Topics A to Z

As part of NEHA's continuos effort to provide convenient access to information and resources, we have gathered together for you the links in this section. Our mission is "to advance the environmental health and protection professional for the purpose of providing a healthful environment for all,” as well as to educate and inform those outside the profession.


Restroom internal door handles have the potential to become contaminated by pathogenic bacteria, particularly because frequent breakdowns occur in hand hygiene. Cleaning these door handles periodically could reduce this cross-contamination risk. The sustained effect following cleaning with chlorhexidine could be beneficial in restroom facilities as cleaning episodes are of necessity at time intervals. The cleaning efficacies and residual effects of Sani Cloth CHG 2% wipes were investigated in a double-blinded randomized crossover controlled trial in a school setting. No significant difference occurred in initial cleaning efficacy; however, following a six-hour period of use by pupils of the restroom facilities, the internal door handles wiped with Sani-Cloth CHG 2% wipes were significantly less contaminated than those with the control wipe (14% v. 32%, p = .02). Cleaning with Sani-Cloth CHG 2% wipes demonstrated significant improvements in the continuous cleanliness of restroom door handles during use with this simple and inexpensive technique.

November 2015
November 2015
78.4 | 14-17
Holly Young, Zara Plumb, James Stevenson, Annabelle Tibbett
Additional Topics A to Z: General Environmental Health


We describe a 2016 community-wide recreational water-associated cryptosporidiosis outbreak investigation and response in Maricopa County, Arizona. Persons with a laboratory-confirmed illness were interviewed using a standardized questionnaire that assessed exposures 2 weeks before symptom onset. A convenience sample of managers and operators of chlorine-treated public aquatic facilities was surveyed regarding permanent supplemental treatment systems for Cryptosporidium. Among 437 cases identified (median age 12, range <1–75 years), 260 persons were interviewed. Public-treated recreational water was the most frequently reported exposure (177, 68%) of interviewed persons; almost 1 in 5 (43, 17%) swam when diarrhea was ongoing.

After the 2016 outbreak, managers of some facilities expressed intentions to install supplementary water treatment systems, and by May 2017, at least one large facility installed an ultraviolet light system. Strategies to prevent additional illness included community messaging, education, and targeted remediation of affected facilities on the basis of interviews. Challenges to remediation during a cryptosporidiosis outbreak in a large jurisdiction with primarily outdoor pools underscore the importance of promoting healthy swimming practices that help prevent contamination from occurring.


November 2018
November 2018
81.4 | 14-21
Sally Ann Iverson, MPH, DVM, Centers for Disease Control and Prevention, Maricopa County Department of Public Health, Nicole Fowle, MPH, LPN, Maricopa County Department of Public Health, Gregory Epperson, RS, Maricopa County Environmental Services Department, Jennifer Collins, MPH, Maricopa County Department of Public Health
Additional Topics A to Z: Recreational Waters


Most occupational research on firefighter exposure in the U.S. has been conducted in large urban cities with career firefighters. Over 70% of U.S. firefighters, however, are volunteers, a population overrepresented in small rural fire departments and thus under studied. We conducted three focus groups with individuals from eight fire departments in the Green River Firefighters Association fire protection district in northwestern Kentucky. Based on these focus groups, we developed a survey and administered it to 43 career and 187 volunteer firefighters at their annual fire training school. Based on their responses, we identified significant variables related to existing personal protective equipment (PPE) use, storage, and cleaning practices of firefighters. Except for storage, work practices related to the use of turnout gear (coats and pants) showed no significant difference between the two groups of firefighters. A majority of both career firefighters (85%, n = 16) and volunteer firefighters (59%, n = 57) stored their gear at the fire department (p < .05). Although turnout gear is the core component of PPE, 11% of the volunteer firefighters did not own turnout gear Both firefighter groups have a substantial challenge with respect to PPE practices. Career firefighters deal with more frequent exposures to fire-related contaminants during training and while on duty. In contrast, volunteer firefighters lack the resources needed to properly maintain, clean, and store their PPE, concerns that are not addressed by National Fire Protection Association recommendations.


December 2019
December 2019
82.5 | 8-14
Jooyeon Hwang, PhD, Department of Occupational and Environmental Health, Hudson College of Public Health University of Oklahoma Health Sciences Center, Ritchie Taylor, PhD, Department of Public Health, College of Health and Human Services, Western Kentucky University, Gretchen Macy, EdD, Department of Public Health, College of Health and Human Services, Western Kentucky University, Charles “Mac” Cann, MPH, Department of Public Health, College of Health and Human Services, Western Kentucky University
Additional Topics A to Z: Injury Prevention


Preventing lead exposure from all sources is critical for children’s optimal health and development. The crisis in Flint, Michigan, drew attention to the role of drinking water in lead exposure. School drinking water might pose significant risks due to aging infrastructure and the particular conditions of water use in schools. In 2016, New Jersey mandated that school districts test all drinking water outlets for lead and specified procedures that districts must follow. This study assessed compliance with this mandate. Districts were required to report results on their websites, so we used district websites as the unit of analysis to assess compliance with testing and reporting procedures and to identify schools that had reported maximum concentrations of lead in water. Most districts complied with the mandate to test their drinking water (90%) and the majority complied with online reporting requirements to some extent (87%). Most districts (79%) had one or more outlets in their district that exceeded the U.S. Environmental Protection Agency’s action level of 15 ppb. Mandated testing for lead in drinking water in schools is an important policy that can prevent childhood lead exposure. New Jersey should consider lowering the action level at which lead in drinking water should be remediated.


July 2019
July/August 2019
82.1 | 14-19
Marianne Sullivan, MPH, DrPH, William Paterson University of New Jersey, Marcos Lopez, William Paterson University of New Jersey
Additional Topics A to Z: Institutions / Schools


The Food and Drug Administration recommended restaurant inspection scores change to a format that incorporated three new categories of violations: priority, priority foundation, and core. It was uncertain whether interested consumers would value the more in-depth information or become more confused. The purpose of this study was to assess consumer perception of the recommended inspection system. Data were collected from an online survey. Results showed that consumers want convenient access to the information either online or on the wall of restaurants, and some consumers do want to read inspection reports and use them in making dining decisions. Choice of restaurant inspection format did appear to change consumer understanding and perceptions about some of the violations. Results also demonstrated the importance of the words used to categorize violations.

June 2017
June 2017
79.10 | 20-25
Jooho Kim, PhD, Jing Ma, PhD, Barbara Almanza, PhD, RD


The purpose of this study was to measure particulate matter (PM2.5) in pubs and bars prior to the adoption of a comprehensive, citywide smoke-free ordinance, as well as at multiple time points after adoption. Ten venues in a Southern U.S. city were measured at 1-month preordinance and at 1-, 3-, and 6-month postordinance. Air quality risk was determined by the U.S. Environmental Protection Agency’s Air Quality Index. Data revealed a statistically significant difference (p < .001; Eta2 = .889) in PM2.5 levels for the four time points. Air quality measurements showed that PM2.5 was 202.17 ± 97.89 (mean ± SD) at 1-month preordinance, 25.53 ± 14.18 at 1-month postordinance, 18.00 ± 8.43 at 3-month postordinance, and 10.77 ± 2.45 at 6-month postordinance. At the preordinance measurement, no venue was found to be in the “good” (minimal risk) range of the Air Quality Index; however, 100% of venues presented minimal air quality risk by the 3-month postordinance measurement. This study shows that adoption of smoke-free ordinances yields immediate reductions in health risks with continued air quality improvements up to 6-month postordinance (the last time point measured).


July 2018
July/August 2018
81.1 | 8-15
Ronald D. Williams, Jr., PhD, CHES, Department of Health and Human Performance, Texas State University, Jeff M. Housman, PhD, MCHES, Department of Health and Human Performance, Texas State University, Jennifer L. Evans, MEd, CHES, Department of Health Science, University of Alabama


Cooling towers have been linked to outbreak-related and nonoutbreak-related legionellosis. Proper cooling tower maintenance and disinfection are imperative for legionellosis prevention but not monitored in Allegheny County, Pennsylvania, which is a high incidence area. To investigate cooling tower maintenance and Legionella positivity, the Allegheny County Health Department (ACHD) performed a survey regarding the presence and maintenance of cooling towers and tested cooling towers for Legionella pneumophila (Lp). ACHD surveyed healthcare facilities, senior apartment buildings, and county-owned buildings.

Associations between maintenance practices and Lp were assessed using Wilcoxon rank-sum tests and multivariable linear regression. Of 408 building managers contacted, 377 (92%) completed the survey and 56 (15%) reported managing a building with a cooling tower. Among 42 cooling towers sampled, 20 (48%) tested positive for Lp. Factors associated with positivity included larger tower capacity, year-round usage, hospital status, and older tower age. Only cooling tower age was associated with Lp after stepwise regression.

Despite maintenance practices, many cooling towers were Lp positive. ACHD recommends that facilities develop a water management plan that is compliant with standards of the American Society of Heating, Refrigerating, and Air-Conditioning Engineers and also conduct annual basin water emptying, quarterly cleaning, and diligent inspection of older towers.


December 2018
December 2018
81.5 | 16-24
Lauren T. Orkis, MPH, CIC, Allegheny County Health Department, University of Pittsburgh, Kristen J. Mertz, MPH, MD and LuAnn L. Brink, MPH, PhD, Allegheny County Health Department, Maria M. Brooks, PhD, University of Pittsburgh, Robert M. Wadowsky, ScD, D(ABMM) and Stacy Gatto, Allegheny County Health Department
Additional Topics A to Z: Pathogens and Outbreaks
Jan|Feb 2014
76.6 | 48-54
Mubashir Ahmed, MBBS, MSc, Zafar Fatmi, MBBS, FCPS, Claudio J. Struchiner, Eduardo Massad, MD
Additional Topics A to Z: Hazardous Materials