Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 1 CHAPTER 34 ENVIRONMENTAL CAREERS

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 2 Chapter 34 Learning Objectives  Define at least eight terms relating to environmental health care.  Describe the function of the environmental health care team.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 3 Chapter 34 Learning Objectives  Specify the role of the environmental health care team members, including personal qualities, educational requirements, responsibilities, and credentialing requirements.  Identify at least five areas of pollution control that are monitored and regulated by environmental health services.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 4 Chapter 34 Learning Objectives  List at least five health conditions that are affected by environmental pollution.  Describe the natural recycling process or chain of life in an ecosystem.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 5 Environmental Health Careers  Environmental careers create a supportive environment for patients.  Support services (ancillary workers) maintain equipment and supplies needed for optimal care.  Workers must know basic medical terminology and principles of asepsis.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 6 Environmental Careers: Educational Cost and Earnings

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 7 Environmental Health Careers

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 8 Nutrition Services  Dietitian  Provides nutritional counseling and services  Supervises food operations and manages the nutritional services of the health care system  Education Bachelor’s degree in dietetic, nutrition, or food systems management, which includes an internship Bachelor’s degree in dietetic, nutrition, or food systems management, which includes an internship Master’s or doctoral degree is preferred. Master’s or doctoral degree is preferred.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 9 Nutrition Services  Dietary technician  Plans menu  Supervises production of food  Education 2-year associate degree program 2-year associate degree program  Dietary assistant (food service worker)  Prepares food and beverages  Helps patient select a menu and processes the order  Collects empty meal trays and washes dishes  Training On-the-job training On-the-job training

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 10 Sample Meal Requisition FIGURE 34-2 Planned meal requisitions allow a variety of food choices within the limits of the individual diet.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 11 Nutrition Services  Weight reduction specialist  Counsels patients to lose weight using dietary and activity guidelines  Various qualifications Training by the organization Training by the organization Individuals who have gone through a weight loss program Individuals who have gone through a weight loss program Licensing is under consideration in 31 states. Licensing is under consideration in 31 states.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 12 Nutrition Services  Food scientist-technologist  Evaluates safety of food processing and ingredients  Develops new foods  Develops methods for producing known foods  Education Minimum of 2 years of college Minimum of 2 years of college

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 13 Environmental Control Careers  Pollution control engineer  Analyzes contamination problems Establishes methods and equipment to prevent pollution Establishes methods and equipment to prevent pollution Reviews data from potential sources of contamination Reviews data from potential sources of contamination  Calculates the pollutants being produced May recommend denial of operating permits in plants May recommend denial of operating permits in plants  Education Bachelor’s degree Bachelor’s degree

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 14 Environmental Control Careers  Environmental engineer  Modifies facilities for environmental protection  Responsibilities Recommending methods for insect and rodent control Recommending methods for insect and rodent control Recommending methods for safe disposal of radioactive waste materials Recommending methods for safe disposal of radioactive waste materials  Researches factors concerning population growth, industrial planning, and natural environments  Education Master’s degree is recommended Master’s degree is recommended

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 15 Environmental Control Careers  Industrial hygienist  Conducts health programs in manufacturing plants and government agencies Identifies, controls, and eliminates health hazards and diseases in the workplace Identifies, controls, and eliminates health hazards and diseases in the workplace  Responsibilities Collecting and analyzing dust, gasses, and other harmful substances Collecting and analyzing dust, gasses, and other harmful substances Reporting and recommending actions to eliminate potential hazards Reporting and recommending actions to eliminate potential hazards  Education Bachelor’s degree with master’s degree preferred Bachelor’s degree with master’s degree preferred

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 16 Environmental Control Careers  Safety engineer  Employed in all work environments  Identifies existing and potential hazards in conditions and practices  Develops, implements, and evaluates methods to control hazards

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 17 Environmental Control Careers  Health and regulatory inspector  Enforces laws and regulations concerning employment hazards  Regulates consumer products  Regulates quarantine for imported products  Regulates quarantine for people from other countries

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 18 Environmental Control Careers  Radiation monitor  Tests air, soil, water, floors, walls, and other areas of human contact for radiation  Education At least 2-year degree or bachelor’s degree in nuclear technology At least 2-year degree or bachelor’s degree in nuclear technology  Certification is available through the National Registry of Radiation Protection Technologists (NRRPT)

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 19 Environmental Control Careers  Ecologist  Analyzes and regulates the quality of the environment  Specialty areas Air pollution analysis Air pollution analysis Water quality analysis Water quality analysis Forest ecology Forest ecology Aquatic ecology Aquatic ecology Plant ecology Plant ecology Animal ecology Animal ecology  Education Bachelor’s degree in one of the major sciences Bachelor’s degree in one of the major sciences

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 20 Environmental Control Careers  Sanitarian  Plans, develops, and executes environmental health programs  Work includes organizing waste disposal procedures  Sets and enforces standards concerning food, sewage, and waste disposal  Education Bachelor’s degree Bachelor’s degree

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 21 Environmental Control Careers  Environmental health technician  Collects and analyzes air and water samples  Works under the supervision of a sanitarian  Education Vocational programs or a community college associate degree Vocational programs or a community college associate degree  Certification is available through the National Environmental Association (NEHA)

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 22 Water Analysis FIGURE 34-3 Water may be analyzed for its quality, bacterial content, or other pollutant content.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 23 Environmental Control Careers  Public health microbiologist  Conducts tests and studies relationships of people to organisms that cause pollution, diseases, or epidemics  Duties Testing food Testing food Monitoring the sludge from treatment plants Monitoring the sludge from treatment plants Identifying organisms that cause widespread disease Identifying organisms that cause widespread disease  Education Minimum of bachelor’s degree in biology or life science Minimum of bachelor’s degree in biology or life science  Licensure required in some states  Certification as a specialist in public health may be granted.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 24 Other Support Service Personnel  Departments of support personnel in a health care facility  Sterile supply  Central supply  Biomedical engineering  Laundry  Security  Maintenance operations

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 25 Other Support Service Personnel  Ancillary services  Groundskeeping  Housekeeping  Other personnel necessary to run a large institution

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 26 Other Support Service Personnel  Housekeeping staff may be responsible for concurrent and terminal cleanings of all parts of the health care environment  Supervised by an infection control nurse  Concurrent cleaning Disinfecting contaminated objects Disinfecting contaminated objects Disposing of soiled articles used by an infected patient Disposing of soiled articles used by an infected patient Using a method that prevents spread of the pathogen Using a method that prevents spread of the pathogen

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 27 Other Support Service Personnel  Biomedical equipment technician  Installs, calibrates, inspects, and maintains electrical, mechanical, hydraulic, and pneumatic equipment  Areas of certification Biomedical equipment technician (CBET) Biomedical equipment technician (CBET) Clinical laboratory equipment specialist (CLES) Clinical laboratory equipment specialist (CLES) Certified radiological equipment specialist (CRES) Certified radiological equipment specialist (CRES)  Education 2-year degree in biomedical equipment technology or on- the-job training 2-year degree in biomedical equipment technology or on- the-job training

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 28 Other Support Service Personnel  Surgical technician (operating room technologist [ORT])  Works under the direction of a surgeon  Maintains the sterile field and passes instruments to the surgeon during the operation  Education Completion of a vocational or hospital-based based training program of 9 to 12 months Completion of a vocational or hospital-based based training program of 9 to 12 months Certification leads to certified surgical technologist (CST). Certification leads to certified surgical technologist (CST).

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 29 Other Support Service Personnel  Central service or sterile supply technician  Sterilizes, assembles, cleans, and stores diagnostic and surgical equipment  Education or training Vocational and 2-year college programs Vocational and 2-year college programs On-the-job training On-the-job training  Central supply assistant  Inventories, receives, stores, and distributes equipment and products  On-the-job training

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 30 Autoclave FIGURE 34-4 The autoclave sterilizes instruments by using steam under pressure to kill all microorganisms, including viruses and spores. (From Bonewit-West K: Clinical procedures for medical assistants, ed 7, St. Louis, 2008, Saunders.)

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 31 Environmental Resources and Hazards  Biosphere is the air, crust of the earth, and water  Made up of ecosystems  Ecology  Study of living organisms and how they relate to their environment Humans produce more waste than can be recycled. Humans produce more waste than can be recycled. Pollution of water, air, and land endangers life. Pollution of water, air, and land endangers life.  Environmental Protection Agency (EPA) is the federal agency that sets and regulates the standards for environmental factors.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 32 Chain of Life: The Ecosystem FIGURE 34-6 The chain of life ecosystem. The chain of life is composed of the following elements. A, Sunlight, water, oxygen, carbon dioxide, organic compounds, and nutrients found in the ecosystem. B, Plants or “producers” on land and in water convert carbon dioxide and other nutrients from the ecosystem in carbohydrates through photosynthesis, releasing oxygen. C, Herbivores (cows, sheep), carnivores, and other “consumers” feed on the producers and on each other. D, “Decomposers” such as bacteria, fungi, and insects break down dead producers and consumers, thereby returning their compounds into the ecosystem for reuse.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 33 Environmental Resources and Hazards  Many diseases and health conditions are linked to environmental conditions.  Emphysema and other lung disorders  Lead poisoning  Carbon monoxide poisoning  Mercury poisoning  Chemicals found in the environment act as mutagens and cause many cancers.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 34 Air Pollution  Composed of dust and soot, carbon monoxide, hydrocarbons, and nitrogen oxides  Thinning of ozone layer has resulted from air pollution. Increased the intensity of ultraviolet rays reaching the surface of the earth, resulting in higher incidence of skin cancer Increased the intensity of ultraviolet rays reaching the surface of the earth, resulting in higher incidence of skin cancer  Physical effects of air pollution have been documented.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 35 Air Pollution Facts

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 36 Noise Pollution  Sound is a form of energy.  Measured by pitch and loudness Loudness of sound is measured in decibels (dB). Loudness of sound is measured in decibels (dB). Lowest sound that can be heard by the human ear is 1 dB. Lowest sound that can be heard by the human ear is 1 dB.  One third of hearing loss is attributed to environmental causes and can be prevented.  There is excessive noise in homes and offices and in traffic and outdoor environments.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 37 Sources and Effects of Noise

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 38 Water Pollution  Water pollution  Water is tested for quality, bacteria, and pollutants.  Determinations of water quality Water temperature Water temperature Turbidity Turbidity Odor Odor Animal and plant life Animal and plant life pH pH Presence of debris Presence of debris

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 39 Water Pollution  Water contamination Industrial plants Industrial plants Oil discharges Oil discharges Pesticides Pesticides Fertilizers Fertilizers Heat from plants producing electricity Heat from plants producing electricity  Water can be polluted by chemicals and waste seeping into ground water.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 40 Other Environmental Hazards  Americans produced 250 million tons of solid waste in  Represents 4.5 lb of trash per person per day  83 million tons recycled or composted  Average size of a landfill is increasing.  Disposal of radioactive and other hazardous waste materials becoming a concern of environmental health services.  Possible harmful effects of electromagnetic fields

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 41 Biohazard Symbol FIGURE 34-9 A biohazard symbol.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 42 Ten Leading Work-Related Diseases and Injuries

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 43 Performance Instruction  Food preparation  Medical asepsis must be maintained. Using good handwashing technique Using good handwashing technique Wearing nets to contain hair and gloves to protect food Wearing nets to contain hair and gloves to protect food Appropriate storage of all prepared food to prevent contamination Appropriate storage of all prepared food to prevent contamination Menu planned to meet individual patient’s medical needs and to provide a balanced 24-hour diet Menu planned to meet individual patient’s medical needs and to provide a balanced 24-hour diet Counters and equipment in the kitchen area must be cleaned and disinfected. Counters and equipment in the kitchen area must be cleaned and disinfected.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 44 Performance Instruction  Water analysis  Tests Determination of the turbidity Determination of the turbidity Odor Odor Presence of microorganisms Presence of microorganisms pH pH

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 45 Performance Instruction  Instrument maintenance  Maintaining medical asepsis by Using good handwashing techniques and wearing disposable gloves Using good handwashing techniques and wearing disposable gloves  Contaminated instruments cleaned by Rinsing them in cold water Rinsing them in cold water Scrubbing with a brush in warm, soapy water Scrubbing with a brush in warm, soapy water Drying them well with a clean cloth or in a hot-air oven Drying them well with a clean cloth or in a hot-air oven Cleaning small instruments in an ultrasonic cleaner Cleaning small instruments in an ultrasonic cleaner  Other instruments may be wrapped and then sterilized by using steam or chemicals.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 46 Washing Instruments FIGURE A, Instruments are washed thoroughly before being placed in the ultrasound. (From Bonewit-West K: Clinical procedures for medical assistants, ed 7, St. Louis, 2008, Saunders.)

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 47 Washing Instruments FIGURE B, Instruments are washed thoroughly before being placed in the ultrasound. (From Bonewit-West K: Clinical procedures for medical assistants, ed 7, St. Louis, 2008, Saunders.)

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 48 Washing Instruments FIGURE C, Instruments are washed thoroughly before being placed in the ultrasound. (From Bonewit-West K: Clinical procedures for medical assistants, ed 7, St. Louis, 2008, Saunders.)

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 49 Washing Instruments FIGURE D, Instruments are washed thoroughly before being placed in the ultrasound. (From Bonewit-West K: Clinical procedures for medical assistants, ed 7, St. Louis, 2008, Saunders.)

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 50 Wrapping Instruments for Sterilization FIGURE A, A wrapper must be selected so that no area of the items to be sterilized remains uncovered. Many items are wrapped twice to provide easier use after sterilization.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 51 Wrapping Instruments for Sterilization FIGURE B, A wrapper must be selected so that no area of the items to be sterilized remains uncovered. Many items are wrapped twice to provide easier use after sterilization.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 52 Wrapping Instruments for Sterilization FIGURE C, A wrapper must be selected so that no area of the items to be sterilized remains uncovered. Many items are wrapped twice to provide easier use after sterilization.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 53 Wrapping Instruments for Sterilization FIGURE D, A wrapper must be selected so that no area of the items to be sterilized remains uncovered. Many items are wrapped twice to provide easier use after sterilization.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 54 Summary  The function of the environmental health care team is to create a supportive environment for the patient.  The role of members of the environmental health care team includes providing nutrition and a clean environment.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 55 Summary  Five areas of pollution control that are monitored by the environmental health care team are air quality, water quality, sound, food, and waste management.  Five health conditions that are affected by environmental pollution are emphysema, heart disease, lung cancer, lead poisoning, and nervous system disorders.

Copyright © 2012, 2007, 2003, 1997, 1991 by Mosby, Inc., an affiliate of Elsevier Inc. 56 Summary  The chain of life in an ecosystem starts with the sun.  A producer makes food for a consumer.  When it dies, the compounds that make the consumer are returned to the soil by a decomposer.