CH 10
Climate Change
*"Climate change is a significant and emerging threat to public health, and changes the way we must look at protecting vulnerable populations." *Nurses main role: **Mitigation: working at individual, community, institutional, and governmental level to ensure energy-conserving policies and practices **Response: public health nurses must be prepared for increased fire- and storm-related disasters
Three Rs to reduce environmental pollution
**Reduce **Reuse **Recycle
The Precautionary Principle
*Advised when animal research and other indicators demonstrate a possible toxic relationship between a chemical and health effect *The American Nurses Association (ANA) has adopted the precautionary principle as the basic tenet on which to guide its environmental advocacy work.
Environmental Health Risk Reduction
*Apply basic principles of disease prevention. *Prevention is a core goal in PHN *Every nurse's role in risk reduction **Shift to electronic records **recycle **work with suppliers to get products with minimum packaging **promote the use of green cleaners **go fragrance free **turn off equipment when no patient is in the room **Report leaky sinks, toilets, and other plumbing sources. **Promote the purchase of local, sustainably grown foods **Start a hospital/clinic/health department garden **Start a Green Team **Create community while doing these activities and build relationships
"I PREPARE" Present work
*Are you exposed to solvents, dusts, fumes, radiation, loud noise, pesticides, other chemicals? Do you know where to find material safety data sheets for chemicals with which you work? Do you wear PPE? Are work clothes worn home? Do coworkers have similar health problems?
Children's Environmental Health
*Children's bodies operate differently than adults, putting them at potentially increased risk for toxic exposure **Increased respiratory rate translates to a proportionately greater exposure to air pollutants **Immature blood-brain barrier **Kidneys less effective at filtering undesirable chemicals
Environmental Exposure by Media- WATER
*Consumer Confidence Reports (CCRs) *Sources of pollution **Waste from industry, pharmaceuticals **Storm runoff, erosion, especially due to loss of 80% of the world's forests leading to massive erosion **Antibiotics, codeine, chemicals found in water.
Environmental Exposure by Media-LAND and SOIL
*Contaminated land designations *Superfund site **Highly contaminated **Threat designated by the Environmental Protection Agency (EPA) ****Superfund sites: highly contaminated sites, with associated health threats that are designated by the EPA (considered a threat to society) *Brownfield site **Previously used **Now slated for redevelopment ****Brownfield sites: land that has been used previously and which is now slated for redevelopment
Applying the Nursing Process to Environmental Health (INTERVENTION)
*Coordinate medical, nursing, and public health actions to meet the client's needs. Ensure that the affected person or family is referred for appropriate clinical care.
Multidisciplinary Approaches
*Earth sciences that show how pollutants travel in air, water, and soil **Geologists **Meteorologists **Physicist **Chemists *Key public health (PH) professionals: **Food safety specialist **Sanitarians **Radiation specialists **Industrial hygienists
Healthy People 2020 Objectives for Environmental Health
*Eliminate elevated lead blood levels in children. *Minimize risks posed by hazardous sites. *Reduce significant pesticide exposures. *Reduce the amount of toxic pollutants. *Reduce indoor allergen levels. *Decrease lead-based paint or related hazards.
Applying the Nursing Process to Environmental Health (EVALUATION)
*Examine criteria that include the immediate and long-term responses of the client as well as the recidivism of the problem for the client.
"I PREPARE" Educate (a checklist)
Are materials available to educate the client? Are alternatives available to minimize the risk of exposure? Have prevention strategies been discussed? What is the plan for follow-up?
"I PREPARE" Environmental concerns
Are there environmental concerns in your neighborhood (e.g., air, water, soil)? What types of industries or farms are near your home? Do you live near a hazardous waste site or landfill?
Risk Assessment- Risk assessment process
Characterizing the risk assessment process and taking into account all three of the previous steps
Risk Assessment- Assess toxicology and epidemiologic data
Determining whether a chemical is known to be associated with negative health effects (in animals or humans)
Risk Assessment- Has the chemical been released?
Determining whether the chemical has been released into the environment: into the air, water, soil, or food
Public heaths #1 priority for healthy people 2020
Environmental Health
"I PREPARE" Referrals and resources
Environmental Protection Agency (www.epa.gov), National Library of Medicine—Toxnet Programs (www.nlm.nih.gov), Agency for Toxic Substances and Disease Registry (www.atsdr.cdc.gov), Association of Occupational and Environmental Clinics (www.aoec.org). Occupational Safety and Health Administration (www.osha.gov), EnviRN website (www.enviRN.umaryland.edu), Local Health Department, Environmental Agency, Poison Control Center
Risk Assessment- How much and by which route of entry of the chemical?
Estimating how much and by which route of entry the chemical might enter the human body (inhaled, ingestion, skin)
"I PREPARE" Activities
What activities and hobbies do you and your family pursue? Do you burn, solder, or melt any products? Do you garden, fish, or hunt? Do you eat what you catch or grow? Do you use pesticides? Do you engage in any alternative healing or cultural practices?
"I PREPARE" Past work
What are your past work experiences? What job did you have for the longest period of time? Have you ever been in the military, worked on a farm, or done volunteer or seasonal work?
"I PREPARE" Residence
When was your residence built? What type of heating do you have? Have you recently remodeled your home? What chemicals are stored on your property? Where is the source of your drinking water?
Community-Wide Environmental Health Assessment Tools
*Windshield survey **A windshield survey is a helpful first step in understanding the potential environmental health risks in a community. **WORRIED ABOUT FARMING COMMUNITIES DUE TO PESTICIDES *"Nature-deficit disorder" **describe what happens to young people who become disconnected from their natural world *Positive environmental factors **Green space, bike paths, walkable communities
Governmental Environmental Protection
*Federal agencies for environmental health regulation **Environmental Protection Agency (EPA), Food and Drug Administration (FDA), Department of Agriculture **United States Department of Health and Human Services (USDHHS) *Important steps and concepts **Permitting- An important step in the process of controlling pollution is permitting, a process by which the government places limits on the amount of pollution emitted into the air or water. A permit is a legally binding document. **Environmental standards- Environmental standards may describe a permitted level of emissions, a maximum contaminant level (MCL), an action level for environmental cleanup, or a risk-based calculation; environmental standards are required to address health risks. It is the responsibility of potential polluters to operate within the regulations and standards. Compliance and enforcement are the next building blocks in controlling pollution. **Compliance- Compliance refers to the processes for ensuring that permit/standard/regulatory requirements are met. **Monitoring- Clean up or remediation of environmental damage is another control step. Public information and involvement processes, such as citizen advisory panels or community forums, are integral to the development of standards, ongoing monitoring, and remediation.
"I PREPARE" Investigate potential exposures
*Have you ever felt sick after coming in contact with a chemical, such as a pesticide or other substances? Do you have any symptoms that improve when you are away from your home or work?
Environmental Exposures
*Herbicides *Pesticides *Other chemical carcinogens *Lead *Radiation
Industrial Hygiene Hierarchy of Controls
*Industrial hygienists: public health specialists in workplace exposure to hazards- physical, chemical, and biological (can include mental health) **Workplace exposure to hazards that contribute to health risks *Hierarchy of controls **Eliminate unnecessary toxic chemicals. **Substitute less hazardous or non-hazardous substances (e.g., using water-based vs. solvent-based products). **Isolate the hazardous chemicals from human exposure (e.g., use closed systems). **Apply engineering controls (e.g., ventilation systems, including exhausts hoods). **Reduce the exposures through administrative controls (e.g., rotating employees in areas with high exposures). **Use personal protective equipment (e.g., gloves, respirators, protective clothing). *Three Rs to reduce environmental pollution **Reduce **Reuse **Recycle
Applying the Nursing Process to Environmental Health (PLANNING)
*Look at community policy and laws as methods to facilitate the care needs for the client; include environmental health personnel in planning.
Environmental Exposure by Media-FOOD
*Pathogenic causes: E. coli, Salmonella; pesticides; genetically modified organisms (GMOs) *Environmental causes: pesticides, antibiotics in animals
Environmental Factors
*Physical *Chemical *Biological *Social *Psychosocial
Risk Assessment
*Process to determine the probability of a health threat associated with an exposure *Four phases **Assess toxicology and epidemiologic data **Has the chemical been released? **How much and by which route of entry of the chemical? **Risk assessment process
Environmental Health Assessments
*Risks can be categorized as follows: **Medium: air, water, soil, or food **Type: chemical, biological, or radiological **Setting: urban, rural, or suburban **Functional location: home, school, workplace, or community
Right to Know
*Several environmental statutes give the public the right to know about the hazardous chemicals in the environment **The EPA has an "Envirofacts" section on its website that provides several sources of exposure data by zip code. *Consumer Confidence Reports **When a water supplier provides drinking water to a community, the supplier, in contrast to individual wells, must test the water and report the results to its customers in the form of a consumer confidence report. *Hazard Communication Standard **Material safety data sheet (MSDS). This standard requires employers (including hospitals) to maintain a list of all of the hazardous chemicals that are used on-site. *******OSHA
Toxicology
*Sometimes called the "study of poisons" *Negative effects of chemicals **can also be positive- CHEMO *Pollutants have multiple routes into the body **lungs (inhalants), GI tract (ingestion), skin, and even mucous membranes (dermal absorption) *Most chemicals cross the placental barrier and can affect the fetus, just as most chemicals cross the blood-brain barrier *Epigenetics: hazardous changes to DNA *Individuals have unique responses *Chemical "families"- similar chemicals
Environmental Exposure by Media- AIR
*Sources of pollution **Point sources (identifiable—e.g., smokestacks or wildfire) **Non-point sources (mobile—e.g., cars and trucks) ***Non-point sources are more prevalent in California *Clean Air Act *Indoor air quality (IAQ) *EPA regulates air, *Mexico and china have no regulations*. Affects the men more than the women- cardiac and respiratory
Epidemiology
*Studies the strength of association between exposures and health effects *Uses **Occupational **Environmental *Epidemiologic triangle **Agent-chemical **Host- people in community **Environment- air, water, soil, food,as well as temperature, humidity, and wind
Information Sources
*ToxTown (NLM) **household products page & environmental pages *Safe cosmetics **right to know- access to all information necessary to make informed decisions to protect our health *State of California Prop 65 **information is predicated on what the manufacturers place on the label as ingredients
Environmental Health Sciences
*Toxicology *Epidemiology *Geographic information systems ** data base utilized for statistics such as new cases of asthma related to pollutants *Multidisciplinary approaches
Individual Environmental Exposure History
*Use of the "I PREPARE" mnemonic device *Investigate potential exposures *Present work *Residence *Environmental concerns *Past work *Activities *Referrals and resources *Educate (a checklist)
Applying the Nursing Process to Environmental Health (ASSESSMENT)
*Use your observational skills (e.g., windshield surveys); interview community members; ask your individual clients; and ask the families of your clients. Review Web-based data on existing exposures, such as air and water pollution monitoring data, drinking water testing, and contaminated soil. Relate the disease and the environmental factors in the diagnosis.
