FACILITY SANITATION CONTROLS AND INSPECTIONS

1 TB MED 531 technical bulletin FACILITY SANITATION CONTROLS AND INSPECTIONS APPROVED FOR PUBLIC RELEASE; DISTRIBUTION IS UNLIMITED. HEADQUARTERS, DEPARTMENT OF THE ARMY 1 March 2019 This page is intentionally left blank. i Army technical bulletin , Medical TB MED 531 DEPARTMENT OF THE ARMY WASHINGTON, DC, 1 March 2019 FACILITY SANITATION CONTROLS AND INSPECTIONS You can help to improve this bulletin . If you find any mistakes or have a recommendation to improve procedures, please let us know. Mail a memorandum or DA Form 2028 (Recommended Changes to Publications and Blank Forms) directly to The Surgeon General (DASG-HS), 7700 Arlington Boulevard, Falls Church, VA 22042-5143. The use of trademarked names does not imply endorsement by the Army but is intended only to assist in the identification of a specific product. TB MED 531 ii Contents CHAPTER 1 INTRODUCTION Purpose, 1 1, page 1 References, 1 2, page 1 Abbreviations and terms, 1 3, page 1 Applicability, 1 4, page 1 Guidance for using this publication, 1 5, page 1 Timeframe to correct violations, 1 6, page 1 Sources used to develop the SANITATION standards, 1 7, page 3 Facilities requiring inspection , 1 8, page 3 inspection documentation, 1 9, page 5 Report administration and distribution, 1 10, page 7 Privatized operations, 1 11, page 8 CHAPTER 2 BARBER AND BEAUTY OPERATIONS Section I General Information Professional services, 2 1, page 11 Beauty operation hazards, 2 2, page 12 Restricted practices and instruments, 2 3, page 17 Section II FACILITY Requirements and Approved Supplies Physical facilities, 2 4, page 18 Approved beauty products and antimicrobials, 2 5, page 19 Section III General SANITATION Requirements Management CONTROLS , 2 6, page 20 Operational CONTROLS , 2 7.

2 Page 21 Instrument and equipment CONTROLS , 2 8, page 22 Beauty product CONTROLS , 2 9, page 23 Foot baths and pedicure spas, 2 10, page 24 Hair removal, 2 11, page 24 Hand and foot wax treatments, 2 12, page 26 Hair weaving, 2 13, page 27 Nail treatments, 2 14, page 27 Mud treatments and baths, 2 15, page 27 Spray tanning, 2 16, page 28 Laundry, 2 17, page 28 Other services and facilities, 2 18, page 29 Section IV Field and Contingency Operation Environments Authorized operations, 2 19, page 29 Employee health and hygiene, 2 20, page 29 FACILITY CONTROLS , 2 21, page 30 TB MED 531 iii Sanitary practices, 2 22, page 30 CHAPTER 3 GYM AND FITNESS CENTER OPERATIONS Fitness operation characteristics, 3 1, page 31 Prohibited services, 3 2, page 33 Physical facilities, 3 3, page 33 Disinfectants, 3 4, page 33 General FACILITY SANITATION , 3 5, page 34 Equipment SANITATION , 3 6, page 34 Sauna and steam rooms, 3 7, page 35 Showers, locker rooms, and toilet facilities, 3 8, page 36 Laundry, 3 9, page 36 Massage services, 3 10, page 36 CHAPTER 4 MASSAGE OPERATIONS Section I General Massage operation characteristics, 4 1, page 37 Physical facilities, 4 2, page 37 Section II SANITATION Requirements Management CONTROLS , 4 3, page 38 Disinfectants, 4 4, page 39 Massage tables, chairs, face rests, and mattresses, 4 5, page 39 Linens, barrier paper, and footwear, 4 6, page 39 Oils, creams, and lotions, 4 7, page 40 Therapy stones and equipment, 4 8, page 41 Shower and toilet facilities, 4 9, page 41 Custodial equipment, 4 10, page 41 CHAPTER 5 TROOP HOUSING General, 5 1, page 43 Habitability assessment guidelines, 5 2, page 43 Disease transmission, 5 3, page 44 Sleeping space allowances, 5 4, page 44 Surge and mobilization, 5 5, page 45 Sleeping configuration, 5 6, page 46 Plumbing fixtures, 5 7, page 48 Ventilation, 5 8, page 48 SANITATION and hygiene, 5 9, page 48 inspection criteria.

3 5 10, page 51 CHAPTER 6 MANUFACTURED HOME PARKS General, 6 1, page 53 Location, 6 2, page 53 Manufactured home space, 6 3, page 53 TB MED 531 iv Design criteria, 6 4, page 53 Water supply, 6 5, page 54 Sewage and liquid waste disposal, 6 6, page 54 Service buildings, 6 7, page 54 Area SANITATION , 6 8, page 55 CHAPTER 7 RECREATIONAL AREAS General, 7 1, page 57 Location, 7 2, page 57 Water supply, 7 3, page 58 Service buildings, 7 4, page 58 Sewage and liquid waste disposal, 7 5, page 60 Area SANITATION , 7 6, page 60 CHAPTER 8 CHILD, YOUTH, AND SCHOOL SERVICES FACILITIES Section I General inspection management, 8 1, page 63 FACILITY design and review, 8 2, page 64 Section II Child Development Centers Food safety, 8 3, page 65 FACILITY general maintenance, 8 4, page 68 FACILITY SANITATION , 8 5, page 68 Health and hygiene CONTROLS , 8 6, page 71 Toys, 8 7, page 71 Mattresses, sleep mats, and other activity pads, 8 8, page 73 Bedding and linens, 8 9, page 74 Water play, 8 10, page 74 Pets, 8 11, page 75 Toxic plants, 8 12, page 76 Outdoor play areas, 8 13, page 76 Custodial and housekeeping services, 8 14, page 77 Section III Family Child Care Homes Home inspection , 8 15, page 79 Home food safety, 8 16, page 79 Home SANITATION and hygienic CONTROLS , 8 17, page 82 Pets and indoor plants, 8 18, page 83 Outside play area safety and SANITATION , 8 19, page 83 Section IV Youth Facilities, SAC, and Schools Environmental health SANITATION and CONTROLS , 8 20, page 85 CHAPTER 9 DETENTION FACILITIES Background, 9 1, page 88 TB MED 531 v General FACILITY requirements, 9 2, page 88 Confinement FACILITY requirements, 9 3, page 89 Detention FACILITY requirements, 9 4, page 89 Enemy combatant facilities, 9 5, page 90 Food and water, 9 6, page 90 inspection guidelines, 9 7, page 90 inspection procedures, 9 8.

4 Page 91 CHAPTER 10 LAUNDRY OPERATIONS Section I General Information Laundry characteristics, 10 1, page 96 Laundry process, 10 2, page 97 Laundry supplied, 10 3, page 97 Section II Laundry Operation Procedures Handling precautions and personal protection, 10 4, page 98 Medical facilities and facilities used to quarantine potentially infectious persons, 10 5, page 99 Norovirus in barracks, 10 6, page 100 Norovirus at lodging facilities, 10 7, page 100 Sanitary process CONTROLS , 10 8, page 100 FACILITY SANITATION , 10 9, page 103 Ventilation, 10 10, page 103 Worker safety, 10 11, page 104 Section III Inspecting Laundry Operations inspection , 10 12, page 104 CHAPTER 11 BODY ART OPERATIONS Section I General Information Body art practices, 11 1, page 106 Body art restrictions, 11 2, page 106 Section II Ear Piercing Operations Physical facilities, 11 3, page 107 Operator qualifications, 11 4, page 107 Operator health and hygiene, 11 5, page 108 Sanitary CONTROLS and procedures, 11 6, page 108 Section III Other Body Art Operations Hazardous conditions, 11 7, page 109 Body art operation CONTROLS , 11 8, page 110 CHAPTER 12 ICE MACHINE SANITATION Background, 12 1, page 112 TB MED 531 vi Administrative CONTROLS , 12 2, page 112 Cleaning ice machines with removable ice contact surfaces, 12 3, page 113 Cleaning ice machines with nonremovable ice-contact surfaces, 12 4, page 114 SANITATION surveillance, 12 5, page 115 Table List Table 1 1: Required minimum inspection frequencies, page 4 Table 2 1: Beauty services, page 12 Table 2 2: Beauty operation hazards, page 13 Table 2 3: Antimicrobial agents for beauty equipment and implements, page 20 Table 3 1: Fitness FACILITY hazards, page 31 Table 5 1: Examples of tent living space and maximum occupancy for sleeping, page 45 Table 5 2: Recommended cleaning cycles and processes, page 49 Table 5 3.

5 Troop housing inspection reference, page 52 Table 7 1: Minimum requirements for comfort stations, page 59 Table 8 1: Manual warewashing procedures, page 82 Table 9 1: inspection equipment and supplies, page 91 Table 9 2: Detention/confinement FACILITY inspection guide, page 92 Table 10 1: Laundry operation inspection guide, page 105 Table B 1: Chlorine solution mixing formulas, page 123 Table B 2: Chlorine test strip suppliers, page 124 Table C 1: Hazard severity characterization, page 129 Table C 2: Baseline values for beauty operations, page 130 Table C 3: Baseline values for fitness operations and independent massage concessions, page 130 Table C 4: Noncompliance levels and points, page 131 Table C 5: Risk assessment matrix, page 134 Table C 6: inspection frequency, page 135 Table D 1: Child development center design standards related to health and SANITATION CONTROLS , page 137 Table D 2: Child development center room finish schedule requirements, page 140 Table D 3: School-age care design standards related to health and SANITATION CONTROLS , page 141 Figure List Figure 5 1: Sleeping Configuration, page 46 TB MED 531 vii Appendices A.

6 References, page 116 B. Antimicrobial Agents, page 121 C. FACILITY Risk Assessment, page 127 D. Child Care FACILITY Design Criteria, page 137 Glossary, page 143 This page is intentionally left blank. TB MED 531 Chapter 1 1 CHAPTER 1 INTRODUCTION 1 1. Purpose The purpose of this publication is to establish sanitary control criteria for FACILITY managers to mitigate the risk for communicable disease transmission and to provide guidance for Environmental Health personnel when conducting SANITATION INSPECTIONS . 1 2. References See appendix A. 1 3. Abbreviations and terms See the glossary. 1 4. Applicability This publication applies to a. The Active Army, Army Reserve, and Army National Guard. b. Joint military installations, field training sites, and contingency operation sites where Army assets are responsible for providing preventive medicine support. c. Privatized facilities operated on behalf of the Army to provide services to Army or DOD personnel, in accordance with leasing and contractual agreements.

7 1 5. Guidance for using this publication a. The term preventive medicine, as used in this publication, is synonymous with environmental health and public health and refers to those individuals responsible for providing environmental health service support as specified in Department of the Army Pamphlet (DA Pam) 40 11. b. Critical requirements are identified by a bold asterisk (*). Critical requirements are terminal CONTROLS that are applied to prevent or significantly reduce the potential for disease transmission. (1) An asterisk immediately following the paragraph title indicates the entire paragraph contents are critical requirements. For example, in chapter 2, paragraph 2 3 is marked with an asterisk following the title Restricted practices and instruments. Thus, all content in paragraphs 2 3a through 2 3e are critical. (2) An asterisk located immediately following a subordinate paragraph header or at the end of the paragraph indicates that only that paragraph and its associated subordinate paragraphs are critical.

8 For example, in chapter 2, subparagraph 2 4c(1) is marked with an asterisk following the paragraph header Water, which indicates all of the contents of paragraph (1) and the subordinate paragraphs (1)(a) and (1)(b) are critical. In the second example, subparagraph 2 4c(2), Sinks, has four subordinate paragraphs. Only subparagraphs (2)(a) and (2)(e) are marked with an asterisk; therefore, subparagraphs (2)(b) through (d) are not critical. c. Hazards and CONTROLS not addressed. (1) If necessary to protect against public health hazards or nuisances, the medical authority or designated Preventive Medicine representative, or Command Surgeon, as applicable, may impose specific requirements or restrictions in addition to the CONTROLS contained in this publication. (2) Additional requirements are formally documented and published in local policy specifying the conditions and underlying public health threat being controlled. A copy of the policy letter should be provided to all applicable FACILITY managers within the regulatory authority s inspection jurisdiction.

9 1 6. Timeframe to correct violations a. All violations found during an inspection are expected to be corrected at the time of inspection . Some situations may require submission of a work order or other action to resolve the condition that contributed to the TB MED 531 Chapter 1 2 violation. Public health inspectors work with the FACILITY manager and apply the following guidelines for violations that remain uncorrected at the time of inspection : (1) The FACILITY manager (or person in charge) takes immediate action at the time of inspection to mitigate the risk associated with a critical violation. Actions to reduce the risk may include (a) Temporarily discontinuing the specific service or practice associated with the violation until the hazard condition is resolved; (b) Modifying the service to exclude activities that result in a critical violation; or (c) Applying a temporary administrative or physical control to reduce the hazard severity until a more permanent solution is achieved.

10 (2) The FACILITY manager takes formal actions to correct the conditions that resulted in the critical violation and to establish operational procedures for administering CONTROLS to prevent a similar violation from occurring in the future. Formal actions are initiated immediately following the inspection and, when possible, are completed within 5 business days. Actions requiring more time to complete should be achieved within a maximum period of 30 days. (a) The temporary CONTROLS specified in subparagraph a(1), above, to mitigate a critical condition remain in place until the underlying factor or factors that contributed to the critical violation are resolved. (b) Underlying factors contributing to a critical violation may require repair to physical facilities or equipment; development of a SANITATION standard operating procedure (SOP); additional employee training; or other action to improve active managerial CONTROLS within the operation.