ENVIRONMENTAL HEALTH AND SANITATION

Environmental Health is a branch of public health that deals with the study of preventing illnesses by
managing the environment and changing peoples behavior to reduce exposure to biological and non-biological agents
of disease and injury

MAN
Manipulated

DISEASE AGENT

ENVIRONMENT

Fig. 1: Man Disease Agent Environmental Triad

In the Man-Disease Agent- Environment link, man by manipulating his environment is able to prevent
contracting disease by blocking agents from entering his body.
MAN-DISEASE AGENT- ENVIRONMENT TRIAD

MAN
3. Increase mans
immunity or resistance
to disease agents

1. Change peoples
behavior

DISEASE AGENT

ENVIRONMENT
2. Prevent production of
disease agents

The first strategy on changing peoples behavior is best exemplified by the peoples use of food safety practice.

FIRST STRATEGY
Food safety practices

Ingestion of clean food

and drinking water

Prevention of
disease

SECOND STRATEGY
Treatment of
wastewater

Uncontaminated
groundwater table in
the environment

Safe and clean

drinking water
available

THIRD STRATEGY

Measles
immunization in
the community

Children in the
community with
resistance against
Measles

Herd immunity
among children
in the
community

What is Environmental Sanitation?

Environmental Sanitation is defined as the study of all factors in mans physical environment, which may exercise
a deleterious effect on his health well-being and survival.
The Environmental and Occupational Health Office (EOHO), under the National Center for Disease Prevention
and Control Program of the Department of Health is responsible for the promotion of healthy environmental conditions
and prevention of environmental related diseases through appropriate sanitation strategies

Health and Sanitation

The Department of Health, through the EOHO, has authority to act on all issues and concerns in environment and
health including the very comprehensive Sanitation Code of the Philippines (PD 856, 1978). However, the
implementation of the environmental health and sanitation programs need to be standardized and intensified coupled
with police power to attain a better quality of life towards the end of the century.

1. WATER SUPPLY SANITATION PROGRAM

POLICIES:
A. APPROVED TYPES OF WATER SUPPLY FACILITIES
LEVEL 1 (POINT SOURCE) - A protected well or a developed spring with an outlet but without a distribution
system, generally adaptable for rural areas where the house are thinly scattered. A level 1 facility normally
serves around 15 to 25 households and its outreach must not be more than 250 meters from the farthest
user. The yield or discharge is generally from 40 to 140 liters per minute.
LEVEL 2 (COMMUNAL FAUCET SYSTEM or STAND SYSTEM) a system composed of a source a reservoir, a
piped distribution network and communal faucets, located at not more than 25 meters from the farthest
house. The system is designed to deliver 40-80 liters of water per capital per day to an average of 100
households. Generally suitable for rural areas where houses are clustered densely to justify a simple piped
system.
LEVEL 3 (WATERWORKS SYSTEM OR INDIVIDUAL HOUSE CONNECTIONS) a system with a source, a
reservoir, a piped distributor network and household taps . iit is generally suited for densely populated
urban areas. This type of facility requires a minim treatment or disinfection.
B. UNAPPROVED TYPE OF WATER FACILITY
Water coming from doubtful sources such as open dug wells, unimproved springs, wells that need priming and
the like shall not be allowed for drinking water unless treated through proper container disinfection. The
community must exert effort to convert to approve of water supply facility.
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C. ACCESS TO SAFE AND POTABLE DRINKING WATER

All households shall be provided with safe and adequate water supply.
D. WATER QUALITY AND MONITORING SURVEILLANCE
Every municipality through its rural health units must formulate an operational plan for quality and
monitoring surveillance every year.
The examination of drinking water shall be performed only in private or government laboratories duly
accredited by the Department of Health.
Certification of portability of an existing water source is issued by the secretary of health or his duly
authorized representative (local health authority).
Disinfections of water supply sources is required on the following:
Newly constructed water supply facilities.
Water supply facility that has been repaired/improved.
Water supply sources found to be positive bacteriologically by laboratory analysis.
Container disinfection of drinking water collected from a water facility that is subject to
recontamination like open dug wells, unimproved springs and surface water.
E. WATERWORKS/WATER SYSTEM AND WELL CONSTRUCTION
Well sites shall require the prior approval of the secretary of health or his duly authorized
representative.
Well construction shall comply with sanitary requirements of the department of health.
Water supply system shall supply safe and potable water in adequate quantity.
Water shall be made readily available to consumers/users preferably through water piped direct to
homes to minimize contamination and encourage personal and home sanitation.
Adequate pressure and volume shall be provided in the water system distribution line. Where low
water pressures prevail in any section of the distribution systems, no booster pump shall be allowed
to boost water from water distribution pipe.

2. PROPER EXCRETA DISPOSAL PROGRAM

POLICIES:
APPROVED TYPES OF TOILET FACILITIES
LEVEL 1- Non-water carriage toilet facility- no water is necessary to wash the waste into the receiving space.
Examples are pit latrines, reed odorless earth closet.
Toilet facilities requiring small amount of water to wash the waste into the receiving space. Examples- pour
flush toilet and aqua privies.
LEVEL 2 - on site toilet facilities of the water carriage type with water sealed and flush type with septic
vault/tank disposal facilities.
LEVEL 3 water carriage types of toilet facilities connected to septic tanks and/or to sewage system to
treatment plant.
o In rural areas, the blind drainage type of wastewater collection and disposal facility shall continue to
be the emphasis until such time that sewer facilities and off-site treatment facilities shall be made
available to clustered houses in rural areas .
o Conventional sewerage facilities are to be promoted for construction in poblacions and cities in the
country as developmental objectives to attain control and prevention of fecal-water-borne diseases.
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3. SOLID WASTE MANAGEMENT

Classification of Wastes according to their Effects on Human Health and the Environment

Hazardous wastes- Substances unsafe to use commercially, industrially, agriculturally, or economically that are
shipped, transported to or brought from the country of origin for dumping or disposal in, or in transit through,
any part of the territory of the Philippines

Non-hazardous - Substances safe to use commercially, industrially, agriculturally, or economically that are
shipped, transported to or brought from the country of origin for dumping or disposal in, or in transit through,
any part of the territory of the Philippines

DISPOSAL METHODS:

Sanitary Landfill- the disposal of waste material or refuse by burying it in natural or excavated holes or
depressions
Incinerator- refuse is burned on moving grates in refractory-lined chambers; combustible gases and the solids
they carry are burned in secondary chambers.
Composting- preparing refuse and degrading organic matter by aerobic microorganisms

SOLID WASTE MANAGEMENT LAW

RA 6969 (Toxic Substances and Hazardous and Nuclear Waste control Act of 1990) regulating the importation,
use, movement, treatment and disposal of toxic chemicals and hazardous and nuclear waste in the Philippines
RA 9003 (Ecological Solid Waste Management Act of 200)-adoption of systematic, comprehensive, and
ecological solid waste management program as the policy of State; adopts community based approach;
mandates diversion through composting and recycling.

MEASURES TO ACHIEVE WASTE MINIMIZATION

Reduction of Source
Recycling
Reuse
Segregation of waste
HOSPITAL WASTE MANAGEMENT PROGRAM
Policies:
All newly constructed/authorized existing government and private hospitals shall prepare and implement a
Hospital Waste Management Program (HWM) as a requirement for registration/ renewal of license.
The use of appropriate technology and indigenous materials for HMW shall be adopted.
Training of hospital personnel involved in waste management shall be an essential part of hospital training
program.
Public information campaign on health and environmental hazards arising from mismanagement of hospital
shall be the responsibility of hospital administration.
DOH HWM guidelines/policies shall be guided by existing legislative health and environmental law policies on
waste management. However, the passage of RA 8949 Clean air Act of 1999 it is now unlawful to use
incinerators in hospitals and LGUs garbage disposal.
Local ordinance regarding the collection and disposal techniques shall be institutionalized.
HOSPITAL WASTE CLASSIFICATION
General Waste
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Infectious Waste
Pathological Waste includes tissues, body organs, human fetus, blood and body fluids
Sharps
Pharmaceutical Waste- spilt, expired, or contaminated vaccines, pharmaceutical products, sera
Genotoxic Waste
Chemical Waste
Pressurized containers
Waste with high content of heavy metal

NURSING RESPONSIBILITIES AND DUTIES

Health Education
Actively Participate in the training component of service like attending workshops related to environmental
health.
Assist in deworming activities for school children and targeted groups.
Effective and efficiently coordinate programs/project/activities with other government and non-government
agencies.
Act as an advocate or facilitator to families in the community in matters of program/activities on environmental
health in coordination with RHU.
Actively participate in environmental sanitation campaigns and projects in the community.
Be a role model for others in the community to emulate in terms of cleanliness in the home and surrounding.
Participate in research/studies to be conducted in their respective area of assignment
Help in interpretation and implementation of PD 856 Sanitation Code of the Philippines
Assist in disaster management which will be all be implemented at all activites.

4. VECTOR CONTROL
Vector
is an organism which transmits a pathogen or disease-causing agent from one host to another.
Arthropods
Arthropods form a major group of disease vectors with mosquitoes, flies, sand flies, lice, fleas, ticks and mites
transmitting a huge number of diseases.
Vector control
is any method to limit or eradicate the mammals, birds, insects or other arthropods which transmit disease
pathogens. The most frequent type of vector control is mosquito control using a variety of strategies.
Methods
Habitat Control
Removing or reducing areas where vectors can easily breed can help limit population growth. For example,
stagnant water removal, destruction of old tires and cans which serve as mosquito breeding environments and
good management of used water can reduce areas of excessive vector incidence.
Reducing Contact
Limiting exposure to insects or animals that are known disease vectors can reduce infection risks significantly.
For example, bed nets, window screens on homes, or protective clothing can help reduce the likelihood contact
with vectors.
Chemical Control
Insecticides, larvicides, rodenticides, Lethal ovitraps and repellents can be used to control vectors. For example,
larvicides can be used in mosquito breeding zones; insecticides can be applied to house walls or bed nets, and
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use of personal repellents can reduce incidence of insect bites and thus infection. The use of pesticides for
vector control is promoted by the World Health Organization (WHO) and has proven to be highly effective.
Biological Control
The use of natural vector predators, such as bacterial toxins or botanical compounds, can help control vector
populations. Using fish that eat mosquito larvae or reducing breeding rates by introducing sterilized male tsetse
flies have been shown to control vector populations and reduce infection risks.
DOH VECTOR CONTROL PROGRAM
Dengue Awareness Month (June) with its theme:
Stop, Look, Listen. Aksyon Barangay Kontra Dengue, Pagtibayin!. Sugpuin ang Dengue, Mag 4 oclock Habit.
At 4pm, we have to STOP, and then LOOK which means we have to search and destroy for the possible
breeding places of mosquitoes outside and inside our homes, and lastly LISTEN to local authorities, community
leaders, or work supervisors on the ways of how to eradicate mosquitoes in the community.
This can be done on a daily basis, or at least on a weekly basis based on institutional capacity and prevailing
resources.

5. FOOD SANITATION PROGRAM

Food sanitation is the practice of following certain rules and procedures to prevent the contamination of
food, keeping it safe to eat. Many jurisdictions around the world have specific food sanitation laws, along
with lists of regulations created by public health agencies. The practice of food sanitation is recommended at
every step of the supply chain within the food industry, from workers in crop fields to waiters at restaurants.
The term "food sanitation" typically refers to rules and procedures within the food industry, whether during
production, packaging, transporting or serving. At the consumer level, such as in a home kitchen, practices
designed to ensure that food is uncontaminated and safe to eat are often referred to using the term "food
hygiene."
Food Safety Issues
From the moment that food is produced or harvested to the time that it is eaten, it is vulnerable to contamination
from bacteria and other substances that could be harmful. The key to food sanitation is keeping food safe and
clean, with all of its handlers complying with the necessary rules and recommendations. These rules concern
things such as safe holding temperatures for the food; safe cooking temperatures; sterilization of cutting
boards and other implements; proper attire for handlers, such as gloves and breathing masks; and times or
dates by which the food should be eaten, served or sold.

Policies:
FOOD ESTABLISHMENTS shall be appraised as to the following sanitary conditions:
Inspection/approval of all food sources, containers, transport vehicles.
Compliance to sanitary permit requirements for all food establishments.
Provision of updated health certificate for food handlers, cooks and cook helpers which include monitoring as
to presence of intestinal parasites (ascaris, amoeba, etc.) and bacterial infection (typhoid, cholera, dysentery,
salmonella infections and others)
DOHs administrative order no. 1 2006 requires all laboratories to use formalin ether concentration technique
(FECT) instead of food handlers. This will enable laboratories to identify food handlers with parasitic infestations
and treat them before they are allowed to work in food establishment. In this way, parasitism will be prevented
from spreading through ingestion of contaminated food and water.
Destruction or banning of food unfit for human consumption.
Training of food handlers and operators on sanitation.
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Ambulant food vendors shall comply with the requirements as to the issuance of health certificate which also
include monitoring the presence of intestinal parasite and bacterial infection.
Household food sanitation are to be promoted and monitored and food hygiene education to be intensified
through health education and provision of IEC materials.

FOUR rights in food safety:

1. Right source:

Always buy fresh meat, fish, fruits and vegetables.

Always look at the expiry dates of processed food and avoid buying the expired ones.

Avoid buying canned foods with dents, bulges, deformation, broken seals, and improper seems.

Use water only from clean source, boil water for atleast 2 minutes (running boiling)
2. Right preparation:
Avoid contact between raw foods and cooked foods
Always buy pasteurized milk and fruit juices
Wash vegetables well if to be eaten raw such as lettuce, cucumber, tomatoes and carrots
Always wash hands and kitchen utensils before and after preparing food
Sweep kitchen floors to remove food droppings to prevent the harbor of rats & insects
3. Right cooking:
Cook food thoroughly and ensure that the temperature on all parts of the food should reach 70
degrees centigrade
Eat cooked food immediately
Wash hands thoroughly before and after eating
4. Right storage:
All cooked foods should be left at room temperature for not more than two hours to prevent
multiplication of bacteria.
Store cooked foods carefully. Be sure to use tightly sealed containers for storing food.
Be sure to store food under hot conditions (at least or above 60 degrees centigrade) or in cold
conditions (below or equal to 10 degrees centigrade) this is vital if you plan to store food for more than
4 to 5 hours. Microbial organisms easily multiply within the 10-60 degrees centigrade temperature.
Foods for infants should always be freshly prepared and not to be stored at all
Do not overburden the refrigerator by filling it with too large quantities of warm food
Reheat stored food before eating. Food should be reheated to at least 70 degrees centigrade.
RULE IN FOOD SAFETY: WHEN IN DOUBT, THROW IT OUT!

6. AIR POLLUTION
is the introduction of particulates, biological materials, or other harmful materials into the Earth's atmosphere,
possibly causing disease, death to humans, damage to other living organisms such as food crops, or
the natural or built environment.
The Philippine Clean Air Act

Republic Act 8749, or the Clean Air Act of 1999

It focuses primarily on pollution prevention rather than on control by encouraging cooperation
and self-regulation among citizens and industries.
It also enforces a system of accountability for adverse environmental impacts to heighten
compliance to government environmental regulations.
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The Clean Air Act is primarily implemented by the Departments of Environment and Natural
Resources (DENR), Transportation and Communication (DOTC), Trade and Industry (DTI), Energy
(DOE), and local government units.

Section 11. Air Quality Control Techniques - Such information shall include:

Best available technology and alternative methods of prevention, management and control of
air pollution
Best available technology economically achievable which shall refer to the technological
basis/standards for emission limits applicable to existing, direct industrial emitters of nonconventional and toxic pollutants; and
Alternative fuels, processes and operating methods which will result in the elimination or
significant reduction of emissions such as aromatics, benzene levelsin unleaded gasoline.
Key activities of PCA:
o PCA undertakes capacity building activities for its members by organizing and disseminating
opportunities for, and/or facilitating their participation in air quality trainings and workshops;
o PCA partners with government and other sectors in the implementation and enforcement of air quality
and transport policies.
o For 2012-2014, PCA is involved in Promotion of Electric Vehicles and Non-Motorized Forms of Mobility,
Tricycle Upgrading, and Anti-Smoke Belching Campaigns.
Simple ways for prevention of air pollution:
Walk or ride a bicycle.
Choose Air-Friendly Products. Many products you use in your home, in the yard, or at the office are made with
smog-forming chemicals that escape into the air. Here are a few ways to put a lid on products that pollute:
o Select products that are water-based or have low amounts of volatile organic compounds (VOCs).
o Use water-based paints. Look for paints labelled "zero-VOC.". Paint with a brush, not a sprayer.
Turn off the lights when you leave a room.
Use a fan instead of air conditioning.
Choose products with recyclable packaging; Reuse paper bags; Recycle paper, plastics, and metals.
Don't smoke.
Products such as cleaning agents, paints, and glues often contain harmful chemicals. Use them outdoors or with
plenty of ventilation indoors.
Use safer products, such as baking soda instead of harsher chemical cleaners.

7. PROPER HOUSING
It is well recognized that good quality homes are important for the health and well-being of those living in them.
Under the standard a Decent Home is one which is warm, weatherproof and which has reasonably modern facilities.
Such homes are a key element in developing thriving, sustainable communities where crime is reduced and where
employment and educational opportunities are improved.
Toolkit
The toolkit provides a method of measuring and showing the value of private sector housing intervention to health,
society and quality of life. It enables users to find a baseline and work out the most effective and cost efficient
methods of improving homes.

Republic Act No. 7279

"Urban Development and Housing Act of 1992"
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AN ACT TO PROVIDE FOR A COMPREHENSIVE AND CONTINUING URBAN DEVELOPMENT AND HOUSING
PROGRAM, ESTABLISH THE MECHANISM FOR ITS IMPLEMENTATION, AND FOR OTHER PURPOSES.
Public Health Inspectors inspect rental houses, apartments, hotels, and other types of accommodations to
determine whether these places are satisfactory and free from health hazards.
Tenants may expect that several basic necessities be provided with most lodgings, including, but not limited to:
Plumbing and heating systems that work properly
Windows and doors that fit and close properly & securely
Homes that are resistant to the elements and moisture damage
Homes that are free from the infestation of pests that can transmit disease
Floors, walls and surfaces that can be cleaned and kept clean
Safe means of egress in case of emergency
Safe indoor air
Owners' Responsibilities
Owners and property managers of rental premises have the responsibility to provide these basic necessities, and
are required to ensure that the premises are properly maintained. They must ensure that the housing units are in
compliance with all sections of the Dwellings and Buildings Regulation on an ongoing basis.
The health impact of poor housing
Evidence suggests that living in poor housing can lead to an increased risk of cardiovascular and respiratory
disease as well as to anxiety and depression. Problems such as damp, mould, excess cold and structural defects which
increase the risk of an accident also present hazards to health.
People spend most of their time at home, work, or school. Some of these environments may expose people to:
Indoor air pollution
Inadequate heating and sanitation
Structural problems
Electrical and fire hazards
Lead-based paint hazards
REFERENCES:
Public Health Nursing In The Philippines,10th Edition, 2007, National League of Philippine Government Nurses, Inc.
http://www.denr.gov.ph/news-and-features/features/29-the-philippine-clean-air-act-eleven-years-of-partnershipsfor-cleaner-healthier-air.html
http://www.pdhre.org/materials/learning4.html
http://www.wisegeek.com/what-is-food-sanitation.htm

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