By B. Vibald. Pacific States University.

The form can be adapted to mirror site specific requirements of each particular disinfection station and can be built up over a period of time cheap maxalt 10 mg amex. Water Treatment Manual: Disinfection Revision of Water Treatment Manual on Disinfection Water Treatment Manual: Disinfection Revision of Water Treatment Manual on Disinfection Water Treatment Manual: Disinfection Revision of Water Treatment Manual on Disinfection Environmental Protection Agency Water Treatment Manual: Disinfection Appendix 2 order maxalt 10 mg without prescription. Introduction Practical guidance relating to the delivery and storage of chemicals for disinfection at treatment plants maxalt 10mg without a prescription, secondary disinfection points and re-chlorination stations are typically confined to those used chemicals for chlorination purposes. At very high concentrations, chlorine gas exposure can cause death after just a few breaths. In addition chlorine in its various forms is very reactive with other process chemicals stored within treatment plants. Because of the danger of respiratory damage, chemical burns, and death, operators need to be trained to use, store and handle chlorine chemicals properly and ensure that associated operational work practices, safety and emergency procedures are adhered to, maintained and updated. These practical guidance notes do not purport to deal with the hazards posed by the storage, generation or use of these chemicals in water treatment or disinfection, the interaction of these chemicals or the associated hazards for plant operators managing the production of drinking water for water service authorities or private drinking water suppliers. The Health Safety and Welfare Act 2005 addresses the responsibilities of water service authorities and private suppliers in the management of these operator risks. This guidance is only intended to supplement site specific operating procedures and the specific material safety data sheets for the various chemicals. The reaction of chlorine with ammonia can create explosive compounds and gases that are toxic to breathe. In the presence of water, chlorine can create a highly corrosive and dangerous acid mist. Keep chlorine isolated and in different rooms from the chemicals that it reacts with. Because of chlorine reactivity, the production of standard operating procedures for its storage and handling are very important. Chlorine storage and equipment rooms equipped with doors, opening outward to the outdoors complete with panic hardware. Viewing window into chlorine storage and equipment rooms for operator security Visual and audible emergency alarms at the chlorine room entrance. Exhaust fans with a typical rating to air changeover every minute A chlorine gas leak detector to generate alarms and attendant ammonia bottle to help locate a leak An emergency kit to repair leaking containers. Hand trucks with chains for cylinders or properly rated electric hoist for chlorine drums Chlorine storage areas, storage containers and process equipment and lines should be properly labelled and appropriate hazard warning should be posted in accordance with site specific operating procedures. Gas containers should be stored in separate or divided rooms separately from flammable materials and other chemicals such as ammonia and sulphur dioxide, if used elsewhere in the installation. Containers should be stored and used above ground level and always in a vertical position. Chlorine gas containers should be stored in marked areas shielded from external heat sources. The protective hood should be kept secure on all unused containers and should only be taken off when the container is being used. All containers in use should be secured in position by chains or other methods as appropriate. Gas containers should only be lifted with suitably rated and tested equipment and never by their protective hoods. Where plastic connections are used, vacuum connections must not be over-tightened. Pressure lines, where necessary, should be seamless carbon steel All pipe, valves, and fittings must be thoroughly cleaned of all oils and foreign matter (grease, pipe chips, dirt, etc. Failure to properly clean may result in undesirable chemical reactions and non-warrantable equipment failure. Vents from chlorine gas installations should be discharged to atmosphere in a suitable open location where the risk to personnel has been risk assessed. The termination point must be open, pointing downward and should covered with a fine mesh screening. Vent pipes from the system should be separately routed and should never be discharged via a manifold with other vented lines. Current material safety data sheets, warning signs and other proprietary chlorine wall charts should be visible for use by site personnel and visitors. In particular written operating procedures should be followed by operators that address the appropriate steps for evacuating and filling chlorine containers. Similarly, a site specific inspection and maintenance schedule should be created for all chlorine storage and handling equipment and associated safety equipment. Equipment and chlorine containers should be regularly monitored for leaks using ammonia leak detection kits. Leaks should be repaired using site specific emergency response procedures and involve more than one person. Chlorine detection instruments in storage and dosing areas should be interfaced into an alarm system with appropriate alarm set points for detection. Where chlorine gas installations are located in confined sites or in built up areas, close to the public, consideration should be given to perimeter chlorine monitoring or air scrubbing equipment. Automatic or remote shut-down capability allows the operator to control of the situation from a distance. A written site specific emergency plan should be prepared for each chlorine gas installation by Water Service Authorities. Plant managers and operators should be trained in any of the procedures that require their involvement. Responses to the plan should be documented and the plan should be regularly updated to take account of such responses. With this, a provision is made for rescuing the endangered worker immediately if his respiratory device fails or he becomes incapacitated for any reason. In case of an accidental exposure, move exposed personnel to a well-ventilated area and seek medical assistance. Chemical reactivity and incompatibility Sodium Hypochlorite, or bleach, is produced by adding elemental chlorine to sodium hydroxide and is a strong oxidant It a clear, slightly yellowish solution with a characteristic odor and a relative density of is 1. Sodium Hypochlorite is normally supplied as a 14% w/v solution Commercial product varies from 5% sodium hypochlorite (I.

Some patients may also think thatheir antihypernsive medication has cured the hypernsion cheap 10 mg maxalt mastercard, because their blood pressure readings are now good purchase maxalt 10 mg with visa, and may therefore think the medications as unnecessary buy 10mg maxalt. Future research, in the group of individualistic ways patients, may benefifrom the findings of the health belief model which tries to explain the probability of individuals to function in ways promoting their health (Janz and Becker 1984). This is affecd by the perceived benefits, barriers of treatmenand threaof disease. These three areas are also modified by demographic and socio-psychological background factors. Furthermore, the model is construcd so thaiis probably nouseful, if a majority of individuals do noregard health as having high value, which makes iimpracticable in priorities of life cases. Iis also possible thainntional non-compliance may improve some patients� health, which is called �inlligent� non-compliance. However, the concep�concordance� is more suitable to these inlligenchoices and the previously mentioned individualistic cases. In both groups of inlligenchoice and individualistic ways, the patienthinks thahis/her actions promo his/her health, i. Priorities of life In situations involving differenpriorities of life the central problem is noa lack of information. This group may have characrs thahave taken into consideration years ago by Jonsen (1979) who points outhanon-compliance may be an indicator of more deeper needs than justhe need for medication. There is no drug for finding a meaning of life or for dealing with the mosprofound questions of life, buthe physician should be able to discuss the meaning of life, and why there are so many priorities thaconflicwith the value of health and especially with the value of life, which is the prerequisi for all other priorities. A Finnish study on 1037 persons aged 60 years showed thathe third mosprevalenpersonal problem was the excessive idealization of youth in our society (Vaarama eal 1999). The moscommon problem was disease and deficiency in capacity, while financial problems came second. The excessive idealization of youth in our society was even more prevalenthan social problems, violence and criminality in neighbourhood, lack of hobby possibilities and lack of health and social services. Both of these findings may be connecd with the time distortion in health-relad behaviours. For some people health seems to have a high priority only in the shorrm, and excessive idealization of youth and desire to remain young may make this trend even worse by leading to an illusion of ernal youth. These people may ask: why use medications thaprevendeath or complications of disease, i. Non-compliance is also relad to an irregular lifestyle or disturbances of everyday life (Balazovjech and Hnilica 1993, Dusing eal. Pride and a desire noto appear weak or non-macho may also be obstacles of treatmen(Rose eal. Iis possible thamedicines are used, to some exnt, when their use does noconflicwith anything thahas higher priority. This may also be visible in our study, which suggesd tha�frustration with treatment� (including aspects of lifestyle changes, health centre visits and inadequaly effective medication) is associad with inntional non-compliance. If some unhealthy living habits are more importanthan health itself, there will be a priority conflict. From the patient�s perspective, medication should be so effective as to make the modification of lifestyle unnecessary. The treatmenof hypernsion may also take time and require visits to the health centre, buif the priority of health is low, imighbe difficulto accepthis, because there would be more importanthings to do. Similarly, costs as a reason for inntional non-compliance (Delgado 2000) may be associad with priority conflicts. Furthermore, iis possible thamedicines are used more regularly prior to scheduled blood pressure measurements (whi coacompliance (Feinsin 1990)), because patients try to please health care professionals or to hide their non-compliant/non- concordanbehaviour. In this situation, one of the patients� high priorities is to give a positive image abouhim/herself to health care professionals. Ethical/moral or religious values Our modern medicine has been builto rely on values. Sometimes the values of modern medicine and the patiendiffer buboth of these sets of values are essential rules of treatment. The reasons for non-compliance may be relad to ethical/moral or religious values of life, in which iis nomeaningful to speak abou�compliance�, burather abou�concordance�. In Finland, there are differenminorities thabelong to this group, and several immigrants groups have further increased the multiplicity of these groups. In this cagory, iis essential to understand thathese are the real values of the patient. Iis therefore importanto identify the situations where this cagory have been used as an excuse for refusing treatment, which in reality involve a problem in the priorities of life. This cagory includes the patients with ethical/moral or religious values, for whom their own health and its treatmenare a matr of high priority, buwho find certain treatmenmethods unacceptable. An example of this mighbe Jehovah�s Witnesses, who refuse blood transfusion (Gyamfi eal 2003). Ihas also been repord thapork- and beef-derived gelatin and/or saric acid, which are used as inercomponents in some drugs, are unacceptable to some patients in the Muslim, Orthodox Christian, and Seventh Day Adventisfaiths (Sattar eal 2004). In birth control some people cannoaccepmethods thahave postfertilization effects, such as intraurine devices, hormonal emergency contraception and oral contraceptives (Larimore 2000, Larimore and Stanford 2000, Kahlenborn eal 2002, Stanford and Mikolajczyk 2002). Ihas been found in Finland that, of several therapeutic classes gynecological patients (the main subgroup was oral contraceptives) received leascounseling from pharmacists (Vainio eal 2002). Furthermore, future embryonic sm cell treatments are considered non- acceptable for those patients who find thaa patient�s sickness should nobe healed with a method tharequires the life of a human embryo to be destroyed. If these ethical/moral or religious values are combined with the patient�s view thahealth is noa high-priority matr, the case does nobelong to this cagory, buto the priorities of life cagory. For example, if the day of death is unchangeable, actions to improve one�s health mighseem unnecessary. However, this view conflicts with all findings of modern medicine showing thaa group of patients taking a certain medicine survive longer than another group of patients taking placebo. And even if the day of death is unchangeable, from a patient�s view, is the quality of life unchangeable? Preventing a hearattack or stroke n years before death mighbe very beneficial for the quality of life.