sanitation,waste management

Welcome 1
Anupama krishnan V.P.S.V
Ayurveda College Kottakkal

Dr Anupama Krishnan
Dept of Swasthavritha
V.P.S.V Ayurveda College Kottakkal
Sanitation,Hygiene
Waste Disposal
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anupama krishnan vpsv ayurveda collegee
kottakkal

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Sanitation is more important than
independence
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Clean Past
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Incredible or Non credible
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s
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Gods own…
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Actually………
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INDUSRIALISATION
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Great Sanitary Awakening
(1800s-1900s)
• Growth in scientific knowledge
• Humanitarian ideals
• Connection between poverty
and disease
• Water supply , sewage removal
• Monitor community health status
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Sanitary revolution
• Clean water; water treatment
• Food inspection
• Soaps, disinfectants, pharmaceuticals
• Personal hygiene (bathing)
• Public works departments; garbage
collection, landfills, street cleaning
• Public health departments and regulation
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Sanitation ??
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What does it mean
Sanitation[san′itā′shən]
• Etymology: L, sanitas, health
science of maintaining a healthful, disease
free, hazard free environment
(Mosby's Medical Dictionary, 9th edition. ©
2009, Elsevier)
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Safe management of human excreta, including
its safe confinement ,treatment, disposal and
associated hygiene-related practices.
National Urban Sanitation Policy (2008)
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• ‘Sanitation’ is a subject matter included in
Entry 6 of the State List
• Article 246 of Constitution of India
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Coverage
• 2.6 billion people lack access to improved
sanitation
• Two thirds of whom live in Asia and Saharan
Africa
• More than half live in India, lack even an
unimproved sanitation facility and must
defecate in the open
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Consequence
• Every year, 1.5 million children die due to
diarrhea caused by combined effects of
inadequate sanitation, unsafe water supply,
and poor personal hygiene
• Lack of sanitation contributes to about 10%
of the global disease burden
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• 1 billion people regularly defecate in the
open (United Nations)
• Dramatic consequences on the human
health, dignity and security
• One out of three women around the world
lack access to safe toilets
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Disparity
Improved sanitation
• Industrialised countries 99%
• Developing countries 53%
• Developing countries - urban sanitation
coverage is 71% while rural coverage is 39%.
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• Causing around 1.6–2.5 million
• Deaths annually, among children under 5
years old living in developing countries
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• Africa every hour 115 person die
• Poor hygiene
• Sanitation
• Contaminated water
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• India most number of people in world
defecating in open
• Among 1 billion population in India, 55%
• 650 million people still defecate in open
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• Ganga river is dumped 1.1million litres of raw
sewage daily
• One gram of faeces
• One million bacteria
• Ten million virus
• Hundred worm eggs
• Thousand cysts
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Is it a big deal
• Toilet seat of public bathrooms
E.coli, streptococcus, hepatitis A virus
Staphylococcus, shigella bacteria
sexually transmitted organisms
• Open defecation and lack of sanitation
• Leading causes for water-borne diseases like
diarrhoea and stunted growth in children
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Impact
• Diseases faecooral transmission pathway
• Soil transmitted helminths - human
roundworm, human whipworm, hookworms
• Infections every year in kids
• Anaemia in pregnant women
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Cause of failure
• About 50% of toilets built by a large
government programme are not used for
their intended purpose
• In India, for example, many toilets are used
as firewood stores or goat sheds
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Gains
• Improved sanitation reduce rates of
diarrhoeal diseases by 32%–37%
• Reduce case by 391 milloion world wide
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School attendance
• Safe
• Separate
• Clean latrines
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Adequate sanitation good hygiene and safe
water - fundamental to good health and to
social and economic development
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Where do we stand
•
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Kerala Calls
• About 93,046 households do not
have access to sanitary toilets
• About 32,425 of these households use
shared toilet facilities
• Open defecation - 60,621
• Adding to the fecal load in the environment
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Ray of hope ……..
• Kerala Total Health and Sanitation Mission
• Clean Kerala program under Rural Development
Department
• Within three years - 413,000 latrines
• Kerala currently highest coverage
of individual household latrines in India
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State Level Sanitation
Committee
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Suchitwa Mission
• Kudumbashree
• General Education Department
• Health & Family Welfare Department
• Kerala State Pollution Control Board
• Kerala Water Authority
• Town Planning Department
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Suchitwa mission
• Package of Practices
• Personal hygiene
• Safe disposal of human excreta
• Home sanitation food hygiene
• Safe handling drinking water
• Liquid waste management
• Solid waste management
• Community environmental sanitation
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Goal of Kerala
State Sanitation Strategy
• Ensuring 100 percent hygienically safe
sanitation
• Awareness sustained behavioral change
• Achieving Open Defecation Free Cities
• Improved Institutional governance
• Human resource capacities for city-wide
Sanitation
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Role
• Social scientists
• Behaviour change Experts
• Health professionals
• Individual people
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FOCUS
Active
participation
Awareness Motivation
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Community Led Total Sanitation
• Ignite community awareness
Encourages a cooperative
participatory approach ending open
defecation
• Creating a clean, healthy, and hygienic
environment from which everyone benefits
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Activities undertaken to assure the
conditions in which people can be healthy
Organized community efforts to prevent,
identify and counter threats to the health of
the public.
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Why Ayurveda
Public Health
“the science and art of pre-venting diseases,
prolonging life, promoting health ,efficiency
through organized community efforts…”.
(CEA Winslow ,1920)
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Ayurveda Role
• Environmental sanitation
• Control of community infections
• Healthy lifestyle , personal hygiene
• Early diagnosis, preventive treatment
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Activity
Explore
• Survey hand washing practices
• Observe behavior of people using public toilets
(flush before using urinal, wash hands after
using urinal)
Discover
• Way people wash their hands
( wash rigourously, use of soap )
• People’s view on open defecation and urination
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Think
• Ways to promote encourage people to wash hands
• Surroundings after visiting toilet
• Spreading awareness about different toilet manners
Act
• How clean are your hands?
• Putting up posters of toilet etiquettes near
washbasins
• Appointing hand-wash monitors
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United Nations has dedicated November 19th
for promoting World Toilet Day
• Bring into limelight plight of all those people
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Food Sanitation
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Process of handling food in ways
that are clean and healthy
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Food we Serve
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Storing food like this?
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• Food Infection - microbial infection
resulting from ingestion of
contaminated foods
• Food Intoxication - type of illness
caused by toxins
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• Food Spoilage - means original
nutritional value, texture, flavor of food
are damaged, food become harmful to
people and unsuitable to eat.
• Food borne Illness – A disease carried
or transmitted to people by food.
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Types of food contaminants
• Biological
Contaminant
• Physical
Contaminant
• Chemical
Contaminant
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Biological contaminant - may cause a food
borne illness (bacteria, viruses, fungi,
parasites, biological toxins)
• Examples
• Sea food toxins
• Mushroom toxins
• Clostridium
Botulinum
• Salmonella bacteria
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Preventing Biological contaminant
• Purchase foods only on reputable supplier
• Do not use wild mushrooms
• Maintain good personal hygiene
• Observe proper hand washing
• Clean and sanitize equipment
• Maintain clean and sanitize facilities
• Control pests
** Cooking does not destroy toxins**
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Physical Contaminant – any foreign
object that accidentally find its way into
food
• Hair
• Staple wire
• Dust
• Metal shavings
• Nails
• Earrings
• Hair clips
• Plastics
• Metal
• Glass fragments
• Insects
• Extraneous vegetable
matter
• Stones
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Preventing Physical Contaminants
• Wear hair restraint
• Avoid jewelry cooking holding foods
• Do not carry pencil or pen
• Do not wear nail polish or
artificial nails
• Clean can openers
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Chemical Contaminant – a chemical substance
that can cause food borne illness. Substances
normally found in restaurant
• Toxic metals
• Pesticides
• Cleaning product
• Sanitizers
• Preservatives
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Preventing Chemical Contaminants
• Store chemicals in original containers to prevent
accidental misuse, as well as leakage into food
• Make sure labels are clearly identify chemical
contents of chemical containers
• Wash hands thoroughly after working with
chemicals
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Utensils and equipment containing potentially
toxic metals
• Lead
• Copper
• Brass
• Zinc
• Antimony
• Cadmium
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Main Causes of Food Borne
Illness
• Cross- Contamination
• Time-Temperature Abuse
• Poor Personal Hygiene
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Cross Contamination
• Microorganisms are transferred from one
surface or food to another
• Hand to food
• Food to food
• Equipment to food
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Preventing
Hand to food
 Wash hands properly
Cover cuts, sores and wounds
Keep fingernails short, unpolished & clean
Avoid wearing jewelry, except for plain ring
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Food to Food Contamination
• When harmful organisms from one food
contaminate other foods. (raw meats,
thawing meat on top of the shelf where it can
drip on the other foods)
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Preventing food to food
contamination
• Wash fruits & veg, in a cold running water
• Do not let raw meat
and raw vegetables be
prepared on
same surface at same time
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Equipment to Food Contamination
• Use separate cutting boards for different foods
(meat- veg)
• Prepare raw foods in separate area from fresh
and ready to eat foods
• Clean & sanitize equipment, work surfaces &
utensils after preparing each foods
• Use specific containers for various food
products.
• Make sure cloth paper towel use for wiping
spills not used for any other purposes
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Time Temperature Abuse
• Food is exposed to Temperature Danger Zone
(41⁰F - 140⁰F) for more than 4 hrs
• Food is not stored, prepared or held at a
required temperature
• Food is not cooled low enough fast
• Food is prepared in advance and not set to a
safe required internal temperature while the
food is on hold
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Potentially Hazardous Foods
• Food items support rapid growth of food
borne disease microorganisms are
• High in protein
• High in moisture
• pH ( 4.5 or higher)
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• Fish
• Meat (beef, pork, lamb)
• Milk & milk products
• Cooked rice, beans
• Textured Soy Protein
• And meat alternatives
• Sea foods
• Sprouts & raw seeds
• Sliced melons
• Eggs
• Baked/boiled potatoes
• Garlic in Oil Mixture
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• Food products requiring refrigeration should
be stored at temperature of 40°F (4.4°C) or
below
Safe temperatures
• 40°F (4.4°C) or below and 140°F (60°C) or
above
• Any temperature between 41°F (5°C) and
139°F (59°C) is in the DANGER ZONE
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• Food products may have danger zone during
some periods of preparation
• Food is being mixed with other ingredients,
chopped, or formed - danger zone
• At each stage of preparing and serving
• Product may be exposed to unsafe
temperatures and chance of becoming
contaminated
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• Goal in temperature control - minimize time
PHF are in danger zone
• Three hours cumulative time is maximum
such food can be in the danger zone and not
be a health hazard
• After 4 hours in danger zone, enough bacteria
may have grown in food to cause foodborne
disease outbreaks
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• Items such as flour, sugar, rice should be
stored in their original containers
• Placed in metal containers with tightly fitting
lids ,protected from excessive heat ,moisture
• Improper storage - rodent or insect
infestation or from deterioration by
excessive heat or moisture
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• Acid food or beverages, potato salad, tomato
juice, lemonade, citrus fruit drink, or other
acidified drinks, must never be stored or
served in galvanized container
• Capable of dissolving the zinc which can
cause heavy metal poisoning
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Poor Personal Hygiene
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When to wash hands?
• Using handkerchief or tissue
• Handling inventory
• Handling raw foods
• Touching or scratching a part of the body
• Coughing, sneezing
• Handling garbage
• Touching dirty surfaces
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Good Personal Hygiene
• Medicines should be kept inside Locker and away
from foods
• Clean and cover cuts and wounds
• Never use bare hands when handling ready to eat
foods
• Disposable gloves should be used once
• Take a bath everyday
• Wear appropriate attire
• Refrain from wearing jewelry, make ups, and nail
polish
• Observe proper hand washing procedures at all times
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• When tasting foods, use a spoon other than
the one used for stirring . Use a clean spoon
for each person tasting and for each time
food tasted
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Employee responsibilities
• No food or drink in storage, processing &
packaging areas
• No use of gum or tobacco in food handling
areas
• Injuries, infections, disease must be reported
• Wash hands thoroughly

Remember
• Foods containing enough microorganisms
or toxins to cause food borne diseases
• May not have any changes in odor, taste, or
appearance
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Hospital Sanitation
• Ensure proper treatment
• Reduce suffering – NOT more harm
• Daily cleaning – everywhere
• Weakened ppulation – 5 % to 30 %
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• Nosocomial Infections or hospital acquired
infections
• Acquired during or as a result of hospitalization
• Any patient who develops an infection after 48
hours of hospitalization considered to have
nosocomial infection
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• Healthcare-associated infections (HAIs) occur
worldwide
• 1.4 million people worldwide suffer from
infections acquired in hospital
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• People who carry bacteria without evidence
of infection (fever, increased white blood cell
count) are colonized
• If an infection develops, it is usually from
bacteria that colonize patients
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Iceberg Effect
Infected
Colonized
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• Bacteria that colonize patients can be
transmitted from one patient to another by
the hands of healthcare workers
• Bacteria can be transmitted even if the
patient is not infected
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• Hands of healthcare providers most common
vehicle for the transmission of
• Microorganisms from patient to patient
• Patient to equipment and environment
• Equipment and environment to the patient
own body
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• Provider‟s hands continuously touch surfaces
and substances including inanimate objects
• Patient‟s intact or non-intact skin, mucous
membranes, food, waste, body fluids and
healthcare provider‟s own body
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Key Terms
• Patient zone- includes the patient, surfaces
and items that are temporarily and
exclusively dedicated to him/her
• Health care area- all surfaces in health care
setting outside of patient zone
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Patient zone
• Patient
• Immediate surroundings - surfaces that are
touched by or in direct physical contact with the
patient
-Bed rails
-Bedside tables
-Bed linens
-Tubing
-Medical equipment
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Any item designed for reuse or temporarily
exposed to patient decontaminated when
entering leaving patients surroundings
•Computers
•Shared bathrooms
• Tables or equipment
• Wheelchairs
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Health-care Area
•Is everything outside of patient zone
• Hand hygiene while caring for patients helps
to protect wider health care environment
from contamination by patients germs
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• “Adherence to hand hygiene
recommendations is the single most
important practice for preventing the
transmission of microorganisms in
healthcare and directly contributes to
patient safety.”
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Clean Care is Safer Care
• Ensure that infection control is
acknowledged universally as a solid
• Essential basis towards patient safety and
supports the reduction of healthcare-
associated infections …..
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Intervention
Hand scrub with chlorinated lime
solution
Hand hygiene basin at the Lying-In Women’s Hospital in Vienna, 1847.
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• Hand hygiene removal of visible soil and
removal or killing of transient
microorganisms from hands
• All humans carry microorganisms on their
skin
• Two groups – Transient and Resident flora
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• Transient (or contaminating) microorganisms
contaminate the upper layers of skin
• Acquired during direct contact with patients,
healthcare providers, contaminated
equipment or environment
• Transient microorganisms may also be easily
passed on to others or to objects in
environment and are a frequent cause of
HAIs
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• Resident flora are found in deeper layers of
skin and are more resistant to removal
• Do not generally cause HAIs
• Beneficial to good health of skin
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Why learn Hand Hygiene?
• Hand hygiene is the most important way to prevent the
spread of germs
• Reduce number of germs on hands and helps reduce
spread of germs to family, friends, coworkers, patients,
residents or clients
• Using appropriate hand hygiene prevents
contamination of the patient’s, client’s, or resident’s
environment
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How to perform hand hygiene
Alcohol-based hand rub Soap and water Without water when
hands are soiled
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 മ ോതിരങ്ങളൂരി വയ്ക്കുക
 നഖങ്ങളുടെ നീളവുും
വൃത്തിയുും പരിമ ോധികുക

 കകത്തണ്ട വമരകുും ടവള്ളും
ഉപമയോഗിച്ച് നനച്ചമ ഷും
മ ോപ്പിെുക

 ഇരുപത് ട കണ്ട് മനരും
എല്ലോയിെവുും മതകുക

പേപ്പർ ടവല് ക ൊണ്ട്
ഈർപ്പം തുടക്കു

െോപ്പ് അെകുമപോള് മനരിട്ടുള്ള
സ്പർ ും ഒഴിവോകുക

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Steps on how to wash hands when
visibly soiled (otherwise, use hand rub.
• . Duration of40-60 seconds)
• Step 0 - Wet hands with water.
• Step 1- Apply enough soap to cover all hand surfaces.
• Step 2 - Rub hands palm against palm.
• Step 3 - Right palm over left dorsum with interlaced
fingers and vice versa.
• Step 4 - Palm against palm with fingers interlaced.
• Step 5 - Backs of fingers to opposing palms with fingers
interlocked.
• use towel
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• Step 6 - Rotational rubbing of left thumb
clasped in right palm and vice versa.
• Step 7 - Rotational rubbing, backwards and
forwards, with clasped fingers of right hand
• in left palm and vice versa.
• Step 8 - Rinse hands with water.
• Step 9 - Dry hands thoroughly with a single
use towel
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Effective Hand Hygiene
• Alcohol-based hand rub (ABHR)
• Should contain 70 – 90% alcohol
• Takes less time than hand washing
• More effective than hand washing with soap
and water when hands are not visibly soiled
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• Common types of alcohols used include
ethanol,isopropanol or combinations
• Antimicrobial action of ethanol and
isopropanol similar
• Ethanol has greater activity against viruses
than isopropanol
• WHO recommended formulations contain
either 75% v/v isopropanol, or 80% v/v
ethanol
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• Mechanical rubbing action is important to kill
transient microorganisms
• Less drying to hands than soap and water
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Efficacy of ABHR
• Depends on the quality of product, the amount
of product used, time
• Spent rubbing ,hand surface rubbed
• NOT be used with water, water will
• Dilute alcohol and reduce its effectiveness
• ABHR should NOT used immediately after hand
washing with soap and water
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• Hand washing with soap and running water
• Preferred when hands are visibly soiled
alcohol is inhibited by organic matter
• Mechanical action of washing, rinsing and
drying removes most transient
microorganisms
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Efficacy of Soaps
• Plain soaps act on hands by emulsifying dirt
and organic substances (e.g., blood, mucous),
which are then flushed away with rinsing
• Atleast 15 seconds of lathering with soap is
required to remove transient flora
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• Antimicrobial soaps have residual
antimicrobial activity
• Not deactivated by presence of organic
material
• Antimicrobial soap may be considered for use
in critical care areas
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• If hands are visibly soiled and running water
is not available
• Use a moistened to wetted to remove visible
soil, followed by ABHR
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Soap Formulations and Product
Selection
• Liquid products should be dispensed in a
disposable pump/cartridge that are discarded
when empty.
• Dispenser should never be “topped-up” or
refilled
• Bar soaps for hand hygiene should NOT be
used in healthcare facilities except for
personal use by a single patient
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• In this case, the soap should be supplied in
small pieces that are single-patient use
• Bar should be stored in a soap rack to allow
drainage and drying
• Discarded on patient discharge
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Hand Hygiene Indications
• Before initial contact with a patient or items in their
environment; this should be done on entry
• Room or bed space, even if patient has not been
touched
• Before putting on gloves;
• Before preparing, handling or serving food or
medications to a patient
• After care involving contact with blood, body fluids,
secretions and excretions of a patient,
• Immediately after removing gloves and before
moving to another activity
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• Immediately after removing gloves and before
moving to another activity
• When moving from a contaminated body site to
a clean body site during healthcare
• After contact with a patient or items in their
immediate surroundings when leaving,even if
• Patient has not been touched
• Whenever in
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When to perform Hand Hygiene
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“ My Five Moments for Hand Hygiene ”
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Before touching a patient
• WHEN? Clean your hands before touching a
patient
• WHY? To protect the patient against harmful
germs carried on your hands
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protect the patient from harmful organisms carried
on your hands.
Before taking temperature,
blood pressure or pulse
Before making someone
comfortable in bed
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Before clean or aseptic procedure
• WHEN? Clean your hands immediately before
performing a clean or aseptic procedure.
• WHY? To protect the patient against harmful
germs, including the patient's own
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Clean your hands immediately before any
aseptic or clean procedure to protect the
patient against harmful organisms.
Handling dressings or
touching open wounds
Performing invasive
procedures
Prevents the patient’s own
organisms from entering his or
her body.
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After body fluid exposure risk
• WHEN? Clean your hands immediately after
an exposure risk to body fluids (and
after glove removal).
• WHY? To protect yourself and the healthcare
environment from harmful germs of patient
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Clean your hands immediately after an exposure risk to body
fluids (and after glove removal)
Contact with blood,
bodily fluids, non-
intact skin or mucous
membranes,
Removal of gloves Contact with
contaminated items
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After touching a patient
• WHEN? Clean your hands after touching a
patient and patient’s immediatesurroundings.
• WHY? To protect yourself and healthcare
environment from harmful germs from the
patient
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Clean your hands when leaving
the environment after touching
patient.
Shaking hands Transferring Making someone
comfortable in bed
Help protect yourself and the health
care environment from harmful
patient organisms.
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After touching patient surroundings
• WHEN? Clean your hands after touching any
object or furniture in the patient’s
• immediate surroundings– even if patient has
not been touched.
• WHY? To protect yourself and healthcare
environment from harmful germs from
patient.
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Clean your hands when leaving after touching any
object or furniture in the patient’s environment
Contact with room Contact with equipment Contact with wheelchair
or stretcher
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Point-of-care
Place where three elements occur together:
• Patient
• Healthcare provider
• Care or treatment involving patient contact
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• Intact skin is the body‟s first line of defence
against infection
• Careful attention to hand care essential part
of the hand hygiene program
• Dermatitis, cracks, cuts or abrasions can trap
bacteria and compromise hand hygiene
• Dermatitis also increases shedding of skin
squames and, therefore, shedding of bacteria
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• 30% of healthcare providers report
symptoms or signs of dermatitis
• 85% give a history of having skin problems
• promoting skin integrity through providing
good hand hygiene products
• correct techniques for hand hygiene vital for
safety of both healthcare provider and
patients
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Impedements
• Long nails are difficult to clean, can pierce
gloves
• Harbour more microorganisms
• Keep natural nails clean and short nail should
NOT show past end of the finger
• Artificial nails and nail enhancements should
NOT be worn
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• Nail polish or nail polish worn longer than 4
days can harbour microorganisms that are
NOT removed by hand washing, even with
• Nail polish should NOT be worn by those
having direct contact with a patient
• Bare below elbows
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Impedements
• Rings, hand jewellery, bracelets and wrist watches
should not be worn when performing hand hygiene.
• Jewellery, which hides bacteria and viruses
• Rings, which increase the number of microorganisms
present on hands
• Increase risk of tears in gloves
• Eczema, which often starts under a ring as irritants
may be trapped under ring causing irritation
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Hand Hygiene Policies and
Procedures
• indications for hand hygiene
• how to perform hand hygiene
• selection of products used for hand hygiene
• appropriate placement of hand hygiene
products
• management of product dispensing container
• hand care program
• use of ABHR as the preferred method of hand
hygiene
• hand hygiene compliance and feedback
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Sink use
• Hand hygiene sinks shall not be dedicated to
any other purpose
• Sinks used for cleaning equipment or
disposing of any waste fluids of any sort shall
not be used for hand hygiene
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• Hand hygiene sinks shall be constructed of a
non-porous material such as porcelain,
enamel, vitreous china, or 18+ gauge
stainless steel
• Granite and marble are not acceptable
materials for hand hygiene sinks
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• Traps shall be metal, and gaskets shall be
plastic or neoprene only
• Traps shall be 40 mm diameter.
• Overflows shall not be used, as difficulty of
sanitizing them presents an unacceptable
contamination risk.
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Standard
• Wash hands before and after all patient or
specimen contact
• Handle the blood of all patients as potentially
infectious
• Wear gloves for potential contact with blood
and body fluids
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• Prevent needle stick/sharp injuries
• Wear personal protective equipment (PPE)
while handling blood or body fluids
• Handle all linen soiled with blood and/or
body secretion as potentially infectious
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• Wear a mask for TB and other contagious
respiratory infections
• Correctly process instruments and patient
care equipment
• Maintain environmental cleanliness
• Follow proper waste disposal practices
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Let’s Review
5 Moments of Hand Hygiene are:
1. Before initial patient or patient
environment contact
2. Before aseptic or clean procedures
3. After body fluid exposure
4. After contact with patient
5. After contact with patient environment
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Gloves
• Gloves should NOT be used in place of proper
hand hygiene
• Hand hygiene should be performed before
donning gloves and after glove removal
• Dry hands completely before donning gloves
• same pair of gloves should NOT be used for the
care of more than one patient
• Gloves should be removed immediately and
discarded after activity
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• Gloves should be changed or removed when
moving from a contaminated body site to a
clean body site within the same patient
• Gloves should be changed or removed after
touching a contaminated environmental
surface
• Disposable gloves should NOT be washed or
re-used
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• Wear gloves ,contact with blood or
infectious materials, mucous membranes,
non intact skin, potentially contaminated
intact skin
• Disposable medical examination gloves for
providing direct patient care
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General
• Hand Basins -detergent and water
• Lockers - detergent and water as necessary
and after patient discharge.
• Mattresses and Pillows -covered with an
impervious plastic cover
• Wiped over with detergent and water if
visibly contaminated
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• Daily cleaning of mops thoroughly washed in
a bucket
• Containing HOT water and detergent
• Squeeze as much water out of mop as
possible and shake strands loose
• Leave hanging to dry in the sun
• Bucket should be turned upside down to
allow overnight drainage
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• Toilet Brushes Should be rinsed in flushing
water, and stored to dry
• Walls Remove visible soiling with detergent
as necessary
• Clinic Trolleys Clean with a cloth dampened
with detergent and water
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• Bed used by the patient, and other equipment
used for the patient should disinfected before
use for another patient.
• Disinfection procedures should be carried out
daily
• Sheets, pillow cases, and blankets should be
changed on a daily basis and more often if
soiling occurs
• Linen should not be shaken in order to prevent
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What is the single most important reason
for healthcare workers to practice good
hand hygiene?
1. To remove visible soiling from hands
2. To prevent transfer of bacteria from the
home to the hospital
3. To prevent transfer of bacteria from the
hospital to the home
4. To prevent infections that patients
acquire in the hospital
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Healthcare-associated organisms
are commonly resistant to
alcohol.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
5. Strongly disagree
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When a healthcare worker touches a
patient who is COLONIZED, but not
infected with resistant organism
HCW’s hands are a source for
spreading resistant organisms to
other patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
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When a healthcare worker touches a patient
who is COLONIZED, but not infected with
resistant organisms the HCW’s hands are a
source for spreading resistant organisms to
other patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
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Use of artificial nails by
healthcare workers poses no risk
to patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
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Use of artificial nails by
healthcare workers poses no risk
to patients.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
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Glove use for all patient care contacts
is a useful strategy for reducing risk of
transmission of organisms.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
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Glove use for all patient care contacts
is a useful strategy for reducing risk of
transmission of organisms.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
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It is acceptable for healthcare
workers to supply their own lotions to
relieve dryness of hands in the
hospital.
1. Strongly agree
2. Agree
3. Don’t know
4. Disagree
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Hygiene
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Hygiene
Hygiene is healthy habits that include
bathing, keeping the mouth clean, keeping
the skin protected from the sun and washing
hands frequently
• Hygei – Greek
• Industrial revolution – 1750- 1850
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Hygiene and Behavior
• Hygiene is a key factor in reducing risk of
sanitation-related diseases
• Hygiene behavior
• Making behavior changes requires actions
– Information about how and why personal and
community behaviors will reduce disease
transmission risks
– Encouragement to make positive changes in
their hygiene behavior
– Hygiene education is essential to achieve hygiene
behavior change
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UNICEF Hygiene Improvement Framework
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Hygiene Awareness and Promotion
• Focus on behavior change by communicating
key hygiene practices like hand washing
• Encourage children, youth and mothers to be
agents of change in their families and
communities
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Implementation
• Life skills training programs
• Curriculum development
• Integrated sanitation
• Hygiene education in schools
• Maternal and child health education
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Enabling Conditions
• The most obvious enabling condition for
personal hygiene is the availability of water
• However, for behavioral change to occur and
be sustained there is a need to continue
hygiene promotion until the new behavior
has become entrenched
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Hygiene Promotion Key Principles
Target a small number of risk practices
1. Target specific audiences
2. Identify the motives for changed behavior
3. Hygiene messages need to be positive
4. Identify appropriate channels of communication
5. Decide on a cost-effective mix of channels
6. Hygiene promotion needs to be carefully planned,
executed, monitored and evaluated.
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Identifying Behavioral Domains for Hygiene
Five Behavioral Domains
(Boot and Cairncross, 1993)
• Disposal of human faeces
• Use and protection of water sources
• Water and personal hygiene
• Food hygiene
• Domestic and environmental hygiene
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Identifying Behavioral Domains for Hygiene
Personal Hygiene Behaviors:
• Washing of hands / cleaning of nails
• Washing of face
• Body wash / bathing
• Hygiene after defecation
• Washing and use of clothes, towels and
bedding
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Personal Hygiene Measures
(Benenson, 1990)
• Washing hands in soap and water immediately after
fecacation/urination ,always before handling food or eating
• Keeping hands and unclean articles, or articles that have
been used for toilet purposes by others, away from mouth,
nose eyes, ears, genitalia, and wounds
• Avoiding the use of common or unclean eating utensils,
drinking cups, towels, handkerchiefs, combs, hairbrushes
and pipes
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• avoiding exposure of other persons to spray
from the nose and mouth as in coughing,
sneezing, laughing or talking
• washing hands thoroughly after handling a
patient or his/her belongings and
• keeping the body clean by sufficiently frequent
soap and water baths
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School Hygiene Program Strategy
• Striving for a common goal, common purpose, common
policy and common planning
• Focusing child as the key resource
• Focusing schools as the knowledge centre
• Focusing on education for behavior change
• Acknowledging teacher as the facilitator
• Concentrating on result oriented/effective delivery system
• Recognizing - community is an equal partner
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Hygiene Promotion for Children
• Children learn through:
–Helping (e.g., with chores)
–Playing
–Being creative
–Dealing with others (interaction and
communication)
–Playing
–Exercising
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Benefits of School Hygiene and Sanitation
• Effective learning
• Increases enrolment of girls
• Reduces incidence of disease and worm
infections
• Environmental cleanliness
• Implementing children’s rights
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വൊയ വൃത്തിയൊക്കല്
(േല്ലുപതപ്പും)
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വൊയ ഴു ല്
എപപ്പൊകഴൊകക്ക
• ഭക്ഷണും
കഴിഞ്ഞമ ഷും
• പല്ലുമതപ്പിമനോടെോ
പ്പും
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വൊയ ഴു ല്
• നല്ല കവള്ളം ക ൊണ്ട് ആദ്യം
ഴു ു
• തുപ്പിയപേഷം
വിരല്ുക ൊണ്ട് േല്ലു ള്
പതക്കു
• കവള്ളം ക ൊണ്ട് വീണ്ടും
ുല്ുക്കുഴിയു
• ൊർക്കിച്ചുതുപ്പിയപേഷം
വീണ്ടും കവള്ളം ക ൊണ്ട്
ഴു ു
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േല്ലുപതപ്പ്
• ദ്ിവപേന 2പ്േൊവേയകെങ്കില്ും
• െൃദ്ുവൊയ പ്രഷ് െൊപ്തം
ഉേപയൊഗിക്കു
• ഉരുണ്ട പ്രിേില്ു ള്, വല്ുപ്പം
ുറഞ്ഞ തല്ഭൊഗം
• പ്രഷ് 3-4െൊേം ൂടുപപൊള്
െൊറ്റു
• പ്രഷ് ഴു ി വൃത്തിയൊക്കി
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• ടൂത്ത്പേസ്റ്റ് - ഫ്ളൂററഡ്
അടങ്ങിയത്
• േല്കപ്പൊടി -
ആയുർപവദ്ീയം
പ രളീയം
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• പ്രഷ്
ഉേപയൊഗിക്കുപപൊള്
പേസ്റ്റിൻകറ അളവില്
പ്േദ്ധിക്കു
Pea-sized amount of fluoride toothpaste
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പ്രഷ് ഉേപയൊഗിച്ച്
േല്ല് പതക്കുന്ന രീതി
• പെപല്യും തൊപഴയും
• െുന്നില് നിന്ന്
േുറ ിപല്ക്ക്
• അ വും േുറവും
• വട്ടത്തില് വട്ടത്തില്
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െറക്കൊതിരിക്കു
ഇടക്കികട ഭക്ഷണം
ഴിക്കുന്നകതൊഴിവൊക്കു
ആപരൊഗയ രെൊയ ഭക്ഷണം േീല്െൊക്കു
217
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െുഖം ഴു ല്
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എപപ്പൊകഴൊകക്ക?
േല്ലുപതപ്പിനുപേഷം
ഭക്ഷണത്തിനുപേഷം
ുളിക്കുപപൊള്
എകപ്പൊകഴൊകക്ക െുഖം െല്ീെേെൊ ുകപൊള്
219
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എങ്ങികന?
• റ ഴു ു
• െുപപൊട്ട് ുനിയു
• ഇളംചൂടുള്ളുപതൊ തണുത്തപതൊ ആയ
കവള്ളം ക ൊണ്ട് െുഖവും ഴുത്തും
നനക്കു
• അധി ം ൊരെില്ലൊത്ത പേൊപ്പ് പതക്കു
• ണ്ണു ളില് പേൊപ്പൊ ൊകത പ്േദ്ധിക്കു
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• 10കേക്കണ്ട് പനരപത്തൊളം രണ്ട്
റ ളിപല്യും നടുവിരല്ു ളും
ചൂണ്ടൊണിവിരല്ു ളും ഉേപയൊഗിച്ച്
പതക്കു
• 10കേക്കണ്ട് പനരപത്തൊളം വിളു ളും
പതക്കു
• 5കേക്കണ്ട് പനരപത്തൊളം തൊടിയും െൂക്കും
പതക്കു
• 10കേക്കണ്ട് പനരപത്തൊളം റ ള്ക ൊണ്ട്
ഴുത്തിന്കറ എതിർവേം പതക്കു
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• ണ്ണു ള് അടച്ചപേഷം
ചൂണ്ടൊണിവിരല്ുക ൊണ്ട് ണപേൊള ള്
5കേക്കണ്ട് പനരം പതക്കു
• രണ്ടുറ യും ക ൊണ്ട് െുഖവും ഴുത്തും
ഴു ു
• റ ഴു ിയ പേഷം പേപ്പർ ടവ്വല്
ക ൊണ്ട് െുഖവും ഴുത്തും തുടക്കു
• ടൊപ്പ് അടക്കുപപൊള് പനരിട്ടുള്ള സ്േർേം
ഒഴിവൊക്കു
• വീണ്ടും ഉണങ്ങിയ ടവ്വല് ക ൊണ്ട് െുഖവും
ഴുത്തും തുടക്കു
222
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• right time
• right way
224
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225
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ുളി - വിവിധതരം
• പെല്ു ഴു ല് - 2പനരം - ൊല്ത്തും
(േല്ലുപതപ്പിനും കേൌചത്തിനും പേഷം),
റവ ീട്ടും (സ് ൂളില്നിന്നും വന്ന്
വിയർപ്പൊറിയപേഷം) [ഉച്ചക്കുെൊ ൊം]
• തല് ുളി - ൊല്ത്ത്
• എണ്ണപതച്ചു ുളി - ൊല്ത്ത്
പെല്ു ഴു ൊന് ഇളംചൂടുകവള്ളവും തല്ക്ക്
ചൂടൊറിയതും ഉേപയൊഗിക്കണം
226
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ുളി - േൊെൊനയരീതി
• എണ്ണ പെകല്ല്ലൊം പതച്ചപേഷം
10െിനുട്ട് പനരം ഴിപഞ്ഞ
ുളിക്കൊവൂ
• കവളികച്ചണ്ണപയൊ നകല്ലണ്ണപയൊ
ഒല്ീവ്ഓയിപല്ൊ
ഉേപയൊഗിക്കൊം
• േരീരം കവള്ളം നനച്ചപേഷം
പേൊപ്പ് പതക്കു
227
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• എണ്ണകെഴുക്ക് ളയൊൻ
കചറുേയറുകേൊടി
• പേൊപ്പ് അധി ം
ൊരെില്ലൊത്തത്
തിരകഞ്ഞടുക്കു
• ഇഞ്ചപയൊ ഉരയില്ലൊത്ത പ്രപഷൊ
ഉേപയൊഗിക്കൊം
228
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 അധി ം ഉരയില്ലൊത്ത ഉണങ്ങിയ
പതൊർത്തുേപയൊഗിച്ച് േരീരം (തല്യും)
തുടച്ച് വൃത്തിയൊക്കു
 നിറു യില് ഒരു നുളള്
രൊസ്നൊദ്ിചൂർണ്ണം തിരുമ്മു
229
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തല്െുടിയും നഖങ്ങളും
• തല്െുടി ചീ ുന്നതിനു
െുപൊയി ഉണങ്ങികയന്ന്
ഉറപ്പ് വരുത്തു
• ഉണങ്ങിയ െുടി
ചീ ുന്നതിനുെുപൊയി
ആവേയകെങ്കില് േവല്േം
എണ്ണ പതക്കൊം
230
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തല്െുടിയും നഖങ്ങളും
• പ്േപതയ ം ടവ്വല്/പതൊർത്ത്,
ചീർപ്പ് ഉേപയൊഗിക്കു
• െുടി ഒതുങ്ങിനില്ക്കുന്ന
രീതിയില്
ചീ ി/ക ട്ടിവയ്ക്ക്കു
231
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നഖങ്ങള്
• 15ദ്ിവേം ൂടുപപൊകളൊരിക്കപല്ൊ,
അധി െൊയി നഖങ്ങള് വളർന്നൊപല്ൊ
കവട്ടണം
• 3-4ദ്ിവേം ൂടുപപൊള് നഖങ്ങളുകട
ആ ൃതി േരികപ്പടുത്തു
• വല്പത്ത യ്യികല് നഖങ്ങളില്
കനയില് പേൊളിഷ് ഉേപയൊഗിക്കരുത്
232
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വസ്പ്തധൊരണം
• വൃത്തിയുള്ള വസ്പ്തം ധരിക്കു
• ഴു ിയുണക്കിയ വസ്പ്തം തകന്ന
ധരിക്കു
• യൂണിപ ൊം ദ്ിവപേന െൊറ്റു
• അടിവസ്പ്തങ്ങള് ദ്ിവപേന
രണ്ടുതവണ െൊറ്റണം
233
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വസ്പ്തധൊരണം
• ീറിയ വസ്പ്തം ഒഴിവൊക്കു
(അകല്ലങ്കില് തുന്നിയപേഷം െൊപ്തം
ഉേപയൊഗിക്കു )
• േരീരത്തിനു െുറിവുണ്ടൊക്കൊൻ
േൊദ്ധയതയുള്ള (െൂർച്ചയുള്ള/തറക്കുന്ന)
േിൻ തുടങ്ങിയവ ഒഴിവൊക്കു
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Five Fallacies - Hygiene Promotion
• Behaviour change is easy
• Knowledge change=behaviour change
• Experts know how to change behavior
• A whole variety of hygiene practices should be
encouraged
• Hygiene promotion is a cheap add-on to water
programmes
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• Over 160,000 Metric Tons (MT) of
municipal solid waste is generated
daily in the country
• Per capita waste generation in cities varies
from 0.2 kg to 0.6 kg per day
• Estimated to increase at 1.33% annually
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• 1,400 km2 of land, which is equivalent
• 2047 size of city - Delhi
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• Over 8 million tons/year of hazardous
waste is generated
• 60% of these wastes, 4.8 milliontons/year
recyclable
• 3.2 million tons/year is non-recyclable
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Biomedical Waste(BMW)
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DEFINITION
Waste generated in diagnosis, treatment or
immunization of human beings or animals, in
research or in the production or testing of biological
products including all categories of infected and toxic
waste that is potential threat to human beings and
environment
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How BMW generated?
• Diagnosis
• Treatment
• Immunization
• Biomedical research
• Production & testing of biological products
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HEALTH HAZARDS
• Diseases
TB,Hepatitis B/C, Tetanus,etc
• Pollution
Soil,water,air
• Increase in green house gases
• Public sensitivity 246
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1. Classification of biomedical waste into categories
2. Colour coding & type of containers
3. Proforma of label used on container/bag
4. Proforma of label for transport of waste
container/bag
5. Standards for treatment & disposal
6. Deadlines for creation of waste treatment facilities247
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CATEGORIES
1.Human anatomical waste
2.Animal Waste
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3.Microbiology & Biotechnology waste
4.Waste sharp
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• 5.Discarded medicine & cytotoxic medicine
• 6.Solid waste (Cotton,dressing plaster etc)
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7.Solid waste (Catheters,Intravenous set etc)
8.Liquid waste
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9.Incineration ash
10.Chemical waste
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Steps in Management
• Generation
• Segregation
• Transport
• Storage
• Treatment
• Disposal
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Generation
• Source/point of generation
• Generator
Doctor
Nurse
Technician
Others
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Segregation
• Process of segregation of diff types of waste
as per treatment & disposal.
• Generator is responsible
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Transport
• Site of generation to site of treatment & disposal
• 2 type:-
Intramural transport : Generation site - temp
storage
Extramural transport : Temp storage - final trtmnt
& disposal
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Storage
• Storing waste before it is sent for final
treatment or disposal
• In hospital/ outside hospital
• Max period : 48 hrs
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Treatment of BMW
• Thermal
• Mechanical
• Chemical
• Irradiation
• Biological
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• Human anatomical waste
Body parts, organs
• Animal waste
Researches
Gomutra,Ajamamsa- vasti
Jalouka
WASTES IN AYURVEDA HOSPITALS
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• Microbiology & biotechnology waste
Laboratory -blood, sputum
• Waste sharp
Needles for siraveda, prachana
Probe, panchaloha shalaka
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• Discarded medicine
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• Solid waste (Cotton,dressing plaster)
Cotton,gauze,ksharasootra,
bandages,gloves
• Solid waste (Catheters,Intravenous set)
Catheters, glycerine syringe,vastinetra
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• Liquid waste
Medicines -asava,arishta,grita,taila etc
Avagaha,Kayaseka
Blood from siraveda
Waste water from kitchen ,bathroom
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• Incineration ash
Incinerator
• Chemical waste
Disinfectants, insecticides
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UNIQUE WASTES
• Kizhi – CPS,PPS,JPS,SPS
• Churna – Kashaya, Upanaha, Udwartana
• Taila – Pizhichil, Dhara
• Other medicated liquids
Dhanyamla.arishta, asavas
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• Sewage
• Incineration
• Land fill
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Biogas plant
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• Treating capacity – 800kg
• Food and toilet waste
• Avoid lemon, oninon, egg shell
• Methane production – 40m3
• Preparation – Food and Kashayam
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Effluent Treatment Plant
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ETP
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• Treated water
• Flushing
• Cleaning
• Herbal garden
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Thanks
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sanitation,waste management

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