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Personal Protective Equipment

(Survival Manual / 6. Medical / c) General Clinic / Personal Protective Equipment)

Personal Protection Equipment (PPE) by hazard
<http://en.wikipedia.org/wiki/Personal_protective_equipment#Biological_hazard_protection>
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Biological hazard protection
Protective equipment for biological hazards includes masks worn by medical personnel (especially in surgery to avoid infecting the patient but also to avoid exposing the personnel to infection from the patient.) Gloves, frequently changed, are used to prevent infection but also transfer between patients.

*** PPE should always be regarded as a ‘last resort’ to protect against risks to safety and health.

Ballistic
Ballistic personal protective equipment (or armor) is used in combat by soldiers and in lesser conflicts by law enforcement.

Blunt Trauma
Law enforcement and Corrections officers wear Blunt Trauma PPE for crowd management, civil disturbances, cell extractions, riot control, violent disturbances, and other emergency response operations.

Fire
Fire proximity suit

Sports
Protective clothing is also worn for contact sports, such as ice hockey and American football. Baseball players wear sliding shorts and a cup under their pants. See baseball clothing and equipment, cuirass, goalie mask, jockstrap. Law in many countries requires protective headgear and eyewear for riding a motorcycle.

Air-Purifying Respirator
Respirators such as “gas masks” and particle respirators filter chemicals and gases or airborne particles. A second type of respirator protects users by providing clean, respirable air from another source. This type includes airline respirators and self-contained breathing apparatus (SCBA). In work environments, respirators are used when adequate ventilation is not available or other engineering control systems are not feasible.
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Biological & Chemical Hazard

1.  Principles for using biological (and chemical ) Personal Protective Equipment (PPE)
In all cases, the following principles apply:
• 
PPE reduces but does not completely eliminate the possibility of  infection (contamination).
•  PPE is only effective if used correctly and at all times where contact may occur.
•  Any contact between contaminated (used) PPE and surfaces / clothing / people outside the isolation area must be avoided.
•  Used PPE must be sealed in appropriate disposal bags and sterilized or decontaminated. If staff temporarily leave the isolation area, a complete change of PPE and hand washing required.
•  The use of PPE does not replace basic hygiene measures such as hand-washing, washing is still essential to prevent transmission.
•  Exposure to the infected patientt should be kept to an absolute minimum necessary for the level of care required.

Who should use Personal Protective Equipment?
•  All those who are handling infected or suspected to be infected poultry and poultry products. These include cullers and animal husbandry/veterinary staff.
•  All doctors, nurses and health care workers who provide direct patient care to avian influenza cases (keep to minimum necessary for patients’ condition);
•  All support staff including medical aides, X-ray technicians, cleaners, transport staff, laundry staff (keep staff to the minimum necessary, designate avian influenza laundry staff, etc.);
•  All laboratory staff who handle patient specimens from suspect cases (keep to the minimum the staff necessary for laboratory procedures);
•  Family members who care for avian influenza patients (visits should be avoided where possible); The patient(s) should wear a mask (N95 preferable) when other people are in the isolation area. Contacts and international travelers during home isolation/quarantine must wear a mask (N95 preferable).

Personal Protective Equipment (lowest level threats)
The items included are:
•  Masks (N-95; N/P/R-100, If not available N80 or surgical masks as last resort)
•  Gloves
•  Gloves and aprons
•  Hair Covers
•  Eye protective ware (goggle)
•  Boots or shoe covers
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2.  Basic Sanitation techniques (If you need to wear PPE then you should be following the steps listed below):
Hand washing
•  It is the single most important and effective component for preventing the transmission of infection and removal of contamination.
•  Running water and soap with friction should be ideally used for 15 to 20 seconds.
•  It is important to dry hands after washing.
•  A 70% alcohol-based hand rub solution after hand washing can be used.

Hand washing  should be done:
•  After removing gloves
•  Before and after patient contact or contact with potentially infected material
•  After contact with blood and body fluids
•  After taking samples
•  After taking blood-pressure or vital signs from patient
•  After using bath room
•  After blowing/wiping nose
•  Before eating and preparing food.
•  When leaving the isolation unit.

Waste disposal
The practices as approved by the Hospital Infection Control Committee or hospital authorities must be followed. Some of these are:
•  Waste should be collected in designated color coded plastic bags for sterilization and disposal.
•  Double bag system for transport should be used.

Cleaning and disinfection of hospital environment and equipment
The practices as approved by the Hospital Infection Control Committee or hospital authorities must be followed. Some of these are:
•  Cleaning staff should wear full PPE
•  Cleaning should be done thoroughly to be followed by disinfection
•  Items and areas requiring cleaning and disinfection are:
•  Bedside table, bed stand, accessible areas of bed and floors (Use 0.1% sodium hypochlorite as disinfectant)
•  If any surface is grossly contaminated, pour 1% sodium hypochlorite first and leave it for 10-15 minutes to be followed by cleaning and usual disinfection (0.1% sod. hypochlorite).
•  Basins and bedpans should be cleaned and disinfected before being used for another patient.
•  Spray disinfectant is prohibited.

PPE reduces but does not completely eliminate the possibility of infection or contamination.
•  PPE is only effective if used correctly and at all times where contact may occur.
•  Any contact between contaminated (used) PPE and surfaces / clothing / people outside the isolation area must be avoided.
•  Used PPE must be sealed in appropriate disposal bags and sterilized or decontaminated. If staff temporarily leave the isolation area, a complete change of PPE and hand washing required.
•  The use of PPE does not replace basic hygiene measures such as hand-washing, washing is still essential to prevent transmission.
•  Exposure to the infected patient should be kept to an absolute minimum necessary for the level of care required.
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3.  Discussion of general protective clothing
•  Surgical mask: Surgical masks are designed to protect the sterile field of the patient from contaminants generated by the wearer. Although surgical masks filter out large-size particulates, they offer no respiratory protection against chemical vapors. These masks are effective against respiratory droplets and are used when treating infected patients who require “droplet precautions” such as pneumonic plague.
•  Protective Clothing: Most protective clothing is aimed at protection against chemicals and CWAs because intact skin provides an effective barrier against all BWAs except the trichothecene mycotoxins.
• Chemical-protective clothing: Chemical-protective clothing (CPC) consists of multilayered garments made out of various materials that protect against various hazards. Because no single material can protect against all chemicals, multiple layers of various materials are usually used to increase the degree of protection. Aluminum-lined, vapor-impermeable garments increase the level of protection. Protection is maximized by total encapsulation. An assortment of types of chemical-protective hats, hoods, gloves, and boot covers complements the garments.
•  Barrier gown and latex gloves: Barrier gowns are waterproof and protect against exposure to biological materials, including body fluids, but do not provide adequate skin or mucous membrane protection against chemicals. Latex gloves also protect wearers from biological materials but are inadequate against most chemicals.
Barrier gowns, latex gloves, and leg and/or shoe covers together comprise “contact precautions” and are useful for agents such as viral hemorrhagic fevers.
•  Chemical-protective gloves: Chemical-protective glove sets consist of a protective outer glove made out of butyl rubber and an inner glove for absorption of perspiration. Glove sets are available in 4 sizes and 3 thicknesses (7, 14, and 25 mL) with varying tactile sensitivities. Gloves may be worn for 12 hours in the contaminated environment. After visual inspection, gloves may be reused for another 12 hours. After use, gloves may be decontaminated and reused.
•  Chemical-protective footwear covers: Chemical-protective footwear covers (CPFC) are single-sized butyl rubber footwear covers that protect combat boots against all agents. Vinyl over boots are also available.
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4.  Biohazard Levels
<http://en.wikipedia.org/wiki/Biological_hazard>
The United States’ Centers for Disease Control and Prevention (CDC) categorizes various diseases in levels of biohazard, Level 1 being minimum risk and Level 4 being extreme risk. Laboratories and other facilities are categorized as BSL (BioSafety Level) 1-4 (Pathogen or Protection Level) as follow:

Biohazard Level 1:
• 
Bacteria and viruses including Bacillus subtilis, canine hepatitis, Escherichia coli, varicella (chicken pox), as well as some cell cultures and non-infectious bacteria.
•  At this level precautions against the biohazardous materials in question are minimal, most likely involving gloves and some sort of facial protection.
•  Usually, contaminated materials are left in open (but separately indicated) waste receptacles. Decontamination procedures for this level are similar in most respects to modern precautions against everyday viruses (i.e.: washing one’s hands with anti-bacterial soap, washing all exposed surfaces of the lab with disinfectants, etc.). In a lab environment, all materials used for cell and/or bacteria cultures are decontaminated via autoclave.

Biohazard Level 2:
•  Bacteria and viruses that cause only mild disease to humans, or are difficult to contract via aerosol in a lab setting, such as hepatitis A, B, and C, influenza A, Lyme disease, salmonella, mumps, measles, scrapie, dengue fever, and HIV.
•   “Routine diagnostic work with clinical specimens can be done safely at Biosafety Level 2, using Biosafety Level 2 practices and procedures. Research work (including co-cultivation, virus replication studies, or manipulations involving concentrated virus) can be done in a BSL-2 (P2) facility, using BSL-3 practices and procedures.

Biohazard Level 3:
•  Bacteria and viruses that can cause severe to fatal disease in humans, but for which vaccines or other treatments exist, such as anthrax, West Nile virus, Venezuelan equine encephalitis, SARS virus, variola virus (smallpox), tuberculosis, typhus, Rift Valley fever, Rocky Mountain spotted fever, yellow fever, and malaria. Among parasites Plasmodium falciparum, which causes Malaria, and Trypanosoma cruzi, which causes trypanosomiasis, also come under this level.

Biohazard Level 4:
•  Viruses and bacteria that cause severe to fatal disease in humans, and for which vaccines or other treatments are not available, such as Bolivian and Argentine hemorrhagic fevers, Dengue hemorrhagic fever, Marburg virus, Ebola virus, hantaviruses, Lassa fever, Crimean-Congo hemorrhagic fever, and other hemorrhagic diseases.
•  When dealing with biological hazards at this level the use of a Hazmat suit and a self-contained oxygen supply is mandatory.
•  The entrance and exit of a Level Four biolab will contain multiple showers, a vacuum room, an ultraviolet light room, autonomous detection system, and other safety precautions designed to destroy all traces of the biohazard. Multiple airlocks are employed and are electronically secured to prevent both doors opening at the same time. All air and water service going to and coming from a Biosafety Level 4 lab will undergo similar decontamination procedures to eliminate the possibility of an accidental release.
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5. Employer Guidelines for appropriate PPE (Personal Protective Equipment)
<http://www.osha.gov/pls/oshaweb/owadisp.show_document?p_table=STANDARDS&p_id=9767>Personal protective equipment is divided into four categories based on the degree of protection afforded.
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PPE Level A 
(To be selected when the greatest level of skin, respiratory, and eye protection is required.  )
Definition: The hazardous substance has been   identified or is an unknown, and requires the highest level of protection for   skin, eyes, and the respiratory system based on either the measured (or   potential for) high concentration of atmospheric vapors, gases, or   particulates; or the site operations and work functions involve a high   potential for splash, immersion, or exposure to unexpected vapors, gases, or   particulates of materials that are harmful to skin or capable of being   absorbed through the skin.
—Substances with a high degree of hazard to   the skin are known or suspected to be present, and skin contact is possible;   or
—Operations must be conducted in confined,   poorly ventilated areas, and the absence of conditions requiring Level A have   not yet been determined.
—When an event is uncontrolled or   information is unknown about: the type of airborne agent, the dissemination   method, if dissemination is still occurring or it has stopped.
Components: A fully encapsulated, liquid and vapor   protective ensemble selected when the highest level of skin, reparatory and   eye protection is required.
Positive pressure, full face-piece   self-contained breathing apparatus (SCBA), or positive pressure supplied air   respirator with escape SCBA, approved by the National Institute for Occupational Safety and Health (NIOSH).  Closed-circuit Rebreather/ open   circuit SCBA.
Totally-encapsulating chemical-protective suit.
—Gloves, outer, chemical-resistant.
—Gloves, inner, chemical-resistant.
—Boots, chemical-resistant, steel toe and   shank, outer booties.
—Disposable protective suit, gloves and   boots (depending on suit construction, may be worn over totally-encapsulating   suit).
—Coveralls.
*—Long underwear.
*—Hard hat (under suit), personal cooling   system, chemical resistant tape.
**Optional/as needed.
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PPE Level B  (The highest level of respiratory protection is necessary but a lesser level of skin protection is needed.) 
Definition:
The type and atmospheric concentration of   substances have been identified and require a high level of respiratory   protection, but less skin protection.
—The atmosphere contains less than 19.5   percent oxygen; or
—The presence of incompletely identified   vapors or gases is indicated by a direct-reading organic vapor detection   instrument, but vapors and gases are not suspected of containing high levels   of chemicals harmful to skin or capable of being absorbed through the skin.
—A liquid-splash-resistant ensemble used   with the highest level of reparatory protection.
—The suspected aerosol is not longer being   generated, but other conditions may present a splash hazard.
Components: A liquid-splash-resistant ensemble used   with the highest level of reparatory protection.
Positive pressure, full-face piece   self-contained breathing apparatus (SCBA), or positive pressure supplied air   respirator with escape SCBA (NIOSH approved).
Hooded chemical-resistant clothing   (overalls and long-sleeved jacket; coveralls; one or two-piece   chemical-splash suit; disposable chemical-resistant overalls).
—Gloves, outer, chemical-resistant.
—Gloves, inner, chemical-resistant.
—Boots, outer, chemical-resistant steel toe   and shank.
—Boot-covers, outer, chemical-resistant.
—Hard hat, personal cooling system,   chemical resistant tape.
*—Coveralls.
*—Face shield.
**Optional/as needed.
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PPE Level C  (The concentration and type of airborne substance is known and the criteria for using air purifying respirators are met)
Definition: The atmospheric contaminants, liquid   splashes, or other direct contact may adversely affect or be absorbed through   any exposed skin.
—The types of air contaminants have been   identified, concentrations measured, and an air-purifying respirator is   available that can remove the contaminants; and
—All criteria for the use of air-purifying   respirators are met.
Components: A liquid-splash-resistant ensemble, with   the same level of skin protection as Level B, used when the concentration(s)   and type(s) of airborne substances(s) are known and the criteria for using   air-purifying respirators are met.
Full-face or half-mask, air purifying respirators (NIOSH   approved).
Hooded chemical-resistant clothing   (overalls; two-piece chemical-splash suit; disposable chemical-resistant   overalls).
Gloves, outer, chemical-resistant.
Gloves, inner, chemical-resistant.
—Boots (outer), chemical-resistant steel   toe and shank.
—Boot-covers, outer, chemical-resistant.
Coveralls.
*—Hard hat, face shield, personal cooling   system.
*—Escape mask.
*—Face shield.
**Optional/as needed.
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PPE Level D
Definition: Selected when the atmosphere contains no   known hazards.   Work   functions preclude splashes, immersion, or the potential for unexpected   inhalation of or contact with hazardous levels of any chemicals.   This level has no respiratory protection   and minimal skin protection. Level D protection is the normal work clothes   and non- respiratory PPE. Work shirt, safety boots and safety glasses are all   examples of PPE used at this level. Dust masks used on a voluntary basis   would still fall under Level D protection. In   hospitals, Level D consists of surgical gown, mask, and latex gloves   (universal precautions). Level D PPE provides no respiratory protection and   only minimal skin protection.
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Level   D Modified
– This Level is the same as Level D for respiratory protection,   but the skin protection is increased to that of Level C. Components: A work uniform affording minimal   protection: used for nuisance contamination only.
—Coveralls.
—Boots/shoes, chemical-resistant steel toe   and shank.
—Boots, outer, chemical-resistant   (disposable).
*—Gloves.
*—Safety glasses or chemical splash   goggles.
*—Hard hat.
*—Escape mask.
*—Face shield.
**Optional/as needed.
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6.  Types of Respirators
Surgical masks
Surgical masks are not respirators and are not certified as such; they do not protect the user adequately from exposure. The primary purpose of a surgical facemask is to help prevent biological particles from being expelled by the wearer into the environment. Persons suspected of having avian influenza should be separated from others and asked to wear a surgical mask. If a surgical mask is not available, tissues should be provided and patients should be asked to cover their mouth and nose when coughing.
The benefit of wearing surgical masks by well persons in public settings has not been established and is not recommended as a public health control measure at this time. Surgical masks are not adequate PPE for airborne infections. Even though influenza is primarily spread via droplet, there may also be airborne spread. An N95 respirator or PAPR should be recommended, at least in the initial stages of a pandemic and while supplies last.
In contrast to healthcare workers who necessarily have close contact with ill patients, the general public should try to avoid close contact with ill individuals. Nevertheless, persons may choose to wear a mask as part of individual protection strategies that include cough etiquette, hand hygiene, and avoiding public gatherings. Mask use may be most important for persons who are at high risk for complications of influenza and those who are unable to avoid close contact with others or must travel for essential reasons such as seeking medical care.
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Respirators
Respirators are designed to help reduce the wearer’s exposure to airborne particles. Respirators protect the user in two basic ways.
•  a) The first is by the removal of contaminants from the air. Respirators of this type include particulate respirators, which filter out airborne particles [ie., volcanic ash, dust storms]; and, b )  “gas masks” which filter out chemicals and gases [‘tear gas’, smoke, many hazardous chemical and dangerous biological agents].
•  Other respirators protect by supplying clean respirable air from another source. Respirators that fall into this category include airline respirators, which use compressed air from a remote source; and self-contained breathing apparatus (SCBA), which include their own air supply.

Respirators are designed to reduce exposures of the wearer to airborne hazards. Biological agents, such as viruses, are particles and can be filtered by particulate filters with the same efficiency as non-biological particles having the same physical characteristics (size, shape, etc.). However, unlike most industrial particles there are no exposure limits established for biological agents. Therefore, while respirators will help reduce exposure to avian influenza viruses, there is no guarantee that the user will not contract avian flu. Respirators may help reduce exposures to airborne biological contaminants, but they don’t eliminate the risk of exposure, infection, illness, or death.

Beards, long mustaches, and stubble may interfere with a good seal and cause leaks into the respirator.

Recent CDC infection control guidance documents provide recommendations that health care workers protect themselves from diseases potentially spread through the air (such as SARS or Tuberculosis) by wearing a fit-tested respirator at least as protective as a NIOSH-approved N-95 respirator. The N95 only offers protection down to .3 microns, and viruses are smaller than this — human SARS coronaviruses measure between 0.1 and 0.2 microns. But viruses often travel on larger particles, such as globs of mucus, which can be filtered. Available data suggest that infectious droplet nuclei may range in size from 1 mm to 5 mm; therefore, respirators used in health care settings should be able to efficiently filter the smallest particles in this range.

[Photo at right: NIOSH approved N95 Particle/ Dust filter mask]

An N-95 respirator is one of nine types of disposable particulate respirators.
Particulate respirators are also known as “air-purifying respirators” because they protect by filtering particles out of the air you breathe. Workers can wear any one of the particulate respirators for protection against diseases spread through the air — if they are NIOSH approved and if they have been properly fit-tested and maintained. NIOSH-approved disposable respirators are marked with the manufacturer’s name, the part number (P/N), the protection provided by the filter (e.g. N-95), and “NIOSH.”
A N-95 filters at least 95% of airborne particles.
Higher level particulate respirators [i.e., N-100 filter at least 99.97% airborne] may also be used.

[Image below: The North® 7600 Full Face Mask Respirator: designed to provide eye, face and N100 respiratory protection, while ensuring optimal comfort and performance. Dual flange silicone seal with superior fitting characteristics, a hard-coated polycarbonate lens w/ over 200° field of vision & protects against irritating gases, vapors and flying particles. Includes 5-strap harness, oral nasal cup, chin cup and speaking diaphragm. NIOSH/MSHA approved.]

An N100 mask is well suited for those who want NIOSH’s highest rated filtration efficiency in a maintenance free respirator. It provides a minimum filter efficiency of 99.97% against non-oil based particles. It is nearly 200 times more effective than the N95 filter (typical style seen above), and is also about ten times more expensive.

Protective Respiratory Devices
Two basic types of respirators are available: atmosphere supplying (self-contained breathing apparatus [SCBA], supplied-air respirator [SAR]) and air purifying respirator (APR).

•  Self-contained breathing apparatus: SCBA consists of a full facepiece connected by a hose to a portable source of compressed air.
•  Supplied-air respirator: SAR consists of a full face piece connected to an air source away from the contaminated area via an airline.
•  Air-purifying respirator: An APR consists of a face piece worn over the mouth and nose with a filter element that filters ambient air before inhalation. Three basic types of APRs are available: powered, disposable, and chemical cartridge or canister.
_a)  Nonpowered APRs operate under negative pressure, depending on the inspiratory effort of the wearer to draw air through a filter. Because PAPRs function under positive pressure, they provide the greatest degree of respiratory protection. Various chemical cartridges or canisters, which eliminate various chemicals including organic vapors and acid gases, are available.
_b)  Disposable APRs are usually half masks, which do not provide adequate eye protection. This type of APR depends on a filter, which traps particulates. The use of a high-efficiency particulate air (HEPA) filter or use in combination with a chemical cartridge enhances disposable APRs.

One measure of respiratory filtration efficiency relevant to BWA exposures is the percent penetration of droplet nuclei into the face piece. For exposures to biological aerosols, a) PAPRs with HEPA filters are most efficient, b) followed by elastomeric half-mask HEPA filter respirators and, c) non-HEPA disposable APRs.
All APRs are limited by the adequacy of their face seals. Accordingly, APRs do not provide adequate respiratory protection in environments immediately dangerous to life or health.
•  High-efficiency particulate air filter (HEPA)
HEPA filters remove particles of 0.3-15 µm diameter with an efficiency of 98-100%, efficiently excluding aerosolized BWA particles in the highly infectious 1- to 5-µm range. HEPA filters are incorporated into various protective respiratory devices including PAPRs and elastomeric half-mask respirators. This type of filtration is required when caring for a patient infected with a disease requiring “airborne precautions” such as smallpox and viral hemorrhagic fevers. Use of an N-100 filter should provide the same protection as the HEPA filter.

7.   Masks
A.  North 760008A Full Face M/L Facepiece (by Honeywell Corporation)
<http://www.amazon.com/North-Products-Facepiece-Respirators-760008A/dp/B002KFAHGU/ref=sr_1_1?s=hi&ie=UTF8&qid=1330858157&sr=1-1>
AMAZON Price (2011): $148.94 +$6.58 = $155.52
Technical Details
•  Type: Full Face
•  Size: Medium/Large
•  Material: Silicone
•  Harness Type: 5 Point
•  For Use With: North Cartridges and Filters
Product Description
Half Full Facepieces – Respiratory Protection Type: Full Face Size: Medium/Large Material: Silicone Harness Type: 5 Point For Use With: North Cartridges and Filters Connection Type: Threaded
Technical Details
Designed to provide eye, face and respiratory protection while ensuring optimal comfort and performance. Dual flange silicone seal give this facepiece superior fitting characteristics. Hard-coated polycarbonate lens provides over 200° field-of-vision and protects the wearer’s eyes and face against irritating gases, vapors and flying particles. Lens meets ANSI standards for high impact and penetration resistance. Compatible with North cartridges, filters and accessories. NIOSH approved.

 B.  North 770030 Medium Silicone Half Mask Respirator 7700 Series, Mask Only
http://www.amazon.com/North-Safety-7700-half-Small/dp/B001429P1S
AMAZON Price: $19.99 +$5.90=$$25.89
The 7700’s soft non-allergenic silicone seal provides excellent protection, comfort and fit. The half masks cradle suspension system allows the facepiece to seal evenly on the face without creating pressure points. It’s low profile gives workers a wide field to vision and does not interfere with protective eyewear. The low inhalation and exhalation resistance of the 7700 Series makes breathing easier to reduce worker fatigue. NIOSH approved when used with North cartridges and/or filters. Dual Cartridge Silicone Half Mask: Silicone facepiece material conforms to facial features and doesn’t harden with age. Silicone is easy to clean, durable and resists distortion. Contoured sealing flange and cradle suspension system eliminates discomfort caused by pressure points on facial nerves. Nose area design is comfortable and well-fitting. Minimal dead air space limits re-breathing of exhaled air. Direct cartridge-to-facepiece seal minimizes replacement parts and simplifies maintenance. The most comfortable and durable half mask available. Does not interfere with protective eyewear.  Size: 770030S – Small 770030M – Medium 770030L – Large.
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8.  Biohazard protection
•  North 7700 N100 filter; Recommended half mask for H1N1-type flu virus (Swine flu).
•  Hantavirus: Use of an N-100 filter should provide the same protection as the HEPA filter. Available evidence suggests that Hantavirus is transmitted by inspiring small (less than 5 micron) viral particles in aerosols which the N-100 is the most effective in removing.

A.  Mask particle filter protection efficiency
USA Filter Standards     Efficiency *
NIOSH N95                      94%
NIOSH N99                      99%
NIOSH N100                    99.97%

Assigned Protection Factors

Type of respirator Dust respirator Quarter mask Half mask Full
facepiece
Helmet/
hood
1. Air-Purifying Respirator max 4 5 10 50 …………..
2. Powered Air-Purifying Respirator (PAPR) ………….. 50 1,000 1,000
4. Self-Contained Breathing Apparatus (SCBA)  Pressure-demand or other positive-pressure mode circuit) ………….. ………….. 10,000 10,000

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Two of North’s many filters
(these are my choices for an emergency kit): One for dust, blowing sand and ash, the other for many chemical and biological hazards.
See at <http://www.amazon.com/North-Safety-Defender-Multi-purpose-cartridge/dp/B002D94BZQ/ref=pd_cp_hi_0>

List of North filter cartriges/pictures/prices:
<http://www.respiratormaskprotection.com/Respirator-Cartridge-Filter-Reference-Chart.html>
Most can be bought at Amazon at better prices than found elsewhere.

  

9.  DuPont TY127S Disposable White Tyvek Coverall Suit 1428
Amazon Price $5.49 + $4.57 S&H (same price as local Home Depot and Lowes paint department, less (my 8.25%) your state sales tax. Choose one size larger than your normal, to ensure al fit over your clothing and allow flexibility.
Technical Details
•  Serged seams, attached hood, front zipper closure, elastic wrists, and elastic ankles.
•  Inherent barrier protection against dry particulate hazards.
•  Applications range from agriculture to spray painting to lead remediation.
•  Even after abrasions, stops microporous particles better than other reusable garments.
•  The best balance of protection, durability and comfort.
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What are the features of  Tyvek disposable coveralls?
•  It is made from a tough material that helps prevent skin contact with wet/dry, harmful objects, or chemicals in the environment.
•  Microscopic particles as small as 0.5 microns are retarded in access through a Tyvek coverall.
•  It can’t be easily scratched or torn
•  The coverall is made from one material in one layer
•  The Tyvek disposable coverall has the ability to let air and moisture pass through which can reduce possible heat stress.
•  Tyvek suits create a barrier to water from mild splash occurrences.
•  It is proved to be six times more breathable than microporous materials
•  It can be used in various low hazard applications. As Personal Protective Equipment it fulfills body/skin protection necessary for many Level D and C threats and partial protection for Level B threats.
•  Tyvek disposable coveralls are perfect for disaster clean-up work in order to protect the wearer with maximum comfort and protection. It comes in hooded coveralls for overall protection.

 

Sports Body Armor
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Types of sports body armor
Padded pants are full-length protective armor for use when protection of hips, quads, shins, and calves is needed.
Upper body armor provides excellent soft-padded protection for the back, sides, shoulders, and arms.

Titan Sport Jacket, by Fox Racing, Amazon $139.95
<http://www.amazon.com/gp/product/B005VBFZQ2/ref=pd_lpo_k2_dp_sr_2?pf_rd_p=486539851&pf_rd_s=lpo-top-stripe-1&pf_rd_t=201&pf_rd_i=B0033PRRCS&pf_rd_m=ATVPDKIKX0DER&pf_rd_r=1P8A4A6CC24CMTQCET0Y>

Full body under jersey coverage has a new standard with the Titan Sport Jacket. Its complete plastic plating of key contact areas is unmatched. Its full mesh main body offers a precise, bunch-free fit. Add in the intelligently engineered ventilation zones and the Titan Sport Jacket truly becomes the ultimate battle suit.

Fox Racing’s new Titan Sport Jacket is probably the first hard-shell under-jersey body armor for down hill (DH) and free ride that doesn’t make you look like a linebacker. Despite protecting all critical upper-body contact areas, including shoulders and elbows, with lightweight, high-impact plastic the Titan is surprisingly svelte. The main body is made of a comfortable stretchy mesh fabric that prevents the jacket from bunching up under your jersey. Smartly designed vents in the chest and back plates also work with the mesh to help keep you cool. A major improvement is the addition of a hard-plastic chest-plate. The articulated spine protector is designed to move fluidly with a rider but can also be zipped off easily. Adjustment straps at the shoulders and ribs allow for a precise fit and better protection. The Velcro on the kidney belt has the mildly annoying habit of attaching itself to the jacket’s soft meshy parts, but that’s probably an unavoidable feature of good Velcro. While the Titan jacket is designed to be worn under your jersey, the anatomically shaped Batman aesthetic almost makes it cool enough to wear on its own.

Design & Function
• 
Anatomic high impact two piece plastic chest plate
•  Removable articulated plastic back coverage
•  High impact plastic shoulder and elbow coverage
•  Soft vented mesh main body fabric for enhanced fit,
•  Comfort and ventilation
•  Center zipper for easy on and off

An Upper Body Bike padded top is often used with the following extreme sports and activities:
Skate: Derby, Mountain Board
Bike: Down Hill, Single Track, Street, Mountain
Motor bike: ATV, Dirt, Street, Street Bike, Motocross, Super Moto, Track
Field sports: Polo
Other sports: Clown Work, Equestrian, Martial Arts, Street Louge.
.

 Ballistic Body Armor

How to choose body armor: < http://bulletproofme.com/How_to_Select_Body_Armor.shtml>
Pictures/prices/sales: <http://www.qmuniforms.com/Body-Armor/?src=SHIPFREE&gclid=CKmDrub_zK4CFQFeTAod0lHK_Q>

Body Armor Threat Levels
Deciding which body armor to purchase is as important as any purchase you will make.
Before deciding on brands, you need a little knowledge about body armor to help with your decision.
All body armor products are categorized into one of six levels.

The levels begin with Level I which offers the least amount of protection and go up to Level IV which offers the most amount of protection. This level system is the most important factor in making a purchase. You don’t need a Level IV – which will stop rifle rounds – if the purpose of the vest is to give you protection from sharp edged weapons while walking a tier a Garden State Prison. However, if you are on a tactical entry team used for high risk assaults or handling prison riots, you will need armored protection that will stop more than just knives.

An old but still very valuable street cop rule-of-thumb is to have a level of ballistic performance that stops, at a minimum, the round you carry in your service weapon. This rule is as relevant and true today as it was when body armor was first available.
Be advised, though, there are many variables.
The ballistic threat of a round depends on more than just the round. Variables include its composition, shape, caliber, mass, angle of impact, and impact velocity. Because of the wide variety of rounds and cartridges available in a given caliber and because of the existence of hand loaded ammunition, body armor that will defeat a standard test round may not defeat other loadings in the same caliber.
The National Institute of Justice (NIJ) is the research, development, and evaluation agency of the United States Department of Justice. It is from the NIJ where we get the levels of body armor. It is called the National Institute of Justice (NIJ) Ballistic Resistance of Police Body Armor.

Below is a list describing the available levels of ballistic performance of body armor:

Level I  (22 LR; 38 Special)
Level I vests offer the most basic level of protection.  This level of protection is virtually obsolete due to the common use of higher velocity ammunition. During testing the ammunition used is a .38 caliber traveling at 850 feet per second and a .22 caliber fired from a long rifle with a traveling speed of 1,050 feet per second.  Level I vests only stop fragmentation and low-velocity pistol ammunition. They are not recommended for pistol ballistic protection but can be used for riot gear or for playing paintball.

Level II-A  (Lower Velocity 357 Magnum; 9 mm)
Level II-A vests are typically 4mm thick and tested using a 9mm full metal jacket at 1,090 feet per second and a .357 Magnum jacketed soft point ammunition at 1,250 feet per second.  These bulletproof jackets offer the minimum level of protection required to protect against most threats faced on the streets.  Since this vest is thinner than a level II or III-A it offers greater comfort and concealability at the cost of offering less protection against blunt trauma.

Level II  (Higher Velocity 357 Magnum; 9 mm)
Level II vests are typically 5mm thick and tested using 9mm full metal jacket ammunition at 1,175 feet per second and .357 jacketed soft point ammunition at 1,395 feet per second.  Since they are thicker they offer more protection against blunt trauma while remaining comfortable to wear and easy to conceal.  These bulletproof vests are ideal when vests need to be concealed, worn for a long time, or when the ability to move a lot is necessary.  Theses vests are often worn by police officers.  Since Level II vests are thicker they offer great levels of protection against blunt trauma caused by higher-velocity rounds.

Level III-A  (44 Magnum; Submachine Gun 9 mm)
Level III-A vests are between 8 to 10 millimeters thick and are tested for 9 mm full metal jacket ammunition at 1,400 feet per second (the velocity of a submachine gun) and .44 Magnum Lead Semi-Wadcutter ammunition at 1,400 feet per second.  These vests offer the highest level of blunt trauma protection while remaining concealable.  Level III-A vests are suited to protect against most handguns as well as all the weapons tested on the lower-level vests.  Among all the concealable bulletproof vests they are the most expensive, thick, stiff, and heavy.  They are ideal for high-risk situations including protection against explosions and grenade attacks.

Type IV  (Armor-Piercing Rifle)
This armor protects against 30 caliber armor-piercing bullets (U.S. military designation APM2), with nominal masses of 10.8 g (166 gr) impacting at a velocity of 868 m (2850 ft) per second or less. It also provides at least single hit protection against the threats mentioned in lower levels.

• Some professionals are more concerned they will be attacked with a knife or a blunt object, so when looking at armor select for penetration protection as well.
 

.
List  of ammunition shown in the photograph above:

1. .22 Magnum 40 gr. JHP (1209 FPS   / 369 MPS)
2. .32 ACP 60 gr. Silvertip JHP (936 FPS / 285 MPS)
3. .380 ACP 95 gr. FMC (902 FPS / 275 MPS)
4. .38 Special 125 gr. Nyclad SWHP (1009 FPS / 308 MPS)
5. .38 Special +P 110 gr. JHP (1049 FPS / 320 MPS)
6. .38 Special +P 140 gr. JHP (869 FPS / 265 MPS)
7. 9mm 124 gr. FMC (1173 FPS / 358 MPS)*
8. 9mm 125 gr. JSP (1121 FPS / 342 MPS)
9. 9mm 147 gr. Black Talon (1010 FPS / 308 MPS)
10. 9mm 147 gr. Golden Saber (1083 FPS / 330 MPS)
11. 9mm 147 gr. Hydra Shok (1011 FPS / 308 MPS)
12. .357 Magnum 158 gr. JSP (1308 FPS / 399 MPS)
13. .357 Magnum 110 gr. JHP (1292 FPS / 394 MPS)
14. .357 Magnum 125 gr. JHP (1335 FPS / 407 MPS)
15. .40 Caliber 180 gr. FMJTC (992 FPS / 302 MPS)
16. .40 Caliber 170 gr. FMJTC (1095 FPS / 334 MPS)
17. 10mm 155 gr. FMJTC (1024 FPS / 312 MPS)
18. 10mm 170 gr. JHP (1137 FPS / 347 MPS)
19. .41 Magnum 210 gr. LSWC (1141 FPS / 348 MPS)
20. .44 Magnum 240 gr. LFP (1017 FPS / 310 MPS)
21. .45 Long Colt 250 gr. LRN (778   FPS / 237 MPS)
22. .45 ACP 230 gr. FMJ (826 FPS / 252 MPS)
23. 12 Ga. 00 Buck (9 pellet) (1063 FPS / 324 MPS)
24. 9mm 124 gr. FMJ (1215 FPS / 370 MPS)*
25. 9mm 115 gr. Silvertip JHP (1252 FPS / 382 MPS)
26. 9mm 124 gr. Starfire JHP (1174 FPS / 358 MPS)*
27. .357 Magnum 158 gr. JSP (1453 FPS / 443 MPS)*
28. .357 Magnum 145 gr. Silvertip JHP (1371 FPS / 418 MPS)
29. .357 Magnum 125 gr. JHP (1428 FPS / 435 MPS)
30. 10mm 175 gr. Silvertip JHP (1246 FPS / 380 MPS)
31. .41 Magnum 210 gr. JSP (1322 FPS / 403 MPS)
32. .44 Magnum 240 gr. SJHP (1270 FPS / 387 MPS)
33. 9mm 124 gr. FMJ (1440 FPS / 439 MPS)*
34. 9mm 115 gr. FMJ Israeli (1499 FPS / 457 MPS)
35. 9mm 123 gr. FMJ Geco (1372 FPS / 418 MPS)
36. 9mm 124 gr. FMJ Cavin (1259 FPS / 384 MPS)
37. .44 Magnum 240 gr. LSWC (1448 FPS / 441 MPS)*
38. .44 Magnum 240 gr. HSP (1320 FPS / 402 MPS)
39. 12 ga. 1 oz. Rifled Slug (1290 FPS / 393 MPS)
40. 12 ga. 1 oz. Rifled Slug (1254 FPS / 382 MPS)

1 Comment

Filed under Survival Manual, __6. Medical, ___c) General Clinic

Waterborne disease

(Survival manual/6. Medical/b) Disease/Waterborne disease)

The lack of clean water resources and sanitation facilities is one of the most serious environmental health problems faced today by a large fraction of the world’s population, especially those living in developing regions. The onset of waterborne diseases from water is enormous, the World Health Organization (WHO) has estimated that 1.1 billion people globally lack basic access to drinking water resources, while 2.4 billion people have inadequate sanitation facilities, which clearly accounts for many water related acute and chronic diseases.

Added to this is the rapid industrialization of many developing regions, where in the past few decades water contamination by toxic chemicals and hazardous wastes has aggravated an already serious water pollution problem. Many freshwater streams and lakes around the world have been contaminated with industrial discharges and agricultural runoffs that carry a large variety of toxic chemical substances and hazardous wastes. Many contaminated water sources contain a number of heavy metals, pesticides and other agricultural chemicals, along with persistent organic pollutants (POPs), many of which remain in the environment for long periods of time and bioaccumulate in the food web, causing many acute and chronic diseases, ranging from severe skin and liver disorders to developmental abnormalities and human cancer.

See also the post dealing with water treatment-purification, located in category:
Survival Manual/3. Food and Water/Water
.

Waterborne infections that may be encountered in U.S. streams and lakes.

Protozoa (little animal) Infections

Disease
and Transmission

Microbial
Agent

Sources of
Agent in Water Supply

General Symptoms

Cryptosporidiosis

Protozoan: Cryptosporidium parvum

Collects on water filters and membranes that cannot be disinfected, animal manure, seasonal runoff of water.

Flu-like symptoms, watery diarrhea, loss of appetite, substantial loss of weight, bloating, increased gas, nausea

Giardiasis (oral-fecal) (hand-to-mouth)

Protozoan: Giardia lamblia.

 Most common intestinal parasite

Untreated water, poor disinfection, pipe breaks, leaks, groundwater contamination, campgrounds where humans and wildlife use same source of water. Beavers and muskrats create ponds that act as reservoirs for Giardia.

Diarrhea, abdominal discomfort, bloating, and flatulence

Microsporidiosis

Protozoan phylum (Microsporidia), but closely related to fungi

The genera of Encephalitozoon intestinalis has been detected in groundwater, the origin of drinking water

Diarrhea and wasting in immunocompromised individuals..

.
Parasitic Infections (Kingdom Animalia)

Disease and Transmission

Microbial Agent

Sources of Agent

in Water Supply

General Symptoms

Taeniasis

(tapeworm)

Tapeworms of the genus Taenia

Drinking water
contaminated with eggs

Intestinal disturbances, neurologic manifestations, loss of weight, cysticercosis

Hymenolepiasis (Dwarf Tapeworm
Infection)

Hymenolepis nana

Drinking water
contaminated with eggs

Abdominal pain,
severe weight loss, itching around the anus, nervous manifestation

coenurosis

(tapeworm)

multiceps multiceps

contaminated drinking water with eggs

increases intacranial tension

Enterobiasis

(pinworm)

Enterobius
vermicularis

Drinking water
contaminated with eggs

Peri-anal itch,
nervous irritability, hyperactivity and insomnia

.
Bacterial Infections

Disease & Transmission

Microbial Agent

Sources of Agent

in Water Supply

General Symptoms

Botulism

Clostridium
botulinum

Bacteria can enter
an open wound from contaminated water sources. Can enter the gastrointestinal
tract by consuming contaminated drinking water or (more commonly)
food

Dry mouth, blurred and/or double vision, difficulty swallowing, muscle weakness, difficulty breathing, slurred speech, vomiting and sometimes diarrhea. Death is usually caused by respiratory failure.

Campylo bacteriosis

Most commonly
caused by Campylobacter jejuni

Drinking water
contaminated with feces

Produces dysentery like symptoms along with a high fever. Usually lasts
2–10 days.

Cholera

Spread by the
bacterium Vibrio cholerae

Drinking water
contaminated with the bacterium

In severe forms it
is known to be one of the most rapidly fatal illnesses known. Symptoms include very watery diarrhea, nausea, cramps, nosebleed, rapid pulse, vomiting, and hypovolemic shock (in severe cases), at which point death can occur in 12–18 hours.

E.
coli
Infection

Certain strains of Escherichia coli (commonly E.
coli
)

Water contaminated
with the bacteria

Mostly diarrhea.
Can cause death in immunocompromised individuals, the very young, and the elderly due to dehydration from prolonged illness.

 (continued)

Dysentery (Shigella)

Caused by a number of species in the genera Shigella and Salmonella with the most
common being Shigella
dysenteriae

Water contaminated
with the bacterium

Frequent passage of
feces with blood and/or mucus and in some cases vomiting of blood.

Legionellosis (two distinct forms: Legionnaires’ disease and Pontiac fever)

Caused by bacteria
belonging to genus Legionella (90% of cases
caused by Legionella
pneumophila
)

Contaminated water:
the organism thrives in warm aquatic environments.

Pontiac fever produces milder symptoms resembling acute influenza without pneumonia. Legionnaires’ disease has severe
symptoms such as fever, chills, pneumonia (with cough that sometimes produces sputum), ataxia, anorexia, muscle aches, malaise and occasionally diarrhea and
vomiting

Leptospirosis

Caused by bacterium
of genus Leptospira

Water contaminated
by the animal urine carrying the bacteria

Begins with flu-like symptoms then resolves. The second phase
then occurs involving meningitis, liver damage (causes jaundice), and renal failure

Otitis Externa (swimmer’s ear)

Caused by a number of bacterial and fungal species.

Swimming in water
contaminated by the responsible pathogens

Ear canal swells causing pain and tenderness
to the touch

Salmonellosis

Caused by many
bacteria of genus Salmonella

Drinking water
contaminated with the bacteria. More common as a food borne illness.

Symptoms include diarrhea, fever, vomiting, and abdominal cramps

Vibrio
Illness

Vibrio vulnificus, Vibrio
alginolyticus
, and Vibrio
parahaemolyticus

Can enter wounds from contaminated
water. Also got by drinking contaminated water or eating undercooked oysters.

Symptoms include
explosive, watery diarrhea, nausea, vomiting, abdominal cramps, and
occasionally fever.

.

Viral Infections

Disease and Transmission

Microbial Agent

Sources of Agent

 in Water Supply

General Symptoms

Adenovirus
infection

Adenovirus

Manifests itself in
improperly treated water

Symptoms include common cold
symptoms
, pneumonia, croup, and bronchitis

Hepatitis A

Hepatitis A virus
(HAV)

Can manifest itself
in water (and food)

Symptoms are only acute (no chronic stage to the virus) and include Fatigue, fever, abdominal pain, nausea, diarrhea,
weight loss, itching, jaundice and depression.

Polyomavirus
infection

Two of Polyomavirus: JC virus and BK virus

Very widespread,
can manifest itself in water, ~80% of the population has antibodies to Polyomavirus

BK virus produces a
mild respiratory infection and can infect the kidneys of immunosuppressed transplant patients. JC virus infects the respiratory system  & kidneys.

.
.
Symptoms and treatment of the most common US waterborne diseases

1.  Cryptosporidiosis: protozoa/ Cryptosporidium parvum
http://www.mayoclinic.com/health/cryptosporidium/DS00907/DSECTION=symptoms

Crypto’  is one of the most common causes of recreational water illness (disease caused by
germs spread through pool water) in the United States.
Cryptosporidium infection (cryptosporidiosis) is a gastrointestinal disease whose primary symptom is diarrhea. The illness begins when the tiny cryptosporidium parasites enter your body and travel to your small intestine. Cryptosporidium then begins its life cycle inside your body — burrowing into the walls of your intestines and later being shed in your feces.

In most healthy people, a cryptosporidium infection produces a bout of watery diarrhea, the
infection usually goes away within a week or two. If you have a compromised immune system, a cryptosporidium infection can become life-threatening without proper treatment.

You can help prevent cryptosporidium by practicing good hygiene and by avoiding drinking
water that hasn’t been boiled or filtered.

Symptoms
The first signs and symptoms usually appear two to seven days after infection with cryptosporidium and may include:

  • Watery diarrhea………………………………….……..93%
  • Stomach cramps or pain……………..…….….….…84%
  • Weight loss (median 10 lbs.)……………….………75%
  • Fever  (median 100.9., Range 98.7-104.9F.).…57%
  • Nausea & Vomiting ………………………………..….48%
  • Dehydration

Symptoms may last for up to two weeks, though they may come and go sporadically for up to a month, even in people with healthy immune systems. Some people with cryptosporidium infection
may have no symptoms. 

When to see a doctor
Seek medical attention if you develop watery diarrhea that does not get better within several days.

 Causes
Cryptosporidium infection begins when you ingest the cells of one of nearly a dozen species of the
one-celled cryptosporidium parasite. The Cryptosporidium parvum (C. parvum) species is responsible for the majority of infections in humans.

The parasites travel to your intestinal tract, where they settle into the walls of your intestines.
Eventually, more cells are produced and shed in massive quantities into your feces, where they are highly contagious.

You can become infected with cryptosporidium by touching anything that has come in contact with contaminated feces. Methods of infection include:
•  Swallowing or putting something contaminated with cryptosporidium into your mouth
•  Drinking water contaminated with cryptosporidium
•  Swimming in water contaminated with cryptosporidium and accidentally swallowing some of it
•  Eating uncooked food contaminated with cryptosporidium
•  Touching your hand to your mouth if your hand has been in contact with a contaminated surface or object
•  Hardy parasites

Cryptosporidium is one of the most common causes of diarrhea in humans. This parasite is difficult to eradicate because it’s resistant to many chlorine-based disinfectants and can’t be effectively removed by many filters. Cryptosporidium can also survive in the environment for many months at varying temperatures, though the parasite can be destroyed by freezing or boiling.

Risk factors
People who are at increased risk of developing cryptosporidiosis
include:
•  Those who are exposed  to contaminated water
•  Animal handlers
•  International  travelers, especially those traveling to developing countries
•  Backpackers, hikers  and campers who drink untreated, unfiltered water
•  Swimmers who swallow water in pools, lakes and rivers
•  People who drink water from shallow, unprotected wells

Complications
Complications of cryptosporidium infection include:
•  Malnutrition resulting from poor absorption of nutrients from your intestinal tract  (malabsorption)
•  Severe dehydration
•  Significant weight loss (wasting)

Treatments and drugs
There’s no commonly advised specific treatment for cryptosporidiosis, and recovery usually depends on the health of your immune system. Most healthy people recover within two weeks without medical attention. If you have a compromised immune system, the illness can last and lead to significant malnutrition and wasting. The goal of treatment is to alleviate symptoms and improve your immune response.
Cryptosporidium treatment options include:
•  Anti-parasitic drugs. Medications such as nitazoxanide (Alinia) can help alleviate diarrhea by attacking the metabolic processes of the cryptosporidium organisms. Azithromycin (Zithromax) may be
given along with one of these medications in people with compromised immune systems.
•  Anti-motility agents. These medications slow down the movements of your intestines and increase fluid absorption to relieve diarrhea and restore normal stools. Anti-motility drugs include
loperamide and its derivatives (Imodium A-D, others). Talk with your doctor before taking any of these medications.

Fluid replacement
You’ll need replacement of fluids and electrolytes — minerals such as sodium, potassium and calcium that maintain the balance of fluids in your body — lost to persistent diarrhea. These precautions will help keep your body hydrated and functioning properly.

Prevention
Cryptosporidium infection is contagious, so take precautions to avoid spreading the parasite to other
people. All preventive methods aim to reduce or prevent the transmission of the cryptosporidium germs that are shed in human and animal feces. Precautions are especially important for people with compromised immune systems. Follow these suggestions:
  Practice good hygiene. Wash your hands with soap and water after using the toilet, changing
diapers, and before and after eating.
•  Thoroughly wash all fruits and vegetables that you will eat raw, and avoid eating any food you suspect might be contaminated.
•  Purify drinking water if you have a weakened immune system or are traveling in an area with a high risk of infection. Methods include boiling — at least one minute at a rolling boil — or  filtering, although filtering may not be as effective as boiling.
•  Limit swimming activities in lakes, streams and public swimming pools, especially if the water is
likely to be contaminated or if you have a compromised immune system.
.

2.  Giardaisis: protozoa/Giardia lamblia
http://www.mayoclinic.com/health/giardia-infection/DS00739/DSECTION=symptoms
Giardaisis is one of the  most common waterborne diseases in the United States. It is an intestinal infection marked by abdominal cramps, bloating, nausea and bouts of watery diarrhea. Giardaisis in is caused by the microscopic parasite, Giardaisis, found worldwide, especially in areas with poor sanitation and unsafe water.

The protozan parasites are found in backcountry streams and lakes, but also in municipal water
supplies, swimming pools, whirlpool spas and wells.

Giardia infections usually clear up within six weeks. But you may have intestinal problems long after the parasites are gone. Several drugs are generally effective against Giardia parasites, but not everyone
responds to them. Prevention is your best defense.

Symptoms
Some people with Giardia infection never develop signs or symptoms but still carry the parasite and can spread it to others through their stool. For those who do get sick, signs and symptoms usually appear one to two weeks after exposure and may include:
•  Watery, sometimes foul-smelling diarrhea that may alternate with soft, greasy stools
•  Fatigue
•  Abdominal cramps and bloating
•  Belching gas with a bad taste
•  Nausea
•  Weight loss

Signs and  symptoms of Giardia infection usually improve in two to six weeks, but in some people they last longer or recur. Giardia infection is almost never fatal in industrialized countries, but it can cause lingering symptoms and serious complications, especially in infants and children under age 5.

The most common, possible complications include
•  DehydrationOften a result of severe diarrhea, dehydration occurs when the body doesn’t have enough water to carry out its normal functions.
•  Failure to thrive. Chronic diarrhea from Giardia infection can lead to malnutrition and harm children’s physical and mental development.
•  Lactose intolerance. Many people with Giardia infection develop lactose intolerance — the
inability to properly digest milk sugar. The problem may persist long after the infection has cleared.

Treatment
When signs and symptoms are severe or the infection persists, doctors usually treat Giardiasis
with medications such as:
•  Metronidazole (Flagyl). Metronidazole is the most commonly used antibiotic for Giardia
infection. Side effects may include nausea and a metallic taste in the mouth. Don’t drink alcohol while taking this medication.
•  Tinidazole (Tindamax). Tinidazole works as well as metronidazole and has many of the same side effects, but it can be given in a single dose.
•  Nitazoxanide (Alinia). Because it comes in a liquid form, nitazoxanide may be easier for
children to swallow.
•  Paromomycin. Although paromomycin is less effective than other treatments, it also is less likely to cause birth defects during pregnancy.

Prevention
No drug can prevent Giardia infection. But common-sense precautions can go a long way toward reducing the chances that you’ll become infected or spread the infection to others.
•  Wash your hands. This is the simplest and best way to prevent most kinds of infection. Wash your hands after using the toilet or changing diapers and before eating or preparing food. When soap and water aren’t available, alcohol-based sanitizers are an excellent alternative.
•  Purify wilderness water. Avoid drinking untreated water from shallow wells, lakes, rivers, springs, ponds and streams unless you filter it or boil it for at least 10 minutes at 158 F (70 C) first.
•  Keep your mouth closed. Try not to swallow water when swimming in pools, lakes or streams.
•  Use bottled water. When traveling to parts of the world where the water supply is likely to be unsafe, drink and brush your teeth with bottled water that you open yourself. Don’t use ice, and
avoid raw fruits and vegetables, even those you peel yourself.
•  Practice safer sex. If you engage in anal sex, use a condom every time. Avoid oral-anal sex unless you’re fully protected.

Self-Care at Home
•  Drink fluids such as sports drinks, diluted fruit juices, flat soda (such as 7-Up or ginger ale, none with caffeine), broth, soups, or preparations such as Pedialyte for children. Fluids should be taken in small
amounts frequently throughout the day. Avoid fluids containing caffeine.
•  Suck on ice chips to keep from becoming dehydrated if you cannot keep fluids down.
•  After 12 hours, the diet can be advanced to bland foods such as potatoes, noodles, rice, toast, cereal, crackers, and boiled vegetables. Avoid spicy, greasy, and fried foods until diarrhea is gone and you feel recovered.
•  After stools become formed, return to a regular diet. Avoid milk for several weeks.

 .
3. 
E. coli Infection: bacteria/ Escherichia coli Definition
http://www.mayoclinic.com/health/e-coli/DS01007
Escherichia coli (E. coli) bacteria live in the intestines of people and animals. Most varieties of E.
coli are harmless or cause relatively brief diarrhea, such as occurs in travelers to developing countries.

But a few particularly nasty strains can cause severe, bloody diarrhea and abdominal cramps, followed by serious organ system damage such as kidney failure. You may be exposed to E. coli from contaminated water or food — especially raw vegetables and undercooked ground beef.

Healthy adults usually recover from infection with E. coli O157:H7 within a week, but young children and older adults can develop a life-threatening form of kidney failure called hemolytic uremic syndrome (HUS).

Symptoms
Signs and symptoms of  E. coli infections typically begin three or four days after exposure to the bacteria, though you may become ill as soon as one day afterward to more than a week later. Signs and symptoms include:
•  Diarrhea, which may range from mild and watery to severe and bloody
•  Abdominal cramping, pain or tenderness
•  Nausea and vomiting, in some people

 When to see a doctor
Contact your doctor if:
•  You become ill after eating fresh produce or undercooked ground beef
•  Your diarrhea is persistent or severe
•  Your diarrhea is bloody

Causes
•  Contaminated water.  Human and animal feces may pollute ground and surface water, including streams, rivers, lakes and water used to irrigate crops. Drinking or inadvertently swallowing untreated water from lakes and streams can cause E. coli infection.
Although public water systems use chlorine, ultraviolet light or ozone to kill E. coli, some outbreaks have been linked to contaminated municipal water supplies. Private wells are a greater cause for concern. Some people have been infected after swimming in pools or lakes contaminated with
feces.
•  Personal contact.   E. coli bacteria can easily travel from person to person, especially when
infected adults and children don’t wash their hands properly. Family members of young children with E. coli infection are especially likely to acquire it themselves
Restaurant workers who don’t wash their hands after using the bathroom can transmit E. coli bacteria to food. Outbreaks have also occurred among children visiting petting zoos and in animal barns at county fairs.

Risk factors
E. coli can affect anyone who is exposed to the bacteria. But some people are more likely to develop problems than others. Risk factors include:
•  Age. Young children and older adults are at higher risk of experiencing illness caused by E. coli and more-serious complications from the infection.
•  Weakened immune systems. People who have weakened immune systems — from AIDS or drugs to treat cancer or to prevent the rejection of organ transplants — are more likely to  become ill from ingesting E. coli.
•  Eating certain types of food. Risky foods include undercooked hamburger; unpasteurized milk, apple juice or cider; and soft cheeses made from raw milk.
•  Stomach-reduction surgery. People who’ve had surgery to reduce the size of their stomachs are more likely to develop symptoms from E. coli, possibly because they have less stomach acid to kill the bacteria.

Treatments and drugs
For illness caused by E. coli, no current treatments can cure the infection, relieve symptoms or prevent
 complications. For most people, the best option is to rest and drink plenty of fluids to help with dehydration and fatigue. Avoid taking an anti-diarrheal medication — this slows your digestive system down, preventing your body from getting rid of the toxins.

Lifestyle and home remedies
Follow these tips to prevent dehydration and reduce symptoms while you recover:
•  Clear liquids. Drink plenty of clear liquids, including water, clear sodas and broths, gelatin, and juices. Avoid apple and pear juices, caffeine and alcohol.
  Add foods gradually. When you start feeling better, stick to low-fiber foods at first. Try soda crackers, toast, eggs or rice.
•  Avoid certain foods. Dairy products, fatty foods, high-fiber foods or highly seasoned foods can make symptoms worse.

Prevention
No vaccine or medication can protect you from E. coli-based illness, though researchers are investigating potential vaccines. To reduce your chance of being exposed to E. coli, avoid risky foods
and avoid cross-contamination.

_A. Risky foods
Avoid pink hamburger. Hamburgers should be well-done. Meat, especially if grilled, is likely to brown before it’s completely cooked, so use a meat thermometer to ensure that meat is heated to
at least 160 F (71 C) at its thickest point. If you don’t have a thermometer, cook ground meat until no pink shows in the center.
•  Drink pasteurized milk, juice and cider. Any boxed or bottled juice kept at room temperature is likely to be pasteurized, even if the label doesn’t say so.
•  Wash raw produce thoroughly. Although washing produce won’t necessarily get rid of
all E. coli — especially in leafy greens, which provide many spots for the bacteria to attach themselves to — careful rinsing can remove dirt and reduce the amount of bacteria that may be clinging to the produce.

_B. Avoid cross-contamination
•  Wash utensils. Use hot soapy water on knives, countertops and cutting boards before and after they come into contact with fresh produce or raw meat.
•  Keep raw foods separate. This includes using separate cutting boards for raw meat and foods such as vegetables and fruits. Never put cooked hamburgers on the same plate you  used for raw patties.
•  Wash your hands. Wash your hands after preparing or eating food, using the bathroom or changing diapers. Make sure that children also wash their hands before eating, after using the  bathroom and after contact with animals.
.

4.  Dysentery: bacteria/Shigella
http://www.mayoclinic.com/health/Shigella/DS00719/DSECTION=prevention
Shigella infection (shigellosis, dysentery) is an intestinal disease caused by a family of bacteria known as Shigella. The main sign of Shigella infection is diarrhea, which often is bloody.
Shigella can be passed through direct contact with the bacteria in the stool. Shigella bacteria can be passed in contaminated food or by drinking or swimming in contaminated water.
Children between the ages of 2 and 4 are most likely to get Shigella infection. A mild case usually clears up on its own within a week. When Shigella infection requires treatment, doctors generally prescribe antibiotics.

Symptoms
Signs and symptoms of Shigella infection usually begin a day or two after exposure to Shigella. Signs and symptoms may include:
•  Diarrhea (often containing blood or mucus)
•  Abdominal cramps
•  Fever
Although some people have no symptoms after they’ve been infected with Shigella, their feces are still contagious.

 When to see a doctor.  Contact your doctor or seek urgent care if you or your child has bloody diarrhea or diarrhea severe enough to cause weight loss and dehydration.

Causes
Infection occurs when you accidentally ingest Shigella bacteria. This can happen when you:
•  Touch your mouth. If you don’t wash your hands well after changing the diaper of a child who has Shigella infection, you may become infected yourself. Direct person-to-person contact is the most common way the disease is transmitted.
•  Eat contaminated food. Infected people who prepare food can transmit the bacteria to people who eat the food. Food can also become contaminated if it grows in a field that contains sewage.
•  Swallow contaminated water. Water may become contaminated either from sewage or from a person with Shigella infection swimming in it.

Treatments and drugs
Shigella infection usually runs its course in five to seven days. Replacing lost fluids from diarrhea may
be all the treatment you need, particularly if your general health is good and your Shigella infection is mild. Avoid drugs intended to treat diarrhea, such as loperamide (Imodium) and diphenoxylate with atropine (Lomotil), because they can make your condition worse.
•  Antibiotics For severe Shigella infection, antibiotics may shorten the duration of the illness. However, some Shigella bacteria have become drug resistant. So it’s better not to take antibiotics unless your Shigella infection is severe. Antibiotics may also be necessary for infants, older adults and people who have HIV infection, as well as in situations where there’s high risk of spreading the disease.
•  Fluid and salt replacement. For generally healthy adults, drinking water may be enough to counteract the dehydrating effects of diarrhea. Persons who are severely dehydrated need treatment in a hospital emergency room, where they can receive salts and fluids intravenously, rather than by mouth. Intravenous hydration provides the body with water and essential nutrients much more quickly than oral solutions do.

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