Hindsight is 20/20.

Editor's note:

The idea for this new column originated with a manuscript that was originally submitted to the Journal for publication as a feature article. Because the manuscript contained so much practical information, the idea of turning it into a regular column for the Journal was proposed to the authors.

We are now pleased to introduce this new column, "Learning from Experience." It is designed to provide you with nothing less than information you can use. We encourage you to comment on its applicability to you by contacting Julie Collins, Content Editor, at the NEHA office. We hope you enjoy this new addition to your Journal!

As the management team for the suburban health department of Garland, Texas, we recently embarked on a misguide our environmental health and animal service professionals so they could "skip" many of the lessons we have learned through our successes and failures of the past 20 years. We developed a document to share with our staff that is full of exhortations and recommendations, two categories of which appear below. The first group of thoughts falls under the heading "correct the cause." (Never just require corrections to the symptoms of a problem. Require a violator to correct the cause of a problem.) We call the second group of thoughts "the tip of the iceberg." The two categories are closely related, and both can be ascribed to that career 20/20 vision we all know as professional hindsight, or if we had just known then what we know now. We hope this advice has some value for the practicing environmental health professional.

Correct the Cause

The goal of any inspection program is to obtain a long-lasting (sometimes permanent) correction to a health or environmental violation or hazard. Although a quick fix to a violation or a nuisance condition may temporarily satisfy a complainant, failure to obtain removal or correction of the underlying cause of a violation will result in recurrences.

Roach Infestation with Filthy Conditions: Requiring a food establishment manager to exterminate roaches without requiring that the establishment stop feeding the roaches only treats a symptom. Harborage should be eliminated by removal of unused, unneeded equipment, and a thorough cleaning should be conducted.

Severe Fly Problem: Find the source of the fly breeding. Chances are, there is a major breeding source within 200 feet of the establishment, usually a filthy dumpster. Have the dumpster replaced; require use of tied, unbroken trash bags; and increase collection frequency if needed.

Repeatedly Clogged Grease Interceptor: Don't just require pumping. Upgrade the trap (or interceptor) if there is a pattern of stoppages and the trap is small.

Nuisance Odor and Corrosive Liquids Leaking from Dumpsters or Compactors at Supermarkets: Repetitive cleaning may be less to the point than the recognition that absolutely no liquids and almost no produce should be deposited in these containers. Require a commercial grinder for waste produce, and require that liquids be dumped into an approved plumbing fixture.

Sewage Effluent Surfacing in the Yard of a 25-Year-Old Home with Six Occupants: Although it's tempting to allow a resident to keep costs down by merely adding another 200 square feet of disposal trench, a proper investigation may reveal a significantly undersized on-site sewage facility (OSSF) (e.g., two 250gallon septic tanks with 400 square feet of disposal trench). Correct the source of the problem by requiring a major upgrade or total replacement of the OSSF.

Nuisance Odor Complaints from Businesses Adjoining an Artificial-Nail Salon: Attempts can be made to require a "complete" sealing of the gypsum board walls that separate nail salons from next-door businesses. (This process involves taping and bedding, painting above a drop ceiling, and installing foam and caulk at the juncture of deck and wall.) The real solution, however, calls for properly designed and installed local exhaust hoods at each work station. The exhaust should be vented through the roof, and stack height should be appropriate.

Regulated Swimming Pool with Frequent Turbidity Violations: The "quick fix" mandates frequent filter back-washing and the addition of coagulants, but a real solution involves determining whether the physical plant (i.e., pump, filter condition and size, turnover rate) is adequate to water volume and bather load. If the physical plant is not adequate, require an upgrade.

Chemical Odor Downwind of an Industrial Plant: Frequent notices and citations may be less effective than requiring installation of a properly designed emission control device. Product lines may have changed, and the plant may now be producing an emission that the existing control device does not neutralize or capture. For example, the more expensive thermal oxidizer removes most components far more efficiently than a caustic or wet scrubber.

The Tip of the Iceberg

With rare exceptions, most of Garland's dramatic, newsworthy, and dangerous health or environmental problems have been discovered as a result of relatively innocuous incidents. Significant outbreaks of measles, hepatitis A, and salmonella were all preceded by single disease case reports. Each of two massive subsurface chemical releases was preceded by the discovery of a minuscule amount of industrial chemical in a drainage. Daily paranoia is not called for, but the prudent health professional should keep a sharp eye out for tip-of-the-iceberg situations.

In every inspection you perform, every complaint you investigate, and every epidemiological investigation you conduct, keep in mind that the environmental health problem you see may be a tiny portion of an unseen major problem.

Single Report of Salmonella Infection: Instead of treating this case as an isolated occurrence, assume that the case is just the only one that has been reported. Do a comprehensive epidemiologic investigation. Check all leads and notify neighboring jurisdictions. Are food handlers or a day care center in the picture?

One Middle-School Student with Measles: One case will not remain one case for very long without intervention. All shot records should be examined, and children should be excluded if proper immunizations have not been received. Remember, at a middle school with 1,400 students, a measles vaccine with 90 percent efficacy still leaves 140 children susceptible to measles.

Small Fish Kill Downstream from a Large Manufacturing Facility: It is easy to interpret a small fish kill as "normal" during certain weather conditions. The water should be completely analyzed to detect any possible chemical releases

from the industrial area. The manufacturing facility immediately upstream should be completely inspected for illicit discharges or improper storage practices.

Gasoline Odors Emanating from a Stream Bank: Health department field staff investigating a "gasoline odor" complaint near the banks of a stream find small amounts of weathered gasoline seeping into the watercourse. Inspection of the nearest upgradient gas station (100 meters upgradient) reveals no product loss and "clean" observation wells. Don't stop looking! When upgradient gasoline retailers within 500 meters (or more) are extensively investigated (with studies of inventory reconciliations and dipping of service station observation wells), it is revealed that one of the businesses cannot account for 10,000 gallons of product. There is a 1-foot layer of gasoline in the tank hold. Proper remediation can now begin.

Kindergarten Student in a Day Care Center with Hepatitis A: Notices given to parents of children who attend the day care center should also be sent to any public or private schools attended. Strict handwashing measures should be initiated. Sanitizing procedures should be examined and should be improved if necessary. Contact the family of the ill student and instruct them on methods for control within the home.