Presenter Disclosure for Brenda M Afzal MS, RN

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Presenter DisclosureforBrenda M Afzal MS, RN

• The following personal financial relationships
  with commercial interests relevant to this
  presentation existed during the past 12 months
• No relationship to disclose

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Learning Objectives At the completion of this
presentation the participant will be able to

• Describe why nurses are well positioned to
  address drinking water hazards.
• Define current national drinking water policies
  and discuss their effectiveness.
• List three categories of drinking water
  contaminants and Identify their possible sources
  of contamination.
• Discuss alternative sources of drinking water for
  individuals and populations with special
  vulnerabilities.
• List at least three alternative sources to tap
  water.
• Discuss emerging national drinking water
  concerns.

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.and drink plenty of water
Brenda M. Afzal, MS, RN Environmental Health
Education Center University of Maryland School of
Nursing November ?, 2009
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Why Nurses?

• IOM Report
• Gallup Polls
• Healthy People 2010
• Nurses, as primary health providers in the
  community, must be able to field questions and
  guide vulnerable populations to informed
  decisions.

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Why Nurses?

• Because we get it!
• We recognize the wisdom of heeding early warnings
• We are fix it people
• We care passionately about our patients and our
  communities.
• We are trusted conveyors of health information to
  our patients, community members, AND policy
  makers
• And there are a lot of us!

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What percentage of our earth is water?
70
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1
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We are 70 water.
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• For millions of people around the world, access
  to clean and adequate water is a daily struggle.
• 1.1 billion people lack access to improved water
  supply.

http//blogtherockies.com/files/2008/11/water-fauc
et.jpg
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Facts and Figures Water and Health

• Water related diseases are killing more than 5
  million people each year.
• 2.3 billion people suffer from diseases linked
  to dirty water.
• 60 of all infant mortality worldwide is linked
  to infectious and parasitic diseases, most of
  them water-related.  
• People and the Planet UN World Water Development
  Report (WWDR)

http//www.globalwater.org/
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Global Warming/Climate Change and Water

• Water Availability
• Water Quality
• Possible Water Resource Impacts in North America
• Special Vulnerabilities

www.water.ca.gov/climatechange/factsheet.cfm
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History of Drinking Water Industrial
Agricultural Concerns
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Water Regulation

• Clean Water Act (1972)
• Safe Drinking Water Act (1978)
• Applies to all public water systems
• 1996 amendments
• source water protection,
• operator training,
• funding for water system improvements, and
• public information

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Drinking Water Standards

• Drinking water standards are regulations that EPA
  sets to control the level of contaminants in the
  nation's drinking water. There are two categories
  of drinking water standards
• National Primary Drinking Water Regulations
• MCL/MCLG
• Treatment Technique
• National Secondary Drinking Water Regulations

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Where Does Drinking Water Come From?
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Drinking Water Contaminants

• Pathogens
• Bacterial
• Viral
• Parasites
• Chemicals
• Inorganic
• Organic
• Radionuclides
• Gross alpha radiation
• Radon

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Point Source Pollution
Storage Tanks
Illegal Dumping
Sewage Overflow
Deep Well Injection
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Example of Point Source Contamination Superfund
Site in Woburn, MA
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Non-Point Source Pollution
Confined Animal Feeding Operations
Source USDA
Pesticide Applications
Run-off From Roads
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E. coli O157H7
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Cryptosporidiosis
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Who is Vulnerable?
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BODY BURDEN
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Contaminants of Emerging Concern in Drinking
Water Sources

• pharmaceuticals,
• synthetic fragrances,
• detergents disinfectants,
• plasticizers, preservatives,
• and others that can be present in wastewater, or
  agricultural and urban runoff. 

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Intersex (testicular oocytes). Most often
observed as immature oocytes (arrows) within
testes. Suggested as a biological indicator of
endocrine disruption.
http//www.fws.gov/ChesapeakeBay/pdf/endocrine.pdf

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EPA Seeks Comments on its Reevaluation of the
Chemical Perchlorate

• Most common use is in explosives and rocket
  propellant
• Detection in soil, surface water, and/or drinking
  water wells has been reported in 49 states, DC
  and Puerto Rico (DoD)
• Perchlorate contamination is of concern because
• it has potential human health effects at low
  concentrations
• it may be widespread in the environment and
• removing it from water and soil may be costly.

Journal of Exposure Science and Environmental
Epidemiology advance online publication
18 March 2009 doi 10.1038/jes.2009.18 Perchlorat
e exposure from infant formula and comparisons
with the perchlorate reference dose Joshua
G Schiera, Amy F Wolkina, Lisa Valentin-Blasinib,
Martin G Belsona, Stephanie M Kieszaka, Carol
S Rubina and Benjamin C Blountb
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Consumer Confidence Reports
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Consider an alternative source of drinking water
if

• a water advisory has been issued
• contaminant known to be in the water
• An individual is immuno-compromised

Boil-water advisory in effect for Jersey City By
Margaret Schmidt/The Jersey Journal September
01, 2009, 726AM United Water has issued a
precautionary boil-water advisory for Jersey City
following last night's break of a 24-inch water
transmission main at the Charlotte Circle.
2009 Press Release EPA Confirms Drinking Water
Contamination by Toxics Used in Hydraulic
Fracturing Joint Press Release EARTHWORKS
Powder River Basin Resource Council EPA will
investigate nearby oil and gas development to
determine contamination source
Centers for Disease Control and Prevention You
Can Prevent Cryptosporidiosis Drink safe
water. You may choose to take extra steps to
lower the risk of getting crypto from tap water.
These steps may take time and may cost money, so
you may want to talk about these with your
doctor. If you take these extra steps, you should
do so all the time, not just at home. Also,
remember that water and ice from a refrigerator
icemaker and drinks made at a fountain are often
made with tap water.
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Tap Water Alternatives
Boiled water Bottled water Home filtration
systems Home distillation systems
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Alternative Boiling Water

• For microbial disinfection
• Water advisories
• Vulnerable populations
• Some contaminates may be concentrated

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Alternative Bottled Water
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GAO Report Bottled Water

• evaluated the extent to which FDA regulates and
  ensures the quality and safety of bottled water
• evaluated the extent to which federal and state
  authorities regulate the accuracy of labels and
  claims regarding the purity and source of bottled
  water and
• identified the environmental and other impacts of
  bottled water, and
• conducted a state survey of all 50 states and the
  District of Columbia reviewed bottled water
  labels and interviewed FDA officials and key
  experts.
• http//www.gao.gov/new.items/d09610.pdf

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GAO Report Findings

• FDAs bottled water standard of quality
  regulations generally mirror the EPAs national
  primary drinking water regulations, although the
  case of DEHP is a notable exception.
• FDAs regulation of bottled water, particularly
  when compared with EPAs regulation of tap water,
  reveal key differences in the agencies statutory
  authorities.
• State requirements to safeguard bottled water
  often exceed FDAs, but still are often less
  comprehensive than state requirements to
  safeguard tap water.
• FDA and state bottled water labeling requirements
  are similar to labeling requirements for other
  foods, but the information provided to consumers
  is less than what EPA requires of public water
  systems under the Safe Drinking Water Act.
• Regarding impacts on landfill capacity, GAO found
  that about three-quarters of the water bottles
  produced in the United States in 2006 were
  discarded and not recycled,
• Regarding the impact on U.S. energy demands, a
  recent peer-reviewed article found that the
  production and consumption of bottled water
  comprises a small share of total U.S. energy
  demand but is much more energy-intensive than the
  production of public drinking water

(GAO. June 2009. Bottled Water, p1.
http//www.gao.gov/new.items/d09610.pdf, accessed
October 2009)
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An EWG investigation found chemical contamination
in all bottled waters tested. The quality of the
samples varied significantly, with some bottled
waters exposing consumers to unexpectedly high
pollution load.
ewg.org
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Alternative Home Treatment Systems

• Type
• Point-of-entry
• Point-of-use
• Product claims (National Sanitation Foundation)
• Effectiveness (Consumer Reports, 1999)
• Cost
• Regulation Certification (NSF)

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Resources
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http//www.waterfootprint.org/?pagefiles/WaterFoo
tprintCalculator
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http//www.tradeobservatory.org/waterprivatization
/index.cfm
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Drinking Water From Private Wells and Risks to
Children

• New recommendations by the AAP call for annual
  well testing
• Approximately one-sixth of U.S. households now
  get their drinking water from private wells.
• Contaminants of concern Nitrate, Microorganisms
  such as coliform bacteria, others
• Circumstances when more frequent testing should
  occur
• new infant in the house
• well is subjected to structural damage.
• Recommendation Families with wells need to keep
  in contact with state and local health experts
• http//www.aap.org/advocacy/releases/june09wellwat
  er.htm

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Sources of Information

• Environmental Protection Agency
  http//www.epa.gov/safewater
• EPA Drinking Water Hotline - 1-800-426-4791
• NSF International http//www.nsf.org,
  1-877-867-3435
• Agency for Toxic Substance Disease Registry
  http//www.atsdr.cdc.gov/toxpro2.html
• National Library of Medicine (toxnet)
  httpwww.nlm.nih.gov
• You can request a copy of the annual
  water-quality report from your city or check
  whether it is posted on-line at
  www.epa.gov/safewater/dwinfo/.
• IATP Trade Observatory http//www.tradeobservator
  y.org/issue_water.cfm
• E-commons.org/water

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• From earliest times, we and our ancestors have
  depended on water as a highway, a sewer, a
  pathway to discovery, a means to an empire, an
  irrigator of crops - in short, as a social as
  well as as chemical necessity. Chemistry,
  however, remains the bottom line whatever else
  we do with water, we must also drink it.
• - Charles J Hitch