CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

HealthPracticesonCruiseShips:TrainingforEmployees Transcript

PotableWater
TheCentersforDiseaseControlandPrevention'sVesselSanitationProgramisproud to bringtoyouthefollowingsession:PotableWater. Whilethispresentationisprimarily intendedforcruisevesselsunderthejurisdictionoftheVesselSanitationProgram,itmay alsobeusedbyanyonewhoisinterestedinthistopic.Thissessionshouldnotbeusedas areplacementforexistinginteractivetraining,butshouldbeusedasanadjuncttoa comprehensivetrainingprogram.Potablewater. Learningobjectives.Ourlearningobjectivesinthissessionwillbetolistpathogensthat cancausewaterborneillness,listthecommondeficienciesindrinkingwatersystemsthat cancausewaterborneillnesses,listthefreehalogenresidualsrequiredforproductionand distribution,listtheinformationrequiredduringdocumentationofmaintenance,cleaning, anddisinfectionofpotablewatertanks,listtherequirementsformanualmonitoring shouldthefarpointanalyzerrecorderfail. Potablewaterillnesses.England.InSoho,England,in1854,therewasalargecholera outbreakresultinginover10,000peopledead.ThisoutbreakoccurredatawellonBroad Streetinthiscommunity.Dr.JohnSnowlivedthereatthetime,andnoticedthatthe incidentsofthediseaseamongstthepopulation occurredfromthepeopledrinkingfrom thisparticularwell.Althoughhecouldn'tgetthetownfatherstostoputilizingthewell,he didgetthem toremovethepumphandle,whichdecreasedtheincidentsofcholerainthat area. Pennsylvania.In1885,inPlymouth,Pennsylvania,therewasalargetyphoidoutbreak resultingin1,000peoplebecomingill.Thetownwaslowonwaterduringthis wintertime,andtheywouldrunpipesintotherivertopumpwateruptofillthereservoirs. UnbeknownsttothepeopleofthecommunityofPlymouth,inasmallcommunitycalled WilkesBarrejustnorthupstreamofPlymouth,thepeopledumpedtheirrawsewageinto theriver.Thetownfatherswereliterallypumpingrawsewageupintothewatersystemin Plymouth. Aswecanseefromthisslide,theratesfortyphoidfeverwereveryhighpriorto1908. In 1908,chlorinationofpublicdrinkingwatersystemswasbegunintheUnitedStates.After that,aswecanseefromtheslide,theratesoftyphoidfeverdroppeddramatically. Missouri.Cabool,Missouri.In1989therewasalargeoutbreakofgastrointestinalillness causedbyE.coli0157:H7.Therewere243cases,32hospitalizations,andfourdeaths.

CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

ThisoutbreakwastheresultofE.colicontamination ofthewellsinthetownofCabool. Thiscitywasnotchlorinatingtheirwateratthetime. Wisconsin.In1996therewasalargecryptosporidiumoutbreakinMilwaukee, Wisconsin,population800,000.370,000peoplebecameill,with4,400people hospitalizedandapproximately40deaths.Thisoutbreakoccurredduetoasurfacewater systemthatthecitypulledfrom.Duringheavyrains,thesurfacewatertreatmentsystem becameoverwhelmed,andcryptosporidiumosisbrokethroughandcontaminatedthe entirewatersystem throughoutthecity. Alabama.In1992therewasalargeoutbreakofVibreocholeraassociatedwithseafood inMobile,Alabama.Thisoutbreakwastracedback totankersdumpingballastwater fromwatertheyhadoriginatedfromSouthAmerica. Waterborneillnesses.Routesofexposureincludeingestion,respiration,andcontact. Pathogentypesofconcernarebacteria,viruses,andprotozoa. Pathogensandwater.Someofthepathogenswe'reconcernedaboutindrinkingwaterare shigellaspecies,giardia,cryptopsporidium,Vibeocholera,Escherichiacoli,and legionella. Cryptosporidiumparvum.Cryptosporidiumparvumisacoccidianprotozoa. The reservoirishumans,cattle,andotherdomesticanimals.Watertreatmentoptimization includessedimentation,coagulation,andfiltration.Filtrationisrequiredatthe0.1 toone micronlevel.Boilingwaterforoneminutewilleliminatetheoocyst. Vibreocholeraisabacterialillness.Humansarethereservoir,anddisinfectionwith chlorineisveryeffective. Eschericiacoli,orE.coli.Twoimportantstrainsareenterohemorrhagicand enteroinvasive.Severalimportantpathogenicstrainsbasedonserologyandvirulence exist. Eschericiacoli,EHEC.ThisisE.coli0157:H7.Cattlearetheprimaryreservoirforthis E.coli.Chlorinationofwaterisaneffectivetreatment. Eschericiacoli,notEHEC. Theinfectiousdoseistentotheeighthtotentothetenth organisms.HumansaretheprimaryreservoirofthisE.coli.Again,chlorinationisan effectivetreatmentforwater. Waterborneillnessassociatedwithdrinkingwater byetiologicagent,UnitedStates, 19992000.Aswecanseefromthisslide,alittlemorethan 50%oftheoutbreaksinthe

CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

UnitedStatesduringthistimeperiodwererelatedtoparasitic,bacterial,andviral organisms. Waterborneillnessassociatedwithdrinkingwater bydeficiency,UnitedStates,1999 2000.Aswecanseefromthisslide,morethan 80%ofthewaterborneillnesseswere associatedwithuntreatedgroundwater,atreatmentdeficiency,adistributionsystem deficiency,oranuntreatedsurfacewatersource. Potablewater. We'regoingtodiscusstheimportanceofpotablewater,watersources, waterstorage,waterdistribution,andbacteriologicaltestingormonitoring. Potablewatersources.Bunkeredwaterorwaterloadedfromshoreside,productionwater whichincludesevaporators andreverseosmosisunits,orROunits. Bunkeredwater.Bunkeredwatercancomefrommanydifferentsources.Youmayhave groundwater,surfacewater, mixedgroundwaterandsurfacewatersources, or desalinizationplants.Bunkeredwater. Theminimumrequirementforbunkeredwaterisit mustmeetworldhealthorganizationdrinkingwaterqualitystandards.Youmusthavea recentwaterqualityreportonboardthevessel.Bunkeredwater. Theadvantagesof bunkeredwaterarelargequantities.Thedisadvantagesarevariablequalityandcost. Potablewaterfilling.Bunkerhoses.We'regoingtodiscussstorage,handling,connection procedures,andlabeling. Hosestorage.Hosesshouldbeusedfornootherpurpose. Theyshouldbedrainedafter use,theyshouldberolleduporplacedonahosereel,andtheyshouldbecappedor coupledtogethertopreventcontamination.Hosestorage. Acabinetorlockershouldbe providedforhosestorage. Thematerialthelockerisconstructedof shouldbedurable. Thelockerorcabinetshouldbelabeled,itshouldbeeasytoclean,itshouldbeself draining,anditshouldbeelevatedoffthedeckatleast45centimetersor18inches. Handling.Hosesshouldbehandledinasanitarymanner.Theyshouldnotbeplacedin theharbororinstandingwater,anddonotdragthehoseendsonthedeck.Connection proceduresrecommended.Sanitizetheconnectionsutilizing100milligramsperliterof chlorine.Flushtheshoresideconnectiontowaste. Connectthehoseorhosestotheshore side.Flushthehosetowaste,thenconnecttothevessel.Potablewaterhoselabeling. Eachconnectionintothehoseshouldbelabeled"potablewateronly." Productionwater. Theadvantagesofproductionwaterareconsistentquality,unlimited supply,andlowcost. Disadvantagesofproductionwaterincludeyoumayoperateatsea only,andyoumayhavequantitieslimitedbyyourproductioncapacity.

CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

Reverseosmosis.Reverseosmosisworksbypressurizingthehighsalinewaterand pushingtheliquidthroughamembrane,resultinginapotablewaterproduct. Producingwaterinport. Thisisallowedonlyifthesystem cannotproducepotablewater. Itmustbecompletelyseparatefromthepotablewatersystem. Treatmentofbunkeredproductionwater. Productionwatermustbehalogenated totwo partspermillion.Halogenlevelmustbetestedandrecordedeveryfourhours. Bunkered watermustbehalogenatedto twopartspermillion.Halogenlevelmustbetestedand recordedeveryhour. Potablewaterstorage. Storagefacilities.Tanksmustbelabeled"potablewater." Tank coatingsmustbeapprovedanddocumentationmustbeavailableonthevesselforthe tankcoatingsandthemanufacturer'sproceduresforapplyingandcuringthosecoatings. Tanksmusthaveasamplepointwhichisturneddown,andtheremustbeasanitarywater depthdeterminationmethod. Eventsandoverflowsmustbeprotected. Potablewatertankmaintenance.Tanksmustbeinspectedeverytwoyearsoreverydry dock, whicheverisless.Detailedrecordsmustbemaintainedonthevessel recordingthe typeofmaintenanceperformed,thecleaningprocedures,anddisinfection,includingthe residual,thecontacttime,andtheflushingordechlorinationtolessthanfivepartsper million. Waterdistribitionsystem,waterdisinfection.Waterdisinfectionmethods.Methods includeboiling,ultravioletlight,ozone, orhalogenation. Waterdisinfection,ultravioletlight.Advantagesofultravioletlightincludenotasteor odor andnobyproducts. Thedisadvantageistherearenomeasurableresidualstoprotect thewatersystemaftertheinitial ultravioletlighttreatment. Waterdisinfection,ozone.Advantagesincludenotasteorodor,andnobyproducts. Again,thedisadvantageisnomeasurableresidualtoprotectthewatersystemafterthe initialtreatment.Waterdisinfection,halogenationofchlorineandbromine.Advantages ofdisinfectingwithchlorineorbromineincludeavailableresidual,easytotestfor,andan inexpensivetest.Disadvantagesincludetasteandodorandbyproductformation. Water treatment.Inthefollowingslideswe'lldiscusstheadditionof chlorinetotreatthe water. Aswecanseeinthiswaterdroplet,wehaveaddedchlorinetotreatpathogens.As thechlorinesitsincontact,itstartscombiningwithpathogensandremovingthem.Some pathogensareslightlymoreresistant,andtakealongercontacttime.Butasthetime passes,thechlorineeffectivelyremovesallofthepathogens.Freeavailablechlorine. Afterthechlorinehasbeenincontactwiththewaterforsometime,allthepathogens

CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

havebeendestroyed,andwehavearesidualleftcalledfreeavailablechlorinewhichis availabletoprotectthewatersystem shoulditbecomecontaminatedlateron. Chlorinemechanics.Howdoeschlorinekillmicroorganisms? Thisslideshowshow chlorineiseffectiveagainstdifferenttypesofmicroorganisms.Totheleft,onthevertical side,representschlorineeffectivenessfromlowesttohighest,bacteriabeingmosteasily destroyedbychlorine.Inbacteria,thechlorinepenetratesthecellwall andkillsthe organism.Withviruses,whicharenotalivingorganism,thechlorineattachestothevirus andinactivatesit.Giardia.Chlorinealsoinactivatesthisorganism.Cryptosporidiumis resistanttochlorineinlevelsseenin drinkingwatersystems.Usedalone,chlorinewould havenoeffectoncryptosporidium. Chlorinationmechanics.Chlorinetreatmentstandards,CtimesT,Tbeingthetimewater isincontactwiththechlorineandCrepresentingtheconcentrationofthefreechlorinein milligramsperlitermeasuredafteragivenamountoftime.Chlorinationmechanics.The fractionofmicrobeskilledincreaseslinearly withthedisinfectionconcentration orthe disinfectioncontacttime.Thereforeconcentrationcanbetradedfortime,asinthe examplebelow.Fivepartspermilliontimes100minutesisthesameas20partsper millionfor25minutes.Bottomline,disinfectantplusmicrobeequalsdeadmicrobe. Halogenlevelrequirements.Halogenlevelmustbemeasuredatthefarpointinthe distributionsystem,andthelevelmustbemaintainedbetween0.2andfivemilligrams perliterorpartspermillion. Treatmentsystem.We'regoingtodiscusshalogeninjectionandmonitoring.Halogen injectionsystem.Thesystemmustbeautomaticwithabackupsystem,anditmustbe analyzercontrolled.Youmayusemanualhalogeninjectioninemergenciesonly. Monitoringsystem.Themonitoringsystemincludesthehalogenanalyzerandthechart recorder. Freehalogenanalyzer.Thefreehalogenanalyzermustbelocatedatafarpoint, theequipmentmustbeaccuratetoplusorminus0.2milligramsperliterorpartsper million,thesystemmustbecalibratedorcheckeddaily,andthosecalibrationsrecorded inalogoronthecharts.Thefreehalogenanalyzermusthavealowhalogenlevelalarm. Thisalarmmustbeaudibleandlocatedinacontinuouslyoccupiedlocation. Chartrecorder. Thechartrecorderrangemustbe0.0tofivemilligramsperliterorparts permillion.Thechartmustbedated, reviewed,andinitialed,andchangedevery24 hours.Thisisanexampleofachartfromachartrecorder. Manualmonitoring.Iftheautomaticsystemfails,you'reallowedtodomanual monitoring.However,readingsmustberecordedeveryfourhours.Manualmonitoring canonlybedonefortenconsecutivedaysmaximumbeforetheequipmentmustbe

CentersforDiseaseControlandPrevention NationalCenterforEnvironmentalHealth VesselSanitationProgram

repaired.Themanualmonitoringsmustberecorded.Theycanberecordedonthecharts orinaseparatelog. Microbiologicaltesting.Requirements.AnalyzeforE.coli(fecalcoliforms).Four samplesmustbetakenamonthfromthedistribution system.Thesesamplesshouldbe takenatdifferentpointsofthedistributionsystemandrotatedmonthly,andafollowup onpositivetestsmustbedone.Analysis.Themicrobiologicalanalysismustmeet standardmethodsfortheexaminationofwaterandwastewater. Colilertandcolisuretests doneonthevesselsmeetthisrequirement.Additionalmethodsincludemembranefilter techniqueandfermentationtube. Recordkeeping.Recordsmustbekeptonboardthevessel foratleast12months. Thisconcludesoursessiononpotablewater.Resourcesandreferences.Forfurther information,pleasevisitthefollowingWebsites:TheCentersforDiseaseControland Preventionatwww.cdc.gov orwww.cdc.gov/nceh/vsp.OrvisittheEnvironmental ProtectionAgencyWebsiteatwww.epa.gov.