1. Sanitation Measures

1. Stress and Strain
2. Definitions
3. Heating
4. Ventilation
5. Air Conditioning
6. Additional Considerations Aboard Ship

1. Responsibilities
2. Procurement
3. Inspection
4. Storage
5. Food Service Personnel
6. Sanitary Precautions for Preparing and Serving Food
7. Standards and Sanitation of Food Service Equipment and Utensils
8. Standards and Sanitation of Food Service Facilities

1. Afloat
2. Sewage Transfer
3. Personal Hygiene, Sanitation and Safety
4. Medical Department Responsibilities
5. Waste Disposal in the Field

1. Responsibilities
2. Effective STD Programs

1. Case Finding
2. Patient Disposition

Quarantine Regulations

1. Metals and Other Materials
2. Asbestos Control
3. Halogenated Hydrocarbons (Halocarbons)
4. Otto Fuel II
5. Accident Prevention Program
6. Hearing Conservation Program
7. Heat Stress Program

References

This chapter deals with many factors that contribute to the cleanliness and efficiency of naval activities as well as to the health and attitude of personnel. Maintaining the highest state of health and physical readiness of all Navy personnel is the responsibility of the commanding officer, who, in turn, looks to the Medical Department for advice, recommendations, and establishment of standards.

Prevention and control of disease have for many years been considered the most desirable route to good health. Material included in this chapter should provide you with a general knowledge of the principles and practices of the Navy's Preventive Medicine Program.

Two of the most important principles of preventive medicine are communicable disease and vector control. For detailed information on these subjects refer to the HM 3 & 2 Rate Training Manual.

A habitable and healthful environment must prevail in living and berthing spaces ashore and afloat to maintain the efficiency of naval personnel. Major factors pertaining to living and berthing spaces are sleeping arrangements, floor area, ventilation and air volume, heating, sanitary fixtures, and related features such as lighting and color.

The Medical Department representative makes recommendations to the commanding officer that will ensure the highest level of sanitation. This can best be accomplished through a program of inspections.

Sanitation Measures

Some sanitary measures are directed toward maintaining the environment as dust-free as possible. Toward this end, the use of detergent and water and other cleaning agents has replaced the practice of "dry-sweeping." Excessive quantities of detergent water warp wooden floors, loosen inlaid tile and linoleum, and splash and foul bulkheads and equipment. Only if grease and grit are ground into the deck should you use a scrub brush and detergent. Generally, "mopping down" with a clean mop moistened with clean water and detergent, followed by a second "mopping down" with a clean mop rinsed in clean water and wrung out, will produce clean floors or decks. Daily attention to the cleanliness of the paint work on stanchions and bulkheads is more desirable than vigorous cleaning at less frequent intervals.

Dry clean and launder textiles such as blankets, sheets, and mattress covers frequently to keep the bedding as clean and dust free as possible. Dirty bedding, bunk bottoms, and lashings result in bad odors and provide ideal living and breeding conditions for insects. If possible, store mattresses for vacant bunks stored in a space or locker inaccessible to loungers. Washable fire-resistant covers are provided for each bunk to keep the bedding clean.

Clean drinking fountains at least once daily, with particular attention paid to the bowl, orifice, and orifice guard, to prevent accumulation of slime. Drinking fountains should be of the angle-jet type.

Water closets, urinals, lavatories, and showers should receive a thorough cleaning daily. This should include not only the inner and outer surfaces, but also all connecting pipes, valves, and other plumbing adjacent to the fixtures. Failure to properly clean these areas results in discolorations and foul odors. Thorough cleaning usually makes the use of deodorant blocks unnecessary. Failure to clean in the area of lavatories and showers results in unattractive accumulations of soap scum, scale, dust, fungus, or mold.

Thoroughly clean mops, brooms, brushes, and rags and then stow them after each use. Store rags on racks with adequate ventilation for air-drying.

All trash cans in living and berthing spaces should be provided with tight-fitting covers and be cleaned inside and out when they become soiled. The use of plastic liners is recommended.

Air all bedding, including mattresses, outdoors at frequent intervals.

Use all mattresses with covers, otherwise they become permeated with body grease, dirt, and discharges.

Mattresses properly protected with impervious covers that have been used by personnel with highly infectious diseases must be disinfected by wiping with approved disinfecting solutions; unprotected mattresses may be autoclaved with facilities that are available and the particular construction materials (e.g., cotton ticking) can withstand heat and pressure. If no facilities for autoclaving unprotected mattresses are available or the materials cannot be autoclaved, survey the mattresses and destroy them by burning.

Clean, renovate, or replace mattresses that are dirty or in a poor state of repair as soon as possible.

The major objectives of heating, ventilation, and air conditioning are to maintain physical fitness, mental alertness, fighting ability, and the general well-being of personnel ashore and afloat. This should include consideration for the stresses of frequent watches, prolonged cruising, and battle or general quarters situations. The design and maintenance of environmental control systems should ensure useful productivity and recovery from undue physical stress rather than thermal comfort alone.

In addition, environmental control systems must ensure that the air in confined spaces contains no harmful components and has sufficient quantities of oxygen.

Special use areas, such as selected Medical Department spaces and those containing equipment and material that require individually controlled surroundings, must be designed to guarantee optimum mission performance under variable environmental conditions.

The problems encountered in maintaining optimum habitability aboard naval vessels can be realized if we consider the many factors involved. The heating, ventilation, and air-conditioning systems must be designed for a wide range of climatic conditions ranging from arctic to tropical. The structural integrity of the ship must be preserved and penetration of watertight structures kept to a minimum. In spite of this, fresh air and heat must be provided to various compartments often far removed from the source of supply.

These problems are further complicated by the lack of uniformity of ventilation or heat demands in the various parts of the ship. Spaces exposed on one or more sides to the prevailing weather may have a high rate of heat gain or loss. Inside spaces may be subject to the effects of "wild heat," that is, uncontrolled or waste heat generated by machinery, boilers, galley stoves and ovens, and the like. Thus adjacent compartments may vary to such an extent that one requires heating while the other needs cooling.

Stress and Strain

The thermal (heat or cold) stress of any working situation is the combination of all factors that result in a gain or loss of body heat or that prevent the body's regulatory mechanism from working properly. Environmental physiologists use the term "stress" to designate the force or load acting upon the biological system and the term "strain" to designate the resulting distortion of the biological system. Thermal stress factors are heat, cold, humidity, radiation, air movement, and surface temperature. Thermal strain manifests itself in specific cardiovascular, thermoregulatory, respiratory, renal, endocrine, and other responses that differ from accepted norms.

Thermal stress has been categorized as "acceptable" when a person is able to compensate without undue strain or "unacceptable" when a person is unable to compensate and incurs excessive strain. Thermal strains have been categorized as those interfering with work performance and safety and those with more overt manifestations such as heat rash, heat cramps, heat stroke, heat exhaustion, or freezing injuries.

Definitions

Dry-bulb Temperature (DBT) - That temperature measured with an alcohol- in-glass thermometer whose bulb is kept dry and shielded from radiation.

Wet-bulb Temperature (WBT) - That temperature measured with a thermometer similar to that used for measuring DBT, except that a wet wick is fitted closely over the bulb (or sensor). A "natural" WBT is obtained with no additional movement of air over the wick other than that which occurs naturally. An "aspirated" WBT is obtained by increasing air movement over the wick with a fan, motorized psychrometer, or sling psychrometer. The "true" WBT environment is approximated when a moderate air flow is maintained and the bulb is shielded from radiant heat. Although the natural WBT depends on the DBT and the moisture content of the air, it does not provide a direct indication of the amount of water vapor in the air. The aspirated WBT is therefore of greater value in planning corrective action than the natural WBT. The term WBT will hereafter refer to aspirated WBT unless otherwise specified.

When the dry- and wet-bulb temperatures are identical, the air is said to be saturated, and the relative humidity is considered to be 100 percent.

Humidity - The quantity of water vapor mixed with other atmospheric gases.

Absolute Humidity - The mass of water vapor present per unit volume of air.

Relative Humidity (RH) - The ratio of the actual amount of water in the air (absolute humidity) to the maximum quantity of water the air can hold at a given temperature.

Dew Point - The temperature at which the absolute humidity reaches a maximum and the air becomes saturated with water vapor.

Psychrometer - An instrument for measuring atmospheric humidity using two thermometers, one with a web bulb and one with a dry bulb, whirled manually or by motor to provide the moderate air flow necessary to obtain an aspirated WBT reading.

Air Movement or Velocity - Usually expressed in feet per minute (fpm) or cubic feet per minute (cfm). It is measured by various instruments depending on air flow velocity.

Radiant Heat - The transfer of thermal energy by wave motion from one object to another without warming of the intervening space.

Vernon Globe Thermometer - Consists of a 6-inch hollow copper sphere, with a wall 0.022 inches thick painted flat black on the outside, and containing a temperature sensor like that of an unshielded dry-bulb thermometer with the bulb, or its equivalent, at the center of the sphere.

Wet-bulb Globe Temperature (WBGT) Meter - A compact electronic instrument that independently measures dry-bulb, wet- bulb, and globe temperatures.

Infrared Thermometer - Used in measuring the temperature of infrared energy emitted from various sources.

Effective Temperature (ET) - An index combining into a single value the effects of temperature, humidity, air velocity, and thermal radiation. Combinations of conditions that produce the same subjective feeling of warmth in reference to still saturated air are assigned the same effective temperature.

Mean Radiant Temperature (MRT) of a nonuniform environment (e.g., walls, ceilings, floors). The temperature of a uniform black enclosure in which a solid body or an occupant would exchange the same amount of radiant heat as in the given nonuniform environment. It is estimated from the globe thermometer reading and is useful in determining radiative heat transfer (net gain or loss) in human beings.

Heating

Aboard ship the conventional approach for heating involves drawing fresh outside air over steam coils and discharging the heated air into various compartments where it is required. To avoid condensation of moisture on the airducts and to provide a flexible heating system, initially preheat outside air to 42° to 50° F DBT. The air is then heated to the desired delivery zone temperature and distributed to the various compartments and spaces within that zone. A "heating zone" is defined as a group of adjacent spaces with approximately the same heating requirements.

A zone temperature of 70° F DBT is required aboard surface vessels for berthing, dressing, lounge, messing, medical, dental, office, and control spaces. No effort is made to control the moisture level in these spaces during cold weather; therefore, Medical Department personnel should anticipate increased symptoms associated with the drying of respiratory membranes among individuals working in these spaces.

Heating designs for submarines differ from those of surface vessels in that they provide regulated humidity for the living and control spaces noted above. Aboard submarines the temperatures should be as follows: DBT: 79° F, WBT: 59° F, RH: 50°, WBGT: 63° F (as ET).

With the exception of the above, inside working spaces are usually maintained at lower temperatures, depending on the amount of physical exertion required of personnel working in those areas. These temperatures will be the minimum consistent with comfort.

Ventilation

The purpose of ventilation is to remove toxic substances, offensive odors, and excessive heat and moisture, and to provide an adequate oxygen supply. Ventilation aboard ship is designed not only to prevent conditions that could lead to acute overheating, but also to maintain an atmosphere conducive to the physical and mental efficiency of personnel. It should be effective during normal operations and in the event of CBR warfare. Ventilation systems must be as flexible as heating systems. Hot weather cooling of given spaces by ventilation is planned so that the temperature within those spaces will remain below specified limits. These limits are determined by using as a base the highest anticipated hot weather (outside) temperature. For planning purposes this is defined as 90 degrees F DBT and 81 degrees F WBT.

Air circulation within compartments must be sufficient to eliminate "dead spaces." An adequate air exchange will ensure removal of odors and prevent the accumulation of moisture on environmental surfaces. Ventilation exhaust from sanitary spaces, food preparation and dining areas, sculleries, and garbage disposal areas must not be recirculated or introduced into other spaces. Ventilation of food preparation and laundry spaces must be balanced to provide a negative pressure within these areas to allow for a net inflow of air.

Cooling by ventilation is the process of diluting inside air with cooler outside air. It may prove of value aboard a ship in limiting excessive temperature from varied indoor sources (personnel, lighting, laundry equipment, machinery, poorly insulated piping in firerooms and enginerooms, etc.).

Obviously, ventilation alone will not usually cool spaces to a temperature as low as that of outside air. Firerooms and enginerooms require spot cooling, because these spaces produce so much "wild heat" that it is practically impossible to reduce the temperature of the entire space to that of a good working atmosphere. This method of cooling is accomplished by air supplied at a high velocity from ventilation ducts that concentrate their discharge on the watch stander's station. It maintains the immediate vicinity within the acceptable range despite the high temperature of the general area.

Keeping the ventilation system clean is very important. As the adhering material accumulates, the capacity of the system to deliver air is reduced. Establish a cleaning schedule for the system, with screens, heaters, and cooling coils receiving special attention.

Air Conditioning

Mechanical cooling and dehumidifying of air aboard naval vessels is accomplished by passing air over coils and fins cooled with a refrigerant. As the warm humid air circulates over the coils, it loses heat and the moisture condenses on the fins. The conditioned air is then circulated through a ducting system to appropriate spaces and compartments. Cooling coils may be located in an air supply duct with the refrigerating unit and fan placed remotely, or the entire apparatus may be assembled into a single unit.

Air conditioning is frequently required in spaces containing precision instruments sensitive to extremes of temperature and humidity. Appropriate filtering will ensure air purity within required tolerance limits.

Mechanical cooling is a current feature of the living areas and office spaces of combat ships and most auxiliaries. When still commissioned, hospital ships were routinely air conditioned, with the improved recovery of patients taking precedence over the customary weight and space limitations.

"Cold shock," defined as rapid heat loss due to increased evaporation of sweat from the skin and damp clothing, may occur in personnel passing from heated areas into air-conditioned spaces. Chills and shivering are common manifestations. Personnel in this situation experience sudden dilation of superficial blood vessels and flushing. "Cold shock" may be minimized by regulating air-conditioned spaces so that the difference in temperatures between those spaces and heated or outdoor environments does not exceed 15° F DBT.

Additional Considerations Aboard Ship

Mechanical air supply and exhaust systems are provided for most working and living spaces; the quantity for each should be balanced respectively within the major sections of a ship. Ventilation of spaces in which excessive heat or undesirable odors are produced requires a greater volume of mechanical exhaust than supply ("negative pressure") to maintain an induced air flow into the compartment and to prevent the spread of heat and odors to adjacent spaces. Compartments used for living and berthing should be provided with a greater volume of mechanical supply than exhaust ("positive pressure") to maintain an induced airflow out of the space and thus to prevent the entrance of contaminated air from adjacent spaces.

Ventilation and air-conditioning designs for living, working, and electronics equipment spaces aboard surface vessels should minimize heat stress and enhance performance in hot and subtropical climates.

In still air the body is enveloped by a layer of warm, moist air resulting from body heat and the evaporation of perspiration. A controlled air movement removes this layer and adds greatly to the feeling of comfort. High-velocity air blowing from the overhead onto the heads of occupants is undesirable except in hot atmospheres. Such an air stream directed against exposed skin becomes uncomfortable to intolerable in many hot environments. In hot weather use bracket fans for high local circulation.

Additional requirements and standards for shipboard heating, ventilation, and cooling may be found in the Manual of Naval Preventive Medicine, NAVMED P-5010, chapter 3, and OPNAVINST 5100.20 series.

One of the most demanding and vital tasks of naval preventive medicine is ensuring proper handling of food in its many phases from the point of production to final consumption. Carelessly handled food is easily contaminated and will readily support the growth of pathogenic organisms that may lead to illness.

Responsibilities

Commander, Naval Medical Command. Establishes sanitary standards for food procurement, inspection on delivery, fitness for human consumption, storage and refrigeration, prepara tion and serving, and disposal of food remains.

Navy Environmental and Preventive Medicine Units (NAVENPVNTMEDU). Provide specialized consultation in preventive medicine and environmental health in the following areas:

• Evaluation of food sanitation training programs
• Surveys and recommendations on insect and vector problems
• Laboratory services
• Epidemiologic investigation of foodborne illness

Commander, Naval Facilities Engineering Command. Responsible for planning, designing, and constructing all shore dining facilities.

Commander, Naval Sea Systems Command. Responsible for designing, constructing, and maintaining dining facilities afloat.

Commander, Naval Supply Systems Command. Administers the Naval Food Service Program.

Commandant, Marine Corps. Administers the food service program for the Marine Corps.

Individual Commands. The commanding officer of each individual command has the ultimate responsibility for ensuring that food and beverages served within his or her jurisdiction are safe and wholesome. However, guidance and support in food service sanitation must be provided by the supply and medical departments.

Procurement

The Department of Defense has designated the Defense Personnel Support Center (DPSC) of the Defense Logistics Agency (DLA) as the organization responsible for the procurement of food items for the Armed Forces. Most food items are procured through contracts let by Headquarters, DPSC, Philadelphia, or regional headquarters located in major marketing areas in the United States.

All foods for the enlisted dining facilities must be procured in accordance with federal and military standards. Except in emergencies, local purchase of food items by naval activities within the United States are limited to fresh bakery items, fresh dairy products, and items designated for local purchase in the Federal Supply Catalog.

Inspection

All foodstuffs procured for the Armed Forces undergo rigid inspections and are subject to various federal and military specifications covering sizes, grades, appearance, and type. These inspections are performed by DPSC quality assurance representatives (QARs), U.S. Department of Agriculture (USDA), U.S. Department of Commerce (USDC), technically qualified inspectors employed by Navy activities and organic to the command, Navy receiving officers, and medical officers and their designated representatives. Army veterinarian personnel are also available to assist Navy commands in most geographical areas.

Responsibilities

• The supply officer is responsible for procuring, receiving, inspecting, and storing foodstuffs.
• The food service officer is in charge of the food service division in a command. He or she is accountable for foodborne illness resulting from improper food preparation, serving or storing.

  Other responsibilities include:

  • Ensuring cleanliness of all food service equipment and spaces.
  • Supervising personal hygiene practices by food service personnel.
  • Ensuring sanitary food preparation, serving and storage.
  • Setting up initial and refresher training programs for all food service personnel.
• The medical officer or the Medical Department representative is responsible for:
  • Routine inspection of all food service facilities at least twice monthly.
  • Sanitary inspection of all Navy and Marine Corps commissaries.
  • Inspection of foodstuffs for fitness for human consumption and for assurance that they are from approved sources.
  • Physical examination of food service personnel.
  • Sanitation training programs (initial and refresher).

Meals served in the enlisted dining facility must be sampled regularly by an officer detailed by the commanding officer (usually the officer of the day).

Occasionally, food items are received that have not been inspected by technically qualified personnel. All food items delivered directly to the facility by vendors will be inspected by the medical officer or his or her representative to ensure fitness for human consumption. The food service officer or the designated representative will inspect the food items to ascertain the exact quantity received and inspected, as above, in accordance with NAVMED P-5010-1. Food items not satisfy ing the above may be rejected.

Food about which there is any doubt must be rejected as unfit for human consumption. To avoid the risk of foodborne illness, observe the old adage "When in doubt, throw it out."

The medical officer is responsible for ensuring that all food served in the command's enlisted dining facility is fit for human consumption. If any food appears questionable or has been purchased on the local market or under contracts requiring inspection at destination, the food service officer must request an inspection. The medical officer or the designated representative will perform the inspection and submit samples for laboratory analysis in accordance with the Manual of Naval Preventive Medicine.

Medical Department personnel concerned with food inspections ashore should maintain liaison with local personnel of the military veterinary services or USDA inspectors to keep current on the information and techniques involved in such inspections.

Food inspections afloat should be made jointly with the supply officer or the designated representative if a combination of knowledge and training can result in an effective inspection program.

Meats

The Federal Meat Inspection Act and the Poultry Products Inspection Act require a USDA official to inspect all meats, meat products, poultry, and poultry products intended for interstate shipment. All such products prepared in the United States and purchased by the Armed Forces must have originated in plants under the supervision of the USDA or USDC and be so marked with their stamp of approval. Various stamps are shown in figure 5-1. The stamp indicates that the condition of the product met with Federal regulations at the time of packing. The markings do not attest to the quality of the product. Criteria by which various meats are judged may be found in the NAVSUP Manual or NAVSUP 421.

Fish and Shellfish

The Fish and Wildlife Act provides for USDC inspection of processed fish and shellfish products. All such products prepared in the United States and purchased for enlisted dining facilities originate from plants under the supervision of the National Maritime Fisheries Service and are marked with the USDC stamp (fig. 5-1).

Each container of unshucked shell stock will be identified by an attached tag that states the name of the shell stock shipper, the kind and quantity of shell stock, and the official certificate number issued according to the law of the jurisdiction. Fresh and frozen shucked shell stock will be packed in nonreturnable containers and marked with the name and address of the shipper, packer, and shucker, and the official certificate number. Make sure shellfish is kept in the original container until use.

Check all fish carefully. Refrozen fish will not be used. Fish that has been refrozen will be soft and discolored and have a sour odor; the wrapping paper may be moist, slimy, or discolored and the bottom of the box distorted.

Fresh fish have bright red gills, prominent clear eyes, and firm elastic flesh. Stale fish are dull in appearance, have cloudy and red-bordered eyes and soft flesh. Finger impressions are easily made and will remain when pressure is released. Fish caught over the side at sea will not be used unless there is absolute certainty that they are not poisonous, since cooking does not destroy the poisonous alkaloid in fish.

Fresh crustaceans must be alive to be acceptable. When inspecting crab, lobster, or shrimp, organoleptical procedures (testing with the senses) must be used to determine fitness for human consumption.

Fruits and Vegetables

Inspect fresh fruits and vegetables upon receipt for wholesomeness. The inspection is based upon USDA standards. Minimum requirements for the various grades are defined in the Manual of Naval Preventive Medicine, chapter 1.

Canned Goods

Canned goods should undergo an inspection to assure the physical state of the containers. When inspecting canned products, take into consideration the following:

• Can labels-the information stamped on the end of each can will be checked to ensure that contents and date of pack are indicated.
• Can exterior-general appearance (dents, rust, swelling, leakage).
• Contents-odor and taste indicate the condition of the contents. Faded color, loss of flavor, and soft texture are undesirable natural results of aging and chemical action.
• Except for coffee and molasses that are discussed below, foods in cans with the following defects are unacceptable and must be surveyed.
• Pinholes-cans with tiny holes caused by the action of acid.
• Flipper-a can with flat ends, one of which may be forced into a convex position when the other is brought down sharply on a flat surface. It indicates a loss of vacuum due to the formation of gas by bacteria or chemical action on the metal of the can. Regardless of the cause, the contents must not be used.
• Springer-a can with one or both ends slightly bulged but yielding to finger pressure. When the pressure is relieved, the ends will again bulge. This condition may be caused by overfilling or by chemical or bacterial action creating gas. Coffee is an exception as the bulging ends are usually an indication of a properly sealed container retaining its natural gases.
• Sweller-Both ends of this can bulge out and remain that way. This is indicative of advanced deterioration. Molasses is an exception. Cans of molasses that bulge at the ends are not unusual, particularly in tropical climates. Micro-organisms cannot exist due to high sugar content.

Do not eat, or even taste canned foods that are abnormal in appearance or odor. They must be discarded. If large quantities are involved, submit a representative package for bacteriological analysis.

Dry Food Items

Dry food items, other than canned goods, are cereals, sugar, dried fruits, vegetables, flour, and meal. Store them under controlled conditions of temperature, humidity, and air circulation.

Torn or broken containers may be exposed to rodents or insects. Rolled oats or other cereal containers may have broken and the food become contaminated. Dried fruits and vegetables may become damp and moldy. Dockside inspection of these items is recommended to avoid taking pests such as cockroaches into the ship or storage facilities and thus to prevent recurring infestations.

Butter, Cheese, and Eggs

Butter, cheese, and eggs spoil quickly under improper storage conditions. The method of handling and the storage temperatures must be correct. Check these products carefully upon delivery and frequently thereafter.

Butter should be received in clean, unbroken cases. For quality, it is best to taste samples for sweetness and freshness. The color should be uniform and the texture firm. Specks or foreign substances should not be present.

Check the rind, color, flavor, and texture of cheese. Cheese may be received in either natural or processed form. The rind should be clean and free from mold or wrinkles. In good cheddar cheese the color should be evenly distributed. This can be determined by holding a thin slice up to a light. The flavor of good cheese is clean and nutty and the texture compact and solid.

Various types of eggs including fresh, frozen, and dehydrated are procured for different conditions and uses. Fresh eggs (not over 30 days old) that have been held at a temperature of 32° F in a dry, ventilated place are preferred. Eggs are not stored at room temperature or allowed to remain at room temperature because they rapidly lose their quality. Fresh processed eggs have been preserved by dipping for a few seconds in warm mineral oil at 100° to 110° F or by treating with other processing fluids. This treatment helps retard shrinkage due to evaporation and also destroys molds and bacteria, thereby prolonging the storage life of the eggs. Also store processed eggs in a cool (32° F), dry, ventilated area. Both dehydrated and frozen eggs are used for making scrambled eggs and omelets or for baking purposes.

Storage

Correct storage procedures play a major role in preventing foodborne illness and increasing the storage life of foods. Proper temperatures, air circulation, and humidity retard food spoilage and growth of pathogenic organisms. Stock rotation reduces spoilage, and adequate pest control reduces infestation and damage caused by insects and rodents.

Maintain high levels of sanitation and safety in all food storage facilities. Palletize food items or place them on shelves in a manner that is safe facilitates proper cleaning, promotes adequate air circulation, and prevents insect and rodent harborage. To prevent food spoilage, rotate foods so the oldest items are used first.

Aboard ship, it is extremely important to conduct pest control treatments of food storage compartments while stores are low and prior to loading large shipments of stores. Use the Navywide Shipboard Pest Control Manual (published by the Disease Vector Ecology and Control Center, Alameda) for guidance or procedure.

Semiperishable Food Items

The term "semiperishable" refers to foodstuffs that are canned, dried, dehydrated, or otherwise processed so they may be stored in nonrefrigerated spaces. Storerooms should be clean, dry, well ventilated, and inspected regularly for cleanliness. Check the foodstuffs for spoilage or damage. Do not store semiperishable food near steam or other heated pipes. Bagged items must be stored off the deck to facilitate cleaning and air circulation.

Semiperishable food must be considered overaged when stored beyond the inspection test date marked on the case or the keeping time shown in the semiperishable food storage table in NAVSUP 486.

An overage item is still usable if the container is in good condition and the food has no offensive odor or appearance. Items will not be surveyed solely because of age. They must be inspected by a qualified inspector, and if found fit for human consumption the shelf life will be extended. Extended food items are consumed as soon as possible.

When inspecting storerooms, check the outward appearance of food containers and the condition of food. Torn or broken bags of flour, meal, sugar, and the like will be surveyed or stored in insect-proof containers. If an insect infestation is discovered, such as weevil-infested flour or grain, specimens of the insects should be carefully collected and sent to the nearest military facility having the capability to identify insects. Refrigerate or freeze items with live insects inside the product if aboard ship and fumigate them if ashore in accordance with procedures outlined in MILSTD-904A.

Fresh and Frozen Food Items

Fresh and frozen food items including dairy products, eggs, fish, fruits, meats, and vegetables are highly perishable and require proper storage temperatures, humidity, and air circulation. To promote proper air circulation, store these items on pallets away from bulkheads and cooling coils, with a minimum 2 feet of clearance between tops of stacks and air ducts. Generally, when the recommended temperatures are uniform in all areas of the refrigerator or freezer, air circulation is considered adequate.

Fresh fruits and vegetables stored in a tight compartment at 40 degrees F or above produce a high concentration of carbon dioxide due to the respiration of the produce. In some instances levels of carbon dioxide may become unsafe for work. Under such conditions the levels of CO2 will be checked by qualified personnel before entry, and an adequate supply of fresh air will be introduced into the space.

Store meats, meat products, poultry, and poultry products in areas that offer proper air circulation to maintain the desired temperatures throughout the storage space. Do not store meat and meat pans on the deck.

With the exception of medical supplies that must be refrigerated and maintained under separate lock and key, only food may be stored in food storage spaces. Do not store foods that readily absorb foreign odors, such as eggs and butter, with fruits and vegetables. Decayed or otherwise spoiled food items must not remain near items that are still wholesome. Store food and food containers at least 2 inches off the deck and away from bulkheads or other items that may impede adequate air circulation.

Inspect stores for the presence of insects before they are placed in the storeroom and at least monthly while in storage.

Refrigerated storage spaces (including milk dispensers, refrigerated display cases, refrigerated salad bars, reefers, and freezers) are maintained as follows:

The temperatures must be held within the appropriate ranges given in table 5-1 and the relative humidity maintained between 85 percent and 90 percent.

Table 5-1 - Temperature Requirements for Refrigerated Spaces

Frost or glaze ice must not be allowed to accumulate to more than 3/16 of an inch on interior surfaces or refrigeration coils.

Routinely wash interior surfaces with warm water and hand dishwashing detergent and rinse these surfaces with warm water in accordance with the manufacturer's instructions.

At least one easily readable and readily accessible thermometer, accurate to within plus or minus (±) 3 degree F, must be providedin all refrigerated storage spaces.

Maintain temperature logs for all bulk cold storage spaces. Accurate entries are made at least twice daily.

Cover all food items that have been removed from their original containers and stored in refrigerated spaces with aluminum foil, wax paper, or plastic. All food containers must have labels indicating the contents, and in the case of prepared foods the date and time of preparation will be included.

For guidance ashore and afloat, tables of safe keeping times, proper storage temperatures, and storage life of perishable and semiperishable items, refer to NAVSUP 486, volume I, chapter 5.

Milk and Milk Products

Milk and milk products have a Jekyll and Hyde reputation. Milk is most valuable to the nutritional well-being of the individual, but if not properly safeguarded it will be instrumental in transmitting disease. Strict surveillance of all handling procedures is necessary to prevent contamination.

The perishability of milk and milk products is a most important factor, thus strict compliance with all sanitary requirements is mandatory. Of prime importance to medical and supply department personnel are maintaining recommended temperatures in storing and dispensing, and enforcing approved sanitary methods in the handling of such products. The following definitions will help you understand milk processing.

Homogenization-The process of passing milk through a homogenizer, which breaks up milk fat and protein, blending cream, water, and milk solids, and preventing separation.

Pasteurization-The process of heating milk or milk products to at least 145° F and maintaining this temperature for at least 30 minutes, or to at least 161° F and maintaining this temperature at least 15 seconds in approved and properly operated equipment, or any other pasteurization technique recognized by the U.S. Public Health Service (USPHS). Milk products having a higher milk-fat content than milk or containing added sweeteners must be heated to at least 5° F above the minimum pasteurization temperature noted.

Ultra-High_Temperature Processed-The process of aseptically packaging milk in containers and bringing it to an ultra-high temperature for a short period of time.

Milk and milk products, to be acceptable for serving at Navy and Marine Corps dining facilities ashore and afloat, must originate from an approved source. These sources are in NAVSUPINST 4355.4 series, Directory of Sanitarily Approved Establishments for Armed Forces Procurement. Also acceptable is an establishment having a pasteurization plant compliance rating of 90 or more, as certified by a state milk sanitation rating officer.

When performing delivery inspections, Medical Department personnel must ensure that milk and milk products are from an approved source and delivered in containers that are in good condition and properly sealed; that milk and milk products are organoleptically acceptable; and that the temperature of the product on delivery is 45 degrees F or below or in accordance with current DPSC contract. Vehicles used in the transportation of milk in its final delivery containers must be clean and constructed with permanent tops and sides. Block or crushed ice on the tops of milk cartons for refrigeration or cooling during delivery or on the serving lines is prohibited.

Single-service containers of milk and milk products must be refrigerated at temperatures below 45 degrees F until served. All milk and milk products dispensed from bulk milk dispensers must be homogenized. Temperatures in the dispenser cabinet must range between 38° to 44° F while milk containers are stored within. A thermometer is an integral part of the dispenser cabinet. Multiuse dispenser tubes are prohibited. Single-service dispenser tubes will be cut with a sanitized cutting instrument to 1/4 inch beyond the termination of the dispensing mechanism. Bacteriological examination of milk and milk products must be made routinely and whenever contamination or contract nonconformance is suspected.

When the pitcher method of recombining and dispensing milk is used, pitchers must be cleaned and sanitized before use. Only cool, potable water will be used for reconstituting, and milk will be dispensed only from corrosion-resistant stainless steel or glass pitchers washed and sanitized after each use. Milk remaining in the pitcher after a meal period must be used within 36 hours for cooking purposes only or be discarded.

Ice Cream and Ice Cream Mixes

Ice cream served in Navy and Marine Corps dining facilities must be from approved sources and meet federal and military standards. If prepared locally from a mix, only potable water will be used. The freezer must be cleaned after each day's operation. Bulk ice cream and other bulk frozen desserts are not authorized for self-service. All utensils including spoons, spatulas, dippers, and scoops used for dispensing ice cream must be kept either in running potable water or potable water that is changed several times during operation. To minimize health risks, only one person per watch section will make ice cream. Ice cream will be stored at temperatures of 0 degree F or lower.

Food Service Personnel

Food service personnel are a most important link in the transmission of disease through foods. The health and personal habits of food service personnel and the methods of preparing and serving foods are vital factors. Health standards for food service personnel are discussed in the HM 3 & 2 Rate Training Manual.

Sanitary Precautions for Preparing and Serving Food

Food poisoning and the spread of foodborne illness would be eradicated if food were procured from approved sources and processed, prepared, and served according to recommended sanitary practices. Most foodborne illnesses can be traced to one or more of the following:

• Food prepared too far in advance of serving time
• Poor refrigeration
• Disregard of time and temperature factors
• Poor personal hygiene practices
• Food service personnel who are ignorant of or careless in applying recommended techniques

Even with exact care and handling, most uncooked foods harbor some microorganisms. Their growth can be prevented or retarded through proper temperature control. Only the quantity of food that will be consumed at each meal should be prepared, and hot foods should be kept hot and cold foods cold.

Do not return open jars or bowls of mayonnaise and salad dressing from salad bars to refrigerators for reuse at later meals.

When leftovers or warm foods are to be chilled, ensure prompt and thorough chilling to the center of the food mass (40° F or lower). Foods to be refrigerated should be placed in shallow pans of not more than 3 inches in depth and covered with lids, waxpaper, or other appropriate covers. Food to be chilled should immediately be placed in the chill box and labeled with the time and date. Leftover foods must not be held longer than 36 hours.

Foods that were cooked and then refrigerated shall be rapidly heated to 140 degrees F (60° C) or higher throughout before being placed in a hot food storage container. Steam tables, warmers, and other food holding facilities must not be used for rapid heating.

Ground or chopped food that is to be cooked later or incorporated into a recipe must be refrigerated immediately in covered shallow pans not more than 3 inches deep.

Cut, sliced, or diced meats must be refrigerated immediately in shallow containers not more than 3 inches deep.

Green vegetables of uncertain origin or suspected of being contaminated must be chemically sanitized by immersion for at least 15 minutes in 100 parts per million (ppm) free available chlorine solution or 30 minutes in 50 ppm free available chlorine solution. These items must then be thoroughly rinsed with clean, potable water before use. Head items such as lettuce, cabbage, and celery must be broken apart before they are sanitized.

Frozen Foods

Frozen foods are subject to deleterious quality changes in color, texture, odor, flavor, and nutritional value if improperly packaged, frozen, stored, or thawed. The proper procedures for managing frozen foods include sealing the foods in moisture- and vapor-proof containers or wrappers to prevent dehydration and freezer burn. Other measures are freezing foods in process freezers designed to cool bulk foods quickly to reduce chemical and biological deterioration, and storing the foods at a constant temperature not above 0° F.

Frozen foods must be thawed in a refrigerated space. Once thawed, frozen foods must not be refrozen. Thawing by exposure to excessive heat is prohibited. Likewise, thawing by immersion in water or with the use of fans is prohibited. Frozen meats must be thawed gradually at temperatures of 36° to 38° F and used as soon as possible thereafter. Frozen foods may be thawed in the galley or meat preparation space on board ship at room temperature if thaw boxes have not yet been installed and if no refrigeration space is available for this purpose. When frozen foods are thawed by this method, the temperature must not exceed 80° F, items must remain in their original containers while thawing, precautions must be taken to ensure that foods are not allowed to remain at room temperature once thawed, and the Medical Department representative (MDR) must be notified of the thawing procedures. Frozen foods may be thawed in microwave ovens provided they are fully cooked immediately thereafter as part of the continuous cooking process.

Freezing leftovers is prohibited. This includes meat sauces, casseroles, and the like. Reconstituted and dehydrated foods are as susceptible to bacteria and spoilage as fresh items. Dehydrated foods must be refrigerated or cooked immediately after reconstitution.

Sandwiches

Due to the method of preparation, types of filling, handling, and storage procedures, sandwiches are potentially hazardous food items. The following requirements are therefore necessary.

Sandwiches not prepared at the activity will be procured from an approved commercial source. They must be freshly prepared and the time between preparation and consumption held to a minimum. Sandwich fillings containing meat, meat products, eggs, poultry, poultry products, and fish that are to be held longer than 3 hours before consumption must be prepared at room temperatures of 80° F or below and refrigerated until consumption. Sandwiches that contain protein fillings exposed to temperatures between 40 to 140° F must be consumed within 3 hours or disposed of.

Mayonnaise, catsup, and other condiments, including pickles, are issued as separate items and not included in the sandwich. Sandwiches must be individually wrapped.

Chilled and frozen sandwiches are categorized as follows:

Class I-Sandwiches containing meat, cheese, salad fillings, and leftovers. These sandwiches are prepared and refrigerated daily and normally dispensed over the counter, in mobile food service trucks, or in refrigerated vending machines.

Class II-Frozen sandwiches intended for use in flight or boat meals. These sandwiches are prepared in enlisted dining facilities and are authorized only when the preferred method of handling special meals is not feasible. The following special requirements apply to class II sandwiches:

• Only freshly prepared sandwiches containing suitable ingredients for freezing will be used.
• Each sandwich will be individually wrapped and sealed in a double thickness of polyethylene film, waxed paper, or other moisture-proof material.
• Immediately after wrapping, sandwiches will be frozen to a temperature of 0F or below and maintained at that temperature.
• Frozen sandwiches must be consumed within 5 hours after removal from the freezer. Each sandwich will be labeled at the time of issue with the time and date; for example, "Consume by ________________________."

Class III-Frozen sandwiches produced in a commercial frozen food operation in which a central kitchen is designed specifically for mass sandwich production. Each sandwich is hermetically sealed and frozen to 0° F or below and maintained at that temperature during transportation and storage. These sandwiches are limited to bread, meat, and cheese portions and condiments not considered potentially hazardous foods, such as mustard.

Frozen sandwiches are subject to the same requirements for thawing as other frozen foods. Outdated sandwiches must be discarded. Each sandwich must be labeled, marked, or stamped with the date and time of preparation and a "pull date." In addition, each carton or case of sandwiches must be stamped or affixed with the name and address of the processor and the preparation date.

Pastries

Cream puffs, custard filled cakes and pies, eclairs, and similar products must be prepared under strict sanitary conditions, covered, cooled quickly, and refrigerated until use. These items are highly perishable and provide ideal breeding grounds for pathogenic organisms. Only the quantity that will be consumed at each meal period will be prepared or procured. They must remain under refrigeration while on the serving line, and any leftover items must be discarded as garbage.

Other Foods

Information concerning salad bars, serving lines, and self-service items is contained in the Manual of Naval Preventive Medicine, chapter 1.

All equipment and utensils used in food service facilities under Navy and Marine Corps jurisdiction must be made of sanitary, nontoxic, corrosion-resistant materials. They must be designed, constructed, and installed to provide for ease of cleaning. Such equipment must not contain inaccessible spaces. All such spaces must be sealed to prevent the entrance of food particles and vermin. Equipment and utensils must be constructed for easy maintenance. Food service personnel cannot be expected to maintain sanitary standards if equipment or utensils cannot be easily cleaned because of improper construction or deteriorated condition, if special or unusual handling and dismantling tools are required, or if the labor is exceedingly tedious, heavy, or time-consuming. For food service equipment to comply with Navy sanitary standards, Medical Department personnel must be consulted prior to local procurement and installation. Equipment must be installed at least 6 inches (8 inches aboard ship) from walls, floors, and adjacent equipment; or sealed to the wall, floor, and adjacent equipment on all sides.

All food service spaces will be provided with hot and cold running potable water under pressure to all lavatories and equipment which require it. With the exception of NAVMEDCOM approved shipboard food waste grinding machines and refrigeration units that use salt water, all food service spaces and equipment must be free from salt water and other nonpotable water inlets. All potable water inlets and connections must be free of cross-connections. A submerged potable water inlet is a cross-connection.

All surfaces that come into direct contact with food must be impervious, corrosion-resistant, and smooth. Cadmium plating, lead, and other harmful materials must not be used in food service equipment or utensils. Wooden paddles and other devices made of wood are likewise prohibited.

Dishwashing

Extensive tests have shown that many communicable diseases are transmitted by improperly washed and inadequately sanitized utensils and equipment. These items, including removable equipment components, may be washed by hand or machine; however, if available, machine dishwashing is preferred. Whatever method is used, the final results depend on the knowledge, skill, and conscientiousness of the dishwasher as well as the equipment and materials available. Equipment maintenance and properly trained operators are key elements to good dishwashing.

Contamination of clean and sanitized dishware can be prevented by eliminating cross-handling of soiled and clean items from splashes or sprays. The flow of dishware and utensils must be from soiled areas (scraping and preflushing) to clean areas (storage) to minimize the possibility of contamination from soiled articles.

Towel drying of dishware and utensils is strictly prohibited, as is the use of dishmops, sponges, or cloths for dishwashing. A sufficient amount of sanitary storage space must be provided to prevent contamination of clean and sanitized articles. Storage of dishware and utensils in sculleries that have approved salt water garbage grinders is prohibited. A sufficient supply of dining gear should be available to prevent the recycling of inadequately cleaned, wet, or hot dishware and utensils.

Approved procedures for both manual and machine dishwashing are contained in the Manual of Naval Preventive Medicine, chapter 1.

In the Field Dishwashing

The proper washing and sanitizing of mess gear and utensils used in the preparation and serving of food in the field is essential to the continuing health of the unit. This becomes particularly difficult since all unit members are expected to wash their own mess gear.

A model field dishwashing unit consists of five GI cans in a line as illustrated in figure 5-2.

Long-handled brushes are attached to the first and second wash cans. In actively boiling water, immersion for 30 seconds in the rinse cans is sufficient for sanitization and will promote rapid air-drying. An additional can may be added for prerinsing before eating; this water should be freely boiling.

With the additional pressures placed on individuals in the field environment, sanitization of mess gear may not receive proper attention. Consequently, close supervision in the washing area is required.

For more information on field sanitation practices, refer to the Departments of the Army and the Air Force publication, Field Hygiene and Sanitation, FM 21-10/AFM 161-10.

Standards and Sanitation of Food Service Facilities

All Navy food service facilities ashore and afloat must be maintained scrupulously clean, clear of refuse and garbage, and free of rodent and insect infestations. All floors, walls, ceilings, studs, joints, rafters, and pipes must be constructed to provide easy access for cleaning. Adequate light must be provided to all surfaces and equipment in food service spaces. All rooms must be adequately ventilated and air intake ducts and interiors of ventilation ducting cleaned at least quarterly to prevent accumulation of dirt and grease. Ventilation hoods and grease filters must be cleaned weekly to prevent fires. Meat cutting and preparation rooms at shore facilities must be air-conditioned and maintained at 50° F or below. The galley spaces aboard ship must be maintained at temperatures below 80° F.

At shore facilities garbage and refuse must be kept in leak-proof, nonabsorbent containers. Sufficient numbers of garbage and refuse containers are required to prevent overfilling. They must be provided with tight-fitting doors, lids, or covers and emptied as necessary during operation hours and at the end of each working day. Garbage and refuse on the premises must be stored in a location inaccessible to insects and rodents. Outside storage of garbage is prohibited except in garbage rooms. When garbage or refuse rooms are used, they should not be located within 100 feet of the food service facility. Garbage containers must be cleaned inside and out after they are emptied at the end of the day. Dumpsters and other large containers for storing garbage must be cleaned with high pressure water or steam at least twice a week during fly- breeding season and whenever necessary at other times.

Effective control measures to eliminate or control the presence of rodents, flies, cockroaches, and other vectors and pests must be maintained. The food service facility and its adjacent grounds must be kept free of litter and debris.

Report of Inspection

Navy and Marine Corps food service facilities will be inspected at least twice a month by a Medical Department representative along with the food service manager/officer or the designated representative. The findings of the inspection will be reported on NAVMED 6240/1. A sample form is shown in figure 5-3. A system has been established in which maximum defect points are awarded for each stated requirement. The inspector assigns an appropriate number of defect points up to the maximum possible and computes a sanitary compliance score (SCS). Complete step-by-step procedures for filing the report and computing the SCS are provided in the Manual of Naval Preventive Medicine.

When inspecting food service facilities and food items, use common sense and intelligence as a yardstick. The main objectives of an inspection are to discover discrepancies in food service operation and to prevent the spread of foodborne illness. To be meaningful, inspections must be conducted carefully, thoroughly, and competently, and then evaluated. Members of the Medical Department who provide inspection services must know what is proper and improper, and why. When they note a defect, they should explain why it is a defect, why it is dangerous, and what can be done to prevent or correct the situation. Authoritarian attitudes may alienate them from the personnel whose cooperation is essential to achieve high levels of sanitation.

The proper disposal of waste materials is one of the most important measures for the control of waterborne diseases such as cholera and typhoid fever. The Federal Water Pollution Control Act Amendments of 1972 established the National Pollutant Discharge Elimination System (NPDES), which is a program to control water pollution in the nation's waterways by limiting the discharge of polluted effluents into waters from point sources.

The Chief of Naval Operations promulgates Navy policy and assigns responsibilities concerning the prevention, control, and abatement of environmental pollution caused by naval ships and shore stations.

The Navy Surgeon General, through the occupational and preventive medicine services at Naval Hospitals and Navy Environmental and Preventive Medicine Units, is responsible for evaluating wastewater disposal systems ashore and afloat to eliminate potentially hazardous conditions that could adversely affect the health of personnel.

The Chief of Naval Material, through the Naval Facilities Engineering Command and the Engineering Field Divisions, provides technical assistance on compliance with federal law and the NPDES Permit System in wastewater disposal.

Individual commanding officers are responsible for ensuring the correct disposal and treatment of wastewaters.

The use of approved municipal or regional wastewater collection and disposal systems is the preferred method of disposal of wastes from shore activities. Accordingly, municipal or regional wastewater disposal systems are used by Navy shore activities whenever feasible.

Whenever use of a municipal or regional wastewater system is not possible or appropriate, the Navy must install and operate its own wastewater treatment and disposal facilities.

Sewage may be treated by a wide variety of methods using simple self-contained systems or sophisticated engineering systems.

Medical Department responsibility in ashore waste disposal consists of periodically inspecting wastewater treatment and disposal systems to detect potential health hazards to operators and the surrounding community. This effort includes being alert for any increase in disease among treatment plant operators or members of the surrounding community that may be attributable to exposure to human wastes.

Health precautions for personnel who work with wastewater treatment systems include:

• Keeping basic immunizations current. (Required immunizations include typhoid, polio, and tetanus.)
• Refraining from eating, drinking, or smoking when working with or inspecting equipment that may be a direct source of contamination.
• Wearing coveralls, rubber boots, and rubber gloves when cleaning up waste water spills or leaks. (On completion of cleanup, contaminated clothing must be removed and placed in plastic bags for laundering. Cleanup personnel should then shower as soon as possible.)

Afloat

The overboard discharge of untreated sewage within the navigable waters of the United States and the territorial seas (within 3 miles of shore) is prohibited by federal law for all DOD ships. To comply with the law, naval vessels are being equipped with marine sanitation devices (MSDs) that either treat sewage before discharge or collect and hold it until it can be properly disposed of through dockside sewer connections or pumped overboard in unrestricted waters.

MSDs on Navy ships increase the potential for contamination of berthing and working spaces with raw sewage. Therefore, the Medical Department representative must be familiar with the wastewater disposal system and the procedures necessary to ensure the health and safety of the ship's crew.

There are basically three different types of MSDs, including zero discharge systems with full volume flush (FVF), zero discharge systems with reduced volume flush (RVF), and flow-through treatment systems.

The zero discharge system with FVF uses a standard 3- to 5-gallon flush and stores this wastewater in holding tanks until it is discharged. The zero discharge system with RVF also collects and stores the wastewaters until they are discharged. This system differs from the FVF system in that it minimizes the volume of wastewater. The flow-through treatment system treats the water to acceptable limits before it discharges the effluent into the receiving water. Effluent is defined as wastewater or other liquid, treated or untreated, flowing out of a reservoir, basin, sewage treatment plant, industrial treatment plant, or MSD.

MSD Systems

The collection, holding, and transfer (CHT) system is the MSD system installed on most naval vessels. It operates in restricted waters where the wastes are collected and stored in holding tanks; at sea the wastes are disposed of over the side; in port all waste is collected in holding tanks and subsequently discharged into a sanitary sewer or ship waste offload barge (SWOB) or held until the ship reaches unrestricted waters and then pumped over the side.

Other, less frequently encountered systems include the Evaporative Toilet System (ETS), the JERED Vacu-Burn Sewage Treatment System, the KOEHLER-DAYTON (KD) Recirculating Flush, and the Pall-Trinity Biological Treatment System. The operation and maintenance of these sewage handling and disposal systems are peculiar to the type of system installed. Such information may be found in the Ships Information Book (SIB) and the Manual of Naval Preventive Medicine, chapter 7.

Inspection of MSDs

MSD components (soil and waste drains, discharge lines, plugs, plates, valves, comminutors, motors, pumps, and tank penetrations and manholes) should be regularly inspected for leaks by engineering personnel. The "paper towel" test can be used to detect leaks from pumps, comminutors, and piping. This test entails opening a paper towel and holding it 2 to 3 inches from the unit for several minutes. Even the finest spray can be detected on the paper towel.

All leaks, spills, or other sources of contamination must be reported to the executive officer, the engineering officer/damage control officer, and the Medical Department representative. The leak must be repaired and the system properly cleaned and, if necessary, disinfected.

Sewage Transfer

Sewage receiving facilities are being constructed at all shore activities with fleet support capabilities. These facilities include sewer risers for the transfer of wastewater from the ship discharge risers to the shore sewer system. Facilities to store, maintain, and repair sewage transfer hoses are also included. Specific information and guidelines concerning all aspects of ship-to-shore wastewater transfer facilities and operations procedures are provided in the Ship-to-Shore Hose Handling Operations Manual, NAVFAC MO-340.

Most Navy ship MSDs are designed to discharge their wastewater to a shore receiving facility when in port. This is normally done by connecting the ship sewage discharge risers directly to the pier sewage discharge risers.

Wastewater may be discharged indirectly through connections to a SWOB or another ship system, which in turn discharges the wastewater into pier sewer risers.

Most sewage connections, including ship-to- shore and ship-to-ship, are made by means of flexible transfer hoses 50 feet in length and 4 inches in diameter. On submarines these hoses measure 2 1/2 inches in diameter. It is the responsibility of the shore based handling crew to deliver sufficient quantities of sewage transfer hoses and to make connections to pier sewage risers. The ship's crew is responsible for all ship sewage riser connections.

Sewage transfer hoses must be kept clean and in good repair. After each use they must be flushed with high-pressure salt water for at least 10 minutes before they are disconnected and stored. Use of unapproved hoses and adapters is prohibited due to the possibility of cross- connections with potable water lines. Under no circumstances will sewage transfer hoses be connected to potable water lines.

If wastewater is spilled onto the deck or pier during discharge, the affected area must be flushed with high-pressure salt water and disinfected if necessary.

As previously stated, sewage transfer hoses will normally be provided by the receiving activity. Sewage hose handling and storage facilities are designed to accommodate the repair, maintenance, and storage of transfer hoses. All hose handling and storage facilities are required to incorporate the following into their design and construction:

• Wooden racks and tables for handling and storage are prohibited.
• All windows and doors must be adequately screened to prevent entry of vectors.
• Back syphonage devices must be installed on all potable water lines used for flushing and cleaning sewage transfer hoses.
• Handwashing and shower facilities with hot and cold water, dispensable soap, and single use towels must be provided.
• All indoor work spaces must be well ventilated.
• The sewage hose handling and storage facility must be constructed, equipped, and operated by Occupational Safety and Health Administration (OSHA) standards.

Personal Hygiene, Sanitation and Safety

Observing good personal hygiene and sanitary practices is essential to prevent the spread of contamination and the resulting outbreak of disease aboard ship.

Personnel who come in contact with sewage wastes must wear protective clothing and observe the following rules to minimize contamination:

• Movement about the ship while wearing contaminated clothing must be kept to a minimum.
• Contaminated clothing must be placed in plastic bags and laundered as soon as possible following cleanup operations.
• Rubber boots, gloves, oxygen breathing apparatus (OBA) and other similar items must be cleaned with hot water and detergent and rinsed with an approved disinfectant solution. Personnel must thoroughly wash with soap and hot water as soon as possible before engaging in other activities.

Spaces that become contaminated with sewage as a result of leaks or spills or sewage system backflow must be thoroughly cleaned with detergent and water. In addition, food service spaces, berthing spaces, and medical areas must be treated with an approved disinfectant.

Bilges contaminated with sewage wastes must be pumped out, washed down, and pumped out again. If potable water tanks form the floor of the bilge, daily bacteriological monitoring will be performed until it is certain that the tanks are not contaminated. Furthermore, all potable water tanks suspected of contamination must be secured until the water is determined to be safe for consumption. Signs are posted in spaces containing MSD equipment warning against eating, drinking, or smoking in these spaces.

Personnel who handle or connect sewage transfer hoses will not handle potable water hoses without first washing and changing into clean clothing. No open flames, flashlights, or electrical apparatus will be in or near holding tanks until they have been certified gas-free. When the space is certified gas-free, personnel may enter using an approved OBA and wearing a safety harness and tending line if only one person is entering the space. If more than one person enters the tank, they must keep each other in sight at all times.

Medical Department Responsibilities

The presence of MSDs and the associated equipment and facilities aboard ship increase the risk of exposure to untreated wastewater, which in turn increases the potential for diseases associated with human waste. Medical Department representatives must become familiar with the MSDs on board their ship and knowledgeable in the proper personal hygiene practices and decontamination procedures concerning the operation and maintenance of MSD systems. The MDR's duties should include:

• Conducting visual inspections of MSD components as part of the routine habitability and sanitation inspection program or, more frequently, at the discretion of the commanding officer. The MDR's routine inspection responsibilities should be limited to spaces where there is an interface between the MSD components and food service, living and berthing, and medical spaces.
• Indoctrination of personnel associated with the operation, maintenance, and repair of MSD systems concerning the potential health hazards associated with human wastes, proper personnel hygiene, and the correct procedures for cleaning and disinfecting contaminated spaces.
• Providing on-site advice, when requested, in the correct procedures for personal protection and disinfection of spaces in the event of major spills or leaks. The MDR must be present for cleanups and disinfection of food service, living, and medical spaces.

Waste Disposal in the Field

The disposal of sewage in the field is accomplished by various special adaptations such as cat holes (for individual one-time use), pit and straddle trenches, deep pit latrines, and urine soakage pits. Specific information on these and other waste disposal systems for field use are contained in the Departments of the Army and the Air Force publication, Field Hygiene and Sanitation, FM 21-10/AFM 161-10.

An effective sexually transmitted disease (STD) program is a command responsibility. The Medical Department is concerned with the medical aspects of STD consistent with the policy outlined in SECNAVINST 6222.1 series.

Responsibilities

Staff Medical Officer. Staff medical officers at major fleet and shore commands will monitor and coordinate STD program efforts.

Medical Department Representative. Officers and petty officers of the Navy Medical Department assigned the function of STD management will advise their commands on STD programs; assist when requested in basic STD education programs; administer the STD interview and contact tracing program; cooperate with other military and civilian health authorities in the contact tracing program; collect data on occurrence; report as required by NAVMEDCOMINST 6300.2 series and as legally required by civil authorities; and maintain liaison with the local Armed Forces Disciplinary Control Board and the local medical chain of command as appropriate.

Clinical Care Personnel. MDRs assigned the responsibility of diagnosing or treating STD, in addition to any of the duties listed above, will use current recommended regimens and methods of diagnosing and treating STD; provide prophylaxis or epidemiological treatment when appropriate; cooperate with the STD program manager; assist in the STD education program; and ensure that patients who have contracted STD are provided with special education aimed at preventing future infections.

Effective STD Programs

Elements of an effective STD program include education, appropriate prophylaxis, current, prompt diagnosis and treatment, complete reporting, contact tracing with epidemiologic treatment, and the evaluation of these measures to determine their effectiveness.

The diagnosis and treatment of STD is discussed in Treatment and Management of Venereal Disease, NAVMED P-5052-1lA, United States Public Health Service Publications (MMWR), and applicable CINC/CGFMF instructions.

Education

Patient education is a primary tool in controlling the spread of STD. As you have heard many times, the best method of combating and containing disease is to prevent it.

The General Military Training Program (OPNAVINST 1500.22 series) is designed to provide all hands with a basic knowledge concerning STD and its prevention and containment. Persons at high risk of contracting STD, especially those who have previously had one of these diseases, require more intensive education. Local commands and program managers must develop local programs to meet this need.

In the past, educational efforts to control STD used the "fear approach" by illustrating gross malignancies and lesions of latent cases, while lightly passing over the early symptoms that, if recognized, encourage personnel to present themselves for early diagnosis and treatment. That type of educational approach, along with a policy of a disciplinary approach with resultant quarantine or other punitive measures, caused personnel to conceal their infection or to resort to self-treatment. The best approach to STD education is one that is straightforward, factual, and nonmoralistic, but which at the same time does not condone promiscuity by implication. Abstinence shall be emphasized as the only sure method of prevention. Condoms should be made available to prevent infections but it should be pointed out that condoms are not foolproof. It should be stressed that no punitive measures will be taken against people who contract one of these infections if they voluntarily report for treatment, regardless of the time lapse. Isolation or restriction is ordinarily not medically justified and is usually counterproductive.

Contact Interviewing

Contact interviewing is a confidential conversation between the interviewer and an infected patient. Its purpose is to elicit information that will make it possible to find and bring to treatment everyone with whom the patient was sexually intimate during the critical period. This period is the time during which the infected patient could have acquired and/or transmitted the infection.

Contact interviews should be performed by qualified personnel who have attended a formal course in interviewing techniques under the auspices of a federal medical service. Activities requiring qualified interviewers may contact area EPMUs for availability of such courses. At least one individual in the Medical Department of each command should be qualified to conduct contact tracing. Therefore, it behooves all senior hospital corpsmen to be familiar with the basic techniques involved.

During the interview, three areas of information should be explored in detail. The first is concerned with general information about the patient's social environment; the second with getting a medical history of previous sexually transmitted diseases; and the third with a history of sexual behavior and the people involved. For epidemiological purposes the interviewer will be concerned with two periods of time: a critical period and an interviewing period. The critical period is always determined individually for each patient and is based on the duration of symptoms and the maximum incubation period for the particular stage of the disease.

The MDR responsible for contact interviewing is the single most important individual in the total STD control program, since epidemiological success or failure is in his or her hands. To be most effective, the MDR must maintain an open mind concerning the patient's sexual behavior. The interviewer's personal moral standards and convictions must not be expressed, implied, or conveyed in any manner to the patient. The goal of the interview is to obtain the names of all the patient's contacts within the critical period of infection. Any and all information obtained in the interview is confidential communication and must remain so.

There are no hard and fast rules for conducting an interview. Each interview must be tailored to the individual patient. What works in obtaining results with one patient may alienate the next patient and result in poor information. Full step-by-step procedures and methods for conducting interviews are contained in Interviewer's Aid for VD Contact Investigation, NAVMED P-5036. The interviewing techniques described in NAVMED P-5036 are by no means the only approach to the contact interview, but are methods that have proven successful for many interviewers. Common sense, sound judgment, and maturity are as important to the interviewer's success as are training and knowledge.

Since patients probably cannot remember all the epidemiological information they are asked to furnish on their sexual contacts during short interview, they should be interviewed again later for additional information.

The contact interviewer is required to complete and distribute the STD contact reports. The Venereal Disease Epidemiologic Report, PHS-2936 (see fig. 5-4) is the most commonly used form in STD contact investigation. It should be completed on every sexual contact obtained in the interview. This form must be completed properly so that there is no doubt in the mind of the investigator as to the disease involved or the follow-up necessary. Instructions for completing and distributing this form are located in NAVMED P-5036. The routing of the form may vary in different locations. Individual commands should check with state and local health authorities for routing procedures in their jurisdiction. Most states and other civil jurisdictions have legal requirements that a patient morbidity card be completed on all patients diagnosed as having STD.

Personnel involved in STD control programs should continually evaluate the effectiveness of the efforts made in local STD control programs so that more effective measures may be instituted, as required, and high risk areas and personnel requiring more intensive attention can be identified.

Complete documentation of all STD diagnoses shall be made on the Chronological Record of Medical Care, SF 600. STD follow-ups are also entered on the SF 600.

Contact Tracing

Contact tracing is defined as the locating and bringing to therapy persons known or suspected to have been exposed to an infected person. These persons are identified and located on the basis of information obtained from the interview.

Few contact tracing investigations are carried out by military STD program managers except on certain military installations and in occupied areas. Civilian contacts are usually the responsibility of the local public health department. However, you should be aware of the methods and techniques used, since a patient might be concerned with how the investigation is to be conducted. The best method of acquiring this information is to meet with the contact investigators of the local health department, who can outline the method of operation for that area.

While the incidence of tuberculosis (TB) is slowly declining in the United States, substantial numbers of cases still occur in the Navy and Marine Corps, and the potential for epidemics remains. The purpose of the TB Control Program is to prevent its spread by early detection and treatment of personnel with active disease. Personnel who develop a reactive skin test are at risk of developing clinical TB and must be placed on isoniazid (INH) for I year and then be followed with annual clinical examinations to detect active diseases. With modern medical management most people who develop clinical TB may be expected to return to duty; but early detection is still essential to reduce the impact of the disease on patients, their associates, and the service.

The Navy and Marine Corps TB Control Program consists of case finding and patient disposition.

1. Case Finding
   • Routine TB Screening Program. The purpose of this program is to detect as early as possible individuals who have been infected by tubercle bacilli or who have progressed and developed clinical TB.
   • The TB skin test (Mantoux method) is the basic method used for routine TB case finding and is used for individuals with previously recorded nonreactive or unrecorded skin tests.
   • An annual clinical evaluation is used for routine TB case finding in individuals who have previously recorded reactive skin tests and who have taken INH for 1 year, if they have remained reactors (most will revert to non-reactors).
   • Tuberculosis Contact Investigation Program. The purpose of this program is the early detection of TB in personnel who may have been exposed to an active TB case and who consequently may be at high risk of developing the disease.
2. Patient Disposition

   Patients with reactive TB tests, abnormal clinical findings, or positive acid test Bacilli smears findings are further investigated. Those suspected to have or diagnosed as having the disease receive care or treatment.

   When to test, how to test, and what to do with reactive and nonreactive personnel; responsibility and procedures for local program management; and reporting requirements are discussed at length in NAVMEDCOMINST 6224.1 series. All Medical Department personnel, especially MDRs aboard ship, must be thoroughly familiar with the contents of this instruction.

   In general, all personnel will be tested at least annually and more often if circumstances dictate. Upon discovery of a case of TB in the command, a Disease Alert Report, MED-6220-3, will be prepared and submitted under NAVMEDCOMINST 6220.2 series. The patient's close contacts, as determined by a medical officer or MDR, will be located, screened, evaluated, and reported. When a present or former member of the command has suspected or confirmed TB, a contact investigation program must be started. Each person who has been a close contact of a known, active, infectious case of TB will be screened. A Tuberculosis Contact/Follow-up Form, NAVMED 6224/1 (Revised 2-84), will be started and placed in the health record of each individual affected. Each contact will be initially tested and subsequently reexamined at 3- and 6-month intervals.

   Report of Tuberculosis Contact Investigation, MED-6224-9, is submitted to the Commander, NAVMEDOM, with copies to the area Navy Environmental and Preventive Medicine Unit and the Navy Environmental Health Center. This report is required upon initial study and again at 3- and 6-month intervals.

   The Annual Report of Tuberculin Retesting, Med-6224-8, is prepared by all activities having Medical Department personnel and submitted annually by 1 February. Medical Department personnel shall maintain a tickler system to ensure compliance with TB control program requirements.

   The current drug of choice for TB chemoprophylaxis is isoniazid. Chemoprophylaxis is given to all personnel who are new reactors regardless of age and all previous known reactors who have never received such a course before, provided no contraindications exist. Decisions concerning chemoprophylaxis in persons aged 35 and over must be made on an individual basis. Generally, chemoprophylaxis is indicated for tuberculin reactors over 35 when the danger of contracting active TB is significant.

   There are other requirements for reporting cases of TB, i.e., Disease Alert Report (NAVMEDCOMINST 6220.2), and Medical Services and Outpatient Morbidity Report (NAVMEDCOMINST 6300.2).

Requirements for routine and special immunizations must be strictly adhered to.

When administering immunizations, it is accepted practice to have a physician nearby. Therefore, routine immunizations are not normally administered at sea. The crews of ships in port will receive immunizations as close as possible to prescribed schedules. However, such restrictions do not apply to individual cases in which there is a clear-cut medical indication for immediate administration of an immunizing agent by a competent MDR. Examples include the administration of appropriate rabies vaccine and rabies immune globulin after possible exposure and the administration of tetanus toxoid if indicated in wound management. In some circumstances mass immunizations, such as prophylactic administration of gamma globulin, will become necessary. The most common method of mass immunization is through the use of "shot lines." You will undoubtedly remember this practice from boot camp. Foresight and preplanning should preclude the routine use of mass administration techniques in routine immunizations. However, in special situations, such as administration of influenza virus vaccine, the use of shot lines is a practical solution to the problem. When immunizations are administered on a mass scale, the tendency to shortcut recommended procedures increases the likelihood of contamination and improper administration. Conscientious- ness, attention to detail, and observance of all recommended precautions and techniques listed in NAVMED P-5052-15, NAVMEDCOMINST 6230.1 series, and NAVMEDCOM notices in the 6230 series must be practiced to ensure safe and effective immunizations.

Quarantine procedures in the Navy are designed to prevent dissemination of human, animal, or plant diseases from place to place. Basic regulations and detailed instructions are contained in SECNAVINST 6210.2 series. Additional information in MANMED, chapter 22, and other published instuctions should be consulted.

It is the responsibility of Medical Department personnel ashore or afloat to be well informed concerning current naval quarantine regulations and instructions and to give advice and make recommendations in matters of quarantine to the commanding officer. In the United States and its territories and possessions, quarantine authority and responsibility is assigned by federal statute to the USPHS for human diseases, the USDA for plant and animal diseases, and the Department of the Interior for wildlife diseases. Local, state, city, and county authority is also recognized by the Navy and must be complied with.

By international agreement, four diseases are quarantinable: cholera, plague, smallpox, and yellow fever.

While emphasis is placed on measures to prevent the spread of quarantinable diseases, the Medical Department is responsible for recommending measures to prevent the spread of all communicable diseases both within and among the naval establishments and civilian communities.

By international convention a Certificate of Deratization, or a Certificate of Deratization Exemption is required of vessels entering most foreign ports to avoid detention for fumigation. This certificate must be issued by the USPHS and is valid for 6 months. MDRs of ships proceeding to foreign ports must apply for a certificate before departure. These certificates are obtained by requesting that a rodent inspection be made by a USPHS representative. If rodents are present on inspection, deratization measures are required. After deratization, a Certificate of Deratization will be issued. If no rodents are found, a Certificate of Deratization Exemption will be issued.

Ships proceeding to foreign ports will meet the quarantine requirements issued by proper authority of such port. Upon arrival at a foreign port, local requirements pertaining to quarantine regulations should be checked.

For ships arriving at ports under the control of the United States, routine submission of a Maritime Public Health Declaration as described in SECNAVINST 6210.2 series will be limited to:

• Ships that in the 15 days before arriving in a U.S. port have had any passengers or crew members with a temperature of 100° F or higher, which persisted for 2 or more days, or which was accompanied by a rash, jaundice, glandular swelling, or diarrhea severe enough to interrupt normal work or cause death.
• Vessels that have been in a smallpox- infected country within 15 days before arriving in the U.S. Vessels that have been in a plague-infected country within 60 days before arriving in the U.S.
• Vessels arriving in ports are no longer required to complete a quarantine declaration unless boarded under the conditions listed above. The boarding inspector will furnish the declaration.

International Health and USPHS Quarantine Regulations no longer require ships to use rat guards except when the ship is berthed in a port where plague is endemic or where large rat populations are present. In some CONUS ports, rat guards are required for all naval vessels.

Interstate movement within the United States of etiologic agents and persons with communicable diseases are governed by federal regulations. These regulations are designed to prevent the spread of disease from one state to another and are enforced by the USPHS and state health departments. CO's should maintain liaison with the USPHS and regional offices.

No preventive medicine program is complete without consideration of the health hazards presented by improper safety practices and hazardous working conditions.

Metals and Other Materials

When heated to specific temperatures, many materials give off very toxic fumes. Lead forms fumes when it is heated or melted. It is primarily a hazard only if it is being welded, melted, cut, or while being sprayed in lead-containing paint. Metal that has been painted with lead-containing paint is also hazardous when it is being cut or welded. Using a proper respirator will generally prevent inhalation of metal fumes.

Selenium is found in many rectifiers that under certain conditions may break down and give off irritating fumes. A proper filter respirator will protect against inhalation. Cadmium-plated objects must not be heated under any circumstances.

Inhalation of beryllium compounds may lead to a chronic, progressive, fatal disease. Use extreme caution when working with metal containing beryllium.

Metal fume fever is a condition caused by inhalation of fumes from zinc, iron, magnesium, or lead; or metals containing any of these base metals. Remember, cutting or welding these metals, or soldering with materials containing hazardous metals, may create health hazards.

When working with hazardous metals, you must refrain from eating and smoking in the work area as this increases the likelihood of ingestion or inhalation of the metallic particles. The assistance of an industrial hygienist must be obtained when selecting respiratory protection devices.

Asbestos Control

Asbestos is a general term used to describe several fibrous mineral salicates used for asbestos cement products, fireproofing, insulation, and asbestos cloth.

Inhaling asbestos fibers can produce severe lung damage in the form of fibrosis. Asbestos is also a factor in the development of cancer (mesothelioma) of the membranes lining the chest and abdomen.

Although asbestos-free substitute materials are being developed, much asbestos containing material can still be found in Navy facilities and on board vessels. When repair is necessitated in these areas where asbestos containing materials are located, "ripout" precautions and procedures must be effected. These areas of asbestos containing material, especially insulation, are found in older facilities and vessels and will continue to create concern for potential personnel exposure for some years. Insulation in modern facilities and vessels is asbestos-free and presents no asbestos problems.

OPNAVINST 5100.23 series and DODINST 6055.5-M series provide guidance concerning occupational health standards, control, and medical surveillance requirements for asbestos exposure.

Local exhaust ventilation control measures and dust collection systems must be installed and maintained to control the concentration of airborne asbestos fibers. See NAVSHIPTECH Manual for control procedures. Asbestos must be handled or otherwise worked in a wet state to prevent it from becoming airborne. All asbestos waste, including bags, containers, equipment, and contaminated clothing will be collected, wetted down, and disposed of in sealed bags or containers. Personnel working with asbestos will be provided with respirators, coveralls, head coverings, gloves, and foot coverings.

Halogenated Hydrocarbons (Halocarbons)

Halogenated hydrocarbons are compounds of carbon and hydrogen, in which one or more of the hydrogen atoms have been replaced by the halogens atoms (chlorine, bromine, fluoride, or iodine). They are normally used in gaseous or liquid form as solvents, refrigerants, fumigants, insecticides, paint removers, dry cleaning fluids, and aerosol propellants.

All halogenated hydrocarbons are hazardous to health in some degree if inhaled, swallowed, or absorbed through the skin.

• Inhalation-Acute inhalation of vapor or gas may produce dizziness, headache, and central nervous system depression leading to unconsciousness and death. Chronic exposure to small amounts may cause serious damage to the liver and kidneys. Halocarbons may also act as simple asphyxiants by displacing oxygen.
• Ingestion-Gastrointestinal irritation and damage to the liver and kidneys.
• Exposure of skin and eyes-Halogenated hydrocarbons may cause severe conjunctivitis if eyes are exposed to gas, vapor or liquid. Many of these materials dry the skin and are absorbed, causing systemic effect.

When exposed to high temperatures or ultraviolet radiation (such as that generated by arc-welding), halogenated hydrocarbons decompose and form extremely toxic materials such as phosgene gas and hydrogen chloride. In case of fires in areas containing these materials, all personnel entering these spaces must be provided with a pressure demand self-contained breathing apparatus. All halogenated hydrocarbons must be labeled properly and special care must be taken to avoid confusing materials because of similarly spelled names. Whenever halogenated hydrocarbons are used, adequate ventilation must be provided. All personnel working with halogenated hydrocarbons in confined or enclosed spaces must use breathing equipment and wear protective clothing. In addition, they must have medical surveillance physicals as prescribed in DODINST 6055.5-M series and receive adequate training.

Otto Fuel II

Otto Fuel II is a liquid propellant used in certain types of torpedoes. It can be harmful or fatal if swallowed, inhaled, or absorbed through the skin. The first symptom is nasal irritation followed by headache.

Personnel exposed to Otto Fuel II should have predeployment and yearly physical examinations. Personnel with a history of arrhythmia, angina, hypertension, or hypotension must not be assigned to work with this fuel. Ventilation systems for preparation and maintenance operations involving Otto Fuel II must be installed to ensure that excess exposure to Otto Fuel II does not occur. Until such ventilation systems are provided, personnel working in and around areas where Otto Fuel II is being used must be provided with a pressure demand self-contained breathing apparatus or a pressure demand airline respirator. A daily or more frequent change of freshly laundered or disposable coveralls is required. A disposable apron must be worn over the coveralls and rubber gloves provided. The gloves must be discarded at the end of each new operation. See NAVMEDCOMINST 6270.1 series for additional information. The hazards discussed herein are not all-inclusive. Each ship or station is an individual command; thus, the health hazards and hazardous materials within each command will vary. You, the MDR, must seek out and identify the hazards within your command.

Accident Prevention Program

Under the direction of the commanding officer, the medical officer or MDR assumes responsibility together with the safety officer for establishing a comprehensive safety and accident prevention program. This includes inspecting machinery, tools, equipment, and work methods for accident hazards and making recommendations to correct discrepancies and ensure compliance with recommended policies. OPNAVINST 5101.2, 5100.19, and 5100.23 series outline responsibilities and procedures for the Shipboard Accident Prevention Program.

Hearing Conservation Program

The health problems created by intense noise ashore and afloat continue to increase. OPNAVINST 5100.23 series provides for the establishment of uniform and effective hearing conservation programs throughout the Navy. NAVMEDCOMINST 6260.5 series implements those portions of the Navy Noise Control and Hearing Conservation Program for which the medical department is responsible. The basic objective of these programs is to prevent hearing loss in personnel exposed to hazardous noise levels.

Commanding officers are responsible for implementing the basic elements of the program. MDRs are responsible for ensuring that the basic elements of the program are accomplished in accordance with OPNAVINST 5100.23 series.

Heat Stress Program

OPNAVINST 5100.20C defines heat stress as any combination of air temperature, thermal radiation, humidity, air flow, and workload that may stress the body as it attempts to regulate body temperature. Its purpose is to set the standards, methods, and procedures for determining heat stress related deficiencies and conditions as they apply to both personnel and to the physical design and function of spaces that are considered heat stress risk areas. These spaces include, but are not limited to, engineering spaces, boiler rooms, laundries, sculleries, galleys, catapult rooms, auxiliary machine spaces, and weather decks.

OPNAVINST 5100.20C tasks the Navy Department with the responsibility to design a heat stress program, evaluate heat stress related data, set standards for control, develop and install alterations to decrease the identified heat stress conditions, and develop a Navywide heat stress educational program. NAVMEDCOM is tasked with rendering assistance, as required, and keeping the PHEL chart and other health-related guidance factors reflecting current knowledge. Individual commanding officers will establish and enforce heat stress compliance programs, ensure preventive maintenance of heat stress related items is performed and any deficiencies are recorded on the CSMP, report and conduct inquiries into any heat stress related injury resulting in unconsciousness, and request assistance in identifying and correcting design deficiencies that contribute to heat stress. The MDR will aid in heat stress monitoring, complete NAVMED 6500/1, Report of Heat/Cold Injury, for any heat-related injury, ensure that any heat injury is correctly recorded as either systemic or local on NAVMED 6300/1, Medical Services and Outpatient Morbidity Report, and aid in training the crew on prevention of heat stress injuries as well as first aid for heat-related injuries.

References:

1. NAVMED P-5010, Manual of Naval Preventive Medicine
2. OPNAVINST 5100.23, Naval Occupational Safety and Health (NA VOSH) Program Manual
3. OPNAVINST 5100.20 series, Shipboard Heat Stress Control and Personnel Protection