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Infection Control Precautions in Cholera
OutbreakDr. Moustapha Ramadan
Infection Control Doctor- Al Adan HospitalOctober 2015
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O Cholera is an acute enteric infection caused by the ingestion of bacterium Vibrio cholerae present in faecally contaminated water or food.
O Primarily linked to insufficient access to safe water and proper sanitation.
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O The incubation period is two hours to five days.
O Period of communicability is as long as stools are positive ( usually a few days after recovery).
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O About 75% of people infected with cholera do not develop any symptoms, however, the pathogens are in their feces and are shed back into the environment, possibly infecting other individuals.
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O Unlike other diarrheal diseases, it can kill healthy adults within hours.
O Individuals with lower immunity, such as malnourished children or people living with HIV, are at greater risk of death if infected by cholera.
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WHO standard case definition
O In an area where the disease is not known to be present, a patient aged 5 years or more develops severe dehydration or dies from acute watery diarrhoea
O In an area where there is a cholera epidemic, a patient aged 5 years or more develops acute watery diarrhoea, with or without vomiting.
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WHO standard case definition
O A case of cholera is confirmed when Vibrio cholerae O1 or O139 is isolated from any patient with diarrhoea.
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Infection Prevention Measures
TriagePatient Placement Isolation PrecautionsPatient equipment and deviceEnvironmental CleaningWaste managementLaundryHandling corps
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TriageO Rapid and early identification of
patients suspected of cholera infection
O Suspected patients should be placed in an area separate from other patients.
O Standard and contact precautions should be promptly implemented.
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Patient PlacementO Suspected or confirmed cases should
be isolated.
O Patients could be placed together in the same room (cohort) patients who are infected with the same pathogen.
O Ensure that patients are physically separated (i.e., >3 feet apart) from each other.
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Isolation PrecautionsO Patient should be under Standard
and Contact isolation precautions.
O The most important elements of these infection precautions are hand hygiene and protection of hand and cloths (body) from the contact with vomit or stool.
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Isolation Precautions
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Isolation PrecautionsPersonnel Protective Equipment:O Long-sleeved gownO Clean, non-sterile which should cover the
cuffs of the gown.
Donning PPE upon room entry and discarding before exiting the patient room.
Perform hand hygiene before leaving the patient-care environment.
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Patient TransferO Avoid the movement and transport of patients
out of the isolation room or area unless medically necessary.
O Notify the receiving area of the patient's diagnosis and necessary precautions as soon as possible before the patient’s arrival.
O Use routes of transport that minimize exposures of staff, other patients and visitors.
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Patient TransferO The patient must be taken straight to and from the
investigation/treatment room, and must not wait in a communal area.
O Ensure that HCWs who are transporting patients wear appropriate PPE and perform hand hygiene afterwards.
O Perform appropriate decontamination after any procedure.,
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Environmental Cleaning
O Cleaning of surfaces must precede the application of disinfectants.
O Clean and decontaminate immediately spills of vomit, stools or other potentially infectious materials.
O Use appropriate PPE for this task.
O Clean and disinfect frequently touched surfaces regularly with chlorine based agent twice a day.
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Environmental Cleaning
Use chlorine based agent ( sodium hypochlorite ) with the following concentrations:
2% chlorine ( 20000 ppm)Used for disinfecting vomit, feces, and corpsesPrepared by adding 40 tablets of 2.5gm over 2.5 litres of water
0.5% chlorine ( 5000 ppm)Used for foot baths, cleaning floors, bedding, latrinesPrepared by adding 10 tablets of 2.5gm over 2.5 litres of water
0.05% chlorine ( 500 ppm)Used for bathing soiled patients, rinsing dishes, laundry.Prepared by adding 1 tablet of 2.5gm over 2.5 litres of water
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LaundryO Containing soiled items in a water
soluble bag.
O Do not shake or handle items in any way that may aerosolize infectious agents.
O Avoiding contact of one’s body and personal clothing with the soiled items.
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WasteO All waste generated from these
patients should be disposed of in suitable containers or bags and treated as infectious waste.
O Sharp containers shall be located at the point of use to discard slides or tubes with small amounts of blood, scalpel blades, needles and syringes, and unused sterile sharps.
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Patient equipmentO Use single use equipment for patients.
O For common use of equipment for multiple patients, clean and disinfect such equipment (i.e. thermometers, stethoscope and sphygmomanometer) before use on another patient.
O Use 70% ethanol solution or 0.1% hypochlorite solution (for non metal equipment).
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Patient equipmentO Eating utensils and drinking vessels that
are being used should not be shared
O If adequate resources for cleaning utensils and dishes are not available, disposable products may be used
O Water and detergents is sufficient to decontaminate dishware and eating utensils
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Dead BodiesO People who wash and prepare the dead
body must: O Wear gloves, apron and mask.O Clean the body with chlorine solution 2%
( 20000 ppm – 40 tablets 2.5 gm in 2.5 litres)
O Fill the mouth and anus with cotton wool soaked with chlorine solution.
O Bandage the head to maintain the mouth shut.
O Do not empty the intestines
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Case ManagementO Efficient treatment resides in prompt
rehydration through the administration of oral rehydration salts (ORS) or intravenous fluids, depending of the severity of cases.
O Up to 80% of patients can be treated adequately through the administration of ORS.
O Appropriate antibiotics can be given to severe cases to diminish the duration of diarrhoea
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Case ManagementO For children up to five years,
supplementary administration of zinc has a proven effective in reducing duration of diarrhoea as well as reduction in successive diarrhoea episodes.
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