Assessing the Influence of Hand-Dug Well Features and Management on Water Quality.

Underground water quality can be affected by natural or human-made influences. This study investigates how the management and characteristics of hand-dug wells impact water quality in 3 suburbs of Kumasi, Ghana, using a combination of qualitative and quantitative research methods. Descriptive analysis, including frequency and percentages, depicted the demographic profiles of respondents. Box plot diagrams illustrated the distribution of physicochemical parameters (Total Dissolved Solid [TDS], Electrical Conductivity [EC], Turbidity, Dissolved Oxygen [DO], and Temperature). Factor analysis evaluated dominant factors among these parameters. Cluster analysis (hierarchical clustering) utilized sampling points as variables to establish spatial variations in water physicochemical parameters. Cramer's V correlation test explored relationships between demographic variables and individual perceptions of water management. One-way ANOVA verified significant mean differences among the physicochemical parameters. Logistic regression models assessed the influence of selected well features (e.g., cover and apron) on TDS, pH, Temperature, Turbidity, and DO. The findings revealed that proximity to human settlements affects water quality, and increasing turbidity is associated with unmaintained covers, significantly impacting water quality (P < .05). Over 80% of wells were located within 10 to 30 m of pollution sources, with 65.63% situated in lower ground and 87.5% being unmaintained. Other significant contamination sources included plastic bucket/rope usage (87.50%), defective linings (75%), and apron fissures (59.37%). Presence of E. coli, Total coliform, and Faecal coliform rendered the wells unpotable. Factor analysis attributed 90.85% of time-based and spatial differences to organic particle decomposition factors. However, Cramer's V correlation analysis found establishing association between demographic factor associations with individual perceptions of hand-dug well management difficult. It is encouraged to promote hand-dug well construction and maintenance standards to ensure that wells are properly built and protected from contamination sources.

Seasonal variations and health risk assessment of microbial contaminations of groundwater in selected coastal communities of Ghana.

This study investigated seasonal variations in microbial contaminations of groundwater and associated health risks in four coastal communities (Essiama, Winneba, Accra, and Keta) in Ghana. Membrane filtration methods, sanitary risk inspection, and quantitative microbial risk assessment were employed, respectively, to (i) quantify bacteriological quality, (ii) identify risks to contamination, and (iii) assess health risks associated with Escherichia coli in groundwater. Results showed 70.00%, 53.33%, 70.37% and 90.00% of groundwater sources in Essiama, Winneba, Accra, and Keta, respectively, were at intermediate risk, whereas 3.33%, 40.00%, 14.81%, and 3.33%, respectively, were at high risk. Very high-risk levels of contamination were recorded only in Accra. The presence of animal wastes within a 10 m radius of groundwater collection point, bad drainage systems, collection of spilt water in apron area, the use of ropes and buckets when fetching groundwater, and absence of aprons and well covers put more than 60.00% of the groundwater points in two or more locations at risk of contaminations. Assessment of bacteriological quality of groundwater indicated that mean total coliforms and E. coli ranged, respectively, between 123.40-501.30 and 30.98-141.90 CFU/100 ml for the communities; the highest microbial counts for dry and wet seasons occurred in Winneba and Keta, respectively. Seasonal variations in E. coli counts in Winneba and Accra were significantly higher in the dry season than in the wet season; Essiama and Keta showed no significant seasonal variations. Exposure to E. coli O157:H7 through drinking groundwater ranged between 5 and 23 cells per day. Although exposure to E. coli O157:H7 through bathing was less than 1 cell per day in all communities, residents were exposed to one E. coli, at least, every 62, 141, 237, and 282 days in Winneba, Accra, Keta, and Essiama, respectively. The risk of infection and illness for all communities was 1 for drinking, whereas that for bathing ranged from 0.57 to 0.98. The estimated Disability-Adjusted Life Years (DALY) exceeded the WHO-acceptable DALY. These findings show that groundwater resources in the selected coastal communities were prone to microbial contaminations, and this may be a setback to Sustainable Development Goals 6. Implications of the findings are discussed.

Proposta de categorização dos serviços de alimentação no Estado do Rio de Janeiro com foco no risco sanitário de doenças transmitidas por alimentos / Proposal for the categorization of food services in the State of Rio de Janeiro with a focus on the sanitary risk of foodborne diseases

A Categorização dos serviços de alimentação com foco no risco sanitário de Doenças Transmitidas por Alimentos no Brasil foi uma experiência pontual e exitosa com o Projeto de Categorização da Copa do Mundo FIFA® de 2014. Devido a Lei Federal de liberdade econômica nº13.874 de 20 de setembro de 2019, que classifica os serviços de alimentação como atividades de baixo risco, as Vigilâncias Sanitárias devem rever o planejamento de suas ações. O objetivo geral desse trabalho foi formular uma proposta para implantar o sistema de Categorização dos serviços de alimentação no Estado do Rio de Janeiro. Para isso foi realizada uma pesquisa aplicada com análise documental que derivou o desenvolvimento de produtos tecnológicos e inovadores. Elaborou-se um roteiro para auxiliar na escrita do ato normativo da Categorização de serviços de alimentação; uma planilha para facilitar o cálculo do risco sanitário; um guia e um vídeo orientativo para auxiliar o processo de implantação da Categorização dos serviços de alimentação. Os produtos desenvolvidos podem ser utilizados para a autoavaliação do serviço de alimentação e pelas Vigilâncias Sanitárias nas inspeções com foco no risco de Doenças Transmitidas por Alimentos. O resultado da Categorização será comunicado ao público consumidor informando a qualidade sanitária dos serviços de alimentação categorizados. A elaboração dessa proposta subsidia os estados e municípios para o processo de implantação da Categorização, bem como auxilia na mensuração do risco sanitário dos serviços de alimentação, planejamento das ações de Vigilância Sanitária com base no risco, valorização dos serviços de alimentação que investem nas Boas Práticas de Manipulação de Alimentos e comunicação da categoria ao consumidor para que faça uma escolha consciente.

Categorization of food services with a focus on the health risk of Foodborne Diseases was a sharp and successful experience during the 2014 FIFA® World Cup in Brazil. Due to the Federal Economic Freedom Act nº 13.874 of September 20, 2019, which classifies food actions by the Health Public Surveillance. The main idea of this project was to formulate a proposal to install The Categorization of food services in the state of Rio de Janeiro. Technological research was carried out with an analysis that resulted in the development of technological and innovative products. A script was created for the surveillance inspector to assist in the writing of the normative act of The Categorization for food services; a spreadsheet to make the calculation of Foodborne Diseases health risks easier; a guide and an orientation video were made on the process of installing The Categorization for food services and establishing the inspection score parameters. The developed products can be used for the self-evaluation of food services and by the Health Surveillance agents in their inspections, always focusing on the risk of Foodborne Diseases. The score of the Sanitary Inspection will be communicated to the consumer audience, informing the sanitary quality of the food service. This proposal sponsors the states and counties for the implementation process of The Categorization, as well as in the measurement of the sanitary risks of food services. The Sanitary Surveillance plan is based on health risks from Foodborne Diseases and the appreciation of food services that invest in Proper Food Handling Practices and the communication from the grade received on the sanitary inspection to the consumer so that they make an informed and smart decision about where they eat.

Contextual Determinants of General Household Hygiene Conditions in Rural Indonesia.

Household hygiene is critical to prevent pathogen transmission at the household level. Assessing household hygiene conditions and their determinants are needed to improve hygiene conditions, especially in rural and less developed areas where the housing conditions are relatively worse than they are in urban areas. This study used data from 278 household interviews and observations in rural areas in the district of East Sumba, province East Nusa Tenggara, Indonesia. The data were analyzed using statistical methods. In general, the household hygiene conditions in the study need to be improved. The main potential sources of pathogen transmission were from the surrounding environment, i.e., non-permanent floor and garbage, and personal hygiene, i.e., handwashing facilities with water and soap were only observed in the homes of four out of ten respondents. The presence of livestock roaming freely in the house's yard was another source of contamination. Easy access to water and wealth significantly influenced the hygiene conditions. Implementing low-cost interventions, i.e., cleaning the house of garbage and animal feces and cleaning nails, should be the priority in immediate intervention, while providing easier access to water supply, especially during the dry season, could be a long-term intervention. This paper also argues that analyzing household hygiene conditions or practices should be complemented by analyzing contextual determinants of the hygiene conditions or practices, so that we can develop more precise intervention by considering the local or household context.

Co-relationship between Escherichia coli in broiler cellulitis and liver lesions / Correlação entre a presença de Escherichia coli em lesões de celulite e fígados de frango

Abstract Pathogenic strains of Escherichia coli may invade the subcutaneous tissue of poultry and cause cellulitis, whilst the pathogen may also cause lesions in internal organs such as the liver. Current paper co-relates Escherichia coli and virulence genes characteristic of Avian Pathogenic Escherichia coli (APEC) in broilers´ cellulitis and liver lesions. One hundred carcasses were retrieved from the production chain in an avian abattoir in the state of Bahia, Brazil, between August 2013 and January 2014, due to detection of cellulitis lesions. Cellulitis and liver samples were retrieved aseptically to quantify E. coli by Petrifilm™ count fast method (3M Company) (AOAC 998.8). Virulent genes iss and iutA were removed from E. coli isolates by Polymerase Chain Reaction (PCR). Escherichia coli was isolated from 82.0% of broilers removed from the production chain and the bacterium was concomitantly detected in cellulitis and liver lesions in 40.0% of broilers. E. coli counts ranged between 1.00 and 4.73 log CFU/g in liver lesions and between 2.00 and 9.00 log UFC/g in cellulitis lesions. Virulent genes iutA and iss were detected in 97.56% and 89.02% of E. coli isolates, respectively. Genotype analysis demonstrated the concomitant amplification of genes iutA and iss in 60.0% (n=40) of samples of cellulitis and liver lesions in which the simultaneous isolation of E. coli occurred. There was a positive and significant co-relationship (r=0.22; p<0.05) between the variables occurrence of E. coli isolated from liver samples and the occurrence of E. coli isolated from cellulitis lesions. There were also positive and significant co-relationships between populations of E. coli from liver isolates and cellulitis lesions (r=0.46; p<0.05) when E. coli isolated in the liver and in cellulitis lesions was detected. Since results showed a relationship between E. coli in cellulitis and liver lesions and possible systemic infection, the occurrence of cellulitis lesions as a criterion for total discarding of carcass may be suggested.

Resumo Cepas patogênicas de Escherichia coli podem invadir o tecido subcutâneo das aves e provocar celulite aviária e este patógeno pode provocar lesões nos órgãos internos, como o fígado. Desta forma, objetivou-se correlacionar a presença de Escherichia coli e os genes de virulência característicos de Escherichia coli Patogênica para Aves (APEC) nas lesões de celulite e nos fígados dos frangos. Entre agosto de 2013 a janeiro de 2014, foram retiradas 100 carcaças da linha de produção por apresentarem lesões de celulite em um matadouro avícola da Bahia (Brasil). Foram coletadas amostras de celulite e fígados de frango assepticamente para quantificação de E. coli pelo método rápido de contagem Petrifilm™ (3M Company) (AOAC 998.8). Em seguida foi realizada a pesquisa dos genes de virulência iss e iutA nos isolados de E. coli utilizando a Reação em Cadeia da Polimerase (PCR). Escherichia coli foi isolada em 82,00% das aves retiradas da linha de produção e a bactéria foi detectada concomitantemente nas lesões de celulite e fígado em 40,00% das aves. As contagens de E. coli variaram de 1,00 a 4,73 log UFC/g nos fígados e de 2,00 a 9,00 log UFC/g nas lesões de celulite. Os genes de virulência iutA e iss foram encontrados em 97,56% e 89,02% dos isolados de E. coli, respectivamente. A análise genotípica revelou a amplificação concomitante dos genes iutA e iss em 60,00% (n=40) das amostras de lesões de celulite e fígado nas quais houve o isolamento simultâneo de E. coli. Foi observada correlação positiva e significativa (r=0,22; p<0,05) entre as variáveis ocorrência de E. coli isolada das amostras dos fígados e ocorrência E. coli isolada das lesões de celulite e, nos casos em que foi detectada a ocorrência de E. coli isolada em fígado e lesões de celulite, correlações positivas e significativas também foram evidenciadas entre as populações de E. coli dos isolados dos fígados e das lesões de celulite, (r=0,46; p<0,05). Assim ficou evidenciada a relação entre E. coli presente nas lesões de celulite e no fígado e uma possível infecção sistêmica, desta forma, sugere-se que a presença de lesões de celulite seja utilizada como critério para o descarte total da carcaça.

Bovine tuberculosis due to Mycobacterium bovis and other mycobacteria among water buffalo (Bubalus bubalis) from the Brazilian Amazon.

INTRODUCTION: Zoonotic tuberculosis is a disease of public health importance worldwide, especially in developing countries. The present study aimed to investigate the role played by Mycobacterium bovis and other mycobacteria as etiologic agents of bubaline tuberculosis (TB) in the Brazilian Amazon region. METHODOLOGY: Granulomatous lesions suggestive of TB obtained from 109 buffaloes (n =109) during sanitary inspection at slaughter were subjected to histopathological evaluation, immunohistochemical (IHC) detection of Mycobacterium antigens, and to molecular tests (PCR) to detect hsp65, IS6110 and RD4 genes, which are specific to Mycobacterium spp., Mycobacterium tuberculosis Complex (MTBC) and M. bovis, respectively. RESULTS: PCR results indicated Mycobacterium infection in 87.2% of the cases, of which 69.5% were positive for M. bovis, 27.4% belonged to MTBC, and 3.1% were probably non-TB mycobacteria. There was good agreement between the genus-specific molecular technique and the histopathological analysis. This high frequency of TB cases caused by non-M. bovis suggests a diversified scenario of mycobacteria associated with bubaline TB in the Brazilian Amazon region. CONCLUSIONS: The results reinforce the need of discussing the inclusion of more accurate techniques in examinations carried out by Inspection Services in Brazil.

Evaluating WHO prescribed sanitary inspection templates for assessing contamination risks in tubewells with handpump - case of 9 Indian districts.

WHO prescribes Sanitary Inspections in recommended formats for assessing contamination risks in Tubewells installed with handpump that often constitute primary drinking water sources in rural and remote areas. Sanitary inspections are easy alternatives to costlier and technically demanding laboratory water quality analysis. However, their efficacy remains uncertain despite decades of widespread usage. This study evaluates sanitary inspections by assessing contamination risk in 324 Tubewells with handpump across 9 districts in India. Results indicate that 62% of sampled sources were safe in lab analysis, despite sanitary inspections indicating varying risks. This implies that WHO prescribed inspections yield higher risks, and overestimated risk perception are likely to skew planning and policy, resulting in budgetary over-allocations and financial mismanagement in water-supplies. There is thus an urgent need to review and revise WHO prescribed sanitary inspection templates.

[The problems of sanitary safety of environment in the USSR during the first five-year plans period in 1930s].

The article briefly considers the history of solving problems of sanitary environmental protection in the USSR during the first five-year plans in 1930s. The numerous examples from the Fund of the all-Union state sanitary inspection in the State archive of the Russian Federation were involved into consideration of issues of conservation of water in open reservoirs and air quality in cities. The conclusion is made about the inability of sanitary organization to implement assigned tasks of environmental safety due to disregarding of these issues by authorities, lacking of necessary legislative basis, subordinated position of sanitary services and deficiency of funds and manpower.

An Assessment of Inter-Observer Agreement in Water Source Classification and Sanitary Risk Observations.

Sanitary risk inspection, an observation protocol for identifying contamination hazards around water sources, is promoted for managing rural water supply safety. However, it is unclear how far different observers consistently identify contamination hazards and consistently classify water source types using standard typologies. This study aimed to quantify inter-observer agreement in hazard identification and classification of rural water sources. Six observers separately visited 146 domestic water sources in Siaya County, Kenya, in wet and dry seasons. Each observer independently classified the source type and conducted a sanitary risk inspection using a standard protocol. Water source types assigned by an experienced observer were cross-tabulated against those of his colleagues, as were contamination hazards identified, and inter-observer agreement measures calculated. Agreement between hazards observed by the most experienced observer versus his colleagues was significant but low (intra-class correlation = 0.49), with inexperienced observers detecting fewer hazards. Inter-observer agreement in classifying water sources was strong (Cohen's kappa = 0.84). However, some source types were frequently misclassified, such as sources adapted to cope with water insecurity (e.g. tanks drawing on both piped and rainwater). Observers with limited training and experience thus struggle to consistently identify hazards using existing protocols, suggesting observation protocols require revision and their implementation should be supported by comprehensive training. Findings also indicate that field survey teams struggle to differentiate some water source types based on a standard water source classification, particularly sources adapted to cope with water insecurity. These findings demonstrate uncertainties underpinning international monitoring and analyses of safe water access via household surveys.

Isolation and genotyping of Mycobacterium bovis in suggestive lesions of tuberculosis in cattle slaughtered in the state of Ceará, Brazil / Isolamento e tipificação genética de Mycobacterium bovis em lesões sugestivas de tuberculose em bovinos abatidos no estado do Ceará

Bovine tuberculosis (BTB) is a zoonosis caused by the bacterium Mycobacterium bovis, which induces the development of nodular and granulomatous lesions in various animal tissues. The recognition of these suggestive gross lesions during postmortem sanitary inspection in slaughterhouses provides a presumptive diagnosis, which requires the use of complementary tests to confirm the disease. This study aimed to verify the occurrence of BTB in cattle slaughtered in slaughterhouses in the state of Ceará, Brazil, using bacteriological and molecular methods. To this end, suggestive lesions were analyzed on carcasses condemned by the "Serviço de Inspeção Estadual" (SIE). The samples were submitted to microbiological analysis using culture media and specific staining followed by spoligotyping molecular technique for identification and genotyping of the mycobacteria. Occurrence of lesions suggestive of BTB was verified in bovine carcasses (0.071%) from different municipalities of the state. These lesions were located mainly in the lung (95.12%), lymph nodes (58.53%), and liver (36.58%). Microbiological culture showed bacterial isolation (17.94%), with the growth of colonies showing morphological and tannic characteristics belonging to genus Mycobacterium spp. Genetic polymorphism analysis identified M. bovis in all isolates, which were discriminated into six spoligotypes (SB0121, SB0295, SB1064, SB0120, SB0870, and SB0852). These profiles have been described in Brazil and several areas of the world, except for profiles SB1064 and SB0852, which were described in the country for the first time. The results show that the association of the diagnostic methods used was the basis for the first study on identification of mycobacteria found in the state, which may provide a database for the epidemiological study of BTB in the state of Ceará.(AU)

A tuberculose bovina (TB) é uma zoonose causada pelo Mycobacterium bovis, o qual induz ao desenvolvimento de lesões nodulares e granulomatosas em vários tecidos do animal. O reconhecimento dessas lesões macroscópicas sugestivas durante a inspeção sanitária post mortem em matadouros fornece um diagnóstico presuntivo, sendo necessário a utilização de testes complementares para confirmação da doença. O objetivo deste trabalho foi verificar a ocorrência da TB em animais abatidos em matadouros-frigoríficos no estado do Ceará através da utilização de métodos bacteriológicos e moleculares. Para tanto, foram analisadas lesões sugestivas de TB em carcaças condenadas pelo Serviço de Inspeção Estadual (SIE). As amostras foram submetidas à análise microbiológica, utilizando meios de cultivo e de coloração específicos, seguida pela técnica molecular spoligotyping para identificação e tipificação genética da micobactéria. Verificou-se a ocorrência de lesões sugestivas de TB em carcaças bovinas (0,071%) oriundas de diferentes municípios do estado do Ceará. Essas lesões estavam localizadas principalmente no pulmão (95,12%), linfonodos (58,53%) e fígado (36,58%). O cultivo microbiológico obteve isolamento bacteriano (17,94%), com o crescimento de colônias apresentando características morfológicas e tintoriais pertencentes ao gênero Mycobacterium spp. A análise do polimorfismo genético identificou a presença de M. bovis em todos os isolados, que foram discriminados em seis espoligotipos (SB0121, SB0295, SB1064, SB0120, SB0870 e SB0852), descritos no Brasil e em diversas áreas do mundo, exceto os perfis SB1064 e SB0852 que foram descritos pela primeira vez no país. Os resultados obtidos demonstram que a associação dos métodos diagnósticos utilizados foram a base do primeiro estudo de identificação das micobactérias encontradas no estado do Ceará, o que pode contribuir para a criação de um banco de dados para o estudo epidemiológico da TB no estado.(AU)

Assessing Drinking Water Quality at the Point of Collection and within Household Storage Containers in the Hilly Rural Areas of Mid and Far-Western Nepal.

Accurate assessments of drinking water quality, household hygenic practices, and the mindset of the consumers are critical for developing effective water intervention strategies. This paper presents a microbial quality assessment of 512 samples from household water storage containers and 167 samples from points of collection (POC) in remote rural communities in the hilly area of western Nepal. We found that 81% of the stored drinking water samples (mean log10 of all samples = 1.16 colony-forming units (CFU)/100 mL, standard deviation (SD) = 0.84) and 68% of the POC samples (mean log10 of all samples = 0.57 CFU/100 mL, SD = 0.86) had detectable E. coli. The quality of stored water was significantly correlated with the quality at the POC, with the majority (63%) of paired samples showing a deterioration in quality post-collection. Locally applied household water treatment (HWT) methods did not effectively improve microbial water quality. Among all household sanitary inspection questions, only the presence of livestock near the water storage container was significantly correlated with its microbial contamination. Households' perceptions of their drinking water quality were mostly influenced by the water's visual appearance, and these perceptions in general motivated their use of HWT. Improving water quality within the distribution network and promoting safer water handling practices are proposed to reduce the health risk due to consumption of contaminated water in this setting.

Desenvolvimento de um instrumento quantitativo para inspeção sanitária em serviços de alimentação e nutrição, Brasil / Development of a quantitative health inspection instrument in food and nutrition services, Brazil

Resumo O estudo visou desenvolver um Instrumento Quantitativo para Inspeção Sanitária (IQIS) em serviços de alimentação e nutrição de grande porte no Brasil. Utilizou-se a tecnologia de inspeção, no Modelo de Avaliação do Risco Potencial (MARP) e legislação sanitária brasileira. Estruturaram-se 12 dimensões, 41 módulos, 57 indicadores de controle de riscos (críticos/não críticos), numa escala de 0-5, totalizando 1.512 índices com codificação de respostas fechadas. O IQIS foi validado com o Coeficiente de Kappa, com excelente concordância para atributos de clareza e relevância (k = 0,82 e k = 0,92) e boa concordância para o atributo aplicabilidade (k = 0,78). O teste de Kruskal-Wallis mostrou inexistir diferença significativa entre as avaliações (p = 0,423), o Coeficiente de Correlação Intraclasse foi satisfatório (CCI = 0,53), o Alpha de Cronbach (α = 0,71) aceitável. O resultado final possibilitou classificar o serviço como tendo risco sanitário inaceitável. Considera-se o IQIS com conteúdo validado, tendo confiabilidade e reprodutibilidade para avaliação higiênico-sanitária, sendo uma inovação tecnológica para serviços de alimentação e nutrição e vigilância sanitária, possibilitando inspeção detalhada e rigorosa.

Abstract The study aimed to develop a Quantitative Health Inspection Instrument (IQIS) large-sized Brazilian food and nutrition services. The inspection technology based on the Potential Risk Assessment Model (MARP) and the Brazilian Health Legislation was used. Twelve dimensions, 41 modules, and 57 risk control (critical/non-critical) indicators were structured on a scale of 0-5, totalling 1,512 indices with closed-ended response coding. The IQIS was validated with the Kappa Coefficient, with excellent agreement for the attributes of clarity and relevance (k = 0.82 and k = 0.92) and good agreement for applicability (k = 0.78). The Kruskal-Wallis test showed no statistically significant difference between the assessments (p = 0.423), the Intraclass Correlation Coefficient was satisfactory (ICC = 0.53), and Cronbach's Alpha (α = 0.71) was acceptable. The final result made it possible to classify the service as having an unacceptable health risk. IQIS is considered to have validated content, be reliable and reproducible to assess the hygienic-sanitary conditions, being a technological innovation for food and nutrition services and sanitary, allowing a detailed and rigorous inspection.

Desafios na gestão de resíduos de estabelecimentos de saúde públicos perante a RDC 222/18 / Waste management challenges of public health facilities subject to RDC 222/18

RESUMO A RDC 222/18 representa um avanço na área da gestão dos resíduos de serviços de saúde, no entanto, alguns desafios precisam ser considerados para o alcance dos impactos esperados na saúde ambiental e na qualidade de vida da população. Nesta perspectiva, considerando que estabelecimentos de saúde públicos precisam ser regulados pelo órgão responsável no que se refere às adequações sanitárias, o presente estudo tem como propósito relatar a experiência acadêmica de um profissional de saúde na coleta de dados de inspeção sanitária para pesquisa nos estabelecimentos de saúde públicos de um município do Sul do Brasil e os desafios ante a RDC 222/18. Como material de observação, foi utilizado o roteiro de inspeção aplicado em 28 estabelecimentos de saúde públicos. As informações coletadas foram categorizadas conforme os desafios observados. Verificaram-se desafios na gestão dos Resíduos de Serviços de Saúde (RSS) relativos à ausência de plano de gerenciamento, falha no manejo, falta de abrigo externo, falhas na tomada de decisão e quanto à responsabilidade técnica. Evidenciou-se que, para o cumprimento da RDC 222/18 e seus consequentes impactos positivos, o tema necessita de maior visibilidade em meio aos profissionais da saúde, especialmente no campo da educação permanente.

ABSTRACT RDC 222/18 represents an advancement in the area of health care waste management, however, some challenges need to be considered in order to achieve the expected impact on environmental health and quality of life of the population. In this perspective, considering that public health institutions need to be regulated by the body responsible for sanitary management, this study aims to report the academic experience of a health professional in gathering data related to sanitary inspections of public health services in a municipality in Southern Brazil and the challenges facing RDC 222/18. As an observation material, the inspection list applied in 28 public health care facilities were used. The obtained information was categorized according to the observed challenges. There were challenges in the management of Health Service Waste (RSS) related to the absence of a management plan, management failure, lack of external shelter, decision-making failures and technical responsibility. It was noted that, in order to comply with RDC 222/18 and its consequent positive impacts, this theme needs greater visibility amongst health professionals, particularly in the permanent education field.

Assessing the Impact of a Risk-Based Intervention on Piped Water Quality in Rural Communities: The Case of Mid-Western Nepal.

Ensuring universal access to safe drinking water is a global challenge, especially in rural areas. This research aimed to assess the effectiveness of a risk-based strategy to improve drinking water safety for five gravity-fed piped schemes in rural communities of the Mid-Western Region of Nepal. The strategy was based on establishing community-led monitoring of the microbial water quality and the sanitary status of the schemes. The interventions examined included field-robust laboratories, centralized data management, targeted infrastructure improvements, household hygiene and filter promotion, and community training. The results indicate a statistically significant improvement in the microbial water quality eight months after intervention implementation, with the share of taps and household stored water containers meeting the international guidelines increasing from 7% to 50% and from 17% to 53%, respectively. At the study endline, all taps had a concentration of <10 CFU Escherichia coli/100 mL. These water quality improvements were driven by scheme-level chlorination, improved hygiene behavior, and the universal uptake of household water treatment. Sanitary inspection tools did not predict microbial water quality and, alone, are not sufficient for decision making. Implementation of this risk-based water safety strategy in remote rural communities can support efforts towards achieving universal water safety.

Economic losses due to the occurrence of cysticercosis in cattle from cities located in Minas Gerais, Brazil / Perdas econômicas devido à ocorrência de cisticercose em bovinos procedentes de municípios localizados em Minas Gerais, Brasil

ABSTRACT: Cysticercosis represents an important public health problem that can cause significant economic losses to the beef industry. The present study aimed to determine the prevalence rate of cysticercosis in cattle and estimate the economic losses to producers associated with this parasitic disease. Data were collected from the official sanitary inspection service of a slaughterhouse located in the city of Uberlândia, Minas Gerais, southeast Brazil, from 2009 to 2016. A total of 358,383 cattle from 46 cities in Minas Gerais, Brazil, were slaughtered, of which 4,243 were infected with cysticercosis (1.18%). A total of 5,194 cysticerci were detected in these carcasses, of which 4,548 (87.56%) were alive and 646 (12.44%) were calcified. Most of the cysticerci were located in the masseter and pterygoid masticatory muscles (72.41%). As to the classification of cysticercosis according to the degree of infection of organs and/or parts affected, mild infection was the most frequently observed (92.36%). Rural producers had a total of R$ 1,755,204.20 (US$ 537,526.80) of economic losses due to bovine cysticercosis during the time span of eight years covered by this retrospective study. The importance of the sanitary inspection of meat in the control of this major zoonotic diseases is emphasized.

RESUMO: A cisticercose representa um importante problema de saúde pública que pode causar prejuízos econômicos impactantes para a cadeia da carne bovina. Objetivou-se com este estudo determinar a frequência da ocorrência de cisticercose em bovinos e as perdas econômicas aos produtores. Foram coletados dados do serviço de inspeção sanitária oficial de um abatedouro frigorífico de Uberlândia, Estado de Minas Gerais, Brasil, no período de 2009 a 2016. Foram abatidos 358.383 bovinos, provenientes de 46 municípios de Minas Gerais, sendo que destes, 4.243 estavam infectados com cisticercose (1,18%). Foram detectados um total de 5.194 cisticercos, sendo 4.548 (87,56%) vivos e 646 (12,44%) calcificados. A maioria dos cisticercos estava localizada nos músculos mastigatórios masseteres e pterigóides (72,41%). Quanto à classificação da cisticercose, de acordo com o grau de infecção dos órgãos e/ou partes, a infecção discreta foi a que mais ocorreu (92,36%). Verificou-se que os produtores rurais tiveram um total de R$ 1.755.204,20 (US$ 537.526,80) de perdas econômicas durante o período analisado de oito anos devido à ocorrência de cisticercose no rebanho bovino. Destacou-se a importância da inspeção sanitária de carnes, no controle desta importante zoonose.

Soluções individuais de abastecimento de água para consumo humano: questões para a vigilância em saúde ambiental / Individual water supply solutions: issues for environmental health surveillance

Resumo Introdução Ainda são vários os desafios da Vigilância da Qualidade da Água para Consumo Humano (VQACH) nos municípios, principalmente em relação às soluções alternativas individuais de abastecimento (SAIs), as quais podem apresentar ágeis mudanças, especialmente, em cenários de restrição hídrica. Métodos Analisaram-se os perigos relacionados às SAIs cadastradas em município de pequeno porte da Zona da Mata de Minas Gerais, integrando dados relativos à notificação de casos de doença diarreica aguda (DDA). Resultados Entre setembro de 2013 e janeiro de 2015, foram cadastradas/inspecionadas 584 SAIs, das quais 19,7% localizadas na área urbana e 80,3% na área rural. Além disso, 92,6% eram utilizadas para fornecimento de água para consumo humano, atendendo a 2.323 pessoas. Maior proteção e/ou cuidado foram observados na área urbana, assim como maior ocorrência de focos de contaminação (o mais frequente foi o esgoto sanitário). Apenas para área urbana foi identificada correlação estatisticamente significante entre número de SAIs e casos notificados de DDA (p=0,002). Conclusão Reforça-se a necessidade de investimentos e a priorização de ações da VQACH direcionadas às SAIs, já que não são alvos de ações de controle da qualidade da água, bem como o aumento da cobertura da população por serviços de saneamento.

Abstract Introduction There are still many challenges concerning the Drinking Water Surveillance in the municipalities, mostly related to individual supply solutions (SAI) which may present quick changes, especially in water stress scenarios. Methods This study analyzed hazards related to SAI recorded in a city at Zona da Mata, Minas Gerais State, integrating data from local report of acute diarrheal disease (DDA). Results From September/2013 to January/2015, 584 SAI were recorded and inspected; 19.8% located at urban area and 80.3% at rural area. Of the total, 92.6% provided water for human consumption, serving 2,323 people. Higher protection and/or care were observed in urban area, where, on the other hand, there was higher occurrence of sources of contamination (being "wastewater" the most frequent). There was statistically significant correlation between the number of SAI and reported cases of DDA (p=0.002) only for urban area. Conclusion The data highlight the need for investments and prioritization of Drinking Water Surveillance actions directed to SAI, since they are not subject to water quality control actions; as well as the increase in population coverage by sanitation services.

Fuzzy Visa: um modelo de lógica fuzzy para a avaliação de risco da Vigilância Sanitária para inspeção de resíduos de serviços de saúde / Fuzzy Visa: a fuzzy logic model for risk assessment of Health Surveillance for health services waste inspection

Resumo A inspeção sanitária de Gerenciamento de Resíduos de Serviços de Saúde (GRSS) carece de metodologia de trabalho padronizada que proporcione bases seguras de avaliação de risco potencial (RP). O objetivo deste trabalho foi propor um instrumento baseado em lógica fuzzy capaz de padronizar a inspeção e gerar indicadores de controle sanitário. O modelo foi desenvolvido com 18 subsistemas relacionados ao GRSS, que resultaram da aglutinação de elementos identificados na inspeção, como aqueles que interferem na avaliação e permeiam todas as etapas do GRSS. A validação do modelo foi realizada em dez unidades de saúde no Rio de Janeiro, de maio a novembro de 2009. Os resultados obtidos no sistema seguiram os diagnósticos realizados pelos especialistas, mostrando a possibilidade de sistematização e racionalização das avaliações de RP. Esse sistema de apoio à decisão torna mais eficiente a gestão e o planejamento de ações na avaliação do RP.

Abstract The sanitary inspection of Health Services Waste Management (HSWM) lacks a standardized work methodology that provides a secure basis for evaluating potential risk (PR). This study aimed to propose an instrument based on fuzzy logic that could standardize inspection and generate indicators of sanitary control. The model was developed with 18 subsystems related to HSWM obtained from the assembly of elements identified in the inspection as those that interfere with the assessment and permeate all stages of HSWM. The validation of the model was conducted in 10 health establishments in Rio de Janeiro between May to November 2009. The results obtained by this model were consistent with the diagnoses made by experts and clearly indicated the possibility of the systematization and rationalization of PR assessments. This decision support system makes management and planning of actions more efficient in PR evaluation.

Roteiro de inspeção sanitária de ambientes e processos de trabalho em postos de revenda de combustíveis: análise de usos e aplicações no estado de Santa Catarina / Uses and applications of the Form for Sanitary Inspection of Work Processes and Environments in Gas Stations, Santa Catarina state, Brazil

Resumo Introdução: o Roteiro de inspeção sanitária de ambientes e processos de trabalho em postos de revenda de combustíveis (RIAT-PRC) é utilizado para fins de vigilância em saúde pelo Centro de Referência em Saúde do Trabalhador (Cerest). Objetivo: descrever os usos e aplicações do RIAT-PRC a partir da experiência da vigilância em saúde do trabalhador do estado de Santa Catarina. Método: relato descritivo e analítico do instrumento RIAT-PRC e da avaliação de sua qualidade e uso no estado de Santa Catarina, no período de 2010 a 2014. Resultados: o roteiro foi aplicado em 459 PRC, com bom grau de preenchimento no geral. A aplicação do instrumento permitiu identificar baixa realização de monitoramentos biológicos e ambientais por parte das empresas. Também permitiu o acompanhamento das condições de trabalho e de saúde dos trabalhadores ao longo do tempo, bem como a possibilidade de identificar fatores e situações de risco nos ambientes de trabalho. Conclusão: o RIAT-PRC mostrou factibilidade para vigilância e para subsídio de estudos sobre exposição ao benzeno em PRC. Evidenciou-se a necessidade de aprimorar a capacitação das equipes técnicas para a efetiva vigilância da exposição ao benzeno e a outros agentes químicos presentes nos PRC.

Abstract Introduction: the Form for Sanitary Inspection of Work Processes and Environments in Gas Stations (RIAT-PRC) is used for health surveillance by Reference Centers in Occupational Health (Cerest). Objective: to describe the uses and applications of the RIAT-PRC tool from the experience of the Surveillance of Occupational Health in the state of Santa Catarina, Brazil. Method: descriptive and analytical report of the RIAT-PRC tool and of the evaluation of its quality and use in Santa Catarina, from 2010 to 2014. Results: the form was introduced in 459 gas stations, with good filling degree in general. The application of the tool, made it possible to verify that the companies carried out only a few biological and environmental monitoring. It also allowed us to follow workers' occupational and health conditions along the study time as well as to identify risk factors in work environments. Conclusion: the RIAT-PRC was useful for surveillance and for supporting studies on benzene exposure in gas stations. The results highlighted the need to improve the training of surveillance technical teams, aiming at an effective monitoring of gas stations workers' exposure to benzene and other chemicals.

Condições higienicossanitárias em serviços de nutrição hospitalar durante período de intervenção / Hygienic-sanitary conditions in hospital nutrition services during intervention period

O objetivo do estudo foi avaliar as condições higienicossanitárias de serviços de nutrição hospitalar, durante período de intervenção sistemática, baseado nos requisitos de higiene pessoal e ambiental. Foram avaliadas 15 unidades, por meio de lista de verificação e realizou-se análise microbiológica das mãos dos manipuladores e superfícies de apoio, antes e após intervenção. A intervenção foi elaborada e implementada nos serviços de nutrição hospitalar, durante um ano, por profissional terceirizado, sendo composto por três etapas: 1) aplicação da lista de verificação e plano de ação; 2) capacitações; 3) visitas mensais para motivação dos manipuladores e responsáveis técnicos, auxílio e acompanhamento na implementação dos requisitos de higiene pessoal e ambiental. Foram avaliados os microrganismos aeróbios mesófilos, Staphylococcus aureus, coliformes totais e termotolerantes. Constatou-se que os serviços de nutrição hospitalar melhoraram as condições de higiene pessoal e ambiental e diminuíram a contaminação nas mãos e superfícies, após intervenção. Conclui-se que a intervenção sistemática por profissional externo auxiliou na adequação das condições higienicossanitárias nos serviços de nutrição hospitalar e proporcionou mudanças positivas no comportamento dos manipuladores.

The objective of the study was to evaluate the hygienic-sanitary conditions in hospital nutrition services during of systematic intervention period based on requirements for personal and environmental hygiene. Fifteen hospital nutrition services were evaluated using a checklist and a microbiological analysis of the hands of food handlers and surfaces in contact with foods, before and after the intervention. The intervention was developed and conducted at the locations for one year by a third-party professional and included three stages: 1) application of checklist and action plan; 2) trainings; 3) monthly visits for motivation of handlers, supervisory technicians, and assistance and supervision in the implementation of the requirements regarding personal and environmental hygiene. The aerobic mesophilic microorganisms were studied as well as Staphylococcus aureus, total coliforms and thermotolerant coliforms. It was found that the personal hygiene and environmental conditions at the hospital nutrition services improved and there was decreased contamination of hands and surfaces after intervention. It was concluded that the systematic intervention by outside professional helped hygienic-sanitary conditions in hospital nutrition services meet the requirements and provide positive changes in the conduct offood handlers.

Condições higienicossanitárias em serviços de nutrição hospitalar durante período de intervenção / Hygienic-sanitary conditions in hospital nutrition services during intervention period

O objetivo do estudo foi avaliar as condições higienicossanitárias de serviços de nutrição hospitalar,durante período de intervenção sistemática, baseado nos requisitos de higiene pessoal e ambiental. Foram avaliadas 15 unidades, por meio de lista de verificação e realizou-se análise microbiológica das mãos dos manipuladores e superfícies de apoio, antes e após intervenção. A intervenção foi elaborada e implementada nos serviços de nutrição hospitalar, durante um ano, por profissionalterceirizado, sendo composto por três etapas: 1) aplicação da lista de verificação e plano de ação; 2) capacitações; 3) visitas mensais para motivação dos manipuladores e responsáveis técnicos, auxílio e acompanhamento na implementação dos requisitos de higiene pessoal e ambiental. Foram avaliados os microrganismos aeróbios mesófilos, Staphylococcus aureus, coliformes totaise termotolerantes. Constatou-se que os serviços de nutrição hospitalar melhoraram as condições de higiene pessoal e ambiental e diminuíram a contaminação nas mãos e superfícies,após intervenção. Conclui-se que a intervenção sistemática por profissional externo auxiliou na adequação das condições higienicos sanitárias nos serviços de nutrição hospitalar e proporcionou mudanças positivas no comportamento dos manipuladores.

The objective of the study was to evaluate the hygienic-sanitary conditions in hospital nutrition services during of systematic intervention period based on requirements for personal andenvironmental hygiene. Fifteen hospital nutrition services were evaluated using a checklist and a microbiological analysis of the hands of food handlers and surfaces in contact with foods, before and after the intervention. The intervention was developed and conducted at the locations for one year by a third-party professional and included three stages: 1) application of checklist and action plan; 2) trainings; 3) monthly visits for motivation of handlers, supervisory technicians,and assistance and supervision in the implementation of the requirements regarding personal and environmental hygiene. The aerobic mesophilic microorganisms were studied as wellas Staphylococcus aureus, total coliforms and thermotolerant coliforms. It was found that the personal hygiene and environmental conditions at the hospital nutrition services improved andthere was decreased contamination of hands and surfaces after intervention. It was concluded that the systematic intervention by outside professional helped hygienic-sanitary conditions in hospital nutrition services meet the requirements and provide positive changes in the conduct of foodhandlers.