prevmed 2 test review Flashcards
define distillation
process of distilling plant forms including evaporation and condensation
what is FAC
Free Available Chlorine
Chlorine available in the form of hypochlorous acid and hypochlorite ions
which is the test to detect coliform and e. coli in potable water
**EPA approved **
colilert and colisure
harmless bacteria that live in soil, water as well as guts of animals
total coliform
fecal coliform found in the intestines in animals and humans
e coli
who is responsible for the shipboard potable water system including treatment facilities and process to assure safe drinking water is available
Design, construct, maintain
NAVSEASYSCOM
who promulgates instructions for ship to shore potable water connections and for providing potable water from approved source when ship is at a naval facility
NAVFACENGCOM
what is the CO responsibilities for potable water surveillance
water sanitation bill
procedures for receipt, transfer, treatment, storage, distribution and surveillance
how many gallons per man per day for new ship construction
50 gal per man per day
what are water hours per man per day
no less than 2 gal per man per day
what type of water does marine sanitation devices use
sea water
types of water distillation
steam
waste heat
vapor compression
type of distillation uses electrical energy
vapor compression
type of distillation uses diesel engine jacket water
waste heat
types of reverse osmosis (RO) and what additional testing is required per pass
single- additional disinfection (chlorination or brominating)
Triple- none. better than distilled
what standard must potable water tank coating meet
NSF and ANSI
what do vents and over flow lines do
reduce accidental contamination
how must sounding tubes be labeled
“POTABLE WATER USE ONLY”
what color coded are filling lines and specifications
dark blue
18inch from deck
turned facing downward
screw caps w/ keeper chains
potable water hose lockers must be
vermin proof
locked
18 in off deck
printed step by step instructions for disinfection of hoses and risers
how are potable water hoses marked and labeled
“POTABLE WATER ONLY” 1inch high letters every 10 feet
what color are valves or valve handles
dark blue
potable water connections between shore and ship must be made or supervised by whom
authorized shore station personnel or properly trained ship personnel/ engineers
what’s the minimum halogen residual requirement when water from doubtful quality
2.0ppm
why is bacteriological testing conducted
ensure fitness for human consumption
to asses adequacy of disinfection process
what the frequency of monitoring for microbiological quality
weekly
when collecting WATER samples what are the required locations #S
400 or less-=4
400-800= 8
800 or more= 12
1/4 ice machines and ships potable water tanks (25% DUMBY)
halogen testing what is tested under DPD1 and DPD 4
DPD1 -FAC and TBR
DPD 4- chloramines
what is used to measure halogen testing? accuracy %?
color comparator =or - 10%
portable spectophotometer= + or - 2%
what are the sources of contamination
cross connections leaks in bulk heads leaks non-potable piping Improper disposal of chemical liquid potable water hoses used for non potable liquids excessive storage in water tanks contaminated raw water source inadequate disinfection transfer of water from shore barges and many more
what is the least desirable method of water disinfection and which is the disinfection of choice
least= Manual chloride disinfection (batch method) choice= calcium hypochlorite (HTH)
what are the halogen residual minimum measurements from an approved source? unapproved source?
Approved= 0.2ppm FAC/TBR after 30 min
unapproved= 2.0 ppm FAC/TBR after 30 min
during chlorine dose calculation one ounce of HTH per 5000 gallons of water equals how many ppm FAC
1.0ppm FAC
if brominator can not achieve a TBR of 2.0 ppm water must be chlorinated by what method
batch method
explain disinfection method 1
fill tank to over flow level add chlorine to achieve 10ppm FAC hold for 24 hours drain tank refill tank w/ potable water bacteriological test neg use water
explain disinfection method 2
spray applied directly 200ppm FAC to all tank surfaces
flush pipes with 10ppm FAC
disinfected surface should remain in contact w/ chlorine solution for
30 minutes
refill tank w/ potable water
bacteriological test
neg use water
describe “method 3” of disinfecting potable water tanks
FILL 5% TANK VOLUME W/ 50PPM FAC SOLUTION
hold solution for 6 hours
add potable water to chlorine solution to fill tank; hold for 24 hours
drain tank
refill tank w/ potable water w/ required halogen residual level
bacteriological test
negative use water
what are the 2 methods for controlling and identifying the source of taste and odor issues if problem cannot be identified first?
chlorination and steam methods
describe chlorination method for taste/odor issues
chlorinate to 5ppm FAC
distribute @ 2 ppm FAC
describe the steam method for taste/odor issues
requires NAVSEASYSCOM approval
boil sample water for 1 minute to ensure proper effect
if resolved then steam may be feasible
not resolved then steam wont work
What is the strength % of HTH? How many ounce bottles? Where and how is it stored?
65-70%
6 ounce bottles
Metal box w/ 3 ¼ inch holes drilled in box to release chlorine
No more than 48 bottles
Labeled “Hazardous material, calcium hypochlorite”
Water sanitation bill should consist of what?
Connection procedures (ship to shore) (ship to ship)
Potable water hoses
Storage tanks
Disinfection procedures
Halogen residual, bacteriological , temperature, pH, and salinity testing
Disinfection of tanks and distribution system
Distribution system
Records
How long with the MDR maintain a potable water log?
2 years
MDR responsibilities for prevention of wastewater hazards
conduct visual inspections of marine sanitation devices quarterly
indoctrination and periodic training concerning potential health hazards associated with human waste
on-site advice when requested in event of major sewages leaks or spills
must be present during clean-ups and disinfection operations involving food service spaces, living spaces, and medical spaces
what does CHT stand for
collection hold and transfer system
what are the there modes of CHT systems
restricted waters
at sea
in port
what is the most common marine sanitation device?
Type II B marine sanitation device
what poses the greatest danger to ship and personnel regarding CHT and wastewater
Hydrogen Sulfate (H2S) which can become explosive if not aerated
must be aerated when held in tanks larger than 2000 gallons must
be aerated
define EEBD. how long are EEBDs good for and where should they be kept
Emergency Escape breathing Device
10 minutes
pump rooms must have them
what are gases associated with CHT
hydrogen sulfide - rotten egg smell
methane
ammonia
carbon dioxide
requirements that must be strictly adhered to for CHT workers to prevent transmission of disease
personal hygiene and PPE
medical, food service, and berthing spaces must be disinfected with what EPA approved disinfectants? what are the 2 types?
Germicides such as phenolic type and iodine type
color coding for ships internal? external CHT systems?
Internal valve handles and operating levers: gold
external: deck discharge same as surrounding structure
Waste water disposal procedures:
- within US waters is?
- sewage and gray water at sea?
- in port?
- restricted waters?
- prohibited within 3 nautical miles
- diverted and discharged overboard
- CHT and discarded using SHIP WASTE OFF LOAD BARGES (SWOB)
- sewage in CHT, gray water discarded overboard via diverter valves
procedures for all ship tp shore transfer facilities of CHT is under what instruction?
NAVFAC PUB 340
engineer officer responsibilities for ground forces water
provides sufficient potable water quantities
selection water sources
construct, operate and maintain
MDR responsibilities for ground forces water
advice CO
assist Engineer Officer
test Halogen and Bacteriological levels
what are three influences on water choice
quality
quantity
accessibility
lakes , streams , river , pond, sea ocean
more accessible. Quality may be problem. More contaminated that other sources. Capable of supplying adequate quantities. Screen intakes carefully
types of surface water
wells and springs
usually less contaminated than surface water. Difficult to determine quantities available. Located at least 30 yards upgradient from known contamination
ground water sources
drinking water that is sealed in bottles, packages, or other containers by commercial interest which may or may not have been treated. Must be tested and determined to be potable.
Commercial bottled water
4 methods of water treatment in the field
ROWPU
MC lightweight medium tactical
lightweight water purification
tactical water purification system
produces 3000 gal water
only used in treating fresh water
non-reverse osmosis water treatment unit
MC lightweight medium tactical
125 gal/hour
used to purify for small units
lightweight water purifier
1500 gal/hour
International Organization Standardization (ISO) compatible
replacing Reverse Osmosis Water Purification Unit
tactical water purification system
different types of potable water disinfectants for ground forces? Include strength and most common.
Calcium Hypochlorite (HTH) 65-70% (most common, granular form)
Sodium hypochlorite 5 or 10% (unscented bleach)
Chlorine dioxide
Chlorine gas
Bromine
Chloramines ozone
UV radiation
Treatment for disinfection natural surface and well water
5ppm FAC after 30 minute contact time
The 3000 gallon tank primary means of receiving and storing what?
bulk drinking water
Semitrailor mounted fabric tank (SMFT) has collapsible ____ and holds how many gallons?
Rubberized tanks. 3000 or 5000 gallons
What are the three modules for Water Distribution and waste management System (WDWMS)? Primary means Receipt and storage of what?
Water distribution set, hpspitals, deployable medical system (DEPMEDS)
bulk potable water and for wastewater management for DEPMEDS hospital under tactical conditions
Will replace the M107, M149 and M1112 series water trailor and sits on an M1095 trailer which allows for better transportability on and off the road than its predecessors using the family of medium tactical vehicles truck
800 gallon unit water pod system (Camel)
disinfecting method 1 key points for potable water containers in the field
chlorinate to 100ppm FAC run solution through valves keep all interior surfaces wet w/ solution for at least 60min drain into sewer rinse twice
disinfecting method 2 key points for potable water containers in the field
water or chemical are in short supply
prepare 5 gallon of water w/ 100ppm chlorine
swap ever 10 min or as necessary to keep walls wet for 1 hours
run solution through valves
drain
rinse twice
alternate disinfecting method for potable water containers in the field
chlorinate to 100ppmFAC
hold for 24 hours
drain
rinse twice
Denotes the number of personnel to be permanently supported in a given ship by habitability spaces, systems, fixtures, and equipment is the definition of
Accommodations
Refers to personnel embark aboard ship for short duration during special operations or exercises and mobilizations
Surge
Refers to personnel embarked for short duration who do not contribute to host ship operational capability
Transients
7 Habitability factors
Floor area, ventilation, heating, sanitary fixtures, water supply, lighting, color
berthing and medical shall be air conditioned to maintain a maximum temp of
80*F dry bulb
berthing, messing, normal working spaces and medical shall be maintained at a minimum of
65*F Dry bulb
Ventilation requirements for habitability
Designed to minimize humidity and odors. 15 per hour
what type of bedding is prohibited? and mattresses required to be? Can you hot bunk?
polyurethane bedding
low smoke mattress.
Hot bunking is prohibited
who will make routine sanitation inspections of toilets, lavatories, and berthing spaces?
XO, MDR, OOD, JOOD, Chief MA, DIVO, DIV CPO
How often must all surfaces of water closets, showers, lavatories, urinals, berthing spaces, common rooms be cleaned and disinfected?
Daily
Shower curtains and mats are sanitized to prevent what?
Mildew, odor, and soap accumulations
MDR will conduct habitability inspections and why? Report to?
At least quarterly to identify problems that may affect the health of personnel, identify discrepancies, recommend corrective action, and preform onsite training.
Report to CO
Barber shop employee screening, sanitation and location requirements include? Prohibited items?
Medically screened for communicable diseases, were clean smock
Must have hot and cold running water
Use FDA/EPA approved cosmetics, tonics, lotions, bleaches, dyes, disinfectants
Prohibited from treating pimples, removing ingrown hairs, common brushes, dusters, shaving mugs, shaving
cannot be located in food service or berthing areas
Barbers should remove hair from decks by
A dustless method
Barbers should use compressed air which does not exceed how much psi?
15 psi
All instruments that come in direct contact with patrons must be cleaned and disinfected when? Not using? How often is solution changed
After each patron.
Prohibit from formaldehyde cabinets and UV light.
Changed weekly or visibly soiled
When do laundry employees who are exposed to solvents receive exams? By who? Hygiene requirements that must be adhered to?
e
Pre-employment and periodically by MO or higher.
Handwashing after toilet/soiled linen and good personal hygiene
What are 4 major sanitary requirements for laundry facilities?
Floors cleaned at least daily by dustless method
Lint removed s necessary from bulkheads, overheads, structural supports
hearing protection must be worn over what dBs
84 dBs
What must be provided in laundry facilities for emergency use?
First aid kits
2 major requirements for making laundry hygienically safe when washed without bleach?
120-140*F water and using hot air dryers
Soiled laundry must be in what type of bags? Sorted where? What must be removed?
Impervious laundry bags.
Sorting room
Sharp objects
Contaminated laundry requirements?
Impervious double sealed bags
Red outer bag and labeled “Biohazard” with universal symbol
Inner bag must be hot water soluble
DO NOT SORT
Intended to prevent the introduction and dissemination, domestically or internationally of diseases affecting humans, plants, animals
Quarantine regulations
QUARANTINABLE diseases
Plague Infectious Tuberculosis Small Pox SARS Yellow fever Diphtheria Influenza caused by novel or reemergent influenza viruses Cholera Viral Hemorrhagic Fevers
what is Cholera?
bacteria that causes it?
how do you get it?
acute, diarrheal illness caused by infection of the intestine by Vibrio cholerae
1/20 people get profuse watery diarrhea, vomiting and leg cramps
drinking or eating contaminated w/ cholera bacterium
source of contamination is usually the feces of an infected person or raw shellfish, brackish rivers or coastal waters
what are control methods of Cholera
active immunization w/ oral vaccines provide high levels of protection for several months
case report universally required by WHO and Medical Event Report (MER)
Isolation w/ enteric precautions of severely ill, HANDWASHING AND FLY CONTROL
concurrent disinfection
Disease of animals and humans caused by bacterium, Yersinia petis
bitten by a rodent flea
plague
forms of plaque
bubonic and pneumonic
form of plague in which lymphadenitis develops where flea bite
fever is usually present
bubonic
form of plague that has extensive involvement of lungs and respiratory outbreaks
pneumonic
6 methods of controlling plague
education
rat proofing
storage and disposal of food and garbage
patient isolation and concurrent disinfection
clothing repellants
case report universally required by WHO and MER
vaccination must be met prior to entering a country
method of control: insect repellant, protective clothing, mosquito netting
live virus vaccine
transmitted by Aedes Egypti
single dose over 9 months =immunity last 10+years
only administered at designated clinics
Yellow fever
when was last naturally occurring case of small pox?
when was it globally eradicated?
october 1977 in somalia
1979
Systemic viral disease generally presenting with a characteristic skin eruption within 2-4 days
Usually occurred in respiratory tract or skin inoculation
Small pox
Quarantine Regulations of the Navy instruction
OPNAVINST 6210.2
Navy Entomology and pest control technology
NAVMED P 5010-8
Ship Sanitation Certificate Program
BUMEDINST 6210.4
NAVMED 6210/1,
/2
/3
- US Navy ship sanitation Control Exemption
- notification of 30 day extension
- US Declaration of Health Certificate
Quarantine requirements for US ports
Last 15 days prior to arrival has any passenger:
100*F temp or greater w/ rash, glandular swelling, jaundice or has persisted more than 48hrs
Diarrhea (3+ episodes in 24hrs period
Death due to illness
If 1 or more conditions exist CO must notify higher authority between 12-72 hours prior to entering port
list the elements of TB Control Program
TB screening Preventive Therapy Tuberculosis Case Identification TB patient management Contact investigation
Tuberculin Skin Test method
Mantoux method
what are the tuberculin PPD products? which is preferred
Tubersol- preferred
Aplisol
bacteria that causes latent and active TB
mycobacterium tuberculosis
illness in which TB bacteria are multiplying and attacking a part of the body, usually the lungs
active TB disease
TB bacteria are alive but inactive in the body
no symptoms and don’t feels like, cant spread
latent TB infection
vaccine for TB named after French scientist Calmette and Guerin that is rarely used in US but infants and small children in other countries where TB is common receive it
BCG
treatment for LATENT TB INFECTION
regimen of choice= Isoniazid (INH) and Rifapentine (RPT) weekly oral dose of INH 15mg/kg (900 max) and RPT BASED OFF WEIGHT 10-14kg; 300mg, 14-25kg(450mg), 25-32kg(600mg), 32-49kg (750mg), >50kg (900mg max) for 3 months
or Rifampin (RIF) daily oral 10mg/kg max 600mg for 4 months
or INH and RIF oral daily INH 5mg/kg(300mg max) and RIF 10mg/kg (600mg max) for 3 months
when and where should Latent TB screening be documented?
PHA and on NAVMED 6224/8
* don’t know how to make this a question or wtf it ispg 720**CIVMARS
During periodic physical exams
Individuals deemed to be at risk of acquiring TB
Additional screening and subsequent testing for TB may be done: as directed by combatant commander
Part of contact or outbreak investigation
Clinically indicated
During operational screenings
As recommended by cognizant NEPMU
when should a chest x-ray be performed during Tb screening
if clinically indicated
rule out active TB or fiberotic changes
a positive TST reaction to BCG immunized individuals should be regarded as what?
Indicative of TB infection
initial isoniazid (INH) preventative therapy evaluation TB high risk classification
induration 5mm or greater
- RECENT CLOSE CONTACT
- FIBEROTIC OR CHANGES IN CHEST X-RAY CONSISTENT WITH PRIOR TB
- SUSPECT ACTIVE TB
initial isoniazid (INH) preventative therapy evaluation TB medium risk classification
10mm induration
IMMIGRATION WITHIN 5 YEARS FROM HIGH TB COUNTRIES
RISK OF OCCUPATIONAL EXPOSURE TO TB
CLINICAL CONDITIONS THAT PLACE AT INCREASED RISK
initial isoniazid (INH) preventative therapy evaluation TB Low risk classification
15mm or greater induration
NO TB RISK FACTORS
How to administer dose for PPD Mantoux method?
0.1 mL intradermal injection site clean and dry bevel up, 5-15* angle pale wheal 6-10mm appears on skin no wheal administer again
when and how to read and where to record PPD?
48-72 hours
measure induration in the nearest whole mm at widest diameter
NAVMED 6230/4 or DD form 2766
enter into AHLTA, MRRS or SAMS
prior to INH treatment what baseline test must be conducted for liver function?
SGOT/SGPT and bilirubin
what does SGOT mean
Serum Glutamic Oxaloacetic Transaminase
what does SGPT mean
Serum Glutamic-Pyruvic Transaminase
Monthly evaluation for INH therapy must include
Physical assessment (check for active TB) Adverse drug reaction counseling When to discontinue meds When to report meds Document NAVMED 6224/9
What steps should be taken for non-compliance extended doses of INH therapy
Consult NEPMU
Direct observation therapy used for patients on INH regimens given twice weekly and those having difficulty w/ treatment adherence
Who should people enrolled in contact investigation but separating from service be identified to and follow up with for meds?
Id: local public health department for follow-up testing
Meds: VA
How to treat ACTIVE TB?
Chemotherapy is extremely effective and usually curative
INTENSIVE PHASE: (INH,RIF,EMB) 7d/wk for 56 doses or 5d/wk for 40 doses
CONTINUATION phase: (INH,RIF,EMB) 7d/wk for 126 doses or 5d/wk for 90 doses
instruction governing Medical Surveillance and Medical Event Reporting Technical Manual
NMCPHC-TM 6220.12 series
what are the primary objectives of Medical event reports
enables Navy Public Health experts to be aware of:
when important medical events occur
prevent and control actions taken or being considered
potential impact to population
proactive and offer assist to local level medical staff
who are medical events and disease reported to
cognizant Navy Environmental and Preventive Medicine Unit (NEPMU)
urgent and routine MER’s must be submitted within what time frame
urgent- 24 hours
routine- 7 calendar days after identification
when internet access is available this is mandatory for Medical Event Reporting (MER)
Disease Reporting System internet (DRSi)
no internet available routine reports submitted to NEPMU by mail
urgent reports by phone, encrypted email, priority naval message
what COMMUNICABLE DISEASES are required to be reported wtihin 24 hours
Smallpox Hemorrhagic fever Influenza A, novel Plague Poliomyelitis
Botulism Outbreak or disease cluster Anthrax Rabies, human Diphtheria Severe acute Respiratory Syndrome (SARS)
Malaria (all) Measles (Rubeola) Meningococcal Disease Tuberculosis, pulmonary Tularemia
a diagnosis, case or medical event becomes reportable once it has been classified as:
suspected
probable
confirmed
who is required to submit a Medical event report for communicable diseases?
Staff responsible for treatment of patient
who sets the policy for implementation plans for anthrax vaccine
DOD or US Coast Guard
Medical Services Immunizations and Chemoprophylaxis instruction
BUMEDINST 6230.15
anthrax vaccine
dose, route, booster
D: 5 shots over 18 MO (0, 4wks, 6MO, 12MO, 18MO, annual booster
R: IM
B: based on if needed for deployment
Hepatitis A
Havrix and Vaqta dose, route and consult
D: 6mo-18yrs old (0.5mL x2) 19yrs+ (1.0mL x2 @ 0 and 6mo interval)
R: IM (delt)
C: NEPMU for guidance concerning interchangeability
if dose 2 delayed just administer, dont repeat dose 2
what population will be administered Hepatitis B
occupational exposure to blood products all healthcare workers HM and Dental schoolers contact with STD high risk area
