Flies: Sub-Saharan Trypanosomiasis (African Sleeping Sickness) picardin, deet. Tsetse Flies: Sub-Saharan Trypanosomiasis (African Sleeping Sickness) picardin, deet. Black Flies: tropics and subtropics filariasis picardin, deet. Black Flies: tropics and subtropics filariasis picardin, deet. Biting Midges: visceral filariasis. Permetherin Biting Midges: visceral filariasis. Permetherin Bot Flies: vaseline Bot Flies: vaseline Ants: premetherin paint Ants: premetherin paint

11 Ticks: Lyme disease, African tickbite fever, Aneruptive fever, Australian spotted fever, Far Eastern spotted fever, Flinders Island spotted fever, Thai tick typhus, Lymphangitis associated rickettsiosis, Maculatum infection, Mediterranean spotted fevers, North Asian tick typhus, Oriental spotted fever, Queensland tick typhus, Rocky Mountain spotted fever, Sao Paulo exanthematic typhus, Minas Gerais exanthematic typhus, Brazilian spotted fever, Tick-borne lymphadenopathy (TIBOLA), Dermacentor- borne necrosis and lymphadenopathy (DEBONEL), Unnamed rickettsiosis, Q fever, Ehrlichosis and Anaplasmosis.permetherin Ticks: Lyme disease, African tickbite fever, Aneruptive fever, Australian spotted fever, Far Eastern spotted fever, Flinders Island spotted fever, Thai tick typhus, Lymphangitis associated rickettsiosis, Maculatum infection, Mediterranean spotted fevers, North Asian tick typhus, Oriental spotted fever, Queensland tick typhus, Rocky Mountain spotted fever, Sao Paulo exanthematic typhus, Minas Gerais exanthematic typhus, Brazilian spotted fever, Tick-borne lymphadenopathy (TIBOLA), Dermacentor- borne necrosis and lymphadenopathy (DEBONEL), Unnamed rickettsiosis, Q fever, Ehrlichosis and Anaplasmosis.permetherin Mites: Rickettsialpox and Scrub typhus, Scabies, Chiggers Lindane Permethrin 5% Sulphur 4% Malathion Mites: Rickettsialpox and Scrub typhus, Scabies, Chiggers Lindane Permethrin 5% Sulphur 4% Malathion Fleas: Plague, Epidemic typhus, Sylvatic typhus, Cat flea rickettsiosis, Murine typhus and Cat-scratch disease. Bug bomb Fleas: Plague, Epidemic typhus, Sylvatic typhus, Cat flea rickettsiosis, Murine typhus and Cat-scratch disease. Bug bomb Lice: Epidemic typhus, Sylvatic typhus and Trench fever RID, Lice: Epidemic typhus, Sylvatic typhus and Trench fever RID, Spiders: premetherin paint or string Spiders: premetherin paint or string

12 Diptera: big fancy word for mosquito Many problems can be easily mitigated by proper insect control measures Many problems can be easily mitigated by proper insect control measures Worldwide, mosquitoes transmit diseases to 700,000,000 annually Worldwide, mosquitoes transmit diseases to 700,000,000 annually Malaria kills 3,000,000 annually Malaria kills 3,000,000 annually Mosquitoes will cause the deaths of 1 out of 17 people now alive Mosquitoes will cause the deaths of 1 out of 17 people now alive

13 Skin products Deet 50% or greater in standard formulation reapply q 4 hours. Cumulative absorption. Increased absorption with sunscreen (in monkeys) Deet 50% or greater in standard formulation reapply q 4 hours. Cumulative absorption. Increased absorption with sunscreen (in monkeys) Lower % in controlled release. Lasts longer less absorbed Lower % in controlled release. Lasts longer less absorbed In Queensland rainforest field trial: In Queensland rainforest field trial: Picaridin 19% gave 95% protection > 9 hr Picaridin 19% gave 95% protection > 9 hr Picaridin 9% gave 95% protection > 2 hr Picaridin 9% gave 95% protection > 2 hr DEET 20% (Sawyer) 95% protection > 6 hr (Scheinfeld. J Drugs Dermatol 3:59, 2004) DEET 20% (Sawyer) 95% protection > 6 hr (Scheinfeld. J Drugs Dermatol 3:59, 2004) Eucalyptus very weak for 2-3 hours (controversial) Eucalyptus very weak for 2-3 hours (controversial) Bite blocker, 97% protection against Aedes 3.5 hours after application (U Guelph, Ontario, Canada) Bite blocker, 97% protection against Aedes 3.5 hours after application (U Guelph, Ontario, Canada)

14 DEET Complete protection from Aedes aegypti: Complete protection from Aedes aegypti: OFF 23.8% DEET302 min OFF 23.8% DEET302 min Controlled Release 20% DEET 234 min Controlled Release 20% DEET 234 min Soybean Oil 2%95 min Soybean Oil 2%95 min Citronella 10%20 min Citronella 10%20 min Avon SSS Bath Oil 10 min Avon SSS Bath Oil 10 min DEET wristband 9.5%0.2 min DEET wristband 9.5%0.2 min 15 Volunteers, Arm-in-Cage Design (Fradin & Day NEJM 2002) 15 Volunteers, Arm-in-Cage Design (Fradin & Day NEJM 2002)

15 Permethrin on clothing Long lasting. Persists after washing. Light stable Long lasting. Persists after washing. Light stable Nongreasy. Nearly odorless Nongreasy. Nearly odorless Skin transfer.0006 mg/kg/d (Snodgrass 92) Skin transfer.0006 mg/kg/d (Snodgrass 92) Rapidly metabolized. No tissue accumulation Rapidly metabolized. No tissue accumulation Not carcinogenic. Not mutagenic Not carcinogenic. Not mutagenic In clothing provides 74% protection against chiggers (Breeden et al 92) In clothing provides 74% protection against chiggers (Breeden et al 92) In clothing more effective than DEET against ticks (Evans et al 90) In clothing more effective than DEET against ticks (Evans et al 90)

16 Permethrin Sheep dip permethrin (non FDA) on outer clothing. Mix solution dunk and dry (swartz and team 08 Bangladesh no bites, we lived) Sheep dip permethrin (non FDA) on outer clothing. Mix solution dunk and dry (swartz and team 08 Bangladesh no bites, we lived) May spray window screens, bednets, door sills, twine around sleeping, paint strip, tent, sleeping pad, ER/OR, shoes, etc… May spray window screens, bednets, door sills, twine around sleeping, paint strip, tent, sleeping pad, ER/OR, shoes, etc… Sawyer products also has spray on premetherin (FDA aproved) Sawyer products also has spray on premetherin (FDA aproved) Permethrin bug bombs (raid) for rooms. Hang your clothes out in room Permethrin bug bombs (raid) for rooms. Hang your clothes out in room

17 Mechanical barriers Bed nets with permethrin Bed nets with permethrin Window screens with permethrin Window screens with permethrin Insect tents for food preparation areas and toilet areas Insect tents for food preparation areas and toilet areas Lids, bags Lids, bags Eat food right after preparation Eat food right after preparation

18 Traps Mosquito traps (CO2 and attractant) Mosquito traps (CO2 and attractant) Fly bait Fly bait UV light for flies in eating areas and at entrances UV light for flies in eating areas and at entrances Good old fly swatter for that pesky one that got in anyway Good old fly swatter for that pesky one that got in anyway

19 SumiOne Emanators Metofluthrin (SumiOne), a vapor-active pyrethroid effective against mosquitoes Metofluthrin impregnated paper emanators placed 1.2 m to sides of volunteers in field Pre and post-tx bite counts after min –In FL >90% reduction Ochlerotatus bites –In WA >95% reduction Aedes bites (Lucas et al. J Am Mosq Contr Assoc, 2007)

20 An Effective combo Alaska study (Lillie et al. J Med Entomol 88) Alaska study (Lillie et al. J Med Entomol 88) -control 1,188bites in 1 hour -Permethrin on clothes and DEET on skin 1 bite in 1 hour -99.9% effective over 8 hours

21 Mosquito reduction Remove or treat standing water ½ mile Remove or treat standing water ½ mile -Tablets in water -Tablets in water -Vegetable oil clogs breathing of larvae in H2O -Vegetable oil clogs breathing of larvae in H2O -Fuel oil may contaminate drinking water -Fuel oil may contaminate drinking water Large scale permethrin fogger around buildings, camp. somewhat effective Large scale permethrin fogger around buildings, camp. somewhat effective Ducks, fish Ducks, fish Muscovy ducks for flies, guinea hens/chickens for ticks Muscovy ducks for flies, guinea hens/chickens for ticks Future…. Transgenic mosquitoes? Future…. Transgenic mosquitoes?

22 Bigger Critters Mice Mice Rats Rats Bats Bats Snakes and lizards Snakes and lizards Skunks, feral cats, dogs Skunks, feral cats, dogs Monkeys and bears Monkeys and bears Oh my! Oh my!

23 Mice & Rats Food/medicine contamination Food/medicine contamination Hantavirus Hantavirus Plague Plague Destruction of equipment/packs Destruction of equipment/packs Poison & traps Poison & traps Metal containers for supplies (paint cans) Metal containers for supplies (paint cans)

24 Bats Rabies, lethal if symptomatic Rabies, lethal if symptomatic Pre vaccinate in endemic areas/cavers Pre vaccinate in endemic areas/cavers If bat is found and someone has been sleeping must vaccinate if not done and must give immune globulin also If bat is found and someone has been sleeping must vaccinate if not done and must give immune globulin also Sleeping in the open discouraged Sleeping in the open discouraged By far most North American rabies is from bats By far most North American rabies is from bats

25 Snakes and Lizards Painful bites Painful bites Poisonous bites Poisonous bites Salmonella, wash hands after touching before eating or preparing raw food Salmonella, wash hands after touching before eating or preparing raw food Encourage a no touch policy Encourage a no touch policy Tetanus vaccine Tetanus vaccine

26 Skunks, feral cats, wild dogs Avoid contact Avoid contact Secure food…solves most problems Secure food…solves most problems.22 semi automatic rifle with scope, pistol if trained (Katrina).22 semi automatic rifle with scope, pistol if trained (Katrina) Gopher poison in cat food (non selective) Gopher poison in cat food (non selective) Skunk, cat, bat, and canine bite = rabies prophylaxis Skunk, cat, bat, and canine bite = rabies prophylaxis

27 Monkeys, Raccoons, and Bears Secure food Secure food Secure it some more Secure it some more Really secure it Really secure it Elevation and metal containers Elevation and metal containers Monkey and racoon bite = rabies prophylaxis Monkey and racoon bite = rabies prophylaxis Bear = trauma center or body bag Bear = trauma center or body bag

28 Field Water Treatment HAND WASHING! HAND WASHING! Boiling Boiling Chemical disinfection Chemical disinfection - Chlorine - Chlorine -Iodine -Iodine -Chlorine dioxide -Chlorine dioxide Filtration Filtration UV UV Sedimentation, Coagulation/flocculation, Granular activated charcoal Sedimentation, Coagulation/flocculation, Granular activated charcoal SODIS 35 deg lat SODIS 35 deg lat

29 Water and Sanitation Globally 1.1 billion persons without access to potable water 1.1 billion persons without access to potable water 2.4 billion persons without adequate sanitation 2.4 billion persons without adequate sanitation 4 billion episodes of diarrhea/year 4 billion episodes of diarrhea/year 2.2 million deaths/year (most under 5 years-old) 2.2 million deaths/year (most under 5 years-old) Safe water, sanitation, and hygiene can: Safe water, sanitation, and hygiene can: reduce diarrhea disease mortality by 65% reduce diarrhea disease mortality by 65% reduce mortality by 26% reduce mortality by 26% WHO and UNCF Global water supply and sanitation assessment 2000 report

30 Sierra Nevada Water 55 lakes and streams in National Parks 55 lakes and streams in National Parks 40% positive for coliforms 40% positive for coliforms Most very low levels Most very low levels 31 lakes and streams in Wilderness areas 31 lakes and streams in Wilderness areas 45 % positive for coliforms 45 % positive for coliforms high levels at 8 sites high levels at 8 sites Correlated with human and animal (beaver) activity Correlated with human and animal (beaver) activity Derlet RW et al. Wild Environ Med 2004

31 Toilets Pre prepared: park service, hand washing, floor washing Pre prepared: park service, hand washing, floor washing Blue lagoon! (blue water backsplash) Blue lagoon! (blue water backsplash) 5 gal pail with liner and lid 5 gal pail with liner and lid Ziplock skills Ziplock skills Slit trench, fenced areas Slit trench, fenced areas Paper, water, Rock, leaf, wipe plan (cultural) Paper, water, Rock, leaf, wipe plan (cultural) Surface deployed poop next to water (what most people and all animals do) Surface deployed poop next to water (what most people and all animals do)

32 Helping you go green! BacterialViral days in H2O Protozoan Parasitic E coliHepatitis AGiardia 2-3 months in H2O Ascaris ShigellaNorwalk EhistolyticaT solium Campylobacter 3-5 weeks in H2O Polio virusCryptosporidium 12 months in H2O Liver fluke V cholera 4-5 weeks in H2O Hepatitis ECyclosporaDracunculosis S typhiMore than 120 enteric viruses Blastocystis Y enterocoliticaI belli B coli

33 Water treatment is secondary to good hygiene Individual Practices: -hand-washing, bathing, toilet practices Group Practices -campsite selection, group toilets, food / water choice and preparation, food waste disposal, dish washing Water treatment should accompany a comprehensive approach to hygiene

34 Handwashing camp sanitation After toilet After toilet Before eating Before eating Simple foot pump device Simple foot pump device In large camps must be enforced In large camps must be enforced Liquid soap can be dispensed by monitor in line Liquid soap can be dispensed by monitor in line Toilets need bleach water spray QD to QID based on use. Not in toilets unless cholera outbreak. Toilets need bleach water spray QD to QID based on use. Not in toilets unless cholera outbreak. Spray toilets with permethrin for flies Spray toilets with permethrin for flies Garden sprayers work great Garden sprayers work great Bathe, do laundry, wash dishes, away from the well head. Bathe, do laundry, wash dishes, away from the well head.

35 Benefits of hygiene with students in a large outdoor training program NOLS data covers a well studied group before and after program wide interventions. Rates of gastrointestinal illnesses (nausea, vomiting, and diarrhea) dropped from 0.51 per 1000 program days to 0.22 per 1000 program days over the same time period. NOLS data covers a well studied group before and after program wide interventions. Rates of gastrointestinal illnesses (nausea, vomiting, and diarrhea) dropped from 0.51 per 1000 program days to 0.22 per 1000 program days over the same time period. These hygiene issues include emphasizing hand washing and camp hygiene, educating students, and instructors on food-born illnesses, expecting all wilderness drinking water to be disinfected, and repeatedly restating the hygiene expectations to the course participants. These hygiene issues include emphasizing hand washing and camp hygiene, educating students, and instructors on food-born illnesses, expecting all wilderness drinking water to be disinfected, and repeatedly restating the hygiene expectations to the course participants.

36 Military applications More died in WWI from disease than combat More died in WWI from disease than combat Soviets in Afghanistan: disease degraded war fighting capability greater than all other causes combined. Examples include entire battalions hospitalized from food borne Hepatitis A from one cook. Soviets in Afghanistan: disease degraded war fighting capability greater than all other causes combined. Examples include entire battalions hospitalized from food borne Hepatitis A from one cook.

37 Boiling water Fuel and time intensive Fuel and time intensive Works great at most elevations Works great at most elevations Most pathogens die well before boiling Most pathogens die well before boiling Rolling boil is the only reliable temp, small bubbles are not consistant Rolling boil is the only reliable temp, small bubbles are not consistant Time at boil shown not to be significant just getting to a boil is reliably adequate Time at boil shown not to be significant just getting to a boil is reliably adequate

38 Thermal Death -Water pasteurized at a boil- Giardia, E histolytica cysts Giardia, E histolytica cysts -2-3 minutes at 60º C (140º F) Cryptosporidium oocysts Cryptosporidium oocysts -2 minutes at 64º C -1 minute at 72º C Enteric viruses Enteric viruses -Seconds at 80º -100º C Hepatitis A Hepatitis A -1 minute at 85º C Enteric bacteria Enteric bacteria -1 minute at 65º C -Seconds at 100º C Elevation Boiling Point Elevation Boiling Point -10,000 ft. 90º C -14,000 ft 86º C -19,000 ft 81º C

39 WATER TREATMENT Choice of Methods: Chemicals Iodine and Chlorine: -widely used and inexpensive -ineffective against cryptosporidium -effectiveness decreases with lower temperatures and higher turbidity -byproducts a concern Chlorine Dioxide (ClO2): -stronger disinfectant than both chlorine and iodine: more resistant to low temperatures and high turbidity -some effectiveness against cryptosporidium (with extremely long contact times) -byproducts a concern Mixed Oxidants: -on-site generated combination of chlorine, chlorine dioxide, and ozone -similar to ClO2 in effectiveness, but more susceptible to turbidity -fewer byproducts than ClO2

40 Iodine/chlorine May miss cryptosporidium. (Illinois river) Safe Water System CDC, WHO, PAHO Safe Water System CDC, WHO, PAHO International Network to Promote Household Water Treatment and Safe Storage International Network to Promote Household Water Treatment and Safe Storage Sodium hypochlorite and closed mouth containers with spigot Sodium hypochlorite and closed mouth containers with spigot Reduced diarrhea Reduced diarrhea 24% in Bangladesh 24% in Bangladesh 25% in Guatemala 25% in Guatemala 30% among persons with HIV infection in rural Uganda 30% among persons with HIV infection in rural Uganda-Inexpensive -Widely available -Flexible dosing -Large volumes -Multiple variables (temp, sediment, concentration, time, pathogen sensitivity, ph) -Taste -Potential toxicity? No evidence -Corrosive, stains -Requires contact time -Cryptosporidiumresistance

41 Chlorine tips Differential Dx of diarrhea and or nausea too much chlorine or iodine. Differential Dx of diarrhea and or nausea too much chlorine or iodine. Chlorine at 1-2 ppm is bacteriostatic Chlorine at 1-2 ppm is bacteriostatic 4-5 ppm it gives you the quick step 4-5 ppm it gives you the quick step Carry a few pool test strips to check camp water where chlorine is routinely used Carry a few pool test strips to check camp water where chlorine is routinely used Allow over treated water to sit and off gas the chlorine or add more water Allow over treated water to sit and off gas the chlorine or add more water

42

43 Filters May need back up halogen for viruses especially in areas with slow water and lots of people. (Bangladesh, Illinois river) May need back up halogen for viruses especially in areas with slow water and lots of people. (Bangladesh, Illinois river) New viral filters 0.2 micron now available however how do you do quality control? New viral filters 0.2 micron now available however how do you do quality control? USACHPPM website ( ) USACHPPM website ( ) for testing overview of most models on the market

44 New stuff Steri-Pen Ultraviolet Steri-Pen Ultraviolet -Effective against virtually all pathogens -leaves no byproducts -requires power -turbidity absorbs and scatters light; essential that source water is clear or pre-filtered -leaves no residual disinfectant in water; re-growth and repair are possible -UV light is harmful to our eyes; devices must be used properly to avoid damage Chlorine Dioxide less taste, improved cold water performance, cryptosporidium coverage Chlorine Dioxide less taste, improved cold water performance, cryptosporidium coverage Miox Pen multiple chemicals derived from salt, requires power Miox Pen multiple chemicals derived from salt, requires power Sawyer/MSR Microfiltration? Unproven Sawyer/MSR Microfiltration? Unproven

45 Sedimentation Large inorganic particles Large inorganic particles like sand and clay settle by gravity Let water sit for Let water sit for minutes Decant or filter clear Decant or filter clearwater Does not disinfect Does not disinfect

46 Coagulation - Flocculation Clarifies Clarifies Removes Colloids (fine suspended matter) Removes Colloids (fine suspended matter) Partially removes Partially removes Microorganisms Microorganisms Metallic compounds and minerals Metallic compounds and minerals Dissolved chemicals (phosphates) Dissolved chemicals (phosphates) Bad taste, smell, color Bad taste, smell, color Use small amounts of alum Use small amounts of alum Found in grocery store for pickling Found in grocery store for pickling Removes up to 90% of bacteria Removes up to 90% of bacteria Removes up to 89% of viruses Removes up to 89% of viruses

47 Alum flocculation

48 Granular Activated Charcoal Action Adsorbs dissolved chemicals, pesticides, oil, uranium? Adsorbs dissolved chemicals, pesticides, oil, uranium? Improves taste, odor, color Improves taste, odor, color Does not disinfect Does not disinfect Finite capacity for adsorption Finite capacity for adsorption

49 Filtration Simple process Simple process No taste imparted No taste imparted Special equipment Special equipment Pore size limitation Pore size limitation Gradual clogging Gradual clogging Organism Maximum pore size (um) Parasitic eggs and larvae 20 Giardia, E histolytica 5 Cryptosporidium 1 Enteric bacteria Viruses 0.01 Common micro-filters

50 SODIS Contaminated water is filled into transparent plastic bottles and exposed to the full sunlight for 6 hours. Contaminated water is filled into transparent plastic bottles and exposed to the full sunlight for 6 hours. UV-A radiation SODIS, Solar water disinfection is a simple method to improve the quality of drinking water by using sunlight to inactivate pathogens causing diarrhoea(wavelength nm) of the sunlight destroys the pathogens. UV-A radiation SODIS, Solar water disinfection is a simple method to improve the quality of drinking water by using sunlight to inactivate pathogens causing diarrhoea(wavelength nm) of the sunlight destroys the pathogens. A synergy of UV-A and temperature occurs, if the water temperature rises above 45°C. A synergy of UV-A and temperature occurs, if the water temperature rises above 45°C. SODIS requires relatively clear water (turbidity less than 30 NTU) SODIS requires relatively clear water (turbidity less than 30 NTU) SODIS is not useful to treat large volumes of water SODIS is not useful to treat large volumes of water Regions well suited for SODIS are locatedbetween latitude 35°N and 35°S Regions well suited for SODIS are locatedbetween latitude 35°N and 35°S 6 hours under bright or up to 50% cloudy sky 6 hours under bright or up to 50% cloudy sky 2 consecutive day under 100% cloudy sky 2 consecutive day under 100% cloudy sky During days of continuous rainfall, SODIS does not perform satisfactorily. During days of continuous rainfall, SODIS does not perform satisfactorily. Water boiling or rainwater harvesting is recommended during these days. Water boiling or rainwater harvesting is recommended during these days.

51 Solar box cooker

52 WATER TREATMENT Risk Assessment Factors to Consider: -potential pathogens (protozoa, bacteria, viruses) -potential toxins -location (wilderness, rural, urban, farmland) -local knowledge, awareness -group characteristics (duty, age, susceptibility, immune status, medical conditions, expectations) -characteristics of trip (length, difficulty, medical support, remoteness)

53 Water summary Understand the advantages and disadvantages of each system and apply them appropriately to your situation Understand the advantages and disadvantages of each system and apply them appropriately to your situationHeatUltraviolet Chlorine Dioxide Filtration+Halogenation or UV

54 Dish washing Wash Rinse Sanitize Wash Rinse Sanitize

55 Sources of grocery outlet syndrome Washing dishes and bathing at the wellhead. Washing dishes and bathing at the wellhead. Drying dishes in contaminated areas. Drying dishes in contaminated areas. Cutting salad and raw meat together. Cutting salad and raw meat together. First in-last out storage. First in-last out storage. Bare feet. Bare feet. No soap. No soap. Actually okay!

56 A fly has six legs… thats six bad things on your food! Keep your rice off the ground… and your butt off the rice!! Remember: And:


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