REGULATION

OF THE MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA NUMBER 1077/MENKES/PER/V/2011

REGARDING

GUIDELINES FOR IMPROVING INDOOR AIR QUALITY IN THE HOME

WITH THE GRACE OF GOD ALMIGHTY

MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA,

Considering : a. that poor indoor air quality in the home can cause health

problems, a preventive effort is required that is appropriate and sustained by all parties.

b. that, based on the consideration set forth in point a, it is

necessary to stipulate a regulation of the Minister of

Health of the Republic of Indonesia regarding guidelines for improving indoor air quality in the home.

In view of: 1. Law No. 28 of 2002 regarding Building Structure (State Gazette of the Republic of Indonesia of 2002 Number 134,

Supplement to the State Gazette of the Republic of Indonesia Number 4247);

2. Law Number 32 of 2004 regarding Local Government (State Gazette of the Republic of Indonesia of 2004

Number 125, Supplement to the State Gazette of the Republic of Indonesia Number 4437) as has been amended several times and latest with Law Number 12

of 2008 (State Gazette of the Republic of Indonesia of 2008 Number 59, Supplement to the State Gazette of the Republic of Indonesia Number 4844;

3. Law Number 32 of 2009 regarding Management and

Environmental Protection (State Gazette of the Republic of Indonesia of 2009 Number 140, Supplement to the State Gazette of the Republic of Indonesia Number 5059);

4. Law Number 36 of 2009 regarding Health (State Gazette of

the Republic of Indonesia year 2009 Number 144, Supplement to the state gazette of the Republic of indonesia Number 5063);

5. Law.....

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5. Law fNumber 1 of 2001 regarding Housing and

Settlements (State Gazette of the republic of Indonesia of 2011 Number 7, Supplement to the State Gazette of the

Republic of Indonesia Number 5188);

6. Government Regulation Number 41 of 1999 regarding

Air Pollution Control (State Gazette of the Republic of Indonesia of 1999 Number 86, Supplement to the State

Gazette of the Republic of Indonesia Number 3853);

7. Government Regulation Number 38 of 2007 regarding

Allocation of Administration Affairs among the Government, Provincial Government and Regency/City Government (State Gazette of the republic of Indonesia

of 2007 Number 82, Supplement to the State Gazette of Republic of Indonesia Number 4737);

8. Regulation of the Minister of Settlements and Regional

Infrastructure of the Republic of Indonesia Number

403/KPTS/M/2002 regarding Technical Guidelines of Simple Healthy Housing Development

9. Regulation of the Minister of Health Number

1407/Menkes/SK/XI/2002 regarding Guidelines of

Impact of Air Pollution Management

10. Regulation of the Minister of Health Number

1114/Menkes/Per/VIII/2010 regarding the Organization and Administration of the Minister of Health

HAS DECIDED

To Stipulate : THE REGULATION OF THE MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA REGARDING GUIDELINES FOR IMPROVING INDOOR AIR QUALITY

IN THE HOME.

Article....

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Article 1

The regulation regarding guidelines for improving indoor air quality in the home aims to provide a reference for homeowners, residents, housing developers, government, provincial government and regency/city

government for the improvement of indoor air quality.

Article 2 Guidelines for improving indoor air quality are specified in the attachment of this ministry regulation.

Article 3

Guidelines, as referred to in Article 2, include requirements, risk factors,

and efforts for improving and monitoring indoor air quality.

Article 4 Monitoring of indoor air quality in the home is implemented by a health officer in the health clinics and health agencies in the Regency/City.

Article 5

(1) Every housing developer must meet requirements of indoor air quality, as referred to in Article 3.

(2) The Regency/City government can impose administrative sanctions

on developers who do not meet requirements, as referred to in paragraph (1), in the form of an oral reprimand, written reprimand, a recommendation of revocation, and revocation of business license in

accordance with the regulation.

Article 6 (1) The Minister of Health, Head of Provincial Health, and Head of

Regency/City Health provides guidance and supervision to the

implementation of this regulation. (2) Coaching and supervision, as meant in paragraph (1), is directed to

public efforts towards the improvement of indoor air quality in the

home. (3) Coaching and supervision, as meant in paragraph (1), is conducted

through coordination, advocacy, dissemination, technical assistance, human resources development, monitoring and evaluation.

Article ....

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Article 7

At the time this regulation commences effective, the Regulation of

Minister of Health of the Republic of Indonesia Number 829/MENKES/SK/VII/1999 on Housing Health requirements, regarding indoor air quality in the home, is revoked and declared invalid.

Article 8

This Regulation of the Minister commences effective on the date of enactment.

To be known by everyone, instruct the enactment of this Regulation of the Minister with its placement in the State Gazette of the Republic of

Indonesia.

Stipulated in Jakarta on 27 May 2011

Health Minister, ttd

ENDANG RAHAYU SEDYANINGSIH

Enacted in Jakarta on

Ministry of Law and Human rights, ttd

PATRIALIS AKBAR

STATE GAZETTE OF THE REPUBLIC OF INDONESIA YEAR 2011 NUMBER

ATTACHMENT

REGULATION OF THE MINISTER OF HEALTH OF THE REPUBLIC OF INDONESIA

NUMBER 1077/MENKES/PER/V/2011

CONCERNING

GUIDELINES FOR IMPROVING INDOOR AIR IN QUALITY

IN THE HOME

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CHAPTER 1

INTRODUCTION

A. Background

Indoor air pollution, especially in the home, is very dangerous for

human health. Since people spend a lot of time on various activities in the home, the home becomes an important environment that may carry

the risks of air pollution.

Impact of indoor air pollution on health can occur either directly or

indirectly. Health problems can occur directly after exposure, for example through irritation of the eyes, irritation of the nose and throat, headaches, nausea, muscle pain (fatigue), asthma, hypersensitivity

pneumonitis, flu and other viral diseases. Indirect health problems, on the other hand, may occur several years after the exposure, such as

with lung disease, heart disease, and cancer. These diseases are difficult to treat and can be fatal (USEPA, 2007).

In addition to the aforementioned diseases, other diseases associated with poor indoor air quality include chronic bronchitis, chronic

obstructive pulmonary disease (COPD), lung cancer, infant mortality due to Low Birth Weight (LBW), mortality in infants less than one week old, otitis media, respiratory infections, and tuberculosis.

In developed countries, the estimated annual death rate due to indoor

air pollution (that is, percentage of all deaths) is 67% in rural areas and

23% in urban areas, whereas in developing countries the death rate

associated with air pollution is 9% in urban areas and 1% in rural

areas (WHO Bulletin 2000). Pneumonia is the leading cause of death in

children under 5 years of age, with 2 million deaths each year.

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For more than 2 (two) decades, acute respiratory infection (ARI) has always ranked first of the 10 most prevalent diseases in Indonesia. One

cause of ARI is poor air quality both inside and outside the home, whether biological, physical, or chemical in nature (Ministry of National Development Planning, http://udarakota.bappenas.go.id accessed

November 29, 2007). ARI most commonly affects children under 5 years old (toddlers) and causes the death of approximately four million infants annually (Kartasasmita, 2004: Indonesian Ministry of Health, 2001).

Indoor air quality in the home is affected by various factors, including

building materials (e.g. asbestos), structure (e.g. ventilation), coatings for furniture and interiors (in organic solvents), residential density, outdoor air quality (ambient water quality), radiation from radon (Rd),

formaldehyde, dust, and excess moisture. In addition, the air quality is affected by the activities in the home, for example, whether or not

energy consumption is environmentally friendly, the use of relatively cheap energy sources such as coal and biomass (wood, dried dung of livestock, agricultural residues), smoking behaviors in the home, the

use of pesticides, the use of cleaning chemicals, and the use of cosmetics. Such chemicals that are used to remove pollutants can linger in the home for a long time.

Indoor air pollution, especially in rural areas in developing countries, is

largely caused by the use of solid fuels when cooking with simple/traditional stoves. The burning of such fuels can produce high concentrations of pollutants due to incomplete combustion. The

situation will become worse for indoor air quality when physical conditions do not meet the physical requirements, such as inadequate

ventilation, and the absence of a chimney in the kitchen. Health problems due to indoor air pollution largely occur in homes that use biomass energy for cooking.

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In an effort to protect public health from air pollutants in the home, it is necessary to have regulations that can serve as a reference for indoor air

pollution control.

B. Definition 1. “Improving indoor air quality” is an effort to both improve indoor air

quality in the home and maintain that level of quality.

2. The home is a building that serves as a habitable place to live, a means of family formation, reflecting the dignity of its inhabitants, as

well as an asset to its owner. 3. Indoor air pollution is a state of existence of one or more pollutants

in the home, which, because of its concentration, increases risk of

health problems to the residents. 4. Biomass energy is energy generated from the combustion of

unprocessed biomass, such as wood, dried dung of livestock, and unused agricultural produce.

5. Air pollution risk factors are factors that are physical, chemical, or

biological, and may contaminate the air. 6. Physical Air Quality is determined by parameters indicating the

physical condition of the air in the home, such as humidity, lighting,

temperature, and particulates. 7. Chemical Air Quality is determined by parameters indicating the

chemical condition of air in the home, such as Sulfur Dioxide (SO2), Nitrogen Dioxide (NO2), Ozone, Carbon Dioxide (CO2), Carbon Monoxide (CO), Lead (Pb = plumbum), and Asbestos.

8. Biological Air Quality is determined by parameters indicating biological condition of air in the home, such as bacteria and fungi.

9. Environmental Tobacco Smoke/ETS is a toxic gas that is released from burning tobacco products usually containing Polycyclic Aromatic Hydrocarbons (PAHs), which are harmful to human health.

10. Ventilation rate is the change rate of the air through vents (holes that allow passage of air and are permanent features of the windows

and doors).

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CHAPTER II

REQUIREMENTS FOR INDOOR AIR QUALITY IN THE HOME

Requirements for indoor air quality in the home include: a. Physical Quality, consisting of these parameters: particulates (Particulate

Matter/PM2,5 and PM10), air temperature, lighting, humidity, as well as setting and air change (ventilation rate);

b. Chemical Quality, consisting of these parameters: sulfur dioxide (SO2), nitrogen

dioxide (NO2), carbon monoxide (CO), carbon dioxide (CO2), lead (Pb=plumbum), cigarette smoke (Environmental Tobacco Smoke/ETS), asbestos, formaldehyde

(HCHO), Volatile Organic Compound (VOC) c. Biological quality, consisting of these parameters: bacteria and fungi.

A. Physical Requirements

No Type of Parameter Unit Levels Required

1. Temperature oC 18 - 30

2. Exposure Lux Minimum 60

3. Humidity % Rh 40 - 60

4. Ventilation Rate m/s 0,15 – 0,25

5. PM2,5 µg/m3 35 in 24 hours

6. PM10 µg/m3 ≤ 70 in 24 hours

B. Chemical Requirements

No Type of Parameter Unit Levels

Required Explanation

1. Sulfur dioxide (SO2) ppm 0,1 24 Hours

2. Nitrogen dioxide (NO2) ppm 0,04 24 Hours

3. Carbon monoxide (CO) ppm 9,00 8 hours

4. Carbon dioxide (CO2) ppm 1000 8 hours

5. Lead (Pb) µg/m3 1,5 15 minutes

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No Types of Parameter Unit Levels Required Explanation

6. Asbestos fiber/ ml

5 Fiber length

5µ

7. Formaldehyde (HCHO)

ppm 0,1 30 minutes

8. Volatile Organic Compound (VOC)

ppm 3 8 hours

9. Environmental Tobacco Smoke (ETS)

µg/m3 35 24 hours

C. Biological Requirements

The parameters of biological contaminants in the home indicate the biological condition of indoor air quality. Such parameters include bacteria and fungi.

No Types of Parameter Unit Maximum Levels

1. Fungi CFU/m3 0 CFU/m3

2. Bacterial Pathogen CFU/m3 0 CFU/m3

3. Number of Bacteria CFU/m3 < 700 CFU/m3

Note: - CFU = Colony Forming Unit - Bacterial pathogens that must be examined: Legionela, Streptococcus

aureus, Clostridium and other pathogenic bacteria, when needed.

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CHAPTER III

HEALTH IMPROVEMENT EFFORTS

Improving indoor air quality includes the improvement of physical, chemical, and biological pollutant sources.

A. Physical Pollutant Sources

Physical pollutant sources are derived from temperature, lighting, humidity, ventilation rate, PM2,5, and PM10. Air quality that does not meet

the physical requirements due to certain risk factors can lead to negative health impact, and efforts should be taken towards improvement.

1. Temperature

a. Impact

Low temperature in the room can cause health problems, such as hypothermia, while too high of a temperature can cause problems from dehydration to heat stroke.

b. Risk Factors Changes in air temperature in the house is affected by several

factors, including: 1) The use of biomass fuels 2) Insufficient ventilation

3) Residential density 4) Materials and structures 5) Geographic Conditions

6) Topographic Conditions c. Health Improvement Efforts

1) If the air temperature is above 30ºC, it should be lowered by increasing air circulation through mechanical/artificial ventilation.

2) If the temperature is less than 18ºC, it is necessary to use a space heater using energy sources that are safe for the environment and

health.

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2. Lighting/Exposure

a. Impact An illuminance value (Lux) that is too low may result in high eye

accommodation, causing damage to the retina. An illuminance value that is too high may lead to an increase in temperature in the room.

b. Risk Factors

Lighting, from both natural and artificial sources, is too low. c. Health Improvement Efforts

Lighting in the home is arranged to enable seeing and reading objects

based on the requirement of at least 60 Lux.

3. Humidity a. Impact

Humidity levels that are too high or too low can lead to the

proliferation of the growth of microorganisms. b. Risk Factor

Poor home construction, such as a leaky roof, non-waterproof floors and walls, and the lack of both artificial and natural lighting.

c. Health Improvement Efforts

1) When the humidity is less than 40%, health improvement efforts include the following: a) Use a tool to increase humidity, such as a humidifier (humidity

control device) b) Open the windows of the home

c) Increase the number and sizes of windows in the home d) Modify the physical building (improve lighting, air circulation)

2) When the humidity is over 60%, health improvement efforts include

the following: a) Install glass tile b) Use a tool to reduce humidity, such as a humidifier (humidity

control device)

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4. Ventilation Rate

a. Impact Insufficient air change leads to the fertile growth of microorganisms,

which impacts human health. b. Risk Factors

1) Lack of ventilation (the number and extent of vents are insufficient,

according to the requirements of health). 2) No periodic maintenance of air conditioning systems.

c. Health Improvement Efforts

Health improvement efforts can be made to control air change in the following ways:

1) The house should have vents, at least 10% of floor space, with a cross-ventilation system.

2) Maintenance of any air conditioner (AC) is conducted on a regular

basis, in accordance with the user guide, and air should be changed by opening windows in the morning on a regular basis.

3) Use an exhaust fan 4) Organize the layout of the room

5. Particulate Matter 2,5µm in diameter and less (PM2,5) and 10µm in diameter and less (PM10)

a. Impact PM2,5 and PM10 can cause pneumonia, respiratory system disorders,

eye irritation, allergies, and chronic bronchitis. PM2,5 can enter the lungs, which can lead to pulmonary emphysema, bronchial asthma, and lung cancer, as well as cardiovascular disorders or heart disease.

b. Risk Factors Generally, PM2,5 and PM10 arises from the influence of outside air (due to human activity and combustion from industrial activity).

Particulate matter from inside the home can result from smoking, the use of biomass fuels when cooking, and the use of mosquito coils.

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c. Health Improvement Efforts

Health improvements efforts can be made to control the concentration

of PM2,5 in the following ways: 1) Clean the house of particulates every day, using a damp mop or

vacuum cleaner.

2) Install a particulate collection device (electrostatic precipitator) for ventilation in the home, which is cleaned periodically.

3) Grow plants around the house to reduce the entry of particulates

into the house. 4) Kitchen ventilation is at least 40% of the floor area, with a cross-

ventilation system, resulting in sufficient air change, or use the appropriate technology to capture smoke and air pollutants.

B. Chemical Pollutant Sources

The chemical pollutant sources of indoor air pollution include sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), carbon dioxide (CO2), lead (Pb=plumbum), asbestos, formaldehyde (HCHO), volatile organic

compounds (VOCs), environmental tobacco smoke (ETS). Air quality that does not meet the chemical requirements, due to various risk factors, can lead to negative health impact, and health improvement efforts should be

made.

1. Sulfur dioxide (SO2) a. Impact

Sulfur dioxide (SO2) can affect the respiratory system and lead to lung problems, eye irritation, inflammation of the respiratory tract, coughing, and mucus secretion. It can also trigger asthma and

chronic bronchitis, as well as low blood pressure, rapid pulse, and headaches.

b. Risk Factors 1) Use of fuels such as charcoal, wood, petroleum and coal.

2) Smoking in the home.

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c. Health Improvement Efforts

Health improvement efforts can be made to control the levels of SO2 in the following ways:

1) Use natural or mechanical ventilation in the house for air change. 2) Use fuel/energy sources that are environmentally friendly, such as

Liquid Petroleum Gas (LPG) and electricity. 3) No Smoking in the house.

2. Nitrogen Dioxide (NO2) a. Impact

Nitrogen dioxide (NO2) can cause respiratory system disorders, such as weakness, cough, shortness of breath, bronchopneumonia,

pulmonary edema, cyanosis and methemoglobinemia. b. Risk Factors

1) Use of fuels such as charcoal, wood, petroleum and coal.

2) Smoking in the home. c. Health Improvement Efforts

Health improvements efforts can be made to control the levels of NO2 in the following ways:

1) Use natural or mechanical ventilation in the home for air change;

2) No smoking in the home. 3. Carbon Monoxide (CO)

a. Impact

1) Toxic effects of CO can result in a lack of oxygen delivery to other parts

of the body, which can then lead to anoxia and central nervous system disorders (loss of fingertip sensitivity, memory loss, poor mental growth especially in infants, low birth weight, fetal death and

cardiovascular disease). 2) Symptoms of carbon monoxide poisoning include dizziness, nausea,

anxiety, shortness of breath and difficulty breathing, chest pain, confusion, pallor, unconsciousness, respiratory failure and death.

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b. Risk Factor

1) Use of fuels such as charcoal, wood, petroleum and coal. 2) Smoking in the home.

c. Health Improvement Efforts Health improvement efforts can be made to control CO levels in the following ways:

1) Use natural or mechanical ventilation in the house so that the air change is sufficient.

2) Use fuel/energy sources that are environmentally friendly, such as

Liquid Petroleum Gas (LPG) and electricity. 3) Do not smoke in the home.

4) Do not turn on the motor vehicle engine in enclosed spaces. 5) Maintain motor vehicles on a regular basis (pass the emissions

test).

4. Carbon Dioxide (CO2)

a. Impact 1) At concentrations above the threshold value, it can cause

drowsiness, headaches, and can lower physical activity. 2) At a concentration of 3% (30.000 ppm), it is mildly narcotic and

causes increased blood pressure and hearing loss.

3) At a concentration of 5% (50.000 ppm), it can lead to respiratory stimulation, dizziness, and difficulty of breathing, followed by a

headache. 4) At a concentration of >8% (80.000 ppm), it can cause headaches,

constant sweating, tremors, and loss of consciousness after

exposure for 5-10 minutes. b. Risk Factors

1) Use of fuels such as coal, wood, petroleum, and coal.

2) Smoking in the home. 3) High density of residents in the home.

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c. Health Improvement Efforts

Health improvement efforts can be made to control CO2 levels in the

following ways: 1) Use natural or mechanical ventilation in the house so that the air

change is sufficient.

2) Use fuel/energy sources that are environmentally friendly, such as Liquid Petroleum Gas (LPG) and electricity.

3) Do not smoke in the home..

4) Do not turn on the motor vehicle engine in enclosed spaces. 5) Maintain motor vehicles on a regular basis (pass the emissions

test). 6) Grow plants around the house.

5. Lead (Plumbum = Pb) a. Impact

1) Problems with the central nervous system, blood cells, and kidneys. 2) In high concentrations, it can cause convulsions/seizures, coma,

and even death.

3) Exposure to the children or the fetus can lead to severe problems, because it causes delayed growth, decreased intelligence, reduced concentration, and behavioral disorders.

b. Risk Factors 1) Paint that contains Pb

2) Gas lead coming from outside the home c. Health Improvement Efforts

1) Clean the floor and any room/space where children play, using a

mixture of water and detergent that contains a high concentration of phosphate, so it can clean up dust containing lead.

2) Familiarize children with washing their hands with soap. 3) Wash stuffed toys and children routinely. 4) Do not use paints containing Pb.

5) Do not burn, clean, or scrape/peel painted wood because the paint may contain lead.

6) Workers that are at risk of exposure to Pb (for example, used-

battery plant workers and waste pickers) should change out of work clothes, as well as wash their hands and feet with soap, before

entering the house.

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7) Consume foods that are high in calcium and iron.

8) Maintain motor vehicles on a regular basis (pass the emissions test).

6. Asbestos a. Impact

Asbestos is carcinogenic and can lead to cancer and asbestosis (permanent lung damage).

b. Risk Factors Building material that contains asbestos (such as roofs and ceilings) and asbestos-containing material for fireproofing/insulating purposes.

c. Health Improvement Efforts 1) Ensure the asbestos-containing material is in good condition, check

periodically, and replace materials before they become damaged (decay/weathering).

2) Do not cut, sand, or use building materials that contain asbestos.

3) Do not carelessly dispose of asbestos-containing materials. When there is a need to destroy asbestos-containing material, use trained personnel.

4) Use personal protective equipment when conducting activity involving asbestos.

7. Formaldehyde (HCHO)

a. Impact

1) Formaldehyde gas can cause watery eyes, burning sensation in the eyes and throat, difficulty in breathing, especially in concentrations

greater than 0.1 ppm. 2) At higher concentrations, it may trigger asthma attacks and may

cause cancer in humans.

b. Risk factors: 1) Building materials and household products. 2) Byproducts of combustion of biomass fuels and other natural

processes, so that the gas lingers naturally inside and outside the home.

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3) In the home, it can come from processed wood preserved with urea

formaldehyde resins or phenol formaldehyde, paint, glue, as well as

other processed wood products. c. Health Improvement Efforts

1) Use wood products for furniture (pressed woods) that are

recommended safe for health; in other words, they have lower emission levels because they contain phenol resins, not urea resins.

2) Determine the levels of formaldehyde in furniture or building

materials before purchasing them. 3) Use air conditioning (AC) and humidity control to maintain a

moderate temperature (not too hot or cold) and reduce the level of humidity.

4) The house should be equipped with ventilation.

8. Volatile Organic Compounds / VOCs

a. Impact 1) Depending on the type of compounds, health problems from

exposure to VOCs vary considerably, from irritation of the eyes,

nose, throat, headache, nausea, and loss of coordination, to damage to the kidney, liver, and central nervous system.

2) Products that contain methylene chloride, including paint, solvents

and aerosol paints, are known to cause cancer in animals. These compounds can also be converted to carbon monoxide in the body

and can cause symptoms such as carbon monoxide poisoning. b. Risk Factors

1) VOCs are produced as a gas by a variety of products, such as

paints and varnishes, cleaning fluids and disinfectants, pesticides, building materials and coatings, and various office equipment, such

as copiers, printers, arts and crafts supplies, glue/adhesives, permanent markers, and photograph solvents.

2) The use and storage of fuel oil or organic solvents

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3) Formaldehyde is one of the VOC compounds that is easily

measured. 4) Benzene is a carcinogen 5) Tobacco smoke

6) Paint supplies 7) Fuel

8) Car emissions in the garage 9) Emissions from clothes that were dry-cleaned using a

Perchloroethylene compound.

c. Health Improvement Efforts 1) Increase ventilation when using products that emit VOCs.

2) Do not store containers of materials that contain VOCs, whether still in use or not in use.

3) Reduce exposure by protecting/covering all surface panels and

other furniture that are exposed. 4) Use techniques of integrated pest management to reduce the need

for pesticides.

5) Use household products according to the manufacturer's directions. 6) Keep materials that contain VOCs out of reach from children and

pets. 7) Never mix household care products, except in accordance with the

instructions on the packaging label.

8) Follow the instructions for use when using materials that contain VOCs.

9) Do not smoke.

9. Environmental Tobacco Smoke/ETS

a. Impact 1) ETS can exacerbate the symptoms of asthmatic children. 2) Compounds in cigarette smoke are strong irritants and can lead to

lung cancer in humans, impotence, heart attacks, and pregnancy/fetal disorders.

3) Infants and children whose parents smoke have a greater risk of developing respiratory disorders, with symptoms including shortness of breath, coughing and excessive mucus.

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b. Risk Factors

Smoke inhaled by breathing.

c. Health Improvement Efforts 1) Smoke outside the home and make sure that the smoke does not

enter the home.

2) Smoke in provided spaces in facilities / public places. 3) Education should be directed to the smokers. 4) Education should be directed to the public about the dangers of

inhaling cigarette smoke.

C. Biological Pollutant Sources Biological pollutant sources include fungi, pathogenic bacteria, and the

number of bacteria (parameters to consider). Air quality that does not meet biological requirements, due to various biological risk factors, could cause

negative health impact, and health improvement efforts should be made. Fungal, pathogenic bacteria, and the number of bacteria;

a. Impact 1) Diseases associated with bioaerosol include infectious diseases, such

as the flu, hypersensitivity (asthma, allergies), and also toxicosis.

Toxins in a contaminated room also lead to symptoms associated with Sick Building Syndrome/SBS. SBS symptoms include headaches, loss

of concentration, dry throat, and irritation of eyes and skin. 2) Other sicknesses/diseases associated with SBS are irritation of the

eyes and nose, irritation of the skin and mucus membranes, mental

fatigue, headache, acute respiratory infections, coughing, sneezing, and hypersensitivity.

3) Physical symptoms commonly experienced due to biological contaminants are coughing, chest tightness, fever, chills, muscle aches, and allergic reactions such as irritation of the mucous

membranes and upper respiratory congestion. One of the indoor air contaminants is Legionella sp., which causes Legionnaire's disease.

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b. Risk Factors

1) Insects

2) Bacteria 3) Fleas on pets 4) Mushrooms

5) Pollen that enters the house 6) Legionella bacteria (soil-borne) that enters the home 7) Algae, from any nearby pond/lake, which enters the room by wind

gusts 8) Insects from outdoors that can enter closed buildings

9) Contamination that originates from a room, and with high humidity, the mold spores increase

c. Health Improvement Efforts

1) Household furniture should be cleaned on a regular basis. 2) The house should be equipped with adequate ventilation.

3) Clean the air conditioner every 3 or 6 months. 4) Clean and dry any wet or damp carpet. 5) If the basement is used as a residential space, make sure there are no

leaks and the room has a good ventilation system. If necessary, use a machine to keep the humidity between 40-60%.

6) The floor should always be cleaned with antiseptic on a regular basis.

7) Isolate a household member who has a communicable disease and prevent contamination by disinfecting equipment that has been used

by the patient. 8) Ensure that morning sunlight can enter the house, especially in every

bedroom.

9) Manage garbage properly.

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CHAPTER IV

PROCEDURES INDOOR AIR QUALITY CONTROL IN THE HOME

Implementation of indoor air quality monitoring in the home is intended to achieve the air quality necessary to meet requirements. Supervision is

conducted through monitoring, data processing, and analysis, as well as providing recommendations, action plans, and reports.

A. Monitoring

Monitoring requires attention to the following: 1. Planning includes the preparation of personnel, material and equipment,

costs, and time.

- Those responsible for monitoring are health officials and public health centers in the regency/town.

- Materials and tools: Materials used to monitor air quality in the home include the Interview Form for Monitoring Indoor Air Quality in the Home (Form 1)

and Observation Form for Monitoring Indoor Air Quality in the Home (Form 2). Additional forms include the data form for diseases in clinics (LB1) and reports of activities in the sanitation clinics.

- Air quality detection equipment;

No. Type of Instrument/

detector

Function How to Measure

1. Personal Exposure

Monitoring Device for PM2,5

Measures the amount of particulates with a

diameter of 0.1 µm to ≤ 2,5 µm that is inhaled

(exposure)

For 24 hours, be with the individual

indoors and outdoors

COLLECTING PRIMARY

AND SECONDARY DATA RISK FACTOR

RISK EXISTS NO RISK

AIR QUALITY

MEASUREMENTS AND

DISEASE INTERVIEW

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No. Type of

Instrument/ detector

Function How to Measure

2. Measuring

device for ultrafine PM

Measures the

amount of particulates, gases,

aerosols in the home/building/ vehicle that have a

diameter of 0.01-0.1µm

For 12 hours during

peak activity time (e.g. while cooking, meals,

family gathering), measure within a 10m radius of individuals

3. Personal gas

sampler and air sampler

Measures

temperature, humidity, CO and SO2

For 24 hours,

accompany the individual while the individual conducts

activities indoors and outdoors.

4. Tool for Measuring Lung Capacity

Measures an individual’s lung capacity

Measure the individual’s breath for a total of three times.

5. Sore and watery ayes

To determine formaldehyde gas

exposure

While cooking

- Execution time/frequency: at least 1 time in a year.

- Costs are sourced from the state budget, local budget and other sources in accordance with the valid regulation.

2. Monitoring Flow Chart

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Description:

a. Primary data collection: Maps the risk factors around the residential settlements/housing to determine the diseases and risk factors inside and outside the home, using the Interview

Form for Monitoring Indoor Air Quality (Form 1), and the Observation Form for Monitoring Indoor Air Quality (Form 2).

b. Secondary data collection: Collects information regarding the health problems or occurrences of disease in people, using the LB1 form and sanitation data from clinical activities.

c. Method of data collection: Quick surveys d. Number of samples: (7 clusters, with each cluster containing 30

homes. In total, there are 210 homes.)

2. Measurements of air quality are conducted for a home that has one or

more risk factors with the following conditions: a. Fuel used for cooking is biomass or kerosene. b. Ventilation < 20% of the floor area.

c. There are family members and/or others who smoke in the house. d. The household uses mosquito repellent (coils/spray/electric) and

air refreshers (sprays).

B. Processing and Data Analysis

1. Data Processing

Processing of monitoring data, including home environmental health conditions, health problems/diseases, and indoor air quality

measurements, is done by grouping the data according to the person (gender, age, education, marital status, length of stay in the house), location (Rukun Tetangga/RT [smallest unit in a community that

consists of several households], Rukun Warga/RW [a group of several RT], village, sub-district, regency/city), and the time of data

collection.

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2. Data Analysis

Data analysis is conducted in the form of univariate and bivariate analysis, as follows: 1) Univariate analysis of monitoring data: determines percentages

concerning the composition of desired variables. 2) Bivariate analysis: determines relationships from the results that

monitor incidences of disease.

3. Data Presentation

Data is presented in the form of tables, images/graphs, and interpretation.

4. Dissemination of Information Interpretation of the results is presented to stakeholders for further decision-making. The results can also be used for the following:

a. Preparation of materials that model air quality improvement in homes; b. Compiling trends of indoor air quality and its impact on health; c. Formulate projections of air quality in the home, and

d. Long-term planning of air quality management in the home.

C. Recommendation Results, as well as the follow-up options to improve health, are presented to

stakeholders. D. Follow-up Plan

Activities that can be conducted as a follow-up plan, and implemented at the

appropriate level, include the following:

No. Follow Up Form Sub-district Regency/City

Province Capital City

1. Counseling V V

2. Air Quality

Measurements

V V

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No. Follow Up Form Sub-district

Regency/ City

Province Capital City

3. Risk factor improvement: ventilation improvement

V V

4. Granting Stimulants V V V

5. Development of appropriate technology

(Making smoke-free stoves, etc.)

V V V

6. Creating Counseling tools (leaflet, poster,

etc.)

V V V

8. Coaching and monitoring

V V V

9. Assistance to the community

V V

10. Technical/means facilitation V V V

11. Information dissemination V V V V

12. Follow up Planning V V V V

13. Socialization and advocacy

V V V V

14. Increasing Capacity of Officer and stakeholder

(tiered)

V V V V

E. Report

The Health Department submits an annual report regarding indoor air

quality conditions in the home to the Governor/Regent/Mayor for

monitoring and evaluation, as well as to the Minister of Health c.q.

Director General of Disease Control and Environmental Health.

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CHAPTER V CONCLUSION

With the enactment of the Requirements for Indoor Air Quality in the

Home, it is expected that a standard of indoor air quality, which meets the health requirements, will be achieved. This will support a healthy home program in order to protect public health from the risk of disease. The

effort to improve indoor air quality in the home requires a strong commitment from the government, local governments, cross-program,

cross-sector, housing providers, the community and relevant stakeholders.

MINISTER OF HEALTH, Signed

ENDANG Rahayu Sedyaningsihengan

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Form 1.

INTERVIEW FORM MONITORING INDOOR AIR QUALITY IN THE HOME

I. GENERAL DATA

1. Province : 2. Regency / City :

3. Sub-District : 4. Health Center : 5. Desa (Village) / Keluharan (Village) :

RT : RW :

6. Hamlet: 7. Residential location : ( industry / highway /

..........................)

8. HH (HouseHolder) Name : 9. Name of Respondent : 10. Age of respondent : .......... Year .......... month

11. HH relationship with the Respondent: 12. Gender of Respondent :

13. Respondent's marital status : married / not married 14. Number of residents : .......... person(s) 15. Education of Respondent:

No school Primary school

Junior high school High School Higher Education / Academy

16. Length of stay at home : 17. Time of observation : 18. Name of officer / cadre :

II. CRITERIA FOR RESPONDENT:

1. Housewife / other adult family member 2. Household with a family member under the age of five years

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No Question Answer

18 Stove that you use for cooking : a. Gas Stove …… 1. Yes 2. No b. Kerosene stove …… 1. Yes 2. No

c. Electric Stove ….. 1. Yes 2. No d. Furnace …... 1. Yes 2. No e. Masonry …... 1. Yes 2. No

f. Others, please mention .... 1. Yes 2. No

19 Fuels/Energy Sources used to cook:

a. Electricity b. LPG

c. Kerosene d. Fire woods e. Charcoal (wood, coconut shell, etc)

f. Husk g. Coal Briquettes (If your answer does not include d, e, f, or g, skip to question

No. 21)

20 Does your wood fuel discharge brown liquid after it is

burned (making your eyes sore and watery)? a. Yes b. No

21 Do you use a kerosene lamp as a light source?

a. Yes b. No

22 Is there any ventilation in your kitchen?

a. Yes b. No

23 Are the window opened every morning?

a. Yes b. No

24 Does any family member smoke inside the house?

a. Yes b. No

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No QUESTION ANSWER

25 Is there any family guest who smokes during a visit? a. Yes

b. No

26 Do you use insect repellent at home (fuel / spray / electric)?

a. Yes b. No

27 How long do you cook every day? ……… Hours

28 While cooking, is your toddler in the kitchen as well? a. Yes b. No

Health Conditions

29 Have you, or any other family member, exhibited any of the

following signs today or within the last two weeks? (You may choose more than one) symptoms of acute respiratory infection.

a. dizziness b. nausea

c. cough d. shortness of breath e. sore throat

f. sore and watery eyes g. cold

30 How many people are experiencing the signs above? ……… people

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Form 2.

OBSERVATION FORM MONITORING INDOOR AIR QUALITY IN THE HOME

No QUESTION ANSWER

1 Interior of the House

a. Has partitions (wall/bulkhead) b. Does not have partitions (wall/bulkhead)

2 There is a wall/bulkhead separating the kitchen. a. Yes, there is. b. No, there isn’t

3 Walls of the house a. Permanent b. Semi Permanent

c. Woven bamboo / wood sheet d. Others ……………..

4 Size of ventilation/vents in the room where the family gathers:

a. < 20% of the floor area b. ≥ 20% of the floor area

5 Size of ventilation/vents in the bedroom: a. < 20% of the floor area b. ≥ 20% of the floor area

6 Does the kitchen have an opening/hole to discharge cooking fumes?

a. Yes, the shape .......................... (Skip to No. 7, on kitchen ventilation) b. No

7 Size of ventilation / vent in the kitchen: a. < 20% of the floor area

b. ≥ 20% of the floor area

8 Is there a chimney in the kitchen? a. Y e s , there is.

b. No, there isn’t.