Part 3 - Professional Services

Chapter 11 - Environmental Health

Title	Section
INTRODUCTION	3-11.1
Purpose	3-11.1A
Policy	3-11.1B
Objectives	3-11.1C
Functions	3-11.1D
Headquarters	3-11.1D1
Area and Program Offices	3-11.1D2
Field Organization	3-11.1D3
Indian and Alaska Native Involvement	3-11.1E
Program Priorities	3-11.1F
PROGRAM PLANNING, REPORTING AND EVALUATION	3-11.2
Planning	3-11.2A
Reporting	3-11.2B
Evaluation	3-11.2C
Guidelines for Reference	3-11.2D
PROGRAM ELEMENT GUIDELINES	3-11.3
Air Pollution	3-11.3A
Community Injury Control	3-11.3B
Emergency Operations	3-11.3C
Epidemiology	3-11.3D
Food Protection	3-11.3E
Hazardous Materials	3-11.3F
Home and Community Health	3-11.3G
Institutional Environmental Health	3-11.3H
Occupational Health	3-11.3I
Operation and Maintenance	3-11.3J
Radiation	3-11.3K
Recreational Sanitation	3-11.3L
Safety	3-11.3M
Sanitation and Safety at Celebrations	3-11.3N
Vector Control	3-11.3O
Waste Disposal	3-11.3P
Water Supply	3-11.3Q

3-11.1 INTRODUCTION

Purpose
This Chapter establishes the policy, the objectives, functions, responsibilities and guidelines relating to the planning, operation and evaluation of a comprehensive environmental health program for eligible American Indians and Alaska Natives.
Policy
An environmental health program which meets Indian Health Service (IHS) criteria and recognized national standards will be provided within each Area/Program Office. The environmental health program will be organized into the Environmental Health Services (EHS), Sanitation Facilities Construction (SFC), and Environmental Management Sections at Headquarters. Each Area/Program Office will be organized into the EHS and SFC Sections at a minimum.
Objective
To protect the health of and prevent disease among the American Indian and Alaska Native population through the development and implementation of a comprehensive environmental health program. This objective is achieved through the following managerial actions:
1. an assessment of the current environmental conditions;
2. the identification and utilization of available resources;
3. the setting of priorities for activities based on a consideration of needs, public health significance, available resources, and tribal desires;
4. the development of specific program activities with attainable goals;
5. the conduct and implementation of the specified program activities; and
6. an evaluation of the effectiveness of accomplishments of the environmental health program.
Functions and Responsibilities
1. Headquarters
  The principal role of IHS Headquarters Environmental Health Branch (EHB) staff is to provide leadership, direction, guidance, technical assistance, and quality control to the Area/Program EHB Offices; establish liaison and provide coordination with National Indian organizations, legislative bodies, and federal/state agencies; review statistical information; establish planning mechanisms; evaluate program efforts; provide staffing support for the field; monitor program operations; and provide support for policy and budget development.
  1. The Director, EHB, reports to the Director, Division of Clinical and Environmental Services, and is responsible for the overall direction and administration of the environmental health program.
  2. The Assistant Director, EHB, reports to the Director, EHB, and is responsible for the administrative aspects of the operation of the environmental health program.
  3. The Chief, Environmental Health Services Section (EHSS), reports to the Director, EHB, and is the individual primarily responsible for the environmental health services activity.
  4. The Chief, Sanitation Facilities Construction Section (SFCS), reports to the Director, EHB, and is the individual primarily responsible for the sanitation facilities construction activity and other public health engineering services
  5. The Chief, Environmental Management Section, reports to the Director, EHB, and is responsible for coordinating Area/Program reviews; developing training materials; preparing special studies; and providing technical assistance and support to the EHS and SFC Sections and their respective Area/Program Office counterparts.
2. Area and Program Offices
  The principal role of the IHS Area/Program EHB Offices is to provide program leadership, direction, guidance, technical assistance and quality control to EHB District Office and Service Unit staff and advice to the Area/Program Director; to develop Area programs; to maintain liaison with tribal groups, federal and state agencies; to establish priorities for the Area; to monitor and evaluate program and individual progress; utilizing EHB data systems; and to generate statistical information and other reports as requested by Headquarters.
  1. Environmental Health Branch
    The Director, EHB, is responsible to the Area or Program Office Director for the overall administration, direction, evaluation and quality control of the Area/Program Office environmental health program within established policies, procedures and guidelines. The functions and responsibilities of the Branch are to recognize, evaluate and promote the control of the biological, chemical and physical factors in the environment which may have an adverse effect on the health of the population served.
  2. Environmental Health Services Section
    The Chief, EHSS, is responsible to the Director, EHB, for planning, implementing, monitoring, controlling and evaluating environmental health activities and services within the Area.
  3. Sanitation Facilities Construction Section
    The Chief, SFCS, is responsible to the Director, EHB, for planning, implementing, monitoring, controlling and evaluating activities under the provisions of P.L. 86-121. The Indian Sanitation Facilities Act of 1959, and for other public health engineering services.
3. Field Organization
  The environmental health field staff is responsible for the day-to-day performance of the IHS environmental health program, which includes the provision of environmental health services and training activities and the implementation of sanitation facilities construction activities. In some locations, District Offices may be located organizationally between the Area/Program and the Service Unit. Staff at the District Offices function as extensions of the Area/Program Office.
  1. District Office Staff
    District Office personnel are responsible to their respective Area/Program Office Section Chief for managing and coordinating the environmental health program within the district. They provide supervision to Field and Service Unit staff, consultation to the Service Unit Directors and assist in the provision of environmental health services, training, and in the implementation of sanitation facilities construction activities.
  2. Service Unit Staff
    The Service Unit staff are administratively responsible to the Service Unit Director but receive technical assistance and supervision from the District or Area/Program Office. Program responsibilities include the establishment and conduct of an environmental health program; development of priorities in respect to services to be provided; determination of needs and establishment of attainable goals; provision of instruction and training; and initiation and solicitation of community involvement and cooperation.
Indian and Alaska Native Involvement
It is the responsibility of EHB to encourage the involvement of American Indians and Alaska Natives in planning, developing and implementing a comprehensive environmental health program. If a tribe or native group desires to conduct and manage an environmental health program, EHB has the responsibility to provide training and technical assistance to enable the tribe or native group to assume that capability and responsibility.
Program Priorities
It is the responsibility of Headquarters, Area/Program Offices, and Field Organizations to establish program priorities and establish goals for the conduct of an environmental health program. These priorities must be based upon factors of public health significance in the environment which may have an effect on the health of the population served. Those factors having the greatest health risk and/or impact on the population must receive an increased program emphasis. Other factors which present a lesser health risk and/or impact on the population may receive less emphasis, but nonetheless must be included as part of the program plan.
Priorities can be classified as follows:
1. Emergent - An unexpected or unplanned event or series of events resulting in immediate danger to life, limb or property but generally of short duration.
2. High Risk - An environmentally related disease or trauma causing situation with a high potential for affecting a major segment of the population at risk.
3. Mandatory - Activities and/or services required by law, memorandum of understanding or memorandum of agreement.
4. Low Risk - An environmentally related disease or trauma causing situation with a low potential for affecting the population at risk.

3-11.2 PROGRAM PLANNING, REPORTING AND EVALUATION

It is the responsibility of the Environmental Health Branch (EHB) to I develop, maintain, utilize and revise as necessary, a planning, reporting and evaluation system for the environmental health program.

Planning
Planning shall be accomplished by the development of a set of activities to be performed within a given time frame.
1. An annual environmental health program plan, based on identified needs and established goals, shall be prepared by each Area and Service Unit.
2. Planning shall be conducted in concert with other Indian Health Service (IHS) program components.
3. All available resources shall be utilized in the planning process.
4. A priority listing by program element shall be established.
5. Work plans for performing planned activities shall be developed on a regularly scheduled basis.
Reporting
Activity reporting shall be accomplished utilizing a data collection system to record services performed.
1. Activities Performed shall be reported in accordance with IHS guidelines.
2. All EHB data systems shall be updated as necessary.
Evaluation
The effectiveness of the environmental health program shall be evaluated on a routine basis to determine the level of accomplishments, the quality of the work product, the utilization of resources and adherence to recognized public health practices.
1. Quarterly evaluations shall be conducted by Area/Program Office staff to compare accomplishments with established goals.
2. Routine evaluations of individual and group efforts shall be conducted to determine attainment of program goals.
3. Routine reviews of planning, reporting and management practices shall be conducted to determine program efficiency.
4. Accumulated data system information shall be used as a program management tool.
Operating Guidelines, Standards, and Publications for Reference
1. “Environmental Health Planning and Reporting System - Instruction Guide,” Office of Environmental Health (OEH), Indian Health Service (IHS).
2. “Guide for the Management and Review of Area and Program Office Environmental Health Activities,” OEH, IHS.
3. “Manual for the Review of Service Unit Environmental Health Programs” Environmental Health Branch, IHS.
4. “Project Data System Coding Instruction Manual,” OEH, IHS.
5. “Sanitation Facility Data System Instruction Guide,” OEH, IHS

3-11.3 PROGRAM ELEMENT GUIDELINES

The program elements which are essential to meet the stated objective of a comprehensive environmental health program include:

Air Pollution
1. Objective
  To assist tribes and native health corporations in the control of atmospheric emissions which may have an adverse effect on health.
2. Activities
  1. Surveillance - Subobjective
    To identify and evaluate potential air pollution sources.
    1. Maintain liaison with local, state and federal agencies having jurisdiction over air pollution evaluation and control activities.
    2. Evaluate federal facilities serving Indian people to determine compliance with current executive orders on air pollution.
    3. Maintain a current inventory of potential air pollution sources.
    4. Provide advice and technical consultation on new and existing industries or commercial operations to ensure compliance with current emission standards.
  2. Investigations - Subobjective
    To respond to complaints, referrals or inquiries regarding air pollution problems.
    1. Prepare a report outlining findings and suggested remedial action. (See Section D., Epidemiology).
3. Operating Guidelines, Standards and Publications for Reference
  1. Executive Order No, 12088, October 13, 1978, “Prevention, Control and Abatement of Environmental Pollution at Federal Facilities”, Federal Register, Vol. 44.
  2. Clean Air Act, as amended by the Air Quality Act of 1967, P.L. 90-148.
Community Injury Control
1. Objective
  To reduce injury morbidity and mortality among American Indians and Alaska Natives.
2. Activities
  1. Planning - Subobjective
    To develop a plan to reduce injury related morbidity and mortality in the community.
    1. Develop a Service Unit community injury control plan in cooperation with tribal governments, other Indian Health Service (IHS) program components and other government agencies.
    2. Conduct an annual evaluation of the community injury control plan.
  2. Surveys - Subobjective
    To identify and evaluate those factors in the community environment that may contribute to injury related morbidity and mortality.
    1. Conduct special community hazard surveys to compliment the Service Unit community injury control plan.
  3. Surveillance - Subobjective
    To monitor the community environment in respect to conditions which may contribute to injury.
    1. Review available data on injury related morbidity and mortality relative to the number, type, location and cause of the injuries as well as the groups at risk.
    2. Enlist community participation in monitoring conditions which may cause injuries and in monitoring the progress of the community injury control plan.
    3. Develop and maintain liaison with local, state and federal agencies and private organizations involved in community injury control activities.
  4. Control - Subobjective
    To control those factors in the environment which may contribute to injury related morbidity and mortality.
    1. Encourage community involvement in eliminating accident hazards.
    2. Initiate specific short and long term intervention strategies.
  5. Investigations-Subobjective
    Respond to referrals, complaints or inquiries regarding injury control.
    1. Prepare a report outlining findings and suggested remedial action. (See Section D., Epidemiology).
    2. Coordinate investigative activities with Service Unit community health and medical staff.
  6. Training - Subobjective
    To create an awareness in the community that injuries are preventable.
    1. Provide instruction on selected injury control subjects.
    2. Collect and disseminate available information on injury-prevention.
    3. Develop and promote periodic safety campaigns and an annual safety awareness month.
3. Operating Guidelines, Standards and Publications for Reference.
  1. Baker, Susan P., and Haddon, William Jr., “Injury Control,” Preventive and Community Medicine, Chapter 8.
  2. Robertson, Leon S., Injuries: Causes, Control Strategies and Public Policy.
  3. Baker, Susan P., et al, The Injury Fact Book.
  4. “Promoting Health, Preventing Disease - Objectives for the Nation,” Department of Health and Human Services.
Emergency Operations
1. Objective
  To minimize the adverse effects on health as a result of unpredictable events.
2. Activities
  1. Emergency Response Plan Development - Subobjective
    1. Develop the environmental health component of the emergency response plan for all Area/Program and Service Unit levels.
      This plan should be integrated with all appropriate local, state and federal agencies.
    2. Emergency response plans for all levels should be updated in accordance with current Indian Health Service (IHS) guidelines.
    3. Evaluate emergency response plan exercises and revise the plan accordingly.
  2. Liaison - Subobjective
    To coordinate emergency preparedness activities with local, state and federal agencies.
    1. Develop and maintain liaison with local, state and federal agencies which have responsibility for emergency preparedness activities.
    2. Coordinate emergency preparedness activities with other Area/Service Unit staff.
  3. Training - Subobjective
    To develop and present programs which will define roles, orient, and involve participants in the implementation of the emergency response plan.
    1. Conduct exercises of the emergency response plan in accordance with Joint Commission for Accreditation of Hospitals and IHS guidelines.
3. Operating Guidelines, Standards and Publications for Reference
  1. “Emergency Preparedness”, Chapter 10, Part 1, Indian Health Manual.
  2. “Disaster Relief Act of 1974,” P.L. 93-288, May 22, 1974.
  3. Executive Order, “Assignment of Emergency Preparedness Functions to Federal Departments and Agencies.”
  4. Comprehensive Environmental Response, Compensation and Liability Act of 1980.
  5. “Emergency Planning and Operations Manual,” Department of Health and Human Services.
  6. “Disaster Response Guides,” U.S. Public Health Service.
  7. “Emergency Preparedness Response Plan,” Health Resources and Services Administration.
  8. “Guidelines for Responding to Emergencies Involving Hazardous Materials,” OEH, IHS.
Epidemiology
1. Objective
  To determine the etiology of disease and trauma.
2. Activities
  1. Surveillance - Subobjective
    To determine the incidence of environmentally related disease or trauma in the population.
    1. Review available morbidity and mortality data on an annual basis.
    2. Prepare a disease and injury incidence profile for the Service Unit.
    3. Develop and implement methods and techniques to reduce the incidence of disease and injuries.
    4. Perform field surveillance activities in cooperation with local, state or federal agencies as necessary.
  2. Investigations - Subobjective
    To investigate a report of a sudden increase in the incidence of environmentally related disease or injury.
    1. Notify immediate supervisor of reported disease or injury in accordance with Indian Health Service (IHS) procedures.
    2. Initiate and conduct the investigation using the following procedure:
      - verify the report
      - collect and tabulate data
      - develop a hypothesis
      - test the hypothesis
      - implement remedial measures
    3. Prepare report(s) in accordance with IHS standards and procedures.
  3. Liaison - Subobjective
    To coordinate epidemiological investigative activities with local, state and federal agencies.
    1. Develop and maintain liaison with local, state and federal agencies which have responsibility for epidemiological activities.
    2. Coordinate field investigative activities with Service Unit community health and medical staff.
  4. Operating Guidelines, Standards and Publications for Reference
    1. “Reporting Outbreaks, Epidemics, or Unusual Occurrences of Communicable Diseases,” IHS Circular 69-2.
    2. Control of Communicable Diseases in Man, American Public Health Association.
    3. “Guide for Investigating Food-borne Disease Outbreaks and Analyzing Surveillance Data,” F.L. Bryan, CDC, 1975.
Food Protection
1. Objective
  To prevent food-borne illness among American Indians and Alaska Natives.
2. Activities
  1. Food Sanitation Surveys - Subobjective
    To evaluate the status of food sanitation practices in food service facilities.
    1. Surveys of all eating and drinking establishments should be conducted in accordance with the Public Health Service (PHS), “Food Service Sanitation Manual” utilizing the current Food Service Inspection Report.
    2. Surveys of all other food service establishments should be conducted in accordance with the “Retail Food Store Sanitation Code.
    3. Food sanitation surveys should be conducted at least semiannually. Survey results should be provided to and discussed with the operator and/or manager of the facility and a copy of the survey report should be filed at the Service Unit.
    4. Consultation and technical assistance on the sanitary operation of a food service facility should be provided when requested and when deemed necessary.
    5. Mobile food units and temporary food service establishments should comply with the provisions of the PHS “Food Service Sanitation Manual."
    6. Food and beverage vending machines should be inspected in accordance with the “The Vending of Food and Beverages” Code.
    7. Whenever a food service establishment is constructed or extensively remodeled and whenever an existing structure is converted to use as a food service establishment, properly prepared plans and specifications for such construction, remodeling or conversion should be submitted to the Office of Environmental Health for review and approval before construction, remodeling or conversion is begun. Plans and specifications should be reviewed in accordance with current local and/or national health, construction, and safety codes and food service equipment standards.
    8. Establish and maintain liaison with county and state agencies to encourage reciprocity of food inspection surveys and cooperation in food protection activities.
  2. Food Quality Surveillance - Subobjective
    To monitor the wholesomeness of food and milk products provided to and served at food service facilities.
    1. Periodic inspections should be made of food, beverages and milk products to ensure compliance with current food and milk codes.
    2. Food, beverage and milk samples should be collected in accordance with current sampling standards. Special samples may be collected when deemed necessary.
    3. Periodic visits should be made to review the operation of food service facilities and to monitor compliance with previous recommendations
    4. Food and beverage vending machines should be installed and maintained in accordance with current regulations and guidelines.
  3. Investigations - Subobjective
    To respond to an inquiry, complaint or referral of insanitary food practices or alleged food-borne illness.
    1. Prepare a report outlining findings and suggested remedial action. (See Section D., Epidemiology).
    2. Whenever food is found to be unwholesome, adulterated or otherwise unfit for human consumption, the owner/operator of the food establishment should initiate voluntary disposal in accordance with recognized standards. If food is suspect, the owner/operator should voluntarily hold the food for a quality assessment.
  4. Training - Subobjective
    To provide instruction on sanitary food practices in order that consumers and food service personnel are able to recognize the relationship between food and illness.
    1. Develop and conduct training courses for all food service personnel on a continued and as needed basis with formal sessions held at least annually.
    2. Encourage food service operators and/or managers to initiate in-service training for all employees.
    3. Develop and conduct training for homeowners in the sanitary storage, preparation and handling of food and milk products.
3. Operating Guidelines, Standards and Publications for Reference
  1. “Food Service Sanitation Manual,” Food and Drug Administration (FDA), HEW Publication No. 78-2081.
  2. “Retail food store Sanitation Code,” Association of Food and Drug Officials and FDA.
  3. “The Vending of Food and Beverages,” DHEW Publication No. (FDA) 78-2091.
  4. “The Grade A Pasteurized Milk Ordinance,” USPHS.
  5. “Recommended Methods for the Microbiological Examination of Foods,” American Public Health Association.
  6. “Procurement of Fluid Milk and Fluid Milk Products; IHS Circular No. 75-l.
  7. “Food Service Equipment Standards,” National Sanitation Foundation.
Hazardous Materials
1. Objective
  To reduce, minimize, and or prevent the effects associated have an adverse impact with hazardous materials which may on health and the environment.
2. Activities
  1. Surveillance - Subobjective
    To determine if hazardous materials are stored, handled, transported and disposed of in accordance with current recognized standards.
    1. Identify sites where potentially hazardous materials exist, or are used, and periodically review operating practices and procedures.
    2. Maintain liaison with local, state and federal agencies in order to monitor and evaluate hazardous materials practices.
    3. Maintain a current inventory of hazardous materials disposal sites.
    4. Establish procedures for the safe disposal of hazardous materials.
    5. Provide technical assistance and consultation, and act as a resource to tribal governments regarding hazardous materials.
  2. Special Studies - Subobjective
    To gather information and data on specific environmental health conditions involving hazardous materials.
    1. Special studies should be conducted as needed and with the concurrence and support of tribal governments. A written report should be prepared and discussed with the tribe and a Copy of the report placed on file at the Service Unit.
  3. Investigations - Subobjective
    To respond to referrals, complaints or inquiries regarding hazardous materials.
    1. Prepare a report outlining findings and suggested remedial action. (See Section D. Epidemiology).
3. Operating Guidelines’ Standards and Publications for Reference
  1. Resource Conservation and Recovery Act of 1976, P.L. 94-580, October 21, 1976.
  2. “Safety Manual for Hazardous Waste Site Investigations,” Environmental Protection Agency (EPA), National Enforcement Investigations Center.
  3. “Manual for Groundwater/Subsurface Investigations at Hazardous Waste Sites,” Office of Enforcement, EPA.
4. Guidelines for Responding to Emergencies Involving Hazardous Materials,” OEH, IHS.
5. Toxic Substances Control Act, P.L. 94-469, October 11, 1976.
6. Comprehensive Environmental Response, Compensation and Liability Act of 1980.
7. “Promoting Health, Preventing Disease - Objectives for the Nation,” Department of Health and Human Services.
Home and Community Health
1. Objective
  To reduce or control those factors in the community and living environments that may have an adverse effect upon health.
2. Activities
  1. Community Profile - Subobjective
    To evaluate the environmental health status of the community.
    1. Conduct an annual inventory of the community in accordance with the “Community Profile Guidelines”.
  2. Surveys - Subobjective
    To evaluate the status of environmental health conditions in itinerant living environments.
    1. Conduct annual surveys of trailer parks, motels, hotels and other temporary housing.
      A report should be prepared outlining findings and suggesting recommendations. The report should be discussed with the operator and a copy of the report placed on file at the Service Unit.
  3. Special Studies - Subobjective
    To gather information and data on specific environmental health conditions and practices in the home and community for a prescribed area.
    1. Special studies should be conducted as needed and with the concurrence and support of the tribal government. Studies should be based on specific public health and safety needs.
      A written report should be prepared and discussed with the tribe and a copy of the report placed on file at the Service Unit.
  4. Investigations - Subobjective
    To respond to referrals, complaints or inquiries regarding of health conditions in the home environment.
    1. A report should be prepared whenever findings indicate that remedial action is warranted. (See Section D., Epidemiology).
  5. Training - Subobjective
    To develop an awareness of health and safety factors in the community and living environments which may have an impact on health.
    1. Provide consultation and technical assistance on health and safety to homeowners, housing authorities and owners and/or operators of temporary housing facilities.
    2. Provide instruction on selected public health and safety subjects to homeowners, housing authorities and owners and/or operators of temporary housing facilities.
3. Operating Guidelines, Standards and Publications for Reference
  1. “Community Profile Guidelines,” OEH, IHS.
  2. “Environmental Health Guide for Mobile Home Communities,” DHHS, PHS, 1973.
Institutional Environmental Health
1. Objective
  To reduce or minimize those factors in the institutional environment which may have an adverse impact on health, safety and well being.
2. Activities
  1. Environmental Health Surveys - Subobjective
    To evaluate all institutional facilities serving American Indians and Alaska Natives to determine compliance with existing standards.
    1. Facility data documents should be completed on all new and existing facilities and whenever facilities undergo either extensive renovation or convert from one use to another. These documents should be prepared in accordance with established guide1ines.
      A copy of the document should be maintained on file at the Area and the Service Unit.
    2. Each facility should be surveyed annually to determine the extent of compliance with, recommendations from previous surveys and to assess the current status of environmental health conditions.
      A report should be prepared in accordance with established guidelines and format and discussed with the officer-in-charge. A copy of the report should be placed on file at the Service Unit.
    3. Operational surveys should be conducted as deemed necessary to provide assistance in a technical or advisory manner.
    4. Participate in activities related to the accreditation and certification of health care facilities.
    5. Special surveys involving a specific review of physical, chemical or biological conditions should be conducted as necessary and as required by existing regulations.
      A written report should be prepared and discussed with the officer-in-charge and a copy of the report placed on file at the Service Unit.
    6. Plans should be reviewed by the Environmental Health Branch and comments provided whenever it is proposed to remodel an existing facility or build a new facility to determine if the institutional layout and equipment comply with existing regulations and standards.
  2. Surveillance - Subobjective
    To monitor the safety and health aspects of the institutional environment.
    1. Perform periodic tests of the physical, chemical and biological environment.
    2. Review hospital census records relative to nosocomial infections.
    3. Conduct walk-through surveys of institutions to determine compliance with recognized operating standards.
    4. Support and participate in infection control and safety committee activities.
    5. Develop and maintain liaison with county and state agencies to encourage cooperation in institutional environmental health activities.
  3. Investigations - Subobjective
    To respond to a referral, complaint or inquiry regarding the institutional environment.
    1. Prepare a report outlining findings and suggested remedial action. (See Section D., Epidemiology)
  4. Training - Subobjective
    To enable personnel to recognize their role and fulfill their responsibility in the maintenance of a safe and clean institutional environment.
    1. Respond to requests for training on specific subjects within the institutional environment.
    2. Recognize and provide instruction necessary to maintain a healthful working environment.
3. Operating Guidelines, Standards and Publications for Reference
  1. “Institutional Environment Control Guidelines,” Office of Environmental Health, Indian Health Service.
  2. “Joint Commission for Accreditation of Hospitals,” American Hospital Association.
  3. “Minimum Requirements of Construction & Equipment for Medical Facilities,” USPHS, HRA-79-4000.
  4. “Life Safety Code, National Fire Protection Associaton (NFPA).
  5. “Guidelines for prevention and Control of Nosocomial Infections,” Centers for Disease Control.
  6. “Health Care Facilities Code,” NFPA.
Occupational Health
1. Objective
  To reduce or minimize those factors in the work environment which may have an adverse impact on health, safety and well being.
2. Activities
  1. Surveys - Subobjective
    To identify physical, chemical and biological hazards in the work place.
    1. Walk through surveys should be conducted annually on all commercial and industrial operations.
    2. Whenever occupational hazards are noted or suspected, an in-depth evaluation of that environment should be arranged and conducted.
    3. A report outlining findings and recommendations should be prepared as a result of each survey. The report should be discussed with the owner and/or operator and a copy of the report placed on file at the Service Unit.
    4. Whenever new industry or commercial operations are proposed, plans and specifications should be reviewed by the Environmental Health Branch for potentially hazardous operations.
  2. Liaison - Subobjective
    To coordinate occupational health activities with local, state and federal agencies.
    1. Develop and maintain liaison with local, state and federal agencies which have responsibility for occupational health.
  3. Investigations - Subobjective
    To respond to complaints, referrals or inquiries regarding occupational health.
    1. Prepare a report outlining findings and suggested remedial action. (See Section D) Epidemiology).
    2. Coordinate field investigative activities with Service Unit medical staff.
  4. Training - Subobjective
    To enable management and staff to recognize the importance of following accepted safety practices in the occupational environment.
    1. Provide periodic training on selected occupational hazards for occupationally exposed personnel.
    2. Provide information to tribal groups regarding the hazards associated with the occupational environment.
3. Operating Guidelines, Standards and Publications for Reference
  1. The Industrial Environment - Its Evaluation and Control, National Institute for Occupational Safety and Health (NIOSH)
  2. “Occupational Health Guidelines for Chemical Hazards,” NIOSH 81-123.
  3. “Criteria for a Recommended Standard and Occupational Exposure to Physical and Chemical Agents,” NIOSH
  4. “Threshold Limit Values,” American Conference of Governmental Industrial Hygienists.
  5. “Promoting Health, Preventing Disease - Objectives for the Nation,” Department of Health and Human Services.
Operation and Maintenance
1. Objective
  To promote and assist in the establishment of an effective and economical mechanism for the operation and maintenance of tribal water, sewage and solid waste systems.
2. Activities
  1. Planning - Subobjective
    To assist the American Indians and Alaska Natives in developing a mechanism to operate and maintain water, sewage and solid waste systems
    1. Assist tribal governments in apprising operation and maintenance needs.
    2. Assist tribal governments in preparing a plan of operation.
    3. Assist in the development of a mechanism to sustain an operation and maintenance program through the establishment of user fees and/or the identification of other funding sources.
  2. Survey of Existing Operation and Maintenance (O&M) Organizations - Subobjective
    To review the operational procedures of the-O&M organization and evaluate its ability, to carry out a preventive maintenance program.
    1. Surveys of O&M organizations should be conducted at least annually. Survey reports should be given to and discussed with the tribe and the operator of the organization and a copys of the report placed on file at the Service Unit.
    2. Make periodic visits to review the current operational procedures of the organization and to provide consultation and technical assistance on questions of management, finance, maintenance and equipment.
  3. Training - Subobjective
    To provide instruction on the operation and management of an O&M organization.
    1. Identify training needs for new and existing staff.
    2. Develop or locate training for all operation and maintenance staff.
    3. Encourage the tribe to establish an in-service training program to maintain a high level of efficiency.
    4. Provide training to operation and maintenance personnel as part of routine visits.
3. Operating Guidelines, Standards and Publication for Reference
  1. “Establishment of O&M Organizations for Native American Sanitation Facilities,” American Water Workers Association.
  2. “A Guide to Operation and Maintenance,” Portland Area, Office of Environmental Health (OEH), Indian Health Service (IHS).
  3. “O&M Guide for Support of Rural Water - Wastewater Systems,” Commission on Rural Water.
  4. “Sanitation Facilities Construction Handbook,” Chapters 1 and 5, Part 11, OEH, IHS.
Radiation
1. Objective
  To reduce or minimize radiation hazards in the living and working environments which may have an adverse effect on health.
2. Activities
  1. Surveys - Subobjective
    To evaluate all sources of natural and man-made radiation to determine compliance with existing standards.
    1. Safety surveys should be conducted on all medical X-ray equipment annually.
    2. Safety surveys should be conducted on all dental X-ray equipment biennially.
    3. Compliance testing of medical and dental X-ray equipment should be performed in accordance with current National Center for Devices and Radiological Health standards
    4. Special surveys and/or tests involving specific radiation conditions should be conducted as necessary and as required by existing regulations.
    5. Whenever it is proposed to erect or remodel any radiology department, plans should be reviewed by the Environmental Health Branch to determine if the layout and equipment comply with existing regulations and standards.
    6. Identify, assess and maintain a current inventory of naturally occurring radiation sources.
    7. Provide assistance to local, state or federal agencies in surveys of radiation sources.
    8. A report of all surveys should be prepared and transmitted in accordance with existing guidelines.
      The report should be discussed with the officer-in-charge and a copy of the report placed on file at the Service Unit.
  2. Surveillance - Subobjective
    To monitor the safety and health aspects in the radiation environment.
    1. Review personnel monitoring records of all occupationally exposed personnel in accordance with recognized standards.
    2. Conduct surveys of all radiation environments to determine if safe operating practices are being followed.
    3. Develop and maintain liaison with local, state and federal agencies with responsibility for monitoring and controlling radiation hazards
    4. Provide technical assistance and consultation and act as a resource to tribal governments regarding radiation concerns.
  3. Investigations - Subobjective
    To respond to referrals, complaints or inquiries regarding radiation.
    1. Prepare a report outlining findings and suggested remedial action. (See Section D., Epidemiology.)
  4. Training - Subobjective
    To enable occupationally and nonoccupational exposed personnel to recognize the importance of following accepted radiation safety exposed personnel.
    1. Provide periodic training on selected radiation safety subjects for occupationally exposed personnel.
    2. Provide information to nonoccupational exposed personnel on the potential hazards related to radiation.
3. Operating Guidelines, Standards and Publication for Reference
  1. “Radiation Protection Guidance to Federal Agencies For Diagnostic X-Rays”, Federal Register, Vol. 43 No. 22, February 1, 1978.
  2. “Routine Compliance testing for Diagnostic X-Ray Systems”, Bureau of Radiological Health (BRH).
  3. “Medical X-Ray and Gamma-Ray Protection for Energies up to 10 MeV - Equipment Design and Use,” National Council on Radiation Protection and Measurements (NCRP, Report No. 33.
  4. “Structural Shielding Design and evaluation for Medical Use of x-ray and Gamma Rays for Energies up to 10 MeV, report No. 499, NCRP”
  5. “United States Public Health Service Personnel Monitoring Program, Instruction Manual,” HHS Publication FDA, 82-8193.
  6. “Dental X-Ray Protection,” Report No. 35, NCRP.
  7. “Procedure for Shield testing Microwave Ovens.”
  8. “Radiation Protection,” IHS Health Circular No. 75-2.
  9. “Routine Compliance Calculation Programs Diagnostic X-Ray Equipment,” BRH.
  10. “Radiology,” Chapter 16, Part 3, Indian Health Manual.
  11. “Promoting Health, Preventing Disease - Objectives for the Nation,” Department of Health and Human Services.
Recreational Sanitation
1. Objective
  To reduce or minimize those factors in the recreational environment which may have an adverse effect on health.
2. Activities
  1. Surveys - Subobjective
    To evaluate the status of environmental health conditions at recreational facilities.
    1. Conduct operational surveys of swimming pools in accordance with PHS guidelines and the following minimum frequencies:
      - Outdoor pool: every three weeks during the swimming season.
      - Indoor pools: every two months.
      The operator of the pool should accompany the surveyor during the survey. A report should be prepared outlining findings and suggested recommendations. The report should be discussed with the operator and a copy placed on file at the Service Unit.
    2. Conduct surveys of all other recreational facilities at least semiannually.
      A report should be prepared outlining findings and suggested recommendations. The report should be discussed with the operator and a copy of the report placed on file at the Service Unit
    3. Whenever it is proposed to construct or remodel recreational facilities, plans should be reviewed by the Environmental Health Branch for conformance to accepted standards.
  2. Investigations - Subobjective
    To respond to a complaint, referral or inquiry regarding the recreational environmental.
    1. Prepare a report outlining findings and suggested remedial action. (See Section D. Epidemiology)
  3. Training - Subobjective
    To enable recreational personnel and pool operators to recognize their role and fulfill their responsibility in the maintenance and care of a healthful recreational environment.
    1. Provide instructions on selected public health and safety topics to recreational maintenance personnel and swimming pool operators on an annual basis.
3. Operating Guidelines, Standards and Publication for Reference
  1. “Swimming Pools, Safety and Disease Control through Proper Design and Operation,” HEW Publication No. (CDC) 76-8319.
  2. “Environmental Health Practice in Recreational Areas,” HEW Publication No. (CDC) 77-8351.
Safety
1. Objective
  To prevent accidental deaths and injuries in the working environment.
2. Activities
  1. Surveys - Subobjective
    To evaluate safety practices and procedures in tribal and Indian Health Service (IHS) facilities.
    1. Surveys should be conducted annually in accordance with recognized standards.
      A report outlining findings and suggested recommendations should be prepared for each survey. The report should be discussed with the owner/operator and a copy of the report placed on file at the Service Unit.
    2. Periodic walk through surveys of facilities should be conducted to determine compliance with recognized safety standards.
    3. Whenever facilities are constructed or remodeled, plans and specifications should be reviewed by the Environmental Health Branch for conformance to accepted standards.
  2. Surveillance - Subobjective
    To monitor safety conditions in the working environment.
    1. Maintain a current inventory of the number, type and location of injuries or accidents occurring in the work place.
    2. Accident reports should be completed and processed in accordance with existing reporting guidelines.
    3. Provide technical assistance and consultation and act as a resource to tribal governments on safety issues.
    4. Develop and maintain liaison with local, state and federal agencies to encourage cooperation, in safety activities.
  3. Investigations - Subobjective
    To respond to referrals, complaints or inquiries regarding safety in the working environment.
    1. Prepare a report outlining findings and suggested remedial action. (See Section D., Epidemiology).
  4. Training - Subobjective
    To provide an awareness of acceptable safety practices the working environment.
    1. Provide periodic instruction to workers on selected safety subjects.
    2. Arrange for and participate in the conduct of routine fire and safety drills.
    3. Explain and encourage the use of safety devices and equipment.
3. Operating Guidelines, Standards and Publication for Reference
  1. “Safety Management,“ Chapter 9, Part 1, Indian Health Manual.
  2. “Safety Management Manual,” TN 75-2, DHHS.
  3. “Promoting Health, Preventing Disease - Objectives for the Nation,” Department of Health and Human Services.
Sanitation and Safety at Celebrations
1. Objective
  To reduce or minimize those factors in the environment at public celebrations and other gatherings which may have an adverse effect on health.
2. Activities - Subobjective
  1. Celebration Surveys - Subobjective
    To evaluate those conditions at the celebration site which may have an adverse effect on the health of the public.
    1. Conduct surveys of the environment at the celebration site prior to and during the celebration and provide recommendations for any improvements that may be required.
    2. Provide a final report to the sponsoring organization relative to findings and recommendations. The report should be discussed with the responsible authority and a copy of the report placed on file at the Service Unit.
  2. Training - Subobjective
    To provide an awareness of acceptable sanitation and safety practices at celebrations and other gatherings.
    1. Provide instruction on selected public health and safety subjects for vendors at celebration sites.
    2. Provide consultation and technical assistance to sponsoring organizations regarding improvements for future celebrations.
3. Operating Guidelines, Standards and Publication for Reference
  1. “Food Service Sanitation Manual,” Food and Drug Administration (FDA) 78-2081.
  2. “Environmental Health Practice in Recreational Areas,” Publication No. CDC 77-8351, DHHS.
Vector Control
1. Objective
  To prevent the introduction and spread of vector-borne diseases.
2. Activities
  1. Surveillance - Subobjective
    To monitor the environment for changes in the population of arthropods and rodents of public health significance.
    1. Review available data regarding incidents of vector-borne diseases.
    2. Gather information and collect biological specimens whenever necessary.
    3. Perform annual surveys of communities to detect significant changes in the arthropod and rodent populations. Survey reports should be given to and discussed with the tribal government.
    4. Maintain a continuous surveillance activity in those areas where vector-borne diseases are endemic or suspected.
    5. Provide technical assistance to tribal governments in the establishment of vector control programs.
    6. Assist in the development and operation of vector control measures in accordance with recognized standards and procedures.
    7. Develop and maintain liaison with local, state and federal agencies having jurisdiction over vectors and vector control activities.
  2. Rabies Control - Subobjective
    To encourage and promote up-to-date immunizations of all dogs, cats and other susceptible pets.
    1. Organize and promote annual rabies immunization clinics.
    2. Provide technical assistance for the development and implementation of animal control measures.
  3. Investigations - Subobjective
    To respond to referrals, complaints or inquiries regarding vector control and animal bites.
    1. Prepare a report outlining findings and suggested remedial action. (See Section D., Epidemiology).
  4. Training - Subobjective
    To create an awareness of the role vectors play in disease transmission.
    1. Disseminate information and health education materials on vectors and vector control.
    2. Provide formal instruction to individuals and community groups on vectors and vector control.
3. Operating Guidelines, Standards and Publication for Reference
  1. “Recommendation of the Public Health Service Advisory Committee on Immunization Practices,” l977.
  2. “The Federal, Insecticide, Fungicide, and Rodenticide Act,” P.L. 92-516, as amended.
  3. “Certification of Pesticide Applicators,” Federal ’ Register, Vol. 39, No. 197, October 9, 1974.
  4. “Federal Certification of Pesticide Applicators in States or on Indian Reservations Where There is no Approved State or Tribal Certification Plan in Effect,” Federal Register, Vol. 43, No. 111, June 8, 1978.
Waste Disposal
1. Objective
  To assist American Indians and Alaska Natives to acquire adequate liquid and solid waste disposal facilities and to encourage the continued use and operation and maintenance of the systems.
2. Activities
  1. Provision of Waste Disposal Systems - Subobjective
    To provide the benefits of satisfactory waste collection and disposal systems.
    1. Assist tribal governments and other agencies in developing a comprehensive plan for the proper disposal of solid and liquid wastes.
    2. Accumulate and analyze health statistics to assist tribal governments in preparing feasibility studies for initiation and installation of waste collection and disposal systems.
    3. Involve the community and/or individual in the planning, development, construction and operation and maintenance of waste collection and disposal systems.
    4. Define the needs for waste disposal system improvements through surveillance, surveys and a review of existing data-systems.
    5. Design and construct waste disposal systems that meet the needs of the individuals and communities being served and are within their capability to operate and maintain.
    6. Assist in the procurement of necessary funding from tribal, Indian Health Service (IHS) and other federal or state sources.
    7. Provide the orderly transfer of completed waste disposal systems to the individual householder, community, tribe or other entity in accordance with the provisions of the “Criteria for Sanitation Facilities Construction.“
    8. Develop and provide. a complete Operation and Maintenance (O&M) Manual for all individual and community systems.
    9. Consultation and technical assistance on the proper use and maintenance of domestic systems should be provided, when requested and when deemed necessary, to individual homeowners, waste collection and disposal system operators and the tribe.
  2. Surveys of Waste Disposal Systems - Subobjective
    To determine the state of repair, use, care, maintenance and operation of installed waste disposal systems.
    1. A survey of community liquid and solid waste disposal systems should be conducted at least annually.
    2. Individual waste disposal system surveys should be conducted at each home upon the request of the homeowner or as a part of a special study, complaint or referral.
    3. The tribal utility manager and/or tribal maintenance personnel should be encouraged to participate in all surveys; a report of the survey should be given to and discussed with the tribe and utility operator.
    4. Waste disposal systems should be surveyed in accordance with OEH Guideline 1, “Survey of Sanitation Facilities,” utilizing the current survey form.
  3. Surveillance - Subobjective
    To determine if both domestic and industrial waste materials are disposed of in accordance with recognized standards
    1. Provide technical assistance to the tribes in order to assist them in operating facilities which meet wastewater effluent discharge standards.
    2. Review collection schedule and make periodic reviews of collection practices and disposal sites.
    3. Develop and maintain liaison with local, state and federal agencies to encourage cooperation in liquid and solid waste disposal activities.
  4. Investigations - Subobjective
    To respond to referrals, complaints or inquiries about insanitary waste disposal conditions.
    1. Prepare a report outlining possible causes and suggested remedial action to prevent future occurrences. (See Section D, Epidemiology).
  5. Training - Subobjective
    To enable American Indians and Alaska Natives to recognize and receive the benefits of waste collection and disposal systems.
    1. Develop and conduct training sessions for homeowners and utility operators in the proper use, care and maintenance of existing or newly installed, waste collection and disposal facilities.
    2. Encourage the development and establishment of a tribal utility operation stressing the management, operation and maintenance of collection and waste disposal systems.
    3. Integrate homeowner’s training with the construction schedule to include demonstrations and hands-on training.
3. Operating Guidelines, Standards and Publication for Reference
  1. “Criteria for Sanitation Facilities Construction," Office of Environmental Health (OEH), Indian Health Service (IHS).
  2. “Survey of Sanitation Facilities,” OEH Guideline 1.
  3. Federal Water Pollution Control Act of 1977 and Executive Order 12088, October 1978, “Federal Compliance with Pollution Control Standards”, 43FR47707.
  4. “Homeowners Guide for Maintenance and Repair of Sanitation Facilities,” OEH, IHS.
  5. “Sanitation Facilities Construction Handbook,” Chapters 1, 3, and 4, Part II, OEH, IHS.
  6. “Onsite Wastewater Treatment and Disposal Systems,” Design Manual, Environmental Protection Agency (EPA).
  7. “Standard Methods for the Examination of Water and Wastewater,” American Water Works Association.
Water Supply
1. Objective
  To assist American Indians and Alaska Natives to acquire an adequate, potable water supply and to encourage the continued use, operation and maintenance of the system.
2. Activities
  1. Provision of Safe Water - Subobjective
    To provide the benefits or a potable water system.
    1. Assist tribal governments and other agencies in developing an overall water resource plan.
    2. Accumulate and analyze health statistics to assist tribal governments in preparing feasibility studies for water systems.
    3. Evaluate environmental conditions in the project area.
    4. Involve the community and/or individual in the planning, development, construction and operation and maintenance of water systems.
    5. Define the needs for water system improvements through surveillance, surveys and a review of existing data systems.
    6. Encourage the installation and operation of water fluoridating equipment to assist in the prevention of dental caries.
    7. Design and construct water systems that meet the needs of the individuals and communities being served and are within their capability to operate and maintain.
    8. Ensure that the water quality of newly designed or renovated systems meets both bacteriological and chemical standards prior to being put in service.
    9. Assist in the procurement of necessary funding from tribal, Indian Health Service (IHS) and other federal or state sources.
    10. Provide the orderly transfer of completed water systems to the individual householder, community, tribe or other entity in accordance with the provisions of the “Criteria for Sanitation Facilities Construction”.
    11. Develop and provide a complete Operation and Maintenance (O&M) Manual for all individual and community systems.
    12. Consultation and technical assistance on the proper use and maintenance of domestic systems should be provided, when requested and when deemed necessary, to individual homeowners, waste collection and disposal system operators and the tribe.
  2. Survey of Existing or Newly Constructed Water Systems -Subobjective
    To determine the state of repair, use, care, maintenance and operation of the installed systems.
    1. Community water system surveys should be conducted at least annually.
    2. Individual water system surveys should be conducted at each home upon the request of the homeowner or as a part of a special study, complaint or referral.
    3. Tribal utility managers and/or tribal maintenance personnel should be encouraged to participate in the surveys; a report of the survey should be given to and discussed with the Tribe and utility manager.
    4. Water system surveys should be conducted in accordance with OEH Guideline 1, “Survey of Sanitation Facilities,” utilizing the current survey form.
  3. Surveillance - Subobjective
    To determine if the chemical and bacteriological quality of water supplies used for domestic purposes meets recognized standards.
    1. Review the schedule, procedure and analysis results of bacteriological and chemical samples which are collected from all proposed and existing community water supplies in accordance with the latest edition of the National Interim Primary Drinking Water Regulations (NIPDWR).
    2. Provide technical assistance and training to the tribes in order to assist them in their sampling responsibilities in accordance with the NIPDWR.
    3. Results of all sample analyses and followup information should be maintained by the tribe or utility authority for review for the time period specified in the latest edition of the NIPDWR.
    4. Develop and maintain liaison with local, state and federal agencies to encourage cooperation in water supply activities.
  4. Investigations - Subobjective
    To respond to a report or occurrence of a water-borne disease outbreak and/or an excessive level of chemical contaminants in the water supply.
    1. Prepare a report outlining possible causes and suggested remedial action to prevent future occurrences. (See Section D., Epidemiology).
  5. Training - Subobjective
    To enable American Indians & Alaska Natives to recognize and receive the benefits of a water supply.
    1. Develop and conduct training sessions for homeowners and utility operators in the proper use, care and maintenance of newly installed or existing water supply facilities.
    2. Encourage the development and establishment of a tribal utility operation stressing the management, and operation and maintenance of water systems.
    3. Integrate homeowner’s training with the construction schedule to include demonstrations and hands-on training.
3. Operating Guidelines, Standards and Publication for Reference
  1. “National Interim Primary Drinking Water Regulations,” Environmental Protection Agency, EPA-570-/9-76-003.
  2. “Criteria for Sanitation Facilities Construction,” Office of Environmental Health (OEH), Indian Health Service (IHS).
  3. “Survey of Sanitation Facilities,” OEH Guideline 1.
  4. “Homeowners Guide for Maintenance and Repair of Sanitation Facilities,” OEH, IHS.
  5. “Safe Drinking Water Act,” P.L. 93-523 (1974), amendments and subsequent EPA regulations.
  6. “Microbiological Examination of Public Water Supplies,” OEH, IHS.
  7. “Standard Methods for the Examination of Water and Wastewater,” American Water Works Association.
  8. “Sanitation Facilities Construction Handbook”, Chapters 1 and 2, Part II, OEH, IHS.
  9. “Testing Equipment and Procedures for Fluoride Analysis of Drinking Water,” OEH, IHS.
  10. “The Venturi Fluoridator,” OEH, IHS.
  11. IHS Fluoridation Policy Issuance.