TRANSCRIBED BY: Tupac, RJ
FAMILY MEDICINE AND COMMUNITY HEALTH
BY DR. BORJA
FAMILY MEDICINE: SCOPE AND PHILOSOPHICAL
STATEMENT
Family medicine- evolution of medical practices,
 first physicians were GENERALIST
 As medicine expands- physicians have specific
area of SPECIALIZATION
 World War II- AGE OF SPECIALIZATION
 After 2 decades:
# of specialist
# Of generalist
 The public is vocal about:
- Fragmentation of care
- Shortage of personal physicians who could
provide initial, continuing and
comprehensive care
Reorientation of medicine
(Personalized care)
 20 century: family medicine is specialty
th
- the reborn of the concept of GENERALIST
Family medicine (family practice): provides
continuing and comprehensive health care for the
individual and family.
 patient- physician relationship
- the center of the process
- context of family
 family physician and its characteristics
- first contact (physician)
- initial provider
- evaluates patients total health needs
- personal care within one or more fields of
medicine
- Comprehensive care which refers to
biological, behavioral or social
- preserve continuity of care
- expert in general family care
- provide comprehensive medical and
preventive care to individual and family
- skilled in primary care
1. health promotion
2. disease prevention
3. health maintenance
4. pt education & counseling
5. diagnosis & treatment of acute and
chronic illness
- convenient and accessible entry point to a
vast health care system (referral system)
o determine the specialist needed
for you
FAMILY PRACTICE, PRIMARY CARE AND
PRIMARY CARE PRACTICE:
FAMILY PRACTICE: is the medical specialty
which provides continuing and
comprehensive health care for the ind and
family.
- scope of family medicine:
1. all ages
2. both sex
3. organ system
4. every disease entity
- providers:
1. physicians
2. family nurses practitioners
3. physician assistants
- Family clinicians are patients advocate for
they possess a unique attitude, skills and
knowledge. They also have a specialize
TRANSCRIBED BY: Tupac, RJ

background with their interactions with the  Community medicine: specialty concerned
family. with health of specific population or group
focus on health of community.
PRIMARY CARE: The medical care delivered
with the pt and the community. Community Family
- traditional Medicine Medicine
- point of first contact Patient Community Ind and family
- works to establish health maintenance skills Setting Community -Community
base- clinic
o disease prevention
-Primary
o health education
health care
- the care provided by clinicians (hospital)
- includes health promotion, disease -home base
prevention, health maintenance, patient care (Hospice)
education , counseling , diagnosis and
treatment
Approach to -Bio- -Bio-
- performed and managed by
care psychosocial psychosocial
o physicians -health - pt center care
o assistant or nurse practitioners promotion, -Coordinate care
- provides advocacy in health care system to disease (health referral
accomplish COST EFFECTIVE CARE prevention, system)
- Promotes effective PT-PROVIDER treatment and
rehabilitation
COMMUNICATION and role of pt as partner
of disable
of their own heath care decisions. people in the
community
PRIMARY CARE PRACTICE: patient’s first point of entry
into health care system
- practice primary care in varied setting
- organized to meet need of pt Assessment Examination
through of pt
- located in the community
analysis of
- facilitates access to health care indicators,
- maintain a wide variety of specialty, surveys and
institutional consultative and referral community
relationship for specific care need wide sampling
- structure include:
1. physicians
Types of Diagnosis of pt
2. nurses health problem
3. physician assistants problems and
their
FAMILY MEDICINE VS COMMUNITY MEDICINE distribution
 Family medicine: specialty providing care to
ind and family.
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Health Health -community -Researcher

assessment of assessment dev. advocate -counselor
entire and -program -community
community maintenance manager leader/social
of an ind -health unit mobilize
manager
Treatment Treatment -researcher
based on according to Goals of Empowerment Cure and relief
community diagnosis, intervention Maximal Health
health preferences -participation promotion
problems, and resources in decision and wellness
priorities and of pt making Disease
resources -use of health prevention
Intervention Intervention resources Cost –effective
follow data usually follow Available and quality
analysis and patient Advocacy care
identification -initiated Shared care
in trends resources of with family
before pt enablement
recognized by Pt and family
the empowerment
community for health
interventions Activities/ -Variety of -Evidence
are more likely modalities educational, based care
to succeed for preventive or -Pharmaco-
with intervention interventions therapeutics
community such as school -supportive/
participation health non-pharmaco
Continued Follow- up programs, -health
surveillance observations immunization, education/
determines determine nursing home counseling
follow-up need for - community -works with
actions and continues organizing team
programs investigation -community -referral and
or treatment development networking
Quality of Population Clinical -trans/ inter-
care perspective perspective sectoral
-how health -how care of collaboration
care system clinicians
affect health affect health
of pop of ind
Practitioner Community Family
medicine physician
practitioner -health care
-clinician provider
-teacher
TRANSCRIBED BY: Tupac, RJ
PHYSICIAN AS SOCIAL MOBILIZER
-Edinburgh declaration: training of physicians and
review its relevance to the need of society
-Montebello Declaration: meeting of APMC, Medical
education meet health needs of society
EVOLVING ROLE OF PHYSICIANS:
WHO Five Star Role of Physicians:
1. CARE PROVIDER
2. DECISION MAKER
3. COMMUNICATOR
4. COMMUNITY LEADER
5. TEAM MEMBER
Filipino version of THE FIVE STARS:
1. HEALTH CARE PROVIDER
2. TEACHER
3. RESEARCHER
4. ADMINISTRATOR
5. SOCIAL MOBILIZER
PHYSICIAN AS SOCIAL MOBILIZER:
- SOCIAL means having to do with human
beings living together as a group that they
have to deal with one another.
- SOCIAL MOBILIZER: person who has the
ability to INFLUENCE people into collective
action towards a common goal.
- The physicals who is a social mobilize is a
ROLE MODEL in effecting change for the
improvement of society welfare.
- COMPETENCIES of a SOCIAL MOBILIZER:
1. Health Advocate
Educational implications:
a) concept and information regarding
determinant of health
b) inc awareness of COST-EFFECTIVE
health interventions
c) information about how policy decisions
are made, who are involve in process of
policy making and how physicians
contribute to the process
d) Encourage students to take direct
advocacy responsibilities for public
health issues.
2. Communicator/ Educator
Educational implication
a) comprehensive communication skills
b) more contact with people/patients
c) influence of effective communication,
negotiation skills and importance of
caring
d) spend more time in community
e) educational experiences with other
culture
f) more attention to humanities
g) consumer involve in curriculum
planning and evaluation process
3. RESOURCE MANAGER/ COMMUNITY
ORGANIZER
Educational implication
a) identify appropriate role of physicians
b) increase understanding of all
determinants of health and its
implications
c) students are important and integral
part of social and health system
4. COLLABORATOR
Educational implication
a) emphasize on competence in working
effectively with other health
professional
b) increase educational opportunities
c) emphasize role of patients
d) expose students to the needs and
resources of the community
e) identify new role models
MOBILIZING FOR HEALTH:
DOH GOAL:
- health for all Filipinoes by year 2000
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- health in the hands of the people by year c. when( time/season)

2020
 achieve by mobilizing all stakeholders of 2. Determinants; involves why/how and its causal
health (public or private) factors of a disease.
- the key in mobilizing is ALLIANCE BUILDING
- PARTNERSHIP and LINKAGES must be EPIDEMIOLOGIC TRIAD:
established and strengthened. AGENT
- it involves REACHING, TOUCHING AND
MOTIVATING PEOPLE in large numbers.
- It requires a SENSITIVE CITIZENRY, AWARE HOST ENVIRONMENT
BENEFICIARY AND COMMUNITY EAGER TO AGENTS OF DISEASE:
PARTICIPATE.
a. biologic agents
1. types of agent
ISSUES OF CONCERN a. bacteria
1. Natural resources deterioration b. virus
- natural resources can only support 100 c. rickettiae
million of people d. protozoa
2. the #1 cause of mortality is HEART e. metozoa
DISEASE f. fungi
- important factor is CIGARETTE SMOKING g. prions
3. physicians as ROLE MODELS and social 2. characteristics related to man:
mobilization a) ability to produce disease:
1. infectivity- infect/gain access
EPIDEMIOLOGY 2. pathogenicity- dose- disease
greek word epi(upon), Demos(population), 3. virulence- fatality; CFR
logy( study) 4. susceptibility: livable
- the study of the distribution and 5. antigenicity- antibodies
determinants of disease in a defined 3. characteristic related to environment:
population. (Brett Cassens) a. reservoir
- the study of distribution and determinants of 1. human
disease frequency (Bryant MacMahon) 2. soil
- study of factors that determine the 3. animals
occurrence and distribution of disease b. source of infection
(James Jeckel)

Epidemiologic concerns: 4. Mode of transmission

A. Direct transmission:
1. Distribution of health status: 1. Direct contact
a. who(host) 2. Droplet- 6ft
b. where(place) B. Indirect transmission
1. Vehicle
TRANSCRIBED BY: Tupac, RJ

2. Vector
3. Airborne CHAIN OF INFECTION
1. RESERVOIR- habitat, grow and multiply
5. physical agent: kinetic energy A. HUMAN: Can be
6. chemical agent- chemicals Person with symptomatic illness
7. nutrients – excess and deficient Carriers: no apparent disease
8. social and psycho stressors B. ANIMAL: - zoonoses
C. ENVIRONMENTAL: eg fungal
HOST 2. Portal of exit: path agent leaves the host.
3. mode of transmission
1. social traits 4. Portal of entry: same with exit. ( fecal oral, blood,
- acquires through life mucous membranes, vehicle)
- Solution: 1. modify lifestyle 2. vaccines 5. Susceptible host: herd immunity: vaccination of a
2. biologic traits population to protect others who are not
a. age vaccinated. Dec chance of spread of disease.
b. sex
c. race IMPLICATION
3. anatomical defenses 1. controlling agent: eliminate source
4. state of immunity: 2. mode of transmission: hand washing
1. Innate: all 3. vehicle: decontaminate
2. acquired: specific 4. airborne: ventilation/ filtration
a. active can be natural (dx)/artificial(vaccines) 5. vector: control
b. passive( mother) 6. Host: vaccines and prophylactic
3. humoral: antibodies
4. cell-mediated: specific cell Biologic spectrum of disease:
5. inherent resistance: sum total of body mechanisms  Iceberg phenomena: unseen cases may be
6. tolerance: person does not show signs (carrier) uncovered by case finding, the number of
7. allergy: reaction to a substance(allergen), role of unseen outweigh the seen cases.
histamine  clinical cases will end up:
8. state of nutrition: Dec= inc virulence a. recovery
b. death
ENVIRONMENT: c. carrier
- External conditions affecting life and  the more severe case the first to come
development.
1. physical environment: ENVIRONMENTAL HEALTH:
- seasonal distribution
- Humidity: Inc= Inc chance of survival 3 elements:
mosquitoes. 1. air
2. biologic environment: 2. water
- in some areas no vectors/ agent exist 3. land
3. social environment:
a. income  Human ecology: deals with cause and effect
b. education relationship of man and environment.
c. customs and belief  Environmental health: Control of all those
d. support network factors in man physical environment w/c
e. health practice and coping style
 all increase= No disease
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exercise or may exercise a deleterious effect 2. unconsolidated: sand, gravel or clay

on his development or health. 3. top soil: shallow, enriched organic ground
 public concerns:  Hydrology: study of water, its precipitations
1. sanitation and movement.
2. waste disposal -precipitation: rain, snow and hail is the
3. Insect &rodent control primary source of water in lakes, streams and
4. Pollution control well.
5. housing development Direct runoff- portion of precipitation that
appear in catchment area.
Ecological factors Transpiration: the process in water taken up
1. Physical environment: man need for survival. by plants return to the atmosphere.
2. biological: animals, plants and micro-org GROUND-WATER BEARING
3. social: interaction b/n man Aquifers: portions that yield usable quantities
of water.
Areas of environmental health concern 1. Unconfined: aquifers that is not overlain by
1. water an impermeable layer (aquiciude)
2. sanitation -channel like water flows.
3. solid and waste management Water surface (table)/ phreatic surface: top
4. food hygiene saturated zone of an aquifer. It has crest and
5. vermin control valleys.
6. air resources management 2. Confined aquifers: water bearing layers are
7. occupational health in b/n 2 less permeable layers.
-water flows like in pipes
- Piezometric surface: the height to w/c water
will raise penetrating confined aquifers
WATER SUPPLY -Artesian wells- w/c penetrates confined
- primary use of water is for drinking and aquifers.
food preparation
Medical concerns: WATER QUANTITY & CONSUMPTION
 water borne disease Inc. demand and use = Inc needs of man
 proper selection of sources
 operation and maintenance WATER QUALITY:
 Determinants
CLASSIFICATION OF WATER BORNE DISEASE a. NATURAL CONDITIONS: rain waters have
1. water borne disease: fecal contaminate the gen. characteristics of distilled water.
- eg. typhoid/ cholera As rain water flows into the land surface
2. water-washed: feces- mouth, lack of water for the quality of water change.
personal hygiene -runoff water from rocky area: clear,
- spread through water supplies alkaline and hard
3. water based dx: worm infections -forest water: acid, highly colored and
4. water related diseases: spread through vectors contains dissolved iron and manganese.
- Depend on water eg. Mosquito -shallow strata: moderately hard and w/o
special strata
HYDROLOGY AND GEOLOGY: -deeper strata: extremely hard and
 subsurface geology: contains salt/ sodium chloride.
1. consolidated: hard solids; stones
TRANSCRIBED BY: Tupac, RJ
-water quality is affected by temp and
presence of microorganism.
b. LAND USE AND TREATMENT: Poor land use
may lead to heavy runoff, erosion and
excessive sediments.
-land treatment: refers to the use of
chemicals which result in deleterious effect
on water quality in lakes and streams.
c. SEWAGE DISCHARGES: inadequate treated
sewage result in:
1. floating and settleable solids
2. consumption of oxygen with attendant
nuisances
3. bacterial contamination
d. WASTE DISCHARGES: this refers to industry
use. Most municipal sewage contains
industrial waste.
CHARACTERISTICD AND STANDARDS:
Water quality is measured by physical,
bacteriological, chemical, Microscopic and
radiological characteristics.
1. PHYSICAL: turbidity, color, taste, odor and
temp.
- presence of suspended materials (clay, salt
and ets) cause TURBIDITY
- turbidity and color are measured by
comparative analysis
- Taste and color are subjective; reported by
TRESHOLD NUMBER: which is the max
dilution of sample still producing taste and
odor.
- Desirable drinking water: consistently cool,
50-60 F.
2. BACTERIOLOGICAL:
- coliform organism: detection of fecal
pollution eg. E. col. it include all aerobic
facultative and gram neg anaerobic, non-
spore forming, rod shape w/c ferment
lactose @ 48 hours at 38 C.
- serve as indicator of contamination
LABORATORY PROCEDURES:
1. Membrane filter: direct count of total
coliforms and fecal coliform
adv: simple , result 18-20 hrs
2. Multiple tube fermentation: enumerate
positive presumptive, confirmed and
completed test. it gives the Most
Probable number(MPN)
-the concentration of coliforms in
untreated water is an indicator of the
degree of sewage pollution
Alternative methods:
PHC method: detection of Hydrogen sulfide production
done by adding water sample to PHC medium
(K2POH) in 30 ml bottle stand @ room temp for 24-
48 hrs.
- if solution is BLACK: contaminated
Autoanalysis Colilert: minimal medium ONPG-MUG
bacterial exam should be done every </= to 6 mons.
3. CHEMICAL: determines corrosiveness,
toxicity and degree of waste
contamination.
- natural water elements: sodium, chloride,
sulfate, fluoride, iron , manganese, nitrates,
copper and zinc.
- industrial and chemical pollution:
contamination by phenols, detergent,
carbon chloroform, selenium and silver
- ph in natural state: 5.5 to 9
a. alkalinity is cause by bicarbonate,
carbonate and OH
- hard water contains carbonate w/c retards
the cleaning action of detergents. when
heated deposits carbonate scale.
QUALITY BASE ON CHEMICAL
CONSTITUENTS:
1. DESIRABLE WATER: no contamination,
clear, odorless , tasteless, noncorrosive.
No deposition of solids.
2. Acceptable water: may have some
contaminant, have excess natural
constituents. no health hazard.
3. Unacceptable Water: real hazard.
TRANSCRIBED BY: Tupac, RJ
- physio-chemical exam of water conducted
every 12 months or often
4. MICROSCOPIC:
- algae common in surface water cause
unpleasant taste, odor and color.
- worms and amoeba common problem
5. RADIOLOGICAL:
-radium 223, iodine 131, strontium-90
are present in h20 in high
concentrations. main sources are
weapon test and waste disposal
(nuclear)
- exam conducted yearly
SANITARY SURVEY:
- refers to evaluation of water supply sources
and water treatment performance
- include are source of water, possible source
of pollution, type of development and
treatment needed and provided, adequacy
of distribution system and presence or
absence of cross or interconnections.
WATER SUPPLY DEV AND PROTECTION
Standard water quality are maintained by:
1. proper development and protection of source
2. adequate treatment and safeguarding
Philosophy: Prevention of Pollution
By: Multiple barriers (establish) b/n source
contamination and its consumer
it is exemplified by selection of best source,
development and protection of source from
contamination.
WATER SUPPLY SOURCES
1. air(rainwater): rainfall stored in cisterns
2. groundwater: stored in interstices of
consolidated and unconsolidated subsurface. it
is often superior in quality, less expensive to
develop and provide more supply. it can be
contaminated by toxic substance.
a. springs: ground water comes to surface and
flows freely under natural pressure
1. Shallow spring: containment of
downward movement of water by
impervious layer occurs. the impervious
layer breaks through the surface of the
ground. dry quickly and easy
contaminated
2. Deep spring: material both above and
below. Outflow of water occurs at the
point where the impervious containing
layer breaks. Temp is 50 to 60 F.
3. Limestone springs: outflow from solution
channels in limestone. protection from
superficial contamination by
construction of a watertight spring
basin with screened overflow pipe with
diversion ditches.
4. Wells: can be shallow, deep or may
come from consolidated or
unconsolidated material.
a. Dug well: hand dug. Shallow and
constructed with hand or machine.
Obtains water from upper layers of
unconsolidated material.
b. Driven well: develop by driving a
well point and pipe. Restricted in
sandy area, in ground water 12 to
20 feet below the surface of
ground. Can be develop @ bottom
of dug well.
c. Drilled wells: develop through going
beyond resistant material. Ground
water must be free from
contamination. Drilling of water
w/n 50 meters distance from a
cemetery is prohibited. (PD 856)
- High level of nitrates, detergents, cyanide
and heavy metals have contaminated water
in some areas. it’s must be protected by
doing watertight seal at least 10 feet to
prevent contamination. sewers and disposal
system must be located away from the well
for household at least 100 ft or 30 meters,
the distance should not be less than 25
meters radius.
3. Surface Water: available from lake and ponds,
streams and rivers
TRANSCRIBED BY: Tupac, RJ
a. Lakes and ponds: shallow water: weedy and
extensive algae-blooms and become turbid
with wind and wave action. Deep water:
clear, cold, less likely to become turbid and
with minor or nonexistent weed and algae
problems.
b. Streams and Impoundments: Upland
streams draining rural areas are major
source of water.
c. Rivers: sense of large, flowing water system.
Raw water is highly contaminated.
Treatment process becomes the single
barrier b/n pollutant and consumer.
WATER TREATMENT:
Preliminary treatment: water supply contains
impurities or objectionable characteristics.
I. Pretreatment Process:
a. Screening: materials that can damage plant
equipment are trapped on screens and
removed.
Types of screens:
1. bar screen: fine, medium and coarse
2. wire- mesh screen
- Clogging and corrosion are two problems, to
prevent this routine cleaning and inspection
is done.
b. Chemical Pretreatment: encountered at
water treatment facilities from aquatic
plants arose from overproduction. the aim
of well planned control program is to
control aquatic plants only to the extent
necessary to prevent water quality and
treatment problems.
1. algae- photosynthetic microorganism
2 major operational problem cause:
a. taste and odor
b. filter clogging: method of binding
and must be backwashed
Algae control methods
1. copper sulfate
2. powdered activated carbon- forms black blanket
cut off sunlight
3. Pond covers: small water bodies. reduce sunlight
4. chemical control of algae-caused odors: use of
chlorine and potassium permanganate.
2. Control of rooted aquatic plants: the
main benefit derived from water
treatment aspect is the ability of these
plants to consume large amounts of
nutrients that would otherwise be
available to stimulate algal growth.
Methods to control aquatic plants:
1. Physical: harvesting, dewatering, dredging, shading
and etc.
2. biological: use of crayfish, snails and fish
3. Chemical: herbicides which are diqual and
endotholl.
3. Pre-sedimentation: removal of gravel, sand, silt
and other gritty material.
Types of Pre-sedimentation system:
a. Pre-sedimentation impoundment: most common
and normally used in river or stream.
3 functions of large pre-sedimentation:
1. sediment removal
2. storage
3. Reduction of the impact of changes in water
quality on later treatment process.
b. Sand traps: depression at the bottom of the
structure. Sand and gritty material settles to
bottom. Water flowing out the sand trap is
pumped to the treatment plant.
c. Mechanical sand grit removal device: most often
used in raw water which is high in suspended
solids. aka cyclone degritters, work the principle of
centrifugal force.
d. Micro-straining: very fine screen to remove algae
and other aquatic organism and debris that may
cause clogging.
4. AERATION: process of bringing water and air in
close contact to remove dissolve gases such as
CO2 and to oxidize dissolve metals. effective
in removing taste and odor cause by volatile
materials or oxidized by methane and
TRANSCRIBED BY: Tupac, RJ
hydrogen sulfide example o gases remove by
aeration.
a. Dissolved oxygen: is to introduce O2 in water
where it dissolves to become DO. it
increases water palatability, too much
cause corrosion problems.
The following can be removed by aeration:
a. carbon dioxide: normal range: 5-15 mg/L
Increase CO2 may cause
1. increase acidity
2. keep iron
3. Reacts with lime and may cause increase in
the cost of softening.
b. Hydrogen sulfide: cause rotten egg odor. it is
corrosive
c. Methane: called swamp or natural gas, it is highly
inflammable. Cause garlic taste.
d. Iron and Mn: very abundant deposits. Produces
stains from dark brown to black. Aeration
followed by filtration removes these 2 in water.
Types of aerations:
1. water in to air aerator( cascade or spray type)
2. air in to water aerator (diffuse and draft tube
aerator)
3. combination aerator (mechanical and
pressure type)
Physio-chemical process
II. Main treatment process
1. Coagulation: process of removal of non
settleable solids. Mixing coagulant into
water causing the formation of floc.
Basic principle: non settleable particle
don’t settle for 2 reasons:
a. particle size: contains 3 types:
suspended, colloidal and dissolve
solids ( largest to smallest)
b. Natural forces: carry electrical charges.
Like poles they repel each other.
-zero potential: natural repelling force
its strong and keep them in
suspension.
-effect of coagulation/ flocculation:
neutralize the zero potential
Coagulant and coagulant aides: troublesome
particles are negative, coagulant are positive,
neutralization happens. Aluminum sulfate and
ferric sulfate are the most common
coagulants. Aides are activated silica and
polyelectrolyte.
2. sedimentation: separation process
Types:
a. horizontal flow: allowed at least 20 mins,
suitable for flows w/c stop and start(
power cuts and intermittent pumping)
required 3 -4 times more land areas
than alternative vertical flow system
b. Vertical flow: rapid flocculation, require
continuous, steady flow of water.
When stop it takes hours or days to
resume.
3. Filtration: removes suspended solids, for
satisfactory filtration there should be no
sudden changes in flow rate.
Types:
a. Slow sand filter: bed of sand about 30
inches depth. on bottom is an under-
drain system. on top is a gravel layer
12-18 inches. Cleaning is manual
Advantages:
1. less skill operation
2. low operation cost
3. best adopted to water
4. more reliable in removal of
bacteria and etc.
b. Rapid sand filter: bed of sand. The filter
is porous bottom. on top 12-24 inches
gravel layer. on top of this is a sand
layer 24-30 inches. rate of flow is 200
to 300 million of galloons/acre of
surface area/ day. clean by draining
filter or reversing flow ( backwashing)
Advantages:
1. smaller space
2. cleaner effluent
TRANSCRIBED BY: Tupac, RJ
3. small amount of sand
4. handle poor quality water
c. Pressure filter: completely enclosed in a
steel tank. Operated under pressure.
Used in swimming pool waters.
d. Diatomite filter: use as a permanent
treatment device for public water
supplies is limited. Use in emergency.
Consist of central pores which a thin
layer of diatomaceous earth is
supported and water passes.
4. Disinfection: chlorination is widely use in
treatment of water supply.
Commonly used disinfecting agents:
a. chlorine
b. ozone
c. ultraviolet
-for effective chlorine: 2 factors must be consider
the concentration and time of contact for which
killing effect is proportional to time of contact and
concentration.
-forms are gas and hypochlorite salts. when added
to water it produce hypochlorous acid and it’s the
most effective form of disinfection.
Reaction with ammonia: natural waters contain
ammonia. When chlorine is added, HA is produce
and react with ammonia which produces
chloramines. It can kill bacteria but require longer
contact time (500-1000X long) but it can cause
nuisance and odor.
Turbidity and its effect on chlorine: turbidity is
caused by the presence of suspended material like
clay and etc. chlorine is a surface-active material
therefore attracted to surface material. It removes
from the solution the HA before it does its effect.
Effect of sunlight: sunlight causes the destruction of
chlorine and thus decreasing efficiency of
disinfection. it also encourages the growth of algae
that consumes HA.
Chlorine demand and chlorine residuals:
- Free residual chlorine is the amount of HA
remaining after the demand has been
satisfied. The most effective disinfectant.
- Combined residual chlorine: the chloramines
formed by chlorine and ammonia which
make up the chlorine demand. less effective
disinfectant
- Total residual chlorine: The sum of the free
and combine chlorine
Breakpoint Chlorination: chlorine is added to pure
water, all chlorine added appear free residual chlorine.
- No free residual chlorine present when
chlorine is added to natural waters,
ammonia react with it forming chloramines.
- Inc dosage chlorine= inc combine residual
chlorine until added chlorine destroy the
chloramines. Dec combined chlorine= free
residual chlorine appears (breakpoint)
- if the dosage rate inc past the breakpoint: 2
effects
a. free residual chlorine will continue to
increase @ rate reflecting increase
dosage rate.
b. The combine residual chlorine will
decrease to minimum value.
- the effect are desirable reflection of
disinfection
- free residual chlorine @ .2-.5 mg/L ( measured
by orthotolidine or ampere-metric test)
- absence of residual chlorine indicator of
oxidized matter or malfunction of
treatment process
CLASSIFYING AND EVALUATION RAW
WATER QUALITY WITH RESPECT TO ITS
TREATMENT PROCESSES THESE CRITERIA IS
USED:
1. Group 1: water requiring disinfection only
- Water from underground or surface water
sources. It has an MPN of not exceeding 50
per 100 ml. low degree of contamination.
2. Group 2: water requiring complete treatment
- MPN of 50 per 100 ml to not more than 5000
per 100 ml.
TRANSCRIBED BY: Tupac, RJ

Emergencies:
Emergency disinfection of drinking water can be
accomplish by
1. boiling for 1 min
2. Adding 2-4 drops of 5% chlorine bleach per quart of
water stand for 3 mins.
3. Adding 5-10 drops of 2% tincture of iodine per quart
of water stand for 3 mins.

Household container chlorination:

1. Prepare a stock solution by dissolving 1 level

teaspoon of powder chlorine compound (65-
75% available chlorine) to 1 liter of water. It’s
for 1 week affectivity.
2. Add 2 teaspoon of stock solution to 5 gallons
(20 liters) of water. Mix and stand for at least
30 mins before using.

Definition of terms refer to pg 22- 23

Classification of water sources:

a. level 1: point source
- Well or spring it has no distribution system.
Serves around 15- 25 households. Outreach
must not be more than 250 meters from
the farthest. yielding 40-140 liters/ min

b. Level 2: communal faucet or standpost

- It has a source, pipe distribution located not
more than 25 meter from the farthest
house. Deliver 40-80 liter per capita per
day, for 100 households. It has 1 faucet per
4-8 households.

c. Level 3: Waterworks system or individual

house connections
- Has a system with source, for urban areas and
has a minimum treatment of disinfection.