Ọwa mmiri na-ejupụta (CSO) banye n'Osimiri Mpaghara, Ọdọ Mmiri, ma ọ bụ N'akụkụ Oké Osimiri Mgbe Oké Mmiri ozuzo gasịrị: Ọrịa nsị mmiri, Leptospirosis, na mmetọ nke imikpu mmiri gachara.¶

Mgbe oke égbè eluigwe, mmiri ozuzo okpomọkụ, ma ọ bụ mmiri ozuzo ọsọ ọsọ na-adaba ihe karịrị 1.5 ruo 2.5 centimeters (0.6 ruo 1.0 inch) nke mmiri ozuzo kwa elekere n'obodo ochie nke ** Ngwakọta Ọwa mmiri Sistemu na-eje ozi (CSS, ụlọ ọrụ na-ahụ maka mmiri na-ekpofu ahịhịa nke ime obodo enweghị ike ijikọ ọnụ ọnụ mmiri ozuzo okporo ụzọ na nsị nsị ụlọ. Iji mee ka nsị nsị ghara ịkwado n'ime puku kwuru puku ụlọ obibi na okporo ụzọ obodo, ihe enyemaka hydraulic na-akpaghị aka ( Ngwakọta mmiri na-asọ asọ [CSO] outfalls**) mepere n'akụkụ osimiri ndị mepere emepe, ọwa ụgbọ mmiri, ọdụ ụgbọ mmiri, na osimiri igwu mmiri, na-ebufe ọtụtụ nde lita ** nsị mmadụ na-agwọghị ya, nsị ụlọ ọgwụ, mpụta mmiri nke ụlọ ọrụ, na mmiri okporo ụzọ merụọ oke oke** banye n'okporo ụzọ ntụrụndụ maka awa 24 ruo 72 mgbe mmiri ozuzo kwụsịrị. Ọ bụrụ na mmiri na-ekpu n'ime osimiri, ọdọ mmiri ma ọ bụ osimiri dị n'ụsọ oké osimiri n'ime ma ọ bụ n'ime awa 48 ka ụgbọ mmiri, onye na-anya ụgbọ mmiri, onye na-anya ụgbọ mmiri, onye na-anya ụgbọ mmiri, onye na-anya ụgbọ mmiri, onye ọrụ mgbapụta, ma ọ bụ anụ ụlọ. CSO Ọpụpụ, ha na-eche ihu ozugbo na ** leptospirosis (ọrịa Weil)**, *enterotoxigenic Escherichia coli (STEC O157:H7 norovirus ***, ** ịba ọcha n'anya A ***, Cryptosporidium, na **Vibrio vulnificus / Aeromonas hydrophila necrotizing anụ ahụ dị nro na-efe efe. Kpọọ nọmba mberede mpaghara gị (911 na United States na Canada, 112 gafee European Union, 999 na United Kingdom) site na anyị. nọmba mberede akwụkwọ ndekọ aha ma ọ bụrụ na onye ọ bụla na-amalite ahụ ọkụ dị elu, jaundice, red-purple skin bullae, ma ọ bụ nsogbu iku ume mgbe imikpu mmiri nsị mmiri, ma kpọtụrụ ụmụnna anyị ntụziaka. Ike ọwa mmiri dị ọcha bụ isi mgbawa, geyser nsị mmiri dị n'okporo ụzọ, yana mmechi valvụ azụ, ọwa mmiri isi iyi na idei mmiri n'okporo ámá, na isi mmiri na-agbaji na mmiri esi mmiri n'obodo dum.

Na-nanarị imikpu na mberede ma ọ bụ kọntaktị ntụrụndụ na ** Ọwa mmiri jikọtara ọnụ (CSO*** ma ọ bụ ** Oke mmiri ozuzoSSO*** plume chọrọ imezu ụkpụrụ anọ nke U.S. Ụlọ ọrụ nchekwa gburugburu (EPA Mba CSO Amụma nchịkwa), ** Centres maka Nchịkwa na Mgbochi Ọrịa (CDC, Òtù Ahụ Ike ỤwaWHO, na ** UK Health Security Agency (UKHSA***: ** na-eme ka windo mmiri ozuzo gafechara awa 48 ruo 72 "Enweghị igwu mmiri / No-Capsize" nke dị n'okpuru obodo mepere emepe. CSO dapụ ***, ** na-eme mmiri ịsa mmiri na-ekpo ọkụ na nkeji iri na ise nke nkeji iri na ise ga-esochi mgbaba mmiri dị elu (500 mL mmiri ọṅụṅụ ma ọ bụ saline na-adịghị mma gbakwunyere 2% Chlorhexidine ma ọ bụ Povidone-Iodine) nke ọ bụla akpụcha akpụkpọ ahụ, ọnya, ma ọ bụ leech/ụmụ ahụhụ tupu nje abata n'ime dermis , ** na-awụpụ anya na akụkụ imi na-adịghị mma. 0.9% saline na-ejighi mmiri mgbata n'ime imi, yana ** na-arịọ nyocha ahụike ezubere iche mgbe mkpughe gasịrị (Doxycycline 200 mg leptospirosis prophylaxis otu dose, Tdap tetanus booster, na Hepatitis A ogwu / immunoglobulin n'ime ụbọchị 14) mgbe ntinye ihe ize ndụ dị elu ma ọ bụ imikpu ọnya na-apụta **.

Mee nke a ugbu a¶

1. ** Wepụ na mmiri ozugbo ma ị hụ ma ọ bụ na-esi ísì CSO Ihe ngosi ọdịda: Brownish-Grey Plumes, Na-ese n'elu "Ahịhịa Ahịhịa" ( Wet Wipes, Tampon Applicators, Condoms), Ntụpọ Foam/Grease Slicks, ma ọ bụ Gulls Diving na a Submerged Pipe.** Ọtụtụ obodo mepere emepe. CSO Mpụpụ na-emikpu n'okpuru mmiri mmiri nke osimiri, ọdọ mmiri, na osimiri wee malite ịpụta n'ime nkeji 15 ruo 30 nke nnukwu mmiri ozuzo **. Ọ bụrụ na oké ifufe na-ada mgbe ị na-akwọ ụgbọ mmiri, kayak, paddleboarding, ma ọ bụ igwu mmiri, ma ọ bụ ọ bụrụ na obodo gị. CSO Maapụ njikere na-egosi mwepụta na-arụ ọrụ ma ọ bụ na nso nso a (within the past 48 hours), pụọ na mmiri ozugbo, mechie ọnụ gị ka mmiri teta ka ọ ghara ịkụ egbugbere ọnụ gị, asachapụla aka ma ọ bụ ihu gị n'ime osimiri.
2. Mee "Mbụ nke mbụ-30-Minute Mucous Membrane & Shower Decontamination" Tupu iri nri, ṅụọ ihe ọṅụṅụ, ma ọ bụ imetụ ihu gị aka.60% to 70% mmanya gel (Rịba ama na gel mmanya na-egbu nje bacteria dị ka E. coli na Leptospira,ma ọ dịghị egbu Norovirus ma ọ bụ Cryptosporidium oocysts, ị ga-eji esemokwu na ncha saa). Yipụ uwe mmiri niile, ihe nchekwa ọkụ, jaket ndụ (PFDs), na akpụkpọ ụkwụ mmiri n'èzí ma ọ bụ n'ime akpa ahịhịa rọba, saa nke ọma na ** mmiri ọkụ na-ekpo ọkụ na ncha nje na-egbu egbu maka opekata mpe nkeji 5 ruo 10*, fesaa imi gị n'ọnụ wee gbasa mmiri ọ bụla kama ilo mmiri ntapu mgbe imi.
3. gbaa mmiri ọ bụla, ọnya ụgbọ mmiri, ọkpụcha ma ọ bụ ahụhụ n'okpuru mmiri na-agba ọsọ maka nkeji ise zuru oke, tinye Povidone-Iodine ma ọ bụ Chlorhexidine, ma mechie ma ọ bụ techie ọnya mmiri nke ekpughere nke ọma. Shei na-agba ụkwụ na-agba ọsọ) na-eje ozdị ka ọnụ ụzọ ntinye ozugbo maka *** Leptospira * spirochetes ***, Aeromonas hydrophila *** na *** Vibrio vulnificus ***. Jiri ** ncha namiri na-asọ asọ (ma ọ bụ a 500 mL karama saline na-adịghị amị amị a mapuru ka ọ kpasuru iyi nke nwere nrụgide), tinye **klzzwh:0083 Betadine) ma ọ bụ klzzwh:0084 (*Hibiclens**, ma jiri akwa gauze na-eku ume na-eku ume* adịla mgbe ejiri cyanoacrylate gluing skin gluu ma ọ bụ eriri nru ububa siri ike, nke na-ejide nje anaerobic na necrotizing n'ime **).
4. ** Ọ bụrụ na mmiri na-asọ asọ n'akụkụ osimiri ma ọ bụ n'ụsọ osimiri fesara n'anya gị ma ọ bụ n'ọnụ gị: jiri ihe na-adịghị mma na-asachapụ anya. 0.9% Saline maka nkeji 5 ruo 10, wee sachaa ọnụ gị site na ịsacha ọnụ na-egbu egbu na-enweghị ilo. were anya saline saline na-adịghị mma were anya abụọ gbaa mmiri. Gwuo ma gbụọ ọnụ mmiri **0.12% Chlorhexidine ma ọ bụ mmanya / cetylpyridinium antiseptik mouthwash ** maka 30 sekọnd iji belata ọnụ mucosal viral na nje ibu.
5. Kpọtụrụ dọkịta ma ọ bụ ụlọ ọgwụ nlekọta ngwa ngwa n'ime awa 24 ma ọ bụrụ na iloro CSO Mmiri ma ọ bụ imikpu ọnya meghere: Jụọ gbasara Doxycycline Leptospirosis prophylaxis, Tdap Tetanus Booster, na Hepatitis A Mgbochi ihe ngosi mgbe emechara. N'okpuru CDC / WHO ntụzịaka ụlọ ọgwụ, imikpu mmiri dị ọcha nwere nnukwu ihe ize ndụ (karịsịa na-adaba na mmịnye mmiri ma ọ bụ mkpughe ọnya n'ime osimiri obodo mepere emepe na-ebu mmamịrị oke) na-akwado ntụle nke ** otu dose ọnụ ọnụ. Doxycycline 200 mg prophylaxis mgbe mkpughe (PEP) n'ime awa 24 ruo 72 *** iji gbochie leptospirosis, a Tdap / Td tetanus booster ma ọ bụrụ na ogbugba ikpeazụ gị karịrị ** afọ ise gara aga** maka ọnya ruru unyi, yana otu dose nke ọgwụ mgbochi ịba ọcha n'anya (gbakwunyere). IG ma ọ bụrụ na immunocompromised) n'ime ụbọchị 14 ** ma ọ bụrụ na agbaghị ọgwụ mgbochi.
6. ** Lezienụ anya maka ọkọlọtọ ọbara ọbara "Oge abụọ" n'ime ụbọchị 2 ruo 30 na-abịa: Cellulitis ngwa ngwa (12 to 72 Hours) vs. Leptospirosis / Ọrịa Weil (5 to 14 Days). necrotizing fasciitis), ma ọ bụ ** (B) Ahụ ọkụ dị elu, oke oke nwa ehi / anụ ahụ dị ala azụ, anya ọbara ọgbụgba (conjunctival suffusion na-enweghị pus), anya/akpụkpọ ahụ na-acha odo odo (jaundice), mmamịrị agba aja aja, ma ọ bụ ụkwara ọbara 2 ruo ụbọchị 30 ka e mesịrị** (Leptospirosis / ọrịa Weil).

Osisi mkpebi: Mkpokọta nsị oke mmiri (CSO) mkpochapụ imikpu & nhazi ahụike¶

flowchart TD
    A["Onye ma ọ bụ anụ ụlọ n'ime mmiri ma ọ bụ fesa n'osimiri, ọdọ mmiri, ọwa mmiri, ma ọ bụ n'akụkụ osimiri n'oge ma ọ bụ n'ime awa 48-72 mgbe oke mmiri ozuzo gasịrị (Ihe omume CSO / SSO)"] --> B{"Nzọụkwụ 1 ozugbo: Ntọhapụ n'ime nkeji iri atọ nke mmiri ịpụ"}
    B --> C["Wepụ ihe mgbochi mmiri n'èzí -> ịsa ahụ 5-10 min na mmiri ọkụ na-ekpo ọkụ & ncha -> Gbasaa mpekere / ọnya niile na mmiri 500 mL na-agbanye mmiri + Povidone-Iodine / Chlorhexidine -> Ghichaa anya na-adịghị mma 0.9% saline."]
    C --> D{"Onye ahụ ọ loro mmiri ruru unyi, mikpuo isi ya, ma ọ bụ kpughee mkpụcha/ọnya/ihe ọkụ ọkụ?"}
    D -->|"EE: Mmiri loro, imikpu isi, ma ọ bụ ọnya akpụkpọ ahụ mepere emepe"| E["Ndụmọdụ nlekọta ahụike otu ụbọchị / ngwa ngwa (n'ime awa 24-72): 1. Tdap Tetanus Booster (ma ọ bụrụ> 5 yrs kemgbe dose ikpeazụ) 2. Kwurịtara Doxycycline 200 mg PO x1 Leptospirosis PEP (mmiri ọhụrụ / ime obodo) 3. Ịba ọcha n'anya n'ime ụbọchị ịgba ọgwụ mgbochi ọrịa 14 PEP"]
    D -->|"Mba: Mfesa dị mkpirikpi na naanị akpụkpọ ahụ adịghị emebi emebi, saa ya ozugbo"| F["Nyochaa akpụkpọ ahụ na okpomọkụ maka ụbọchị 30; kpochapu ụgbọ mmiri / ngwa / wetsuit nwere 0.1% sodium Hypochlorite (1:50 bleach) ma ọ bụ Quaternary Ammonium"]
    E --> G{"Nyochaa maka Ọkọlọtọ uhie na-acha uhie uhie gafere ụbọchị 1 ruo ụbọchị 30"}
    F --> G
    G -->|"Oge awa 12 ruo 72: Ọzịza anụ ahụ na-acha uhie uhie/acha odo odo na-agbasa ngwa ngwa, oke mgbu na-enweghị oke ka ịkpụ, ma ọ bụ bullae."| H["Ngalaba Mberede ozugbo: Onye a na-enyo enyo Aeromonas hydrophila (mmiri ọhụrụ) ma ọ bụ Vibrio vulnificus (brackish / saltwater) Necrotizing Infection -> IV Ceftriaxone/Cefepime + Doxycycline + Ndụmọdụ ịwa ahụ"]
    G -->|"Ụbọchị 1 ruo 10: Mgbawa mmiri na-agbawa agbawa ma ọ bụ nke ọbara, ọgbụgbọ, ọnya afọ"| I["GI Pathogen Workup: Oral Rehydration Salts (ORS) -> Stool PCR (STEC O157: H7, Salmonella, Campylobacter, Cryptosporidium, Giardia) -> Zere ọgwụ antimotility (Loperamide) ma ọ bụrụ na afọ ọsịsa / ahụ ọkụ"]
    G -->|"Ụbọchị 2 ruo 30: oké ahụ ọkụ mberede, nnukwu nwa ehi/azụ myalgia, anya uhie (conjunctival suffusion), jaundice, mmamịrị gbara ọchịchịrị, ma ọ bụ mkpụmkpụ ume."| J["Ngalaba Mberede ozugbo: A na-enyo enyo Leptospirosis / Ọrịa Weil -> Blood / Urine PCR + MAT Serology, Renal / Hepatic Panel -> Malite Doxycycline ma ọ bụ IV Ceftriaxone ozugbo tupu nkwenye ụlọ nyocha."]

Nkebi nke 1: Otu esi jupụta n'ọwa mmiri jikọtara ọnụ (CSO) Na-arụ ọrụ & Ihe kpatara "Iwu 48 ruo-72-Hour Post-Rain" dị¶

Ihe karịrị obodo 700 dị na United States *** (gbadoro na Northeast, Great Lakes, Midwest, na Pacific Northwest, dị ka New York City, Chicago, Boston, Philadelphia, Washington D.C., Seattle, Portland, St. Louis, na Indianapolis), yana nnukwu obodo n'ofe ** United Kingdom (London Thames Tideway, Manchester, Vancouver, Glasgow)**ToCanada,**ToCanada,ToCanada. Europe (Paris Seine, Berlin Spree), dabere na narị afọ nke 19 na mmalite narị afọ nke 20 ** Ngwakọta Ọwa mmiriCSS).

1. The Hydraulic Physics nke a CSO Onye na-achịkwa Weir¶

• ** Igwe mmiri na-efe efe:** N'oge ihu igwe kpọrọ nkụ, pasent 100 nke nsị ọcha nke ụlọ (ụlọ mposi, sink, ụlọ ọgwụ, ebe a na-emeputa ihe) na-esi n'otu paịpụ gaa na ** Osisi Ọgwụ Na-ekpofu ahịhịa (WWTP)**.
• ** Iju mmiri na-ejubiga ókè (> 0.5 to 1.0 inch / 1.3 to 2.5 cm nke mmiri ozuzo):** N'ihi na mmiri ozuzo na-agbapụta mmiri n'okporo ámá na-abanye n'ime ** kpọmkwem otu ọkpọkọ dị n'okpuru ala **, oke mmiri ozuzo na-abawanye ụda ọsọ ọsọ **10- ruo 50-fold *** n'ime nkeji iri abụọ.
• ** The Relief Weir:** Iji gbochie ụlọ ọrụ ọgwụgwọ idei mmiri ma kwụsị nsị nsị ka ọ na-agbawa n'ime ụlọ mposi ndị bi, ihe mgbochi mmiri n'okpuru ala ** mgbagha (dam).regulator weir ma ọ bụ tide gate*** na-awụfu oke mmiri a gwakọtara ọnụ, nke gụnyere ** raw, enweghị enyo, mmiri nsị mmadụ na-enweghị chlorin nke agwakọtara yana mmiri na-asọpụta n'okporo ụzọ mepere emepe ***, na-esi n'akụkụ osimiri ma ọ bụ n'akụkụ osimiri **CSO ọkpọkọ na-apụ apụ ***.
• ** Ọwa mmiri na-ejubiga ihe ókè (SSOs) n'obodo ndị dị iche iche:** Ọbụlagodi n'obodo ndị ọhụrụ nwere oke mmiri ozuzo na ọkpọkọ ịdị ọcha dị iche iche, oke mmiri ozuzo na-abanye n'ime mmiri dị n'okpuru ala (Mbabata na ntinye).I&I) ma ọ bụ kụpụ nfuli ọdụ ụgbọ mmiri eletrik, na-eme ka mmiri mmiri na-asọ asọ (Sanitary Sewer).SSOs** nke na-esi n'olulu mmiri na-asọpụta ozugbo banye n'ọwa mmiri na ọdọ mmiri.

2. Gịnị mere mmiri ahụ ji dị ize ndụ n'ime awa 24 ruo 48 ka elu-igwe kpochasịrị?¶

Ndị na-egwu mmiri, ndị na-agba ọsọ triathletes, na ndị na-akwọ ụgbọ mmiri na-emehiekarị nke ịbanye n'osimiri ma ọ bụ osimiri n'ụtụtụ mgbe oké égbè eluigwe nwere n'ihi na anyanwụ na-enwu. ** Mgbe a CSO nkwụsịtụ agwụ, ụzọ mmiri na-anọgide na-emerụ emerụ ruo awa 48 ruo 72 (EPA / Ọhaneze Mmechi n'ụsọ osimiri)** n'ihi ihe atọ: 1. ** Fecal Coliform & Enterococcus Na-akwụsị Lag:** Mgbe ultraviolet kpọmkwem (UV) ìhè anyanwụ na mmiri doro anya na-eji nwayọọ nwayọọ eme ka nje bacteria kwụsị ọrụ, CSO A na-eju plumes na ** silt kwụsịtụrụ na turbidity organic *** (high Nephelometric Turbidity Units [NTU]) nke na-echebe nje bacteria, nje, na cysts protozoan pụọ na ìhè UV. 2. ** Ọdọ mmiri Tidal & Ọdọ mmiri Na-aga nwayọ:** N'ime osimiri ndị na-efe efe (dị ka Hudson, Potomac, Thames, ma ọ bụ Delaware) na ọdọ mmiri / ọdụ ụgbọ mmiri ndị mechiri emechi, mmiri na-abata na-eme ka mmiri na-asọpụta mmiri na-asọ asọ ** gbagoro elu **, na-agbada otu fecal uka azụ na azụ ụlọ ụgbọ mmiri na osimiri na-aga n'ihu ruo awa 6. 3. ** Mweghachi nke sedimenti dị n'okpuru: ** Nje virus na-abanye (Norovirus, Adenovirus, Hepatitis A) na Cryptosporidium oocysts na-ejikọta na ụmụ irighiri ụrọ dị arọ na-abanye n'ime mmiri na-emighị emeri ma ọ bụ ájá osimiri; mgbe ndị na-akwọ ụgbọ mmiri, ndị na-akwọ ụgbọ mmiri na-ebupụta shei ma ọ bụ nkịta na-akpalite sedimenti dị n'ala ala ụkwụ ka ụbọchị abụọ gachara, ha na-eweghachite nje na-efe efe gbanyere mkpọrọgwụ.

Nkebi 2: Ọrịa 6 dị oke egwu dị na Raw CSO Mmiri (Mbabata, ihe ngosi na ọgwụgwọ akọwapụtara)¶

Mgbe onye ọrịa na-amalite ọrịa mgbe CSO ma ọ bụ imikpu mmiri idei mmiri, ndị dọkịta ga-amata ọdịiche dị n'etiti ** klaasị nje nje isii dị iche iche ** nwere usoro oge nnabata dị iche iche yana ọgwụgwọ antimicrobial:

Nkebi nke 3: Usoro-Szọụkwụ ga-esochi-imikpu Protocol (mmadụ, ngwa na anụ ụlọ)¶

1. Mmebi ahụ mmadụ (The First 30 Minutes)¶

Ọ bụrụ na ị daa n'ụgbọ mmiri kayak, ịkwọ ụgbọ mmiri, ma ọ bụ ụgbọ mmiri, daa n'ọdụ ụgbọ mmiri, ma ọ bụ na-egwu mmiri n'ụzọ mmiri n'oge ụgbọ mmiri. CSO / SSO ndụmọdụ: 1. ** Ọnụ, imi, na anya mbụ (N'ọdụ ụgbọ mmiri ma ọ bụ ụgbọ ala):** - Gbasa ọnụ, E ilo: Wepụ mmiri ọ bụla ozugbo n'ọnụ gị. Jiri mmiri karama kpochaa ọnụ gị nke ọma wee gbụọ ọnụ mmiri, wee swish 15 to 20 mL ọgwụ antiseptik ọnụ (0.12% Chlorhexidine ma ọ bụ Listerine / cetylpyridinium chloride) maka 30 sekọnd wee gbụọ ọnụ mmiri. - Anya: Wepu anya abụọ na sterile 0.9% pọd mmiri nku anya sodium chloride (100 to 250 mL per eye) ka isi gi gbatuo n'akụkụ ka mmiri na-agbapụta ghara ịbanye n'anya nke ọzọ. - Imi: Jiri nwayọọ fesaa imi gị n'ihe a na-atụfu ihe. Ọ bụrụ na oke oke mmiri batara n'oghere imi, sachaa naanị sterile 0.9% saline spray (Efela mmiri mgbata esighị esi n'imi, n'ihi Naegleria fowleri / Acanthamoeba ize ndụ). - Ntị (Mgbochi Ntị Swimmer): Tụgharịa isi gị n'akụkụ nke ọ bụla iji wụpụ mmiri osimiri site na ọwa ntị, wee tinye ** 4 ruo 5 tụlee nke a. 1:1 ngwakọta nke 70% Isopropyl mmanya na mmanya ọcha (2% Acetic Acid) n'ime ọwa ntị nke ọ bụla * (ma ọ bụrụ na ị nwere oghere ntị gbawara agbawa ma ọ bụ tubes ntị) igbu * Pseudomonas aeruginosa* na Aeromonas. 2. ** Wepụ Gear n'ime akpa ekechiri ma were ịsa ncha nkeji iri:** - Wepụ uwe mmiri mmiri, akwa mmiri, akpụkpọ ụkwụ, na uwe aka ** gbadata wee pụọ n'ihu gị ** (wepụ ihe nchebe mmiri mmiri na ala na anya na ọnụ, ma ọ bụ buru ụzọ banye n'ime mmiri ịsa ahụ wee sachaa n'èzí uwe elu ahụ tupu ị dọba ya n'isi gị). - Jiri mmiri na-ekpo ọkụ na-agba ọsọ na ncha mmiri sachaa ahụ na ntutu gị dum (ma ọ bụ )4% Chlorhexidine Gluconate ịwa ahụ ** maka ụkwụ, aka, na anụ ahụ) maka opekata mpe ** 5 ruo 10 nkeji . 3. ** Mgbasa mmiri na-enwe nrụgide dị ukwuu na nlekọta na-emepe emepe: - Lelee aka gị (karịsịa ** nkwụ nkwụ na-akwọ ụgbọ mmiri), shins, nkwonkwo ụkwụ, na ụkwụ n'okpuru ìhè na-egbuke egbuke. - Jiri ** opekempe, kpochaa ịkpụ, ọnya, ma ọ bụ kpụchaa ọ bụla 500 mL nke mmiri pọmpụ mmiri ma ọ bụ saline na-adịghị mma** (use an 18-gauge catheter tip on a 35 mL syringe or poke a pinhole in a sterile water bottle cap to generate 7 to 15 psi irrigation pressure). - Tinye 10% Povidone-Iodine ngwọta ma ọ bụ 2% Ude Mupirocin/Bacitracin ma jiri akwa gauze na-adịghị na-eku ume kpuchie. ** Lelee ọnya ahụ kwa awa 6 maka awa 72 mbụ ***: ọ bụrụ na oke uhie na-aga n'ihu (draw a pen line around any redness), gaa na Ngalaba Mberede ozugbo.

2. Na-emebi Wetsuits, Jaketị ndụ (PFDs), Kayaks, Shell ịkwọ ụgbọ, na nkịta¶

• ** Shell ịkwọ ụgbọ mmiri, Kayaks, Oars na Hard Gear:** Efela ala a CSO-ụgbọ mmiri emetọọ nke nwere ihe nrụnye ike dị elu n'ogo isi (nke na-eme ka aerosolizes ** Norovirus ** na ** STEC * E. coli *** n'ime alụlụ inhalable nke na-emetụta onye ọ bụla nọ na ọdụ ụgbọ mmiri). Kama nke ahụ, yiri ** nitrile gloves na nchedo anya , jiri ** ncha na eriri ubi nwere obere nrụgide, wee jiri ** chịkọta ihe niile.0.1% Sodium Hypochlorite (1:50 mmiri ọcha ụlọ: 1/3 cup [80 mL] nke 5% to 6% ịcha ọcha kwa 1 gallon [3.8 L] nke mmiri) ma ọ bụ ** Ndepụta EPA N Quaternary Ammonium disinfectant ** nwere oge kọntaktị mmiri nkeji nkeji 10 **, na-esochi mmiri dị ọcha.
• ** Neoprene Wetsuits, Booties, na PFDs (Ebe ákwà na-emebi bleach):** Bleach na-eweda neoprene ma na-ebelata ịwepu uwe mkpuchi ndụ nylon. Tinye akwa mmiri na PFDs n'ime tub mmiri dị jụụ agwakọta ya na ** phenolic ma ọ bụ quaternary ammonium wetsuit/gear sanitizer (dị ka Steramine ma ọ bụ Revivex BCD/Wetsuit Sanitizer)** maka nkeji iri na ise, sachaa nke ọma, ma kwụba n'ime ** ìhè anwụ anwụ UV dị n'èzí** ka ọ kpọọ nkụ kpamkpam.
• ** Nkịta na-egwu mmiri ma ọ bụ ṅụọ mmanya CSO Mmiri:** Nkịta na-enwekarị ike ibute Leptospirosis na-egbu egbu na Giardia / * Campylobacter * enteritis** (ọbụlagodi nkịta gbara ọgwụ mgbochi leptospirosis nwere ike ọ gaghị ekpuchi ya megide serovars oke obodo niile). Yiri uwe mgbochi mmiri, eriri na ncha ntutu n'èzí na ** chlorhexidine pet shampoo ** (na-ewepụ ncha n'anya), kpochaa pas na afọ ha, ** gbochie ha ịracha ajị mmiri mmiri, kpọọ dọkịta gị ozugbo jụọ maka ** Oral Doxycycline / Amoxicillin prophylaxis** ma ọ bụrụ na nkịta na-aṅụ mmiri.

Enyemaka mbụ na ntuziaka ọrịa na-efe efe na ibe a bụ naanị maka ntuziaka mberede ma ọ dịghị mgbe edochi nyocha ahụike. Anyị na-akwado ka ị nweta akwụkwọ ikike ** enyemaka mbụ na nchekwa mmiri ** sitere na ** American Red Cross **, ** St John Ambulance **, ma ọ bụ obodo ** Red Cross ma ọ bụ Red Crescent ọha.

Nọmba mberede mpaghara na ụkpụrụ ụlọ ọrụ¶

• United States: Kpọọ 911 maka ahụike mberede ọ bụla (dị ka ọrịa Weil a na-enyo enyo ma ọ bụ ọrịa ọnya necrotizing). Mkpokọta nsị nke ọwa mmiri (CSOs) na oke mmiri ozuzoSSOs) bụ ndị U.S na-achịkwa ya. Ụlọ ọrụ nchekwa gburugburu (EPA* n'okpuru ** Iwu mmiri dị ọcha (NPDES Mmemme ikike, 1994 CSO Control Policy, na 40 CFR 122.38 Iwu ọkwa ọkwa ọha maka nnukwu ọdọ mmiri)**. *EPA na-achịkwa mmechi mma mmiri osimiri ntụrụndụ BEACH Act Ngosipụta ịdị mma mmiri ntụrụndụ *** (nke na-akpalite ndụmọdụ n'ụsọ osimiri mgbe Enterococci gafere n'ụzọ geometric. 35 CFU/100 mL ma ọ bụ ọnụ ahịa ọnụ ọgụgụ statistical [STV] nke 130 CFU/100 mL ma ọ bụ *** E. coli karịrị ihe geometric pụtara 126 CFU/100 mL / STV nke 410 CFU/100 mL**). Kọsaara ndị obodo gị ihe mkpofu ahịhịa na-enweghị maapụ **311 / Line Utility Emergency Line ** na State Department of Environmental Protection.
• United Kingdom: Kpọọ 999 maka ihe mberede ahụike ma ọ bụ NHS 111 maka ndụmọdụ ahụike ngwa ngwa mgbe imikpu mmiri na nyocha leptospirosis / tetanus (na-ezo aka na ** UK Health Security Agency.UKHSA] / Ịkwọ ụgbọ mmiri Britain * Leptospirosis (ọrịa Weil) Nduzi***). Iji kọọ akụkọ mwụfu nsị ma ọ bụ azụ na-egbu n'osimiri ma ọ bụ osimiri, kpọọ ** Environment Agency 24-Hour Incident Hotline na 0800 80 70 60** (England), ** Natural Resources Wales na 0300 065 3000, ** SEPA na 0800 80 70 60 (Scotland), ma ọ bụ ** NIEA na 0800 80 70 60** (Northern Ireland). Lelee mwepu oke mmiri ozuzo dị ndụ site na Rivers Trust Sewage Map ma ọ bụ ** Ndị na-ahụ maka Ọsọ mmiri * Ọrụ Oké Osimiri na Osimiri dị mma ***.
• Canada: Kpọọ 911 maka ihe mberede ma ọ bụ 811 (HealthLink / Info-Santé / Health811) maka ndebanye aha nọọsụ 24/7 mgbe mkpughe mmiri nsị. Obodo CSO mkpesa na mmechi mmiri ntụrụndụ na-eso ** Health Canada * Ntuziaka maka ogo mmiri ntụrụndụ Canada *** (E. coli <= 200 CFU/100 mL geometric pụtara, <= 400 CFU/100 mL otu-sample kacha; Enterococci <= 35 CFU/100 mL geometric pụtara, <= 70 CFU/100 mL otu sample) na ** gburugburu ebe obibi na mgbanwe ihu igwe Canada (ECCC) Iwu Sistemụ Mmiri Na-ekpofu Mmiri*.
• European Union: Kpọọ 112 maka nlekọta ahụike mberede. A na-ahazi mmiri igwu mmiri n'ụsọ oké osimiri na nke ime obodo gafee mba ndị otu EU n'okpuru ** EU Bathing Water Ntuziaka (2006/7/EC** na ntụzịaka ọgwụgwọ mmiri n'ime obodo nke edegharịrịUWWTD***, nke nyere iwu ndụmọdụ mmetọ obere oge n'oge mmiri ozuzo CSO ihe omume dabere na **Intestinal Enterococci *** na *** Escherichia coli *** ọnụ ụzọ.
• Australia na New Zealand: Kpọọ 000 (Australia) ma ọ bụ 111 (New Zealand) maka ihe mberede. Mmemme nche osimiri EPA steeti (dị ka **NSW *Beachwatch *** na EPA Victoria Yarra Watch) na New Zealand's LAWA ( Land, Air, Water Aotearoa *Enwere m ike igwu mmiri ebe a? Mmiri ntụrụndụ ***. Hụ akwụkwọ ndekọ aha anyị na nọmba mberede.

Ajụjụ a na-ajụkarị¶

Ogologo oge ole ka oke mmiri ozuzo gachara ka osimiri, ọdọ mmiri, ma ọ bụ osimiri mepere emepe enweghị nchekwa maka igwu mmiri, kayak, ma ọ bụ ịkwọ ụgbọ n'ihi Combined Sewer Overflows (CSOs)?¶

Ụlọ ọrụ ahụike ọha (gụnyere US EPA, UK Environment Agency, Health Canada, na steeti Beachwatch mmemme) na-enye ndụmọdụ ịpụ na osimiri, ọdọ mmiri, ọdụ ụgbọ mmiri, na osimiri dị n'ụsọ oké osimiri dị nso na oké mmiri ozuzo ma ọ bụ CSO na-adaba ma ọ dịkarịa ala 48 ruo 72 awa mgbe oke mmiri ozuzo kwụsịrị. Ọbụlagodi mgbe anyanwụ pụtara n'ụtụtụ echi ya, silt kwụsịtụrụ na-echebe nje bacteria, Norovirus, na Cryptosporidium site na ìhè UV, na mmiri mmiri na-asọpụta n'akụkụ mmiri na-asọpụta n'elu mmiri na ala ruo 4 ruo 6 nke usoro mmiri ozuzo tupu ọnụọgụ nje alaghachi n'ọkwa dị mma.

Kedu ihe m ga-eme ozugbo ma ọ bụrụ na m dakpuo ma ọ bụ loda mmiri n'ime osimiri n'oge mmemme Mkpokọta Ọwa mmiri?¶

Ngwa ngwa gbapụ mmiri mmiri ọ bụla n'ebughị ụzọ were, sachaa ọnụ gị na mmiri a na-aṅụ karama, wee sụọ ma gbụpụ ọnụ mmiri na-egbu egbu (dị ka 0.12% chlorhexidine ma ọ bụ cetylpyridinium chloride) maka sekọnd 30. Jiri saline 0.9% sachaa anya gị, ịsa ahụ na mmiri ọkụ na ncha maka nkeji 10 n'ime nkeji iri atọ ka ịpụpụ mmiri ahụ, wee kpochaa ma kpochapu akpụkpọ anụ ọ bụla, ncha, ma ọ bụ ọnya ụgbọ mmiri na mmiri dị ọcha nke nwere nrụgide na povidone-iodine ma ọ bụ chlorhexidine. Kpọtụrụ onye dọkịta n'ime awa 24 ka ị kparịta ihe gbasara tetanus, prophylaxis ọgwụ mgbochi ịba ọcha n'anya, na otu dose Doxycycline (200 mg) leptospirosis prophylaxis.

Kedu ihe ịrịba ama mbụ ịdọ aka ná ntị nke Leptospirosis (ọrịa Weil) mgbe igwu mmiri ma ọ bụ ịkwọ ụgbọ mmiri n'ime mmiri dị ọcha emetọru?¶

Leptospirosis na-amalitekarị ụbọchị 5 ruo 14 (ihe dị ka ụbọchị 2 ruo 30) mgbe ekpughere ya na nnukwu ahụ ọkụ na mberede, oyi, isi ọwụwa, ọgbụgbọ, na ihe ngosi abụọ mara mma nke na-amata ọdịiche dị na ya site na influenza mgbe niile: oke mgbu akwara dị na ụmụ ehi na azụ azụ, na conjunctival suffusion (acha ọbara ọbara na-egbuke egbuke, anya ọbara na-enweghị odo). Ọ bụrụ na a naghị agwọta ya, pasent 10 ruo 15 nke ndị ọrịa na-aga n'ihu na-agba ọsọ na-adọ 2 (ọrịa Weil), nke jaundice na-acha odo odo, agba aja aja ma ọ bụ mmamịrị na-adịghị (nnukwu akụrụ ọdịda), meningitis, na ụkwara ọbara. Gwa dọkịta ụlọ mberede gị ozugbo gbasara mkpughe osimiri gị ma ọ bụ nsị mmiri ka ha nwee ike ịmalite Doxycycline ma ọ bụ IV Ceftriaxone ozugbo.

Kedu ihe kpatara mgbapu ma ọ bụ ọnya mepere emepe n'akụkụ mmiri mmiri na-ekpo ọkụ ma ọ bụ mmiri na-asọ oyi na-ekpo ọkụ bụ ihe mberede ozugbo ma ọ bụrụ na ọ na-acha ọbara ọbara ma na-egbu mgbu?¶

Mmiri na-ekpo ọkụ, estuarine, na mmiri dị n'ụsọ oké osimiri nke mmiri ebili mmiri na mmiri na-asọpụta n'ọdụ ụgbọ mmiri Vibrio vulnificus meruru, ebe nsị mmiri na-asọba n'ọdụ ụgbọ mmiri Aeromonas hydrophila. Nje bacteria abụọ ahụ nwere ike ịwakpo obere akpụkpọ anụ, ịkpụ oporo, ma ọ bụ ọnya ịkwọ ụgbọ mmiri ma kpalite necrotizing fasciitis n'ime awa 12 ruo 48. Ọ bụrụ na ọnya ọ bụla ekpughere n'osimiri ma ọ bụ mmiri osimiri na-etolite ngwa ngwa na-agbasa ọbara ọbara, ọzịza, ahụ ọkụ, odo odo ma ọ bụ ọbara jupụtara na blisters (bullae), ma ọ bụ oké mgbu n'ogo nha nke ịkpụ, gaa na ngalaba mberede ụlọ ọgwụ ozugbo maka ọgwụ nje na-agba ọsọ na nyocha ịwa ahụ.

Ntuziaka emetụtara¶

• Ike nsị nke ịdị ọcha bụ isi mgbawa, geyser nsị mmiri dị n'okporo ụzọ, yana mmechi valvụ azụ
• Ọwa mmiri isi na-ejupụta na idei mmiri n'okporo ámá
• Isi nkwụsị mmiri na-esi mmiri n'obodo dum
• Aṅụla ihe vs. ndụmọdụ mmiri esi mmiri: mmetọ kemịkalụ ma ọ bụ mmanụ ụgbọala na mmiri mgbata
• Oke idei mmiri

Isi mmalite na nduzi ọchịchị¶

• ** U.S. Ụlọ ọrụ nchekwa gburugburu (EPA):** Mkpokọta ọwa mmiri na-ejupụta (CSO) Amụma nchịkwa (59 FR 18688), NPDES Ọha Ịma Ọhaneze chọrọ maka ikpokọta ọwa mmiri na-asọba na nnukwu ọdọ mmiri (40 CFR Part 122), na ihe ntụrụndụ ogo njiri mara (EPA 820-F-12-058: Enterococci & E. coli Thresholds).
• ** Ụlọ ọrụ maka Nchịkwa na Mgbochi Ọrịa (CDC) & World Health Organization (WHO): ** * Ntuziaka Clinical Leptospirosis maka ndị na-enye nlekọta ahụike (Doxycycline 200 mg Mgbochi Mgbochi Mgbasa Ozi & Ọgwụgwọ Ọrịa Weil), Vibrio vulnificus & Aeromonas Nlekọta ọnya na Iju mmiri/mmiri nsị, yana ACIP Ntuziaka Prophylaxis Post-Exposure maka ịba ọcha n'anya A na Tetanus*.
• ** Ụlọ ọrụ nchekwa ahụike UK (UKHSA), Environment Agency (EA), & Ịkwọ ụgbọ mmiri Britain: *** * Leptospirosis (ọrịa Weil): Nduzi nchekwa nchekwa mmiri nke ụlọ ọgwụ na nke ntụrụndụ maka ndị na-anya ụgbọ mmiri, ndị na-egwu mmiri, na ndị na-egwu mmiri na-emeghe, na nleba anya ogologo oge omume (EDM) Ụkpụrụ mkpesa oke oke mmiri ozuzo*.
• Health Canada: * Ntuziaka maka ogo mmiri ntụrụndụ Canada (Mbipụta nke anọ: Microbiological Pathogens, Ngwakọta ihe ize ndụ nke oke mmiri ozuzo, yana ndụmọdụ ndụmọdụ mmiri ozuzo gachara 48-hour)*.
• ** Ọrịa na-efe efe Society of America (IDSA):** * Usoro ọgwụgwọ ọgwụgwọ maka nchọpụta na njikwa nke ọrịa anụ ahụ na anụ ahụ dị nro (Mmetụta ọnya mmiri: Aeromonas hydrophila, Vibrio vulnificus, na Mycobacterium marinum) na ọrịa ọsịsa na-efe efe (STEC O157:H7 Ihe mgbochi mgbochi)*.