Yakasanganiswa Sewer Kufashukira (CSO) MuNzvimbo yeRwizi, Lake, kana Beach Mushure meKunaya Kwemvura Yakanyanya: Mapathogen eSewage Yakasvibirira, Leptospirosis, uye Post-Immersion Decontamination.¶

Kana mabhanan’ana muzhizha, kunaya kwemvura kunopisa, kana kukurumidza kunyungudika kwechando kunorasa masendimita anopfuura 1.5 kusvika 2.5 (0.6 kusvika 1.0 inch) yemvura paawa muguta rekare rinoshandirwa ne Combined Sewer System (CSS), masisitimu ekuchenesa mvura yetsvina haigone kubata kusanganiswa kwemvura yemumugwagwa netsvina yemumba. Kuchengetedza tsvina yetsvina kubva mukukwira muzviuru zvedzimba dzepasi nemigwagwa yemuguta, otomatiki hydraulic relief weirs (Combined Sewer Overflow [CSO] madhiri) anovhurika munzizi dzemumaguta, migero inokwasva, zviteshi, nemahombekombe ekutuhwina, achibudisa mamiriyoni emarita etsvina yevanhu isina kucheneswa, tsvina yemuchipatara, inoyerera mumaindasitiri, nemvura yemumugwagwa ine makonzo-weti yakananga mumigwagwa yekutandarira kwemaawa 24 kusvika ku72 mushure mekunge mvura yamira. Kana kayaker, rower, triathlete, surfer, angler, mushandi wekununura mafashama, kana chipfuyo chakanyura murwizi, nyanza, kana mahombekombe egungwa panguva kana mukati maawa makumi mana nemasere CSO kubuda, vanotarisana nekukasira ku** leptospirosis (* Weil's disease*)**, enterotoxigenic Escherichia coli (STEC O157:H7), norovirus, hepatitis A, Cryptosporidium, uye Vibrio vulnificus / Aeromonas hydrophila necrotizing soft-tissue infections. Fonera nhamba yako yemunharaunda yechimbichimbi (911 muUnited States neCanada, 112 mhiri kweEuropean Union, 999 muUnited Kingdom) kuburikidza neyedu. nhamba dze emergency dhairekitori kana paine munhu anorwara nefivha yakanyanya, jaundice, red-purple skin bullae, kana kusagadzikana kwekufema mushure mekunyudzwa mumvura yetsvina, uye bvunza hama dzedu sanitary sewer force main rupture, raw sewage geyser mumugwagwa, nekuvharwa kwevharuvhu yekumashure, masuweji makuru mafashama uye mafashama emumigwagwa,uye citywide water main break and boil water.

Kupona kunyudzwa netsaona kana kutandara kusangana ne ** Yakasanganiswa Sewer Kufashukira (CSO)** kana Sanitary Sewer Kufashukira (SSO) plume inoda kuita zvirevo zvina zvakasimbiswa ne U.S. Environmental Protection Agency (EPA National CSO Kudzora Policy), iyo Centers for Disease Control and Prevention (CDC, iyo World Health Organisation (WHO), uye UK Health Security Agency (UKHSA): **kumanikidza 48-kusvika-72-awa mushure mekunaya kwemvura "No-Swim / No-Capsize" hwindo rezasi kwedhorobha CSO kubuda **, **kuita maminitsi gumi nemashanu kubva kumusoro kusvika kuzvigunwe zvinodziya sipo-nemvura shawa inoteverwa nekudiridza zvine simba guru (500 mL mvura inonwiwa kana sterile saline plus 2% Chlorhexidine kana Povidone-Iodine) yeganda rega rega, blister, kana leech / kurumwa netumbuyu bhakitiriya risati rapinda mudermis **, **kupuruzira maziso nemhino zvisina utachiona. 0.9% saline pasina kushandisa mvura yepombi mukati memhino **, uye ** kukumbira kunangwa mushure-kufumurwa kuongororwa kwekurapa (Doxycycline 200 mg single-dose leptospirosis prophylaxis, Tdap tetanus booster, uye Hepatitis A vaccine/immunoglobulin mukati memazuva gumi nemana) apo kunyudzwa kwepamusoro-soro kana kunyudzwa kwemaronda akazaruka kunoitika **.

Ita izvi ikozvino¶

1. Buda Mumvura Pakarepo Kana Ukaona Kana Kunhuwa CSO Outfall Indicators: Brownish-Grey Plumes, Anoyangarara "Sewage Litter" (Wet Wipes, Tampon Applicators, Makondomu), Surface Foam/Grease Slicks, kana Gulls Diving paPipe Yakanyura. Madhorobha mazhinji CSO madhamu anonyura pazasi pemvura yenzizi, madziva, nemahombekombe uye inotanga kubuda mukati me15 kusvika 30 maminetsi emvura zhinji. Kana dutu rikarova paunenge uchikwasva, kayaking, paddleboarding, kana kushambira, kana kana manispala wako CSO mepu yekuzivisa inoratidza kushanda kana kuchangobva kubuda (within the past 48 hours), buda mumvura nekukasika, chengeta muromo wako wakavharika kuti wake pfapfaidzo isarove pamuromo wako, uye usageza maoko ako kana kumeso murwizi.
2. Ita "First-30-Minutes Mucous Membrane & Shower Decontamination" Usati Wadya, Wanwa, Kana Kubata Kumeso Kwako. Usati wabata bhodhoro remvura, snack, foni, kana chidhiraivho chemota, geza maoko ako ne 60% to 70% doro gel (ona kuti gel doro rinouraya mabhakitiriya akaita se E. coli uye Leptospira, asi HAAurayi Norovirus kana Cryptosporidium oocysts, unofanira kugeza ne friction nesipo). Bvisa masutu ese akanyorova, magadhi anogadzika, mabhachi ehupenyu (PFDs), neshangu dzemvura kunze kana mubhegi remarara epurasitiki, nyatsogeza nemvura inodziya inonwiwa nesipo inorwisa utachiona kwenguva ingangoita maminitsi mashanu kusvika gumi, wofuridzira mhino dzako nekupfira mate pane kumedza madhip epamhino.
3. Diridza Chese Chechekwa, Rower's Blister, Scrape, or Bug Bite Under High-Pressure Running Water for 5 Full Minutes, Isa Povidone-Iodine kana Chlorhexidine, uye USAFAMBA Kana Kuvhara kana Tepa Ronda Rinobuditswa Netsvina Zvakasimba. Kunyange mabrasions eganda asingaonekwi (zvakadai semabhurangi, marevhisi eganda, marevhisi kana maronda epamazamu. bare-foot shell scrapes) inoshanda seyakananga masuo ekupinda e Leptospira spirochetes , Aeromonas hydrophila, uye Vibrio vulnificus. Geza uye geda pese pakaputsika paganda nesipo uye nemvura inoyerera (kana a 500 mL bhodhoro resaline risingabereki rakabayiwa kuti risvitse rukova rwakamanikidzwa), shandisa 10% Povidone-Iodine (Betadine) kana 2% to 4% Chlorhexidine Gluconate ( Hibiclens), uye vhara nepedhi inofema isingabereki gauze ( usambofa wakasunga ronda rine tsvina ine tsvina ine cyanoacrylate liquid ganda guruu kana twumashavishavi twakaoma, izvo zvinoteya anaerobic uye necrotizing mabhakitiriya mukati **).
4. ** Kana Mvura yeRwizi kana yeBeach Sewage Ikapfapfaidza Mumaziso Ako kana Mumuromo: Svitsa Meso NeSerle 0.9% Saline kwemaMinutes mashanu kusvika ku10, uye Shamba Muromo Wako neAntiseptic Mouthwash Usingamedze.** Usakwesha maziso ane tsvina yetsvina (anokuya silt uye Adenovirus / Acanthamoeba mucornea); diridza maziso ose newash yemaziso isina munyu. Rova uye pfira **0.12% Chlorhexidine kana doro / cetylpyridinium antiseptic mouthwash ** kwemasekonzi makumi matatu kuderedza muromo mucosal viral uye bacterial load.
5. Bata Chiremba kana Urgent Care Clinic mukati memaawa makumi maviri nemana Kana Wamedza CSO Mvura kana Kunyudza Ronda Rakavhurika: Bvunza Nezve Doxycycline Leptospirosis Prophylaxis, Tdap Tetanus Booster, uye Hepatitis A Post-Exposure Prophylaxis. Pasi peCDC / WHO nhungamiro yekiriniki, kunyudzwa kwetsvina yemvura ine njodzi huru (kunyanya kunyura nemvura kana kubuda maronda akazaruka munzizi dzomumaguta dzine weti yemakonzo) kunoda kuti tifungisise ** dozi rimwechete remuromo. Doxycycline 200 mg post-exposure prophylaxis (PEP) mukati me24 kusvika kumaawa 72 ** kudzivirira leptospirosis, Tdap / Td tetanus booster kana pfuti yako yekupedzisira yaive makore anopfuura 5 apfuura nekuda kweronda rakasviba, uye dosi rimwe chete reHepatitis A vaccine (pamwe chete IG kana immunocompromised) mukati memazuva gumi nemana kana asina kubaiwa.
6. ** Tarisa kune "Two-Phase" Red Flags Pamusoro peInotevera 2 kusvika 30 Mazuva: Rapid Cellulitis (12 to 72 Hours) vs. Leptospirosis / Weil's Disease (5 to 14 Days).** Enda kuChipatara Emergency Department nekukasika uudze chiremba wechitatu "Ndakanyura muRwizi rwakasanganiswa Sewer Overflow river/beach on [Date]" kana ukakura (A) Kukurumidza kupararira dzvuku/pepuru kuzvimba kweganda, kurwadziwa kwakanyanya kusaenzana nekuchekwa kudiki, kana mabhunu akazadzwa neropa mukati memaawa 21*2 necrotizing fasciitis), KANA ** (B) Kupisa kwakanyanya, mhuru yakanyanyisa / pasi-musana-musuru aches, maziso eropa (conjunctival suffusion isina pus), maziso eyero / ganda (jaundice), weti yakasviba, kana kukosora ropa 2 kusvika kumazuva makumi matatu gare gare ** (Leptospirosis / Weil's disease).

Muti wesarudzo: Yakasanganiswa Sewer Kufashukira (CSO) kunyudzwa decontamination & kurapwa triage¶

flowchart TD
    A["Munhu kana Chipfuwo Chakanyura kana Kunyura muRwizi, Lake, Canal, kana Beach Munguva kana Mukati 48-72 Maawa Mushure meKunaya Kwemvura (CSO / SSO Chiitiko)"] --> B{"Pakarepo Danho 1: Decontamination Mukati 30 Maminitsi Ekubva Mvura"}
    B --> C["Bvisa giya rakanyorova kunze -> Shawa 5-10 min nemvura inodziya inonwiwa & sipo -> Diridza machekwa ESE ne500 mL mvura yakamanikidzwa + Povidone-Iodine / Chlorhexidine -> Meso anotsveya neyakaora 0.9% saline"]
    C --> D{"Munhu wacho akamedza mvura ine tsvina, akanyudza musoro wavo, kana kufumura mucheka wakavhurika / blister / rash?"}
    D -->|"EHE: Mvura yakamedzwa, kunyudzwa mumusoro, kana ronda reganda rakashama"| E["Same-Day Medical / Urgent Care Consult (Mukati 24-72 hrs): 1. Tdap Tetanus Booster (kana >5 yrs kubva padanho rekupedzisira) 2. Kurukurai Doxycycline 200 mg PO x1 Leptospirosis PEP (mvura yakachena / rwizi rwemuguta) 3. Hepatitis A mukati memazuva asina 1 PEP"]
    D -->|"HAPANA: Kupfapfaidza kupfupi paganda rakasimba chete, nekukasira kugezwa"| F["Tarisa ganda uye tembiricha kwemazuva makumi matatu; disinfecting chikepe/giya/wetsuit ine 0.1% Sodium Hypochlorite (1:50 bleach) kana Quaternary Ammonium"]
    E --> G{"Tarisa kune Acute Clinical Red Mireza Pamusoro peZuva 1 kusvika Zuva 30"}
    F --> G
    G -->|"Maawa 12 kusvika 72: Kukurumidza kupararira tsvuku / yepepuru ganda kuzvimba, kurwadziwa kwakanyanya kunze kwechiyero chekucheka, kana bullae"| H["BASI RACHINHU ZVINONYAMISA PANGUVA: Mufungidziro Aeromonas hydrophila (mvura yakachena) kana Vibrio vulnificus (brackish/saltwater) Necrotizing Infection -> IV Ceftriaxone/Cefepime + Doxycycline + Surgical Consult"]
    G -->|"Mazuva 1 kusvika 10: Kuputika kwemvura kana manyoka ane ropa, kurutsa, dumbu remudumbu"| I["GI Pathogen Workup: Oral Rehydration Salts (ORS) -> Stool PCR (STEC O157:H7, Salmonella, Campylobacter, Cryptosporidium, Giardia) -> Dzivisa antimotility zvinodhaka (Loperamide) kana ropa remanyoka / fivha"]
    G -->|"Mazuva 2 kusvika ku30: Kamwe kamwe kupisa kwakanyanya, mhuru yakakomba / musana myalgia, maziso matsvuku (conjunctival suffusion), jaundice, weti yakasviba, kana kupfupika kwekufema."| J["CHIKAMU CHINOKOSHA CHIKAMU CHINOKOSHA: Suspect Leptospirosis / Weil's Disease -> Ropa/Urine PCR + MAT Serology, Renal/Hepatic Panel -> Tanga Doxycycline kana IV Ceftriaxone PAMBERI PAMBERI PAMBERI PAMBERI PAMBERI SIMBA"]

Chikamu 1: Mafambisirwo eSewer Yakasanganiswa (CSO) Inoshanda & Nei iyo "48-to-72-Hour Post-Mvura Rule" Uripo¶

Anopfuura ** mazana manomwe emaguta eUnited States** (akatarisana kuNortheast, Great Lakes, Midwest, nePacific Northwest, akadai seNew York City, Chicago, Boston, Philadelphia, Washington D.C., Seattle, Portland, St. Louis, neIndianapolis), pamwe nemaguta makuru mhiri kwe ** United Kingdom (London Thames Tideway, Manchester, Glasgow, Vancouver, Vancouver, Vancouver, Canada*, Toronto, Vancouver, Vancouver, Canada* (Paris Seine, Berlin Spree) , vanovimba ne19th- uye yekutanga-20^th-century ** Yakasanganiswa Sewer Systems (CSS).

1. Iyo Hydraulic Physics ye CSO Regulator Weir¶

• Dry Weather Flow: Munguva yekuoma kwemamiriro ekunze, chikamu zana kubva muzana chetsvina yemumba (zvimbuzi, singi, zvipatara, madhini emumaindasitiri) inoyerera nepapombi imwe ichienda ku Wastewater Treatment Plant (WWTP).
• Kufashukira Kwemamiriro ekunze kwakanyorova (> 0.5 to 1.0 inch / 1.3 to 2.5 cm yemvura): Nokuti mabheseni anobatwa nedutu remumugwagwa anodyira mupombi yepasi pevhu chaiyo, dutu remvura zhinji rinowedzera kuyerera kwemvura 10- kusvika ku50-petatu mukati memaminitsi makumi maviri.
• The Relief Weir: Kudzivirira nzvimbo yekuchenesa kuti isafashame uye kumisa tsvina yetsvina kuti isaputika kubva muzvimbuzi zvinogara vanhu, dhamu repasi pevhu ** diversion dam (regulator weir kana tide gate)** inorasa kuyerera kwakawanda kwakasanganiswa, kunosanganisira mbishi, isina kucheneswa, isina chlorine tsvina yevanhu yakasanganiswa nekuyerera kwemudhorobha, yakananga kunze kwerwizi kana kumahombekombe egungwa **CSO mapombi anobuda **.
• Sanitary Sewer Inofashukira (SSOs) muSeparate Sewer Cities: Kunyangwe mumaguta matsva ane madutu akasiyana uye pombi dzehutsanana, mvura zhinji inonaya inopinda nekupaza mapombi epasi pevhu (Inflow and Infiltration [I&I]) kana kugogodza pombi dzekusimudza tsvina dzemagetsi, zvichikonzera Sanitary Sewer Overflows (SSOs) iyo inotubuka kubva mumakomba yakananga mumipata nemadziva.

2. Sei Mvura Ichiri Nengozi Maawa 24 kusvika 48 Mushure mekunge Denga Rakachena?¶

Vanoshambira, vanomhanya katatu, uye vakwasvi vanowanzokanganisa kupinda murwizi kana mumhenderekedzo yegungwa mangwanani pashure pemabhanan’ana makuru nokuti zuva riri kupenya. Mushure mea CSO kubuda kunopera, nzira yemvura inoramba yakasvibiswa zvakanyanya kwe48 kusvika maawa 72 (EPA / Public Health Beach Kuvhara Standard) nekuda kwezvikonzero zvitatu: 1. ** Fecal Coliform & Enterococcus Die-Off Lag:** Nepo yakananga ultraviolet (UV) chiedza chezuva mumvura yakachena zvishoma nezvishoma chinomisa mabhakitiriya, CSO plumes inoremerwa ne yakamiswa silt uye organic turbidity (high Nephelometric Turbidity Units [NTU]) inodzivirira mabhakitiriya, mavhairasi, uye protozoan cysts kubva kuUV mwenje. 2. ** Tidal Estuaries & Madhamu Anofamba Zvishoma:** Munzizi dzine mvura (seHudson, Potomac, Thames, kana Delaware) nemadhamu akakomberedzwa/zviteshi, mafungu ari kuuya anosundira pombi yetsvina yetsvina ** kumusoro kwerwizi**, ichikwenya mafecal mass kuseri nekumashure kuma 4 mabhoathouses kusvika kuma 4 mabhoathouses (6) maawa)**. 3. Bottom Sediment Resuspension: Mavhairasi eEnteric (Norovirus, Adenovirus, Hepatitis A) uye Cryptosporidium oocysts anosunga kune zvidimbu zvevhu zvinorema zvinogara murwizi rwusina kudzika kana jecha remumahombekombe; apo vafambi, vakwasvi vanokanda mateko, kana imbwa dzinomutsa dongo rinodzika mumakumbo mazuva maviri gare gare, dzinomisazve utachiona hwakazara.

Chikamu 2: The 6 High-Risk Pathogens muRaw CSO Mvura (Incubation, Clues & Specific Treatments)¶

Kana murwere aita chirwere mushure CSO kana kunyudzwa kwemvura yemafashamo, varapi vanofanira kusiyanisa pakati pemakirasi matanhatu akasiyana epathogen ane nguva dzakasiyana siyana dzekufukidzira uye nemishonga inorwisa utachiona:

Chikamu 3: Nhanho-ne-Nhanho Pashure-Kunyudzwa Decontamination Protocol (Munhu, Gear, uye Zvipfuwo)¶

1. Kusvibiswa kweMuviri Wemunhu (The First 30 Minutes)¶

Kana ukapidigura kayak, goko rekukwasva, kana chikepe chechikepe, ukadonha pachiteshi, kana kushambira munzira yemvura panguva CSO / SSO kuraira: 1. Muromo, Mhino, uye Meso Kutanga (PaBoat Dock kana Mota): - Spa, Usamedza: Chibva wasvipa chero mvura mumuromo mako. Sukurudza muromo wako nemvura yemubhodhoro inonwiwa wopfira, wobva waswish 15 to 20 mL mushonga weantiseptic mouthwash (0.12% Chlorhexidine kana Listerine / cetylpyridinium chloride) kwemasekonzi makumi matatu uye pfira. - Maziso: Geza maziso ese neisina utachiona 0.9% sodium chloride eyewash pods (100 to 250 mL paziso) wakarerekera musoro nedivi kuitira kuti kuyerera kusapinde mune rimwe ziso. - Mhino: Vhura mhino yako zvinyoronyoro muchidimbu chinoraswa. Kana gobvu remurwizi gobvu rakapinda mumhino, sukurudza CHETE neisina utachiona 0.9% saline spray (usafe wakanyungudusa mvura yemupombi isina kubikwa mumhino , nekuda kwe Naegleria fowleri / Acanthamoeba njodzi). - Nzeve ("Swimmer's Ear" Prevention): Rereka musoro wako kudivi rega rega kuti ubvise mvura yemurwizi kubva munzeve, wozoisa madonhwe mashanu kusvika mashanu 1:1 musanganiswa we 70% Isopropyl Doro uye White Vinegar (2% Acetic Acid) mugero renzeve rega rega (kunze kwekunge uine dhamu renzeve rakaboborwa kana machubhu enzeve) kuuraya Pseudomonas aeruginosa ne Aeromonas. 2. Bvisa Giya Mubhegi Rakavharwa & Tora Sipo Yemaminetsi gumi: - Bvisa zvipfeko zvakanyorova, masututi emvura, bhutsu, uye magirovhosi ** bururudza uye kure nechiso chako ** ( dhonza maguard emvura akanyorova kubva pasi nekuchenjerera nemaziso nemuromo zvakavharwa zvakasimba, kana kupinda mumvura yekugeza kutanga uye wogeza kunze kwehembe usati waidhonza pamusoro wako). - Geza muviri wako wese nevhudzi nemvura inodziya inoyerera uye sipo yemvura (kana **4% Chlorhexidine Gluconate kukwesha ** kwemakumbo, maoko, uye torso) kweinenge ** 5 kusvika 10 maminetsi **. 3. Kudiridza Kwekudzvanya Kwemaronda & Chengetedzo Yekupfeka: - Ongorora maoko ako (kunyanya **mablister emuchindwe wevakwasvi **), mashini, zviziso zvemakumbo, netsoka pasi pechiedza chakajeka. - Geza zvese zvakachekwa, blister, kana kukwenya ne ** zvirinani 500 mL yemvura yakamanikidzwa inonwiwa kana sterile saline ** (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) - Shandisa 10% Povidone-Iodine mhinduro kana 2% Mupirocin / Bacitracin mafuta uye vhara nejira rakasununguka, rinofema risingabereki. ** Tarisa ronda pamaawa matanhatu ega ega kwemaawa makumi manomwe nemaviri ekutanga **: kana muganhu mutsvuku ukabuda kunze (draw a pen line around any redness), enda kuDhipatimendi reEmergency nokukurumidza.

2. Decontaminating Wetsuits, Life Jackets (PFDs), Kayaks, Rowing Shells, uye Imbwa¶

• Magomba ekukwasva, Kayak, Oars, uye Hard Gear: Usambofa wakapfapfaidza pasi a CSO-igwa rakasvibiswa rine simba guru rekushambidza simba kumusoro kwepamusoro (iyo aerosolizes ** Norovirus ** uye ** STEC * E. coli ** ** mumhute inoputika inobata munhu wose ari mubhotihouse bay). Pane kudaro, pfeka ** magirovhosi enitrile nekudzivirira maziso**, geza mbariro uye zvibatiso zvekukwasva ne detergent nepoipi yebindu ine simba shoma, uye chiponji pasi pese pese pekubata ne 0.1% Sodium Hypochlorite (1:50 imba bleach dilution: 1/3 cup [80 mL] ye 5% to 6% bleach per 1 gallon [3.8 L] yemvura) kana EPA Rondedzero N Quaternary Ammonium disinfectant ine **maminetsi gumi ekunyorova yekuonana nguva **, ichiteverwa neinosuka mvura yakachena.
• Neoprene Wetsuits, Booties, uye PFDs (Apo Bleach Inokuvadza Mucheka): Bleach inokanganisa neoprene uye inonetesa naironi life-jacket webbing. Soak wetsuits uye PFDs mubhabhu remvura inotonhorera yakasanganiswa ne ** phenolic kana quaternary ammonium wetsuit/gear sanitizer (yakadai se Steramine kana Revivex BCD/Wetsuit Sanitizer)** kwemaminetsi gumi nemashanu, nyatsogeza, uye kurembera mu ** yakananga kunze UV ​​chiedza chezuva ** kuti uome zvachose.
• Imbwa Dzaishambira kana Kunwa CSO Mvura: ** Imbwa dziri ** zvakanyanya kubatwa neacute fatal Leptospirosis uye * Giardia * / * Campylobacter * enteritis ** (kunyangwe imbwa dzakabaiwa kurwisa leptospirosis dzinogona kusavharwa kune ese emudhorobha serovars). Kupfeka magirovhosi asingapindi mvura, hosi neshampoo yekugeza imbwa panze nechlorhexidine pet shampoo** (inochengeta sipo kubva mumaziso), omesa makumbo nedumbu, dzidzivirire pakunanzva mvere dzakatota, uye fonera chiremba wemhuka nekukasika kuti akubvunze nezve muromo Doxycycline/Amoxicillin prophylaxis kana imbwa ichinwa mvura.

Rubatsiro rwekutanga uye mirairo yezvirwere zvinotapukira pane ino peji ndeyekutungamira kwechimbichimbi chete uye usambotsiva kuongororwa kwekurapa. Isu tinokurudzira kutora yakabvumidzwa ** Yekutanga Rubatsiro uye Mvura Yekuchengetedza kosi ** kubva ku ** American Red Cross **, ** St John Ambulance **, kana nyika yako ** Red Cross kana Red Crescent nzanga **.

Nhamba dzenharaunda dzechimbichimbi uye zvirongwa zveagency¶

• United States: Fonera 911 kune chero emergency emergency yekurapa (sekufungidzirwa chirwere cheWeil kana necrotizing ronda utachiona). Sewer Yakasanganiswa Inofashukira (CSOs) uye Sanitary Sewer Kufashukira (SSOs) zvinodzorwa ne U.S. Environmental Protection Agency (EPA) pasi peClean Water Act (NPDES Purogiramu yemvumo, 1994 CSO Control Policy,uye 40 CFR 122.38 Public Notification Rule yeGreat Lakes). Recreational beach water quality kuvharwa kunotongwa ne EPA BEACH Act Recreational Water Quality Criteria (izvo zvinotanga kuraira kwemahombekombe kana Enterococci inodarika zvinorehwa nejeometric 35 CFU/100 mL kana Statistical Threshold Value [STV] ye 130 CFU/100 mL, kana E. coli inodarika geometric zvinoreva 126 CFU/100 mL / STV ye 410 CFU/100 mL). Mhan'ara kuparara kwetsvina isina kurongwa kunanispala wako **311 / Mvura Utility Emergency Line ** uye State Department of Environmental Protection.
• United Kingdom: Fonera 999 nezve emergency zvekurapa kana NHS 111 yekukurumidzira mushure mekunyudzwa zano rekurapa uye leptospirosis/tetanus ongororo (ichitaura nezve UK Health Security Agency [UKHSA] / British Rowing Leptospirosis (Weil's Disease) Nhungamiro). Kuti utaure kubuda kwetsvina yakasvibirira kana hove kuuraya murwizi kana kumahombekombe, fonera Environment Agency 24-Hour Incident Hotline pa 0800 80 70 60 (England), Natural Resources Wales on 0300 065 3000, SEPA on 0800 80 70 60 (Scotland), kana NIEA pa 0800 80 70 60 (Northern Ireland). Tarisa mhenyu mafashama anoyerera kuburikidza ne Rivers Trust Sewage Mepu ** kana ** Surfers Kurwisa Sewage Safer Seas & Rivers Service.
• Canada: Fonera 911 kuitira emergency kana 811 (HealthLink / Info-Santé / Health811) ye24/7 yakanyoreswa mukoti triage mushure mekuratidzwa kwemvura yetsvina. Municipal CSO kuzivisa uye kuvharwa kwemvura yekuvaraidza kunotevera Health Canada's Nhungamiro dzeCanada Recreational Water Quality (E. coli <= 200 CFU/100 mL geometric zvinoreva, <= 400 CFU/100 mL imwe-sample yakawanda; Enterococci <= 35 CFU/100 mL geometric zvinoreva, <= 70 CFU/100 mL sampuli imwe chete) uye ** Zvakatipoteredza uye Kuchinja Kwemamiriro ekunze Canada (ECCC) Wastewater Systems Effluent Regulations**.
• European Union: Fonera 112 kuti uwane rubatsiro rwekukurumidzira. Mvura yekushambira yemahombekombe uye yemukati menyika dzenhengo dzeEU inodzorwa pasi pe EU Kugeza Mvura Direki.2006/7/EC) uye yakadzokororwa Urban Wastewater Treatment Directive (UWWTD), iyo inoraira kuraira kwekusvibisa kwenguva pfupi panguva yemvura yemadutu CSO zviitiko zvinobva ku Intestinal Enterococci uye Escherichia coli zvikumbaridzo.
• Australia neNew Zealand: Fonera 000 (Australia) kana 111 (New Zealand) kuitira emergency. Zvirongwa zveState EPA beach watch (zvakadai se NSW Beachwatch uye EPA Victoria Yarra Watch) uye **LAWA yeNew Zealand (Land, Air, Water Aotearoa *Ndinogona Kushambira Here Mvura Yekuvaraidza ***. Ona dhairekitori redu rakazara pa nhamba dze emergency.

Mibvunzo inowanzo bvunzwa¶

Inguva yakadii mushure memvura zhinji rwizi, dhamu, kana mahombekombe egungwa asina kuchengetedzeka pakutuhwina, kayaking, kana kukwasva nekuda kweCombined Sewer Overflows (CSOs)?¶

Masangano ehutano hweveruzhinji (kusanganisira U.S. EPA, UK Environment Agency, Health Canada, uye zvirongwa zveBeachwatch) vanokurudzira kugara kunze kwenzizi dzemumaguta, madhamu, zviteshi zvezvikepe, nemahombekombe egungwa pedyo nedutu kana kubuda kweCSO kweanenge maawa makumi mana nemasere kusvika makumi manomwe nemaviri mushure mekunaya kwemvura zhinji. Kunyangwe zuva parinobuda mangwanani anotevera, yakamiswa nhovo yejecha inodzivirira fecal bacteria, Norovirus, neCryptosporidium kubva kuUV mwenje, uye mafungu emvura mumikova anosundira mapombi etsvina kukwira nekudzika kwe 4 kusvika ku6 mafungu emvura isati yadzokera kune yakachengeteka.

Chii chandinofanira kuita nekukasika kana ndikapidigura kana kumedza mvura murwizi panguva yechiitiko cheCombined Sewer Overflow?¶

Pakarepo svipa chero mvura yerwizi usina kumedza, sukurudza muromo wako nemvura inonwiwa yemubhodhoro, uye geza nekupfira mushonga wekugeza mumuromo (se0.12% chlorhexidine kana cetylpyridinium chloride) kwemasekonzi makumi matatu. Geza maziso ako nesaline isina utachiona 0.9%, geza nemvura inodziya uye sipo kwemaminetsi gumi mukati memaminetsi makumi matatu kubva mumvura, uye korobha nekudiridza ganda rega rega rakachekwa, kukweshwa, kana blister remukwasvi nemvura yakamanikidzwa yakachena uye povidone-iodine kana chlorhexidine. Bata chiremba mukati memaawa makumi maviri nemana kuti ukurukure nezve tetanus booster, Hepatitis A vaccine prophylaxis, uye imwe-dose oral Doxycycline (200 mg) leptospirosis prophylaxis.

Ndezvipi zviratidzo zvekutanga zveLeptospirosis (Chirwere cheWeil) mushure mekushambira kana kukwasva mumvura ine tsvina yakasvibiswa netsvina?¶

Leptospirosis inowanzotanga 5 kune 14 mazuva (kusiyana kwemazuva 2 kusvika ku30) mushure mekusangana nefivha yakangoerekana yanyanya, kutonhora, musoro wakakomba, kusvotwa, uye zviratidzo zviviri zvinozivikanwa zvinozvisiyanisa kubva kune furuwenza nguva dzose: kurwadziwa kwakanyanya kwemisungo kunowanikwa mumhuru uye kumucheto kumashure, uye conjunctival suffusion (yakajeka isina tsvuku tsvuku, maziso eropa). Kana ikasarapwa, 10 kusvika 15 muzana yevarwere vanofambira mberi kuenda kuChikamu 2 (Weil's disease), inoratidzwa neyero jaundice, rima rakasvibira kana kuti usipo urini (acute itsvo failure), meningitis, uye kukosora ropa. Udza chiremba wako wepachipatara nekukasira nezve rwizi rwako kana mvura yetsvina-mvura kuitira kuti vatange Doxycycline kana IV Ceftriaxone ipapo ipapo.

Sei kuchekwa kwakavhurika kana blister kuratidzwa kune inodziya yegungwa kana brackish sewage inoyerera chiri chimbichimbi kana ikatsvuka uye ichirwadza?¶

Mvura inodziya ine brackish, estuarine, uye mvura yemumhenderekedzo yegungwa yakasvibiswa nemvura yemadutu netsvina inoyerera pachiteshi chengarava cheVibrio vulnificus, nepo pombi dzetsvina dzemvura yakachena dzinotakura Aeromonas hydrophila. Ose mabhakitiriya anogona kupinda mudiki diki ganda, kucheka oyster, kana kukwasva blister uye kukonzeresa necrotizing fasciitis mukati meawa gumi nemaviri kusvika makumi mana nemasere. Kana ronda ripi neripi rinosangana nerwizi kana mvura yemugungwa rikakura nekukasira kupararira hutsvuku, kuzvimba, fivha, ruvara rwepepuru kana kuti azere neropa mablister (bullae), kana kurwadziwa kwakanyanya zvisingaenderane nehukuru hweakachekwa, enda kuchipatara chedhipatimendi rekukurumidzira nekukasika unopihwa mishonga inorwisa mabhakitiriya uye kuongororwa kwekuvhiya.

Mazano anoenderana¶

• Sanitary seweji inomanikidza kuputika kukuru, geyser yakasvibirira yesuweji mumugwagwa, uye kuvharika kwevharuvhu yekumashure
• Sewer main mafashama uye mafashama emumigwagwa
• Guta rese mvura yekupwanya uye kufashaidza mvura
• Usanwe-inopesana neinofashaidza-mvura yambiro: kusvibiswa kwemakemikari kana mafuta mumvura yepombi
• Mafashamo anopenya

Nzvimbo uye nhungamiro yepamutemo¶

• U.S. Environmental Protection Agency (EPA): Combined Sewer Kufashukira (CSO) Control Policy (59 FR 18688), NPDES Public Notification Zvinodiwa zveCombined Sewer Inofashukira kuGreat Lakes Basin (40 CFR Part 122), uye Recreational Water Quality Criteria (EPA 820-F-12-058: Enterococci & E. coli Thresholds).
• ** Centers for Disease Control and Prevention (CDC) & World Health Organization (WHO):** Leptospirosis Clinical Guidance for Healthcare Providers (Doxycycline 200 mg Post-Exposure Prophylaxis & Weil's Disease Treatment), Vibrio vulnificus & Aeromonas Wound Management muMafashamo/Sewage Water, uye ACIP Post-Exposure Prophylaxis Guidelines for Hepatitis A neTetanus.
• UK Health Security Agency (UKHSA), Environment Agency (EA), & British Rowing: Leptospirosis (Weil's Disease): Clinical and Recreational Water Safety Guidance for Rowers, Paddlers, and Open-Water Swimmers, uye Chiitiko Chenguva Yekutarisa (EDM) Dutu Rinofashukira Kushuma Mazinga.
• Health Canada: Nhungamiro dzeCanadian Recreational Water Quality (4^th Edition: Microbiological Pathogens, Combined Sewer Overflow Risk Management, uye 48-Hour Post-Rainfall Advisories).
• Infectious Diseases Society of America (IDSA): Clinical Practice Guidelines for the Diagnosis and Management of Skin and Soft Tissue Infections (Aquatic Wound Infections: Aeromonas hydrophila, Vibrio vulnificus, uye Mycobacterium marinum) uye Infectious Diarrhea (STEC O157:H7 Antimotility Contraindications).