Nursing 2220A/B Lecture Notes - Lecture 8: Personal Protective Equipment, Engineering Controls, Indoor Air Quality
17 Dec 2016
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Week 8 Readings
Chapter 24: Environmental and Occupational Health
Einstein: the environment is everything that isn’t me
Globally, the diseases with the largest absolute burden attributable to modifiable
environmental factors include diarrhea, lower respiratory tract infections,
unintentional injuries, and malaria. Compared to other countries, Canada is
considered healthy in terms of environmental burden of disease, although
vulnerable and disparate groups would differ from the national average.
Defining environmental health
The WHO defines environmental health as all aspects of human health, disease,
and injury that are determined by factors in the environment. These
environmental factors include the effects of chemical, physical, and biological
agents as well as impacts related to the broad physical and social environment.
Environmental factors have the potential to impact health at the individual, family,
community, and population levels, and the ability to initiate, promote, sustain, or
stimulate disease.
The role of the multidisciplinary team is to anticipate, recognize, evaluate, and
control for environmental factors that arise and have the potential to cause
impaired well-being at the individual, community, or population level. Nurses
must be knowledgeable about how specific factors in the environment can impact
human health.
DPSEEA Framework
- Driving forces: factors that created pressures, which can influence the state of
the environment. Include poverty, population density
- Pressures: the environment can be altered by pressures. Public health policy
could minimize the extent to which driving forces generate pressures
- state of the environment: the state of the environment can be altered in
response to pressures
- exposures, effects: occur through inhalation, ingestion, and absorption of
hazards
- actions: undertaken to affect the environment factor, including policy changes,
pollution monitoring, environmental improvements, and education/awareness
programs
CHNs would most typically be actively involved in environmental health at the
exposure and effects (EE) and action (A) levels.
EXAMPLE: driving forces such as poverty, create pressures, such as poor
sanitation and hygiene, which create an environmental state with high risk of
diarrhea.
Environmental Factors
Modeling environmental influences on health. Exposure to individual
environmental factors will primarily occur at home, at work, or during recreational
activities.
Categories of environmental factors. Individual environmental factors are typically
categorized as chemical, physical, biological, psychological, and ergonomic.
- Chemical: vapours, gases, dusts, fumes, and mists. Can be raw materials
or by-product of the chemical breakdown
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- Physical factors: ionizing and non-ionizing radiation, noise, vibration, and
extremes in temperature and pressure
- Biological factors: are any living organisms or their components or
properties that can cause an adverse health effect, such as micro-
organsims, pests and insects, and animals.
- Psychological factors: stree or distress events that have the ability to
impact heatlh, such as illness, death, birth, job promotion, finances, and
interpersonal conflict.
- Ergonomic factors: include factors that influence the compatibility or fit
between the person and his or her immediate environment, task, job, or
activity (improper use of tools, poor visual conditions, repetitive motion
activities
Routes of entry
- Inhalation: in respiratory tract and lungs
- Absorption: entrance through skin
- Injection: can involve accidental or intentional injection of agents from
either a high velocity source (i.e. an agent released under high pressure)
or a point source (i.e., needle puncture)
- Ingestion: eating or drinking a harmful agent and subsequentlt having a
toxic compound absorbed from the gastrointestinal tract into the
bloodstream.
Degree of hazard: the relationship between the dose of an agent and the
response it elicits is a fundamental concept in toxicology. The degree of hazard
from exposure to environmental factors depends on (1) the nature of the agent
involved, (2) the intensity of the exposure, (3) the duration of exposure.
Hazard control: when an environmental factor is recognized, three strategies are
typically employed to control for exposure. The appropriate types of controls will
depend on the exposure in question. Engineering controls are the first line of
defense by providing or creating a design, structure, enclosure, or system to
engineer the exposure away. Examples of engineering controls include
substitution (i.e. replacing a substance of concern with something associated
with less or no effects), changing the design of a process so that exposures do
not or are less likely to occur (i.e., building enclosures, isolating the hazard from
the public), and adding ventilation to dilute or to remove the agent.
Administrative controls are utilized when engineering controls are not feasible.
Can be changing jobs.
The third form of control is personal protective equipment (PPE). Need to be
fitted and used properly.
Dose-response. Exposures to an agent may result in a dose-response that has
no effect, a minimal effect, or an acute and/or chronic health outcome.
Environmental health assessment
An environmental health assessment is performed to examine possible links
between environmental exposures and health outcomes. Certain populations
might also be considered vulnerable to environmental factors, including children,
elderly, pregnant, and immune-compromised individuals.
Personal exposure history
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The individual interview involves asking the individual about the nature of his or
her environmental exposures, when and where they occur, the circumstances of
how they occur, and whether or not he or she feels any ill effects from the
exposures.
Occupational information would include present and past jobs and work
exposures, as well as any protective measures related to work exposures. An
occupational health nurse would be involved in assessing the work site, providing
healthcare, doing medical assessments, and providing emergency response
among other things.
Residential information includes water sources, dampness and mold issues, and
indoor air quality issues.
Recreational information would include social activities and community
exposures. Environmental factors associated with industries and processes
within the community would be documented during a community assessment.
Environmental Epidemiology
Utilized to clarify relationships between environmental factors and human health
effects. (1) characteize health effects from known exposures, (2) characterize
exposures and effects in populations and attempt to determine dose-response
relationships, or (3) report on a disease pattern for which there is no causal
explanation and where attempts were made to identify potential agents.
Environmental Indicators
Air quality indicators, water quality indicators, and greenhouse gas indicators.
Risk assessment: is the systematic process for describing and quantifying the
level of exposure to particular substances that will result in increased risks to
health.
Risk management options include minimal intervention (i.e., enhancing public
awareness) to maximum intervention (i.e., legislation).
Risk communication is the process of making risk assessment and risk
management information comprehensible and taking the necessary steps to
distribute and present that information accordingly. CHNs are typically involved in
risk communication at the prevention level. Applying the basic principles of
disease prevention, including primary, secondary, and tertiary levels of
prevention, is important when planning strategies for environmental health.
- primary prevention: promoting activities that prevent the actual occurrence
of a specific environmentally related illness or disease. Such activities
might include immunization, counseling about reducing exposures,
supporting development of policy and standards related to environmental
health, as well as practicing positive activities such as washing fruit and
vegetable under running water before eating them.
- Secondary prevention involves promoting early detection or screening of
environmentally related disease and limiting disability. (Blood test and
urine tests for specific compounds)
- Tertiary prevention involves recovery and rehabilitation of an
environmentally related disease or condition after the disease has
developed. Assisting in distribution of information as well as taking action
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