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					                                   Preventive Medicine and
                                    Environmental Health
                                    LT Crystal E. Dailey
                                    Force Environmental Health Officer
                                    Commander Naval Air Forces
                                    1279 Franklin Street
                                    Norfolk, VA 23511
                                    COMM: 757-444-9421
                                    DSN: 564-9421
                                    NIPR: crystal.dailey@navy.mil
                                    SIPR: crystal.dailey@navy.smil.mil




Standard 1998 P1 4/27/98 15:15 0
                                                  Introduction



                                   • COMNAVAIRFORINST 6000.1
                                   • Chapter 16, section 16101 through 16306

                                   • This chapter addresses policies that promote the health,
                                   welfare, and comfort of the personnel stationed aboard CNAF
                                   carriers.

                                   • SMO is responsible for implementing Preventive Medicine,
                                   Occupational Medicine and Environmental Health programs
                                   and advising the CO of all conditions affecting the health of the
                                   crew.




Standard 1998 P1 4/27/98 15:15 1
                                                      Introduction


                                   These programs include:
                                   a.   Birth Month Medical Surveillance Program and
                                        Preventive Health Assessments

                                   b.   Communicable Disease Control and Immunization
                                        Tracking Program

                                   c.   Tb Surveillance Program

                                   d.   Food Safety Program

                                   e.   Potable Water and Ice Surveillance Program




Standard 1998 P1 4/27/98 15:15 2
                                         Introduction (cont)


                                   These programs include:

                                   f.   CHT System and Solid Waste Surveillance

                                   g.   Pest Control Program

                                   h.   Habitability

                                   i.   Medical Waste Program

                                   j.   Bloodborne Pathogen Program

                                   k.   Heat Stress Program




Standard 1998 P1 4/27/98 15:15 3
                                            Inspections and Reports


                                   •   Inspections

                                       1.   SMOs or their PMTs must conduct routine sanitation and
                                            habitability inspections to identify health threats that could
                                            be potentially degrading to the health and well being of the
                                            ship’s crew

                                       2.   Findings must be documented and reported to the CO with
                                            copies provided to cognizant DHs, DIVOs or LCPOs

                                       3.   Inspection frequency is determined by published guidelines
                                            and instructions, CO’s direction, workload considerations,
                                            potential for illness or injury, and degree of compliance with
                                            published health standards




Standard 1998 P1 4/27/98 15:15 4
                                            Inspections and Reports


                                   •   Preventive Medicine/Occupational Health
                                       Reporting

                                       1.    Pertinent aspects from the Prev Med and Occ
                                             Health Programs will be submitted in the
                                             monthly Medical QA report.


                                       2.    Report format is contained in Appendix E of the
                                             instruction


                                       3.    The compliance goal for each program area is 90
                                             percent. The achieved compliance score should
                                             be documented for each program, including an
                                             explanation of deficiencies and corrective action




Standard 1998 P1 4/27/98 15:15 5
                                                  Disease Reporting


                                   • The Medical Event Report (MER) is the primary method of
                                   reporting various medical events; including communicable
                                   diseases, injuries and outbreaks; to the Chain of Command and
                                   appropriate medical authorities

                                   • Reporting requirements and guidelines for preparing and
                                   submitting MERs are provided in BUMEDINST 6220.12 (series)

                                   • Submit routine MERs using SAMS on the first of the month
                                   when a reportable event is suspected or confirmed. Urgent MERs
                                   shall be reported within 24 hours of suspected diagnosis followed
                                   up by a final MER when diagnosis is confirmed.




Standard 1998 P1 4/27/98 15:15 6
                                         Disease Reporting (cont)



                                   • Contact TYCOM Force EHO and cognizant NEPMU
                                   via telephone and email in the event of suspected disease
                                   outbreak, unusual conditions, or high interest diagnoses
                                   (i.e., Unit SITREP)

                                   • Review dept sick call log daily for tracking potential
                                   disease trends and f/u on reportable diseases and injuries.

                                   • Gastroenteritis/diarrhea and URI rates should be
                                   tracked on a regular basis to monitor overall disease
                                   threat/trends to the crew




Standard 1998 P1 4/27/98 15:15 7
                                       Communicable Disease Control


                                   •   Immunizations

                                           1.   Ship’s company and embarked squadron personnel
                                                shall be immunized and re-immunized, as applicable,
                                                per BUMEDINT 6230.15 (series)

                                           2.   Squadron personnel should be fully immunized by
                                                their cognizant shore-based MTF prior to
                                                deployment.

                                           3.   If a significant number of personnel arrive not fully
                                                immunized, the specifics of the immunization
                                                shortfall should be reported to the appropriate Force
                                                Medical staff in the monthly QA report




Standard 1998 P1 4/27/98 15:15 8
                                   Communicable Disease Control (cont.)


                                     •   Immunizations

                                         4.   Prev Med must provide program oversight to
                                              ensure required immunizations are
                                              administered and documented correctly.

                                         5.   Medical personnel administering
                                              immunizations must receive annual training
                                              in the current policies and procedures

                                         6.   Immunizations are tracked through SAMS

                                         7.   Accurate documentation in the database and
                                              individual medical record is critical.




Standard 1998 P1 4/27/98 15:15 9
                                                Tuberculosis Control

                               • Navy policies governing tuberculosis control, treatment and case
                               management are detailed in BUMEDINST 6224.8 (series)

                               • Annual summary report must be sent to the cognizant NEPMU with a
                               copy to CNAF no later than 28 February of each year using the format
                               in series instruction

                               • All operational personnel must have a PPD administered and read
                               annually. All previous PPD reactors must be evaluated annually with a
                               screening questionnaire. This shall be documented in the individual
                               medical record

                               •PMTs must evaluate all PPD reactors, regardless of induration. An
                               MO or PA must see all reactors prior to beginning INH preventive
                               therapy. A second opinion is required from a Prev Med physician or
                               Infectious Disease specialist if an initial reactor who meets the guidelines
                               of BUMEDINST 6224.8 (series) is not started on INH.




Standard 1998 P1 4/27/98 15:15 10
                                    Sexually Transmitted Disease Program


                                      • Navy guidance for the diagnosis and treatment of STDs
                                      is detailed in BUMEDINST 6222.10 (series)

                                      • The most current CDC treatment guidelines must be
                                      available and utilized for STD patient management and
                                      treatment

                                      • An STD log or database (in SAMS) must be maintained
                                      to track the overall management of patients being
                                      evaluated and treated for STDs

                                      • All STD patients must be directed to Prev Med for
                                      contact interviews to fulfill various reporting
                                      requirements. SAMs can be used to track required
                                      patient f/u and MER reporting




Standard 1998 P1 4/27/98 15:15 11
                                                         STDs (cont)



                                    • A MER must be submitted for any case of chlamydia,
                                    gonorrhea, or syphilis (all stages), and Hepatitis-B

                                    • All patients evaluated for an STD must be tested for
                                    syphilis and HIV

                                    • Hep-B vaccine must be administered to all patients
                                    evaluated for an STD per the current BUMEDINST 6230,
                                    immunization requirements and recommendations

                                    •When STD patients return for their third dose of HBV
                                    vaccine they should also be offered f/u HIV testing




Standard 1998 P1 4/27/98 15:15 12
                                    Rabies Prevention and Control



                                      • Follow guidance per SECNAVINST 6401.1 (series) and
                                      BUMEDINST 6220.13 (series)

                                      • In addition, cognizant NEPMU or local MTF must be
                                      contacted for current treatment protocols and guidance
                                      with various local/state reporting requirements, methods
                                      and forms

                                      • All animal bite cases must be individually evaluated for
                                      possible rabies vaccine administration.

                                      • In most cases, rabies vaccine should be administered
                                      when patients cannot provide adequate information for
                                      local authorities to locate the suspect animal




Standard 1998 P1 4/27/98 15:15 13
                                    Malaria Prevention and Control


                                      • Chemoprophylaxis and treatment protocols are defined
                                      in the current edition of the Navy Medical Department
                                      Pocket Guide to Malaria Prevention and Control, NEHC-
                                      TM PM 6250.1 (series) and BUMEDINST 6230.2 (series)

                                      • Medical intelligence sources, such as the AFMIC
                                      MEDIC CD-ROM, provide information on current
                                      malaria threats and recommendations

                                      • Chemoprophylaxis drug quantities and shelf life must
                                      be verified prior to deployment




Standard 1998 P1 4/27/98 15:15 14
                         Hand Washing Techniques and Control


                                    •   In order to decrease the spread of communicable
                                        diseases through direct and non-direct hand
                                        contact, the usage of waterless hand sanitizers shall
                                        be implemented

                                    •   Waterless hand washing stations shall be located at
                                        various key locations throughout the ship and must
                                        be conspicuously mounted to bulkhead. They must,
                                        at least be located at:

                                        1.    Entrance to all galley food service lines

                                        2.    Snack food vending stations

                                        3.    Medical spaces ( including patient waiting
                                              areas)




Standard 1998 P1 4/27/98 15:15 15
                               Hand Washing Techniques and Control


                                    •   Waterless hand washing stations shall be located at
                                        various key locations throughout the ship and must be
                                        conspicuously mounted to bulkhead. They must, at least
                                        be located at:

                                        4.   Liberty brows (to be used primarily during
                                             foreign port call visits)

                                        5.   Gym facilities

                                        6.   Any other area as deemed necessary by the SMO




Standard 1998 P1 4/27/98 15:15 16
                                       Medical Intelligence/Health
                                             Threat Briefs


                               • Information concerning endemic diseases and vectors in potential ports of call
                               is available from NEPMUs and NECE. The phone numbers and website address
                               are as follows:


                                     • NEPMU 2:        (757) 953-6600, DSN: 377-6600
                                                       NEPMU2NorfolkThreatAssessment@med.navy.mil


                                     • NECE:           (904) 542-2424 ext. 3031, DSN: 942-2424
                                                       NECE-MEI@med.navy.mil

                                     • AFMIC:          (301) 619-7574, DSN: 343-7574
                                                       http//mic@afmic.detrick.army.mil




Standard 1998 P1 4/27/98 15:15 17
                                       Medical Intelligence/Health
                                          Threat Briefs (cont)


                                    •The most current version of the MEDIC CD-ROM must be
                                    maintained in Preventive Medicine. This AFMIC CD-ROM is
                                    considered an intelligence product.

                                    • The Port Directory Guide for Visiting Ships is another valuable
                                    source of medical information

                                    • SMO, as CSG Medical Officer, should request a pre-deployment
                                    brief from the supporting NEPMU prior to a major deployment for all
                                    CSG medical representatives

                                    • Health threat education briefs must be provided to the crew prior to
                                    port calls while on overseas deployment




Standard 1998 P1 4/27/98 15:15 18
                                Birth Month Medical Surveillance
                                       Program Guidelines

                               • All personnel must be seen annually by the Medical
                               Department!

                               • In addition, personnel checking in and out of the command must
                               process though the Medical Department (Birth Month Recall Program)
                               is proven to be effective and efficient in maintaining overall medical
                               readiness

                               • Goal of the BMR program is 90% or better compliance at all times

                               • DHs will be notified prior to the beginning of each birth month of
                               personnel requiring annual medical readiness verification. DHs will
                               also be notified of personnel failing to complete their BMR evaluation
                               and verification




Standard 1998 P1 4/27/98 15:15 19
                                Birth Month Medical Surveillance
                                       Program Guidelines


                                    • Each dept aboard the ship shall assign a BMR Liaison representative
                                    to facilitate the completion of all medical requirements

                                    • SAMS must be used to track and manage all medical readiness and
                                    immunization requirements for all command personnel.

                                    • A monthly summary of the overall crew medical readiness will be
                                    generated and reported in the monthly medical QA report

                                    • Force medical will conduct a BMMSI annually. When applicable, the
                                    BMMSI will be conducted in conjunction with the HSRI. BMR
                                    indicators (routine imms, PPD, HIV, DNA, audiogram and annual
                                    verification) will be evaluated based on a review of approximately 120
                                    randomly selected medical records




Standard 1998 P1 4/27/98 15:15 20
                                    Preventive Health Assessments



                                    • Navy policies directing PHAs are detailed in OPNAVINST
                                    6120.3 (series). Specific guidance may be obtained from either
                                    the TYCOM or the NMCPHC.

                                    • PHAs purpose is to consolidate medical, occ health and risk
                                    screening services, medical record review, preventive counseling,
                                    and risk communication under one annual assessment for all
                                    active duty service members

                                    • It is suggested that commands complete their assessments
                                    during the individual’s birth month. Commands may elect to
                                    follow another mechanism of ensuring annual assessment




Standard 1998 P1 4/27/98 15:15 21
                                            Environmental Health


                                    • Food Safety

                                        •  Applies to all areas where food is stored, prepared,
                                        served or consumed!

                                        • SMO or PMTs will conduct a formal food safety
                                        inspection of each food service space at least once a month.

                                        • All cited critical violations must be corrected at the time
                                        of the inspection or within ten days of initial inspection

                                        • Formal inspection reports must be routed via the chain
                                        of command to the CO

                                        •Informal walk-through assessments are highly
                                        encouraged. A minimum of weekly walk-through
                                        assessments of the galleys and wardrooms should be
                                        conducted



Standard 1998 P1 4/27/98 15:15 22
                                    Environmental Health (cont)


                               •    Food Safety (Communicable Disease Occurrences)
                                    •    If communicable disease outbreak occurs which has direct impact on
                                        food service operations, e.g. VGE or norovirus; the SMO will notify
                                        the CO and SUPPO to inform them of the disease threat

                                    •    In order to eradicate the spread of disease via respiratory discharge
                                        and hand contact, the following will be imposed:

                                        1.    Self service at the galleys will cease. All food will be dispensed
                                              by galley personnel until disease threat has been confined (as
                                              determined by SMO)

                                        2.    Hand rails of ladder wells will be disinfected by wiping them
                                              with a sanitizing solution at least twice a day until disease rates
                                              have lowered




Standard 1998 P1 4/27/98 15:15 23
                                        Environmental Health (cont)


                                    •   Food Safety (cont)

                                    •   In order to eradicate the spread of disease via respiratory discharge and
                                        hand contact, the following will be imposed:

                                        3.    Prev Med will regularly monitor hand washing stations to enforce
                                              and educate the crew on the significance of hand washing. They
                                              will properly educate the crew concerning hand washing
                                              techniques.

                                    •   NAVMED P5010-1 is the Navy basic guidance document. In addition,
                                        FDA “Food Code” provides a frequently cited reference source

                                    •   All personnel working in foodservice must be initially evaluated by
                                        Medical. Screening will be administered and completed prior to
                                        commencing duties in any food preparation area




Standard 1998 P1 4/27/98 15:15 24
                                    Environmental Health (cont)

                                    • Food Safety (Training)

                                    • All foodservice workers must receive a minimum of
                                    four hours of food safety and sanitation training.

                                    • Designated supervisors or PIC must receive 18 hours of
                                    supervisor/manager foodservice sanitation training.
                                    Completion of training also certifies supervisors to teach
                                    the 4 hr foodservice worker training

                                    • PMTs must provide oversight for the Food Safety and
                                    Sanitation Training Program.

                                    • If galley personnel conduct the training, PMTs should
                                    routinely audit the training sessions to determine the
                                    validity and effectiveness of the training curriculum.




Standard 1998 P1 4/27/98 15:15 25
                                             Potable Water Sanitation


                                    •    Each ship must have a Water Sanitation Bill that delineates
                                        all policies and procedures for the provision and monitoring
                                        of potable water

                                    •    The CHENG or Reactor Officer, as appropriate, is
                                        responsible for supply and treatment of potable water

                                    •    SMO is responsible for conducting a comprehensive medical
                                        surveillance program of the potable water system including:

                                        1.    Adequacy of disinfection procedures

                                        2.    Collection of samples for bacteriological analysis

                                        3.    Daily halogen residuals from the potable water
                                              distribution system




Standard 1998 P1 4/27/98 15:15 26
                                    Potable Water Sanitation (cont)


                                    •   References:
                                        •   NSTM Chapters 531 & 533

                                        •   NAVMED P-5010-6

                                        •   BUMEDINST 6240.10 (series)

                                    •   Surveillance:

                                        •   PMTs must conduct a comprehensive potable
                                            water system inspection on a quarterly basis. A
                                            copy of the inspection must be routed via the chain
                                            of command to the CO




Standard 1998 P1 4/27/98 15:15 27
                                    Potable Water Sanitation (cont)



                                     • Surveillance (cont):
                                         • Daily halogen residuals must be taken from 12 sampling
                                         sites. Eng/Reactor Depts will be notified daily of sampling
                                         results

                                         • Bacteriological quality of potable water and ice must be
                                         tested weekly unless otherwise noted

                                         • A water log shall be maintained that documents the
                                         source and location the sample was taken from and the
                                         results of all daily halogen and all weekly bacteriological
                                         testing




Standard 1998 P1 4/27/98 15:15 28
                                        CHT System and Solid Waste
                                              Surveillance
                                    •   Responsibilities:

                                           •The Engineering Officer is responsible for operating and
                                           maintaining the CHT system.

                                           • SMO is responsible to ensure all CHT personnel are trained
                                           in the medical aspects of marine sanitation devices, and for
                                           conducting periodic medical surveillance inspections of the
                                           CHT system

                                    • References:

                                           • OPNAVINST 5090.1 (series) establishes Navy policy
                                           concerning environmental and natural resource protection

                                           •NAVMED P-5010-7 Wastewater Treatment and Disposal,
                                           Ashore and Afloat

                                           •NSTM Chapter 593 which provides guidelines concerning safe
                                           and efficient operation of the CHT system


Standard 1998 P1 4/27/98 15:15 29
                                     CHT System and Solid Waste
                                           Surveillance

                               • Training

                               • PMTs must provide annual training to all personnel who operate or maintain the
                               CHT system and its components as well as personnel assigned to clean up CHT spills

                               •PMTs must inspect all solid waste collection and processing sites for overall cleanliness
                               and sanitation on a monthly basis. All plastic waste processing areas must also be
                               included in the monthly sanitation




Standard 1998 P1 4/27/98 15:15 30
                                           Pest Control Program


                                    • Responsibilities:

                                        • The Medical Department is responsible for performing
                                        pest surveys, and conducting or supervising safe pest
                                        control operations

                                        • An integrated pest management approach must be
                                        followed and the indiscriminate use of pesticides is
                                        prohibited

                                        • The SMO must be delegated by the CDC Quarrantine
                                        Division as the ship’s USPHS Officer for granting
                                        SSCEC/SSCC to other US Navy vessels

                                        • The SMO should contact the regional NEPMU to
                                        determine any unique host nation entry requirements prior
                                        to making a port visit



Standard 1998 P1 4/27/98 15:15 31
                                      Pest Control Program (cont)

                               Responsibilities:

                               • PMTs and all Medical Dept personnel who assist with pest control
                               must maintain a current shipboard pest management certification

                               • PMTs must also maintain current DoD Category 8 Pest Control
                               Certification per BUMEDINST 6250.12 (series)

                               • The Supply Dept is responsible for funding and procuring pest
                               control supplies and equipment

                               • Other depts requiring pesticide applications must ensure their
                               spaces are prepared properly for the pesticide treatment




Standard 1998 P1 4/27/98 15:15 32
                                        Pest Control Program (cont)


                                    References:
                                    • SECNAVINST 6210.2 (series) “Medical Service Quarantine
                                    Regulations of the Armed Services”

                                    • OPNAVINST 6250.4 (series) establishes Navy policy for
                                    implementing pest management programs

                                    • NAVMED P-5010-8 Navy Entomology and Pest Control Technology

                                    • Navy-wide Shipboard Pest Control Manual (NECE publication)
                                    discusses Navy policies for a safe and effective pest control program

                                    • BUMEDNOTE 6210 provides guidelines for the SSCEC/SSCC




Standard 1998 P1 4/27/98 15:15 33
                                          Pest Control Program (cont)


                       • Surveillance and Treatment:
                                    • Monthly surveys of all food storage and service areas are required to
                                    actively search for signs of insect infestations. Active infestations will
                                    require frequent follow-up

                                    • All income provisions also need to be assessed for potential insect
                                    infestation

                                    • A pest control log must be maintained that documents all surveys and
                                    pesticide application




Standard 1998 P1 4/27/98 15:15 34
                                           Habitability Inspections


                               • Responsibilities:

                                    • The SMO or PMT must conduct periodic (quarterly) sanitation
                                    inspections of berthing areas, heads, showers, laundry, brig, gyms,
                                    barbershops and ship stores

                                    • The CO must be advised of conditions that are harmful to the health
                                    and morale of the crew

                               • References:

                                    • OPNAVINST 9640.1 (series) Shipboard habitability standards

                                    • NAVMED P-5010-2 provides guidelines concerning sanitation of living
                                    spaces and related facilities




Standard 1998 P1 4/27/98 15:15 35
                                        Medical Waste Management
                                                 Program


                                    • Infectious medical waste requires special handling, sterilization,
                                    storage and disposal by Medical Dept personnel

                                    • The Commanding Officer shall ensure that no medical materials
                                    are disposed of in a manner that poses a risk or perception of a risk to
                                    public health welfare or the marine environment

                                    • Disposal of medical materials must also comply with existing state
                                    and local regulations or Status of Forces Agreements (SOFA)

                                    •   References:

                                          • OPNAVINST 5090.1 (series)

                                          • BUMEDINST 6280.1 (series) “Management of Infectious
                                          Waste”




Standard 1998 P1 4/27/98 15:15 36
                                        Medical Waste Management
                                                 Program

                                    •   Medical Waste Requirements:
                                        1.   In port, potentially infectious medical waste from
                                             ships shall be delivered to a designated Navy MTF or
                                             turned over to an authorized PWC contractor

                                        2.   Each CVN shall ensure compliance with their
                                             respective municipalities’ regulations regarding
                                             disposal of medical waste

                                        3.   For foreign countries, the guidelines for medical
                                             waste shall be consistent with standards to protect
                                             public health and the environment as prescribed by
                                             applicable SOFAs and international agreements

                                        4.   Tracking, storage and disposal of shipboard
                                             infectious medical waste will be recorded by Medical
                                             Dept



Standard 1998 P1 4/27/98 15:15 37
                                    Preventive Medicine and
                                     Environmental Health




Standard 1998 P1 4/27/98 15:15 38

				
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