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CHAPTER-8
HYGIENE & SANITATION

INTRODUCTION
Hygiene can be taken under two headings-personal and communal. If personal hygiene
standards are high it will naturally follow the communal hygiene of a high standard. The
physical well being of a person and the prevention of disease hinge around good hygiene
practical the medical staff have an important role to play in maintaining these standards and
will have to be familiar with the conditions through out the ship especially in problem areas.
The medical branch must lead by example and adhere to high standard if they are to guide
others. Many communal diseases spread by low hygiene standards and the Medical branch
personnel must be familiar with these diseases and the control measure to be exercised.

DISINFECTION
1. Definition: Disinfection is a process of killing all the pathogenic microorganisms
except their spores, (with the application of disinfectants) non-pathogenic microorganisms
may or may not be killed.
2. Disinfectants: Disinfectants or germicide is a chemical substance which
destroys potential infectious microorganisms (not usually spores) present on the surface of
inanimate objects. Examples: Phenol, Lysol, Cl2, Formaline etc.
3. Types of disinfection:
a. Concurrent disinfection.
b. Terminal disinfection.
c. Precurrent (prophylactic) disinfection.
a. Concurrent disinfection: It is the application of disinfective measures as
soon as possible after the discharge of infectious material from the body of an infected
person. This includes disinfection of urine, feaces, vomit, contaminated linen, clothes,
hands, dressing, aprons, gloves etc. (throughout the course of an illness).
b. Terminal disinfection: It is the application of disinfective measures
taken to destroy or purify the infected materials after the removal of the patient to a
hospital or termination of the case by recovery or death. This includes disinfection of
the room, premises and the articles that have been in contact with the patient.

c. Precurrent (Prophylactic) disinfection: It is the application of disinfective

measures to prevent infection e.g boiling of water, pasteurization of milk, washing of
hands with soap and water, chemical treatment of water etc.

Classification of disinfection:
DISINFECTION

Natural- Physical Chemical

i. Fresh Air i. Bleacning powder
ii. Sun light ii. Potassium per mangnate.
iii. Formaline
Radiation- iv. Dettol
Heat-
i. Infra-Red v. Lysol
i. Burning
vi. lzol
ii. Boiling
vii. Cl2
iii. Steam
viii. Phenyl

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4. Criteria of Ideal disinfectants:

The following are the criteria of an ideal disinfectant:
a. Should be cheap.
b. Should be easily available.
c. Should be a powerful germicide, rapid in action.
d. Should be non-poisonous.
e. Should be non irritant.
f. Should not attack metal or bleach pigments.
g. Should not damage cloths.
h. Should be stable in the presence of organic matter.
i. Should be homogenous.
j. Should mix in water and form a uniform emulsion in all properties.
k. Should be a high solvent power for grease.

5. Methods for disinfection of various goods:

Inexpensive articles such as contaminated dressings, rags, pillows, old mattresses, bandages
and swabs can be disposed off by burning. Feaces can be disposed off by burning. It is best
done in air incinerator. Lather goods, books, rubber goods can be disinfected in hot dry air
that is (HOT AIR OVEN) on exposure at a temperature of 1600 C for one hour is employed in
it. Dry glass wares and instruments such as forceps, Scalpels, scissors and all glass syringe
and dressing are sterilized by this method. Boiling is useful for disinfection.
a. Bedpans.
b. Urinals.
c. Small instruments tools etc.
d. Glass syringes, petridishes.
e. Linen stained with Faeces, Pus or blood.
6. How to disinfect a room?
We can disinfect a room by formaldehyde. It is a powerful disinfectant and is used in the form
of vapor. There are two methods to use formaldehyde. Those are:
a. Potassium permanganate method.
b. Bleaching powder method.
a. Potassium permanganate method: Special tin buckets or jars are used for this
purpose. 300 of 40% formaldehyde are taken into a bucket and 150 gm of KMnO4 is added to
it. Then 450 ml of water (in equal volume of formalin and KMNO4) is added. This amount is
sufficient for disinfection of 1000 cubic ft of air space.
DISINFECTION PROCEDURE OF ROOM:
1. All furniture, cots, table, chair locker etc are to be removed from ward, cleaned
and kept them in the direct sun light for 06 hours. Every after 02 hours position
to be changed.
2. To burn the inexpensive articles such as contaminated dress, pillow, old
mattress, bandage, tissue paper etc. by incinator.
3. Glass wares, instruments such as forceps, scissors are sterilized by autoclave.
4. Bedpan, urinal etc are to be sterilized by boiling.
5. Floor is to be washed by water, then savlon, lysol etc.
6. To wash the drain, bath room, toilet area and apply bleaching powder.
7. To close all the doors, windows, ventilations except one door.
8. Keep the disinfectants chemical in the room.
a. Formalin -300 ml
b. Potassium permanganate -150 gm for 1000 CFT room
c. Water -450 ml

9. All the doors and rooms should be airtight and to be kept closed for 72 hours.
10. After 72 hours open the room, clean & wash. Place all the items on original
position.
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Sterilization
Definition: Sterilization is the process by which all viable micro-organisms including
spore are killed or eliminated.

Methods of sterilization: There are three main methods of sterilization. Such as

a. Physical method.
b. Chemical method.
c. Filtration.

Methods of sterilization are given in a table as under:

Sterilization

Physical Chemical Filtration

Heat Radiation 1. Alcohols 1. Berkefeld

2. Phenols 2. Chamber land
3. Dyes 3. Seitz
4. Detergents 4. Sintaed glass
1. X-Rays 5. Ethylene oxide 5. Membrane filters.
High temperature Low temperature 2. Y-Rays
Vaccine bath 6. Oxidizing agents
3. B-Rays 7. Halogens.
inspector 4. UV- Rays
5. Infrared rays.

Dry heat Moist heat

1. Incineration Boiling Steaming Pasteurization

2. Flaming
3. Hot air oven

Without pressure With pressure Hading method Flash method

1. Kocks steamer Autoclave

2. Arnolds steramer
3. Tyndalization

Sterilizing procedure of various instruments:

a. Blunt instruments: All types of blunt instruments are sterilized in two methods:
1. By boiling method.
2. By autoclaving method.

To sterilize the blunt instrument are required following temperature, pressure and time.

Methods Name of Temperature Sterilization Pressure Drying time

items Time
Boiling Blunt 1000 C 30 Minutes - -
instrument (From boiling
point)
Autoclaving Blunt 1340 C 05 minutes 1.2 kg/cm2 10 minutes
instrument

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b. Rubber goods: We can sterilize rubber goods in three following methods:

1. By boiling method.
2. By autoclaving method.
3. By chemical method.

Methods Name of Temperature Sterilization Pressure Drying

items Time time
Boiling Rubber 1000 C 10 minutes - -
goods like
catheters
corrugated
sheet ryles
tube etc.
Autoclaving Gloves & 1340 C 05 minutes 1.2 kg/cm2 10 minutes
other rubber
goods.

By chemical methods: We can sterilize the rubber goods in chemical method also.
After case all rubber goods are to be well washed and dried in air, then we keep them in a box
containing with formaldehyde for 24 hrs. Some of rubber goods are sterilized by ethylene
oxide gas during manufacturing. We get them ready for use in packet.

c. Scissors: Scissors and other sharp instruments are sterilized in chemical method.
If we keep them immersing in pure lysol and in gluteratedhyde for half an hour then they are
to be sterilized before use, they must be washed in rinsed water.

d. Gown and towels: Gown and operation towels are to be sterilized in autoclaving
method only. To sterilize them the following temp. pressure sterilization time and drying time
are required.

Methods Name of Temperature Sterilization Pressure Drying time

items Time
Autoclaving Gown & 1340 C 05 minutes 1.2 kg/cm2 10 minutes
towels

OT STERILIZATION PROTOCOL

Step-1 : Cleaning / washing floor by using soap water or chlorhexidine Gluconate/

Cetrimide (Savlon) 50ml/ltr water. Then wait up to 10 minutes for drying.

Step-2 : Cleaning /washing floor by using Carbolic acid 20ml or Phenol -50ml/ltr
water. Then wait up to 10 minutes for drying.

OT Table, door and trolley: Clean by using Alcohol 70% (Rectified spirit) /Lysol .

Note:
1. Weekly schedule: All
2. Daily schedule : Step-2 and clean OT table, door, trolley etc.
3. Fumigation : (After operation of hepatitis virus positive cases or any
infected cases).

Keep Formalin 40%-300ml /1000 sqft mixed with Potassium Permanganate (KMnO4
)-150gm solution in an open container for 48 hours.

4. Bacteriological Test: Swab/sample from gauge, cotton, silk, floor, wall etc
should be sent for the bacteriological test in every 15 days interval
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HYGIENE
Personal hygiene

1. Definition: Personal hygiene may be defined as that branch of hygiene which

concerns itself with the adjustments, which the individual must make to preserve and improve
the health of his body and mind. The main object of personal hygiene is to maintain a high
standard of health.

2. Factors responsible for personal hygiene:

a. Habit.
b. Indigestion.
c. Constipation.
d. Control of weight.
e. Fatigue.
f. Anger.
g. Sleep.
h. Sleeplessness or insomnia.
i. Heredity.
j. Cleanliness.
k. Baths.
l. Oral hygiene.
m. Hands, Feet with Nails.
n. Eye and ears.
o. External genitals.
p. Posture.
q. Exercise.
r. Clothing.
s. Sex.

To maintain personal hygiene we are to take care and abide by the factors responsible
for personal hygiene.

a. Habit: Habit grows into practice and becomes the second nature. It
influences the physical and mental conditions. Habit may be dealt with under various
headings.
(1) Eating & drinking:
(a) Meal should be taken after due intervals.
(b) Food should be taken slowly after desire.
(c) Food taking society should be agreeable.
(d) Food should be tasty and desirable.
(e) Always wait for true appetite.
(f) To take cold water rising from bed at morning.
(g) Small walk after meal at night.
(2) Alcohol:

(a) Alcoholism should never be encouraged.

(b) Use of alcohol and other drugs of addiction should there fore be
avoided.
b. Indigestion: Indigestion is not beneficial for health. So we should take the
following steps to avoid it.
(1) Balanced diet to take.
(2) No eating between meals.
(3) No rapid eating.
(4) Chewing of food much.
(5) Always wait for true appetite.
c. Rest and sleep: Rest is essential to body function an Exercise, Rest and
sleep restore one’s physical ability and mental capacity. An adult need 7-8 hours sleep
per 24 hours.

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d. Recreation: Closely associated with the body need for rest and sleep is the
need for diversion from regular activity. True recreation is essential for heath and
efficiency.

e. Care of bowels: Constipation is an evil of modern civilization. It can be

corrected by eating bulky foods e.g. green vegetables fruits & drinking plenty of
water, attend toilet regularly.

f. Smoking & Drinking: tobacco smoking, chewing and sniffing and

drinking of alcohol is harmful for human health. These habits should be left.

g. Exercise: Physical exercise is very essential for normal growth and

development of the body and maintenance of health. So to maintain personal hygiene
is necessary to make a habit for regular physical exercise.

h. Cleanliness:
(1) Daily bath by soap and water.
(2) Washing of mouth daily.
(3) Washing of hands before meal and after uses of toilet.

i. Clothing: Clothing is one of the basic needs of personal hygiene. The

dress should be suitable to both comfort and healthful. Cotton and linen dress is good
for health.

j. Weight control: Obesity is an abnormal condition which increases the

risk of diabetes, HTN, affections on kidney, heart, blood vessels, liver and gall
bladder. Obesity can be prevented by physical exercise and restriction of food.

k. Dental health care:

(1) Adequate nutrition is essential for building sound teeth. Milk, eggs,
Vitamin rich, vegetable and fruits to be taken in a rational rate daily.
(2) Necessary dental inspection by dental surgeon every after six months.
(3) Teeth to be clean at least twice in a day.
(4) After brushing the gums should be massaged with fingers.
l. Marriage & Sex education: The young children should be given necessary
education on marriage, reproduction, heredity and evolution. The adolescents should
be plainly discussed about the meaning and consequences of STDs and the hygiene of
sexual organs etc.

INSECTS
1. Definition: Insects are a class of arthropods and are characterized by a hard
exoskeleton with the body divided into head, thorax and abdomen. The thorax has a minimum
of three pairs of legs, and two pairs of wings, some insects use man as their host. e.g. Fleas,
lice and mosquitoes and are capable of transmitting disease from one person to another.

2. Mosquitoes: This insect is of great importance of public health. It spreads malaria,

yellow fever, dengue fever, filariasis etc. The control of these mosquitoes is usually by
attention to breeding sites e.g. stagnant water and killing of adults by knock down
insecticides. The wearing of long sleeved garments and trousers is a valuable preventive
measure.

3. Cockroaches: The cockroaches fly in its ability to carry micro organisms both
internally and externally. It hides in cracks and crevices coming out at night to feed. The basis
for control is strict attention to general hygiene & cleanliness.

4. Flies: Flies are a large group of insects capable of carrying diseases. When the fly
feeds, it can contaminate food staffs. The control of breeding is important. Fly screen are
externally useful in preventing access of flies to galleys. Open refuse container to be enclosed
with canvas and dustbin should be close fitting lids. Cleaning of surrounding area is also
important.

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5. Lice: They may carry typhus and other fevers transmission to man is usually by
personal contact.

6. Fleas: The flea is only a nuisance intemperate climate but in certain area is a plague
carrier in conjunction with rats. Control measures include vacuum cleaning and disposal of
bag contents by burning.

7. Bed bugs: Bed bugs are a sing of poor hygiene and their bites can become
secondarily infected.

INSECTICIDES
The only insecticide available for general use is pyruthrin aerosol fly spray. It is useful for
“Knockdown”, killing of flies, Mosquitoes, etc and for occasional cockroach invasions. Other
insecticides such as Fenitrathion and bendiocarb are available for use by trained personnel.
Post control arrangements should be made thrush the local Naval health department.

HOUSING
1. Definition: A healthful residential accommodation in which the family can develop
and flourish physically, mentally and socially.

2. Criteria for healthful housing:

a. Healthful housing provides physical protection and shelter.

b. Provides adequately for cooking, eating, washing and excretory functions.
c. It is designed and constructed to prevent the spread of communicable diseases.
d. It should protect people from noise pollution.
e. It is free from toxic or harmful materials.
f. It promotes social relationship.

3. House standards: House standards are as follow:

a. Site:

(1) To protect from flooding it should be elevated from surroundings.

(2) Should have an independent access to a road.
(3) Should be away from breeding place of mosquito flies.
(4) Should be away from nuisances like dust, smokes, bad smell, noise and
traffic.
(5) Pearland surroundings.
(6) The soil should be dry and safe.

b. Set back: there should be an open space all around the house for proper
lighting & ventilation which is called set back.

c. Floor

(1) Floor should be easily washable to keep clean & dry.

(2) Must be smooth & free from cracks and crevices.
(3) Should be damp proof.
(4) The height of the plinth should be 2-3 feet.

d. Walls:

(1) Should be reasonably strong.

(2) Should have a low heat capacity.
(3) Weather resistant.
(4) Unsuitable for rats and vernis.
(5) Not easily damaged.

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e. Roof:

(1) The height should not be less then 10 feet.

(2) Should have a low heat transmittance co-efficient.
(3) Water supply- should have a safe and adequate water supply available
at all times.
f. Rooms: The rooms should be adequate in number and size according to
family size.
g. Floor area: Floor area of living room for more than one person 120 sq ft,
for singe person 100 sq ft is optimum.
h. Windows: Every living room should be provided with 02 windows and
should not more than 3 feet above the ground. Window area should be 1/5th of the
floor area.
i. Lighting: Daylight factor should be 1 % over half of the floor.
j. Kitchen: Must be a separate kitchen protected against dust & smoke and
arrangement for food, fuel water supply and proper drainage.
k. Privy: A sanitary privy is a must in every house.
l. Batting: Bathing & washing should have faculties for bathing & washing
with proper privacy.
m. Ventilation: Is the science of maintaining atmospheric conditions which are
comfortable and healthful to the human body.
(1) Internal: Means the removal or dilution of the atmosphere (which
has become stagnant, worm and moist through the vitiating process) by air
(Which is comparatively drier, cooler and in motion).
(2) External: Means the ventilation of street and surrounding of the
buildings.
(3) Criteria of good ventilation:
(a) It should prevent, chilling or drying of the body as well a
stagnation of the body heat.
(b) It should be able to remove gases, odors bacteria dust etc. which
contaminate the air.
(4) Effects of ill ventilation:
(a) Rise of temperature.
(b) In-creased humidity.
(c) Stillness.
At these changes produce the following illness

i. Headache.
ii. Drowsiness.
iii. Depression of spirits.
iv. Loss of appetite.
v. Tendency to catch cold easily.

(5) Types or system of ventilation: There are 2 basic types of

ventilation.

(a) Natural ventilation.

(b) Artificial ventilation.

(a) Natural ventilation:

i. Wind: When the wind blows it sweeps away the

impurities, this blowing tendency of wind is called perflation.
ii. Diffusion: Air passes through the smallest openings
like cracks and crevice of various doors and windows.
iii. Inequality of temperature: When air is heated by
human body or by fire place then required adequate inlets of the

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entrance of fresh air and out lets for the escape of impure air
must be provided.

S.No Different types of inlet Different types of out let

1. Double sach window MC kinnels ventilation
2. Cooper’s ventilation Chimney flue
3. Tobit’s tube Ridg opening
4. Louver ventilation Cowls

LIGHTING
1. Sources of light:

a. Natural.
b. Artificial.

a. Natural:

(1) Sunlight.
(2) Reflected light.

b. Artificial:

(1) Artificial
(2) Tubelight.

2. Criteria for good lighting.

a. Sufficiency: Should be sufficient (Not excess or poor) to avoid eye strain.

b. Distribution: Should be uniform & having the same intensity and properly
dispersed without production of shadows.
c. Absence of glare: Glare means excessive brightness. It hurts the eye and a
cause for accidents specially road accidents.
d. Steadiness: The source of light should be constant and should not flicker.
e. Colour of light: Should be suitable for eye and should be day light
colour.
f. Surroundings: Contrasting colours are useful to prevent accidents e.g.
culverts, bridge etc.

3. Effects of ill or bad lighting.

a. Eye strain.
b. Headache.
c. Irritability of temper.
d. Great liability to accident.
e. Loss of efficiency, lack of concentration.
f. There is risk of more accident and quantity and quality of the product may fall.

4. Effects of lighting on health

a. Breakdown of bilirubin.
b. Stimulation of physical activity.
c. Stimulation of melanin synthesis.
d. Activation of Vit ‘D’ precursor in skin thus helps in synthesis of Vit ‘D’.
e. Secretion of adreno cortical hormones.
f. Stimulation of food consumption.

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WATER
1. Definition: Water is a colorless, odorless fluid which is used for domestic uses.
2. Types: There are four types of water.
a. Pure water: Safe for human consumption and will not endanger life.
b. Impure water: It may either polluted or contaminated.
c. Polluted water: Deteriorated physical quality and change color, odor and
taste may be or may not be harmful for health.
d. Contaminated water: Deteriorated in chemical and bacteriological quality. It
is unsafe for use.
3. Uses of water:
a. Domestic purpose:
(1) Drinking, Cooking.
(2) Personal hygiene.
(3) Ervironvental sanitation.
(4) Temperature control.
(5) Gardening.
b. Public purpose:
(1) Public cleansing, fire fighting, maintenance and swimming pools.
c. Industrial purpose: Some industries required water for production.
d. Agricultural purpose: To grow food and agricultural crops.
4. Sources of water:
a. Rain water.
b. Surface water: river, pond, sea, lakes. etc.
c. Ground water: tube-well, shallow wells, springs.
5. Purification: There are two methods of water purification.
a. Natural.
b. Artificial.
a. Natural method:
(1) Storage: Sedimentation, Oxidation, Biological action.
(2) Percolation: Steaming, Oxidation, Biological action.
(3) Evaporation and condensation (By sun light).
(4) Self purification of rivers and streams.
(5) Filtration through earth.
b. Artificial method:
(1) Physical:
(a) Distillation with condensation.
(b) Boiling, (5-10) minutes). After boiling point.
(c) Absorption, (Charcoal process).
(d) Sedimentation.
(e) Aeration.
(2) Chemical agent:
(a) Germicides.
(b) Precipitants.
(c) Disinfectants.
(3) Filtration.
(a) Slow sand filtration (Biological).
(b) Rapid sand filtration (Mechanical).
(4) Chlorine tablet/Solution.
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6. Storage of water: It is a natural method of water purification. When water is drain

out from the source and stored in the natural or artificial reservoirs, a very considerable
amount of purification takes place. This method is utilized in slow sand filtration process.
Storage mechanism takes about 2 weeks to purity water. Purification occurs by the
following processes.

a. Sedimentation (Physical method): By this process 90% (about) of

suspended impurities settle down in 24 hours by gravity. The water becomes clean.
b. Oxidation (Chemical method): In this method the aerobic bacteria with
the aid of dissolved oxygen oxidize the organic ingredients. As a result the content of
free ammonia is reduced.
c. Biological action: In this process, the purification depends on the food
habits of fish and other animals present in the water, they eat out the impurities.

7. Distribution of water:

a. Safe water supply in the village of Bangladesh:

(1) Safe drinking water should be collected from tube-well. For this,
adequate supply of tube-well must be ensured.
(2) Proper maintenance of tube well is also a part of safe water supply.
(3) In lacking or shortage of tube-well surface water to be supplied after
boiling or chemically disinfected.
b. Water supply in cities:
(1) Deep tube well.
(2) River water (in Khaka) for old part of Dhaka is supplied by the water of
the river Buriganga. For this there are two water treatment and supply
plants, situated at Chandinaghat and Demra.

(a) Parts of a deep tub-well

i. Tube well roper.

ii. Pumping units.
iii. Production metering.
iv. Chlorine chamber.
v. Under ground piping,
vi. Pump house.

Water is pumped up by electric motor and is stored in an over head

tank, or supplied direct to the consumers’ underground tank.

i. A chamber containing bleaching powder solution is

connected to the main pipe of the deep tube-well. The water
pumped out is mixed with bleaching powder.
ii. Water from deep tube well stored in over head tank is
supplied through under ground pipe system.

8. Water borne disease: The diseases which are spread by the water is called
water borne diseases.

a. Those due to the presence of an infective agent.

(1) Viral: Viral Hepatitis, poliomyelitis, rota virus diarrhoea in infants.

(2) Bacterial: Cholera, Typhoid, Paratyphoid, Bacillary dysentery, E-coli
etc.
(3) Protozoa: Amoebiasis, Giardiasis.
(4) Helminthic: Roundwarm, Whipworm, thread worm.
(5) Leptospiral: Weil’s disease.

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b. Prevention of water borne disease:

(1) Uncovered food should not be taken.

(2) Use of fly proofing net to cook house.
(3) Water to be taken after boiling or chlorination.
(4) Personal hygiene of food handlers to be well maintained.
(5) Rotten food should not be taken.
(6) Excreta should be disposed far from the cook house and water sources.
(7) No food and drinks to be taken from unauthorized sources.

Sewerage system: It is a system of waste transfer and consists of sewers,

pumps and all of the facilities for carrying the sewerage to the place of final
disposal.

(a) Methods of sewerage disposal: There are several methods

for the final disposal of sewerage. Those are as follows:

i. Dilution in water.
ii. Land treatment.
(i) Intermittent down-ward filtration.
(ii) Broad irrigation.
iii. Chemical treatment.

c. Dilution in water: Discharge of sewerage into the sea is the easiest process.
A sea out fall should be taken as away as possible from the shore. The river should be
big one and flow of water is rapid.
d. Land treatment.

(1) Intermittent down ward filtration: In this process sewerage is kept in

a well and purified by the action of soil which acts as a mechanical filter.
Purification is chiefly affected by soil bacteria.
(2) Broad irrigation: It means distribution of sewerage over a large
surface of agriculture land. The idea is grow of agriculture from the manure
available in the sewerage.

e. Chemical treatment: In this method the sewerage may be disinfected

by chlorinating. Some chemicals, such as lime alum etc are also used which acts as
disinfectants and carry down suspended matter along with some organic impurities of the
sewerage’s.

SANITATION IN SHORE
Shore establishment are normally connected to the local authority sewerage system, although
a few isolated establishments have their own sewerage treatment pants. In those cases
responsibility for the efficient functioning of the system within the establishment rests with
the properly services agency of the department of the environment to whom any complaints of
malfunction must be addressed.

SANITATION IN AFLOAT
For sanitation in afloat two systems exist in ships. One is for disposal of waste water from
galleys and bathrooms. The other is for disposal of sewerage from water closets and urinals.

1. Waste water disposal

a. Waste water is piped to run away at sea level through valued out lets in the
ship side. In modern ships there is a sewerage treatment plant for waste water, after
final disposal the sewerage pumped over board.
b. The sewerage system may discharge either directly through the ships side or
via a self contained sewerage treatment plant in the vessel. In both systems all heads
are flushed from the salt water main through a reducing valve. Older ships’ discharge
sewerage by direct disposal.
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NOTIFICATION
1. Definition: It is the process by which we can take preventive measures against the
notifiable infectious diseases.

2. Notificable disease: There are some diseases which are required for notification
immediately after their out break for prompt control and its protection/prevention.

As per WHO notifiable diseases are divided in to two groups.

a. Group-I Cholera.
b. Group-II Mumps, Measles, Whooping cough, Influenza, TB, Diarrhoea,
Dysentery, Anthrax, Tetanus, Cerebral/ Spinal Fever, Plague, Enteric fever, Typhus
Fever, Viral hepatitis, Chicken pox, Epidemic influenza.

3. Causes of notification:

a. For information about the notifiable infections diseases.

b. To take preventive measures against the notifiable diseases.
c. Find out the causes and take necessary action accordingly like epidemic area.

4. Actions to be taken after diagnosis of a notifeable disease:

a. When a notifiable infectious disease is diagnosed by a physician then initiate

the F(MD)-52 and counter singed by CO of the Hospital.
b. F (MD)-52 fill up in 5 copies.
c. Patient to be isolated.
d. The case sheet to be marked with red ink.
e. The notification is to be marked secret and classification.
f. After preparation of F (MD)-52 it is to be distributed by a covering letter
singed by the CO of the hospital.

Distribution of copy

(1) 1st copy = DMS (N)

(2) 2nd copy = Area Commander
(3) 3rd copy = Cantt. board office.
(4) 4th copy = Civil surgeon.
(5) 5th copy = Office copy.

NUTRITION
1. Definition: Nutrition signifies a dynamic process concerning with food values,
food processing, digestion, absorption and metabolism of food for nourishing the body.

2. Criteria of good nutrition:

To protect the body from infection.

To protect the body from deficiency disease.
To protect the body from obesity.
To make a good complexion e.g. clean skin, bright eyes.
To help in building of body and make the person energetic.

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PROTEINS
1. Definition: proteins are composed of carbon, hydrogen, oxygen, nitrogen and
sulphar in varying amounts. Some proteins also contain phosphorus, iron and occasionally
other elements. Protein contains amino acids. These are as follows:

Leucin.
Isoleucin.
Lysine.
Methionine.
Phenylalamine.
Threnine.
Tryptophane.
Valine.

2. Sources of proteins: Eggs, Meat, fish, Milk and milk products, pulses, Cereals, Nuts,
Beans, oilseed cakes etc.

3. Function of protein:

For growth & development.

For repair of body tissues & their maintenance.
For synthesis of antibodies, enzymes and hormones.

4. Daily requirement of protein:

a. Man (55 kg) = 55 gm

c. Woman (45 kg) = 45 gm.
d. Pregnancy (2nd & 3rd trimester) = +14 gm
e. Lactation (0-6 months) = +25 gm

5. Effects of protein deficiency:

a. Pregnancy period: Still birth.

Premature baby.
Anaemia.
b. Infancy period: Kwashiorkor.
Marasmus.
Mental retardation.
c. Adults: Loose of weight.
Anaemia.
Cirrhosis of liver.
Edema.

FATS
1. Definition: Fats are compounds composed of fatty acids and chemically contain
carbon, hydrogen and oxygen. Fat contains some essential fatty acids like.

Linolic acid.
Lonolenic acid.
Arachidonic acid.

2. Sources: Mustard oil, Ground nut oil, Sesame oil, Corn oil, Ghee, Butter, Fat of
meat, Fish oils.

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3. Function:

Supplies energy and remains stored in the body when in excess.

Essential for absorption of fat soluble vitamin A, D, E, K.
Stimulates secretion of digestive juice for digestion.
It stimulates the secretion of hormones enterogastrone and there by reduce appetite.
It stimulates the secretion of bile.
Essential fatty acids promote growth.
Gives support to the viscera.
Gives protection from cold.
Maintain the decency of body.
4. Fats & Disease: Excessive consumption of fats results in.

Obesity and.
Disease of blood vessels:
(1) Atherosclerosis.
(2) Arterial HTN.
(3) Arteriosclerosis.

CARBOHYDRATES
1. Definition: Carbohydrates are composed of carbon, hydrogen, and oxygen. They
are the cheapest and main sources of energy.

2. Sources: There are 3 main sources of carbohydrates.

a. Starches: Cereals, Millets, Roots, Tubers, Plants stems.

b. Sugar: Glucose, Fructose, Galactose and Sucrose.
c. Cellulose: Fibrous lining of fruits, Vegetable &cereals.

3. Function of carbohydrates:

a. Main sources of energy.

b. A fuel for combustion of fat and is essential for oxidation of food.
c. It itself can be converted in to fat.
d. Essential for synthesis of non essential amino acids.

VITAMIN
1. Definition: Vitamins are vital accessory food factors which are essential for normal
growth and development of the body.

2. Classification of vitamins:

a. Fat soluble vitamins:

(1) Vit – ‘A’

(2) Vit - ‘D’
(3) Vit – ‘E’
(4) Vit – ‘K’
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b. Water soluble vitamins.

(1) Vitamin B-Complex.

(a) Thiamin.
(b) Riboflavin.
(c) Nicotinic acid.
(d) Biotin.
(e) Folic acid.
(f) Vit B-12.

(2) Ascorbic Acid.

3. Sources: Liver, Egg yolk, Butter, Cheese, Whole milk, Fish and fish liver oil,
Fresh/dark green leafy vegetable viz Spinach, Coloured vegetables, fruits etc.

4. Functions:

a. Plays a crucial role in normal vision.

b. Helps in growth and development especially skeletally growth.
c. Has Anti infective action.
d. It stimulates the intestinal cells to synthesis protein in calcium absorption.
e. Essential for utilization of carbohydrate in the body.
f. For maintenance of good appetite.
g. It is involved in protein fat and carbohydrate metabolism.
h. Essential for normal function of skin, intestinal tract and the nervous system.
i. Plays a vital role in the biosynthesis of gamma amino butyric acid in the brain.
j. Necessary for synthesis of DNA.
k. It is essential for enzymatic role, wound healing, Haemorrhages control, Iron
absorption and maturation of RBC

MINERALS
1. Definition: The body contains about 24minerals all of which must be obtained
from the foods we eat.

2. Sources: Green leafy vegetables, Fruits, Eggs, Flesh foods, Whole grain cereals,
Sea foods etc.

3. Function:

a. Formation of bones & teeth.

b. Maintain the osmotic pressure of body fluid.
c. Maintain the acid bases balance.
d. Maintain the tone of the muscle and nerves.
e. Formation of blood by iron and normal function of the thyroid by iodine.

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SANITARY ROUND

Points to be checked during sanitary round:

Ans: The following points are to be checked during sanitary round.

S.No Remarks
1. Accommodation a. Adequacy.
b. Lighting.
c. Ventilation.
d. Other points.
2. Bathroom & heads a. Adequacy.
b. Lighting.
c. Water supply.
d. Cleanliness.
e. Other points
3. Dinning hall a. Fly proofing.
b. Cleanliness.
c. Lighting.
d. Other points.
4. Cook house a. Fly proofing.
b. Cleanliness.
c. Lighting.
d. Other points.
5. Ration stores. a. Adequacy.
b. Fly proofing.
c. Method of storage.
d. Incident of rodent.
e. Other points.
6. Canteen a. Adequacy.
b. Personal hygiene of the
canteen boy.
c. Wet canteen.
d. Dry canteen.
e. Other points.
7. Ward room a. Adequacy.
b. Lighting.
c. Ventilation.
d. Cleanliness.
e. Other points.
8. Recreation room a. Adequacy of recreation
items.
b. Lighting.
c. Ventilation.
d. Other points.
9. Disposal of refuse. a. Dry refuse.
b. Wet refuse.
10. Incidents of inf. Disease
11. General condition of sips surroundings.
12. State of mental health.
13. Any suggestion/recommendation.

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