CTC estabilishement & Hygiene Final 1.ppt

cyte scan

1. By Birhanu Areda
.
Oromia regional health bureau, Oromia regional health bureau,
PHEM core processPHEM core process
CTC Establishment and Its Hygiene
1

2. 2
PRESENTATION OUTLINES
•What is Cholera?
•Where Does Cholera Epidemic Develop?
•Public Information About Cholera.
•Cholera Mode of Transmission
•Ways To Prevent cholera
•What Is CTC?
•How To Set Up CTCs
•CTC Site Selection Criteria
•Materials Used For CTC Establishment
•Types of Rooms In The CTC
•Job Description Of Personnel's In The CTC
•Disinfectant Solution Preparation & Its Utilization

3. 3
What is Cholera?
•It is an acute enteric disease
•It is caused by Vibrio cholerea O1 and O139
•It is characterized by sudden onset of profuse painless
watery diarrhoea
•or rice-water like diarrhoea,
•vomiting may or may not exist
•The diseases spreads easily
•It may end up in severe dehydration and death if
cases are not managed well
•It Causes 30-50% death if cases are not well managed

4. 4

5. 5
Cholera epidemic develops where
•There is no access to safe and adequate
water
•Personal & domestic hygiene is poor
•Environmental Sanitation is poor

6. 6
Public Information About Cholera
Promote personal hygiene practices like
•Hand washing after defecation
•Hand washing before preparing food
•Hand washing before eating
•Hand washing after cleaning Child’s bottom
•Breast washing before feeding a child
•Use of safe and clean water collection,
storage, handling and consumption (boil or
treat it before consumption)

7. Public information Cont…
•Treatingt water with Wuha Agar, PUR,
Bishan gari or Water maker
•Safe food preparation, cooking,
storage and dish washing
•Appropriate toilet utilization/giving
emphasis to children’s waste

8. 8
Public information cont…
•Inform suspected cases to go immediately
to cholera treatment center (CTCs)
•Prepare Oral Rehydration Point (ORP)
sites and avail medications in every
health facility
•Inform the public that treatment of AWD is
freely available to every one
•Inform pharmacies and private health
facilities to refer Cholera cases to CTC
sites

9. 9
Public info...
Mode of transmission
•Cholera is transmitted by a faecal-oral
route.
•Person to person transmission ( by dirty hands)
be aware of asymptomatic cases
•It is transmitted through Contaminated water
and or food
•Corpse of cholera patients are highly
infectious
•CTCs are also the cause of cholera
transmission if the sanitation is poor

10. 10
cholera transmission &
prevention

11. 11
Public information cont…
Ways to prevent the disease
•Hand washing at critical points
•Food hygiene
•Water safety
•Hygiene of caretakers
•Hygiene at funeral ceremonies
•Appropriate latrine utilization
•Avoiding eating food from street vendors
•Proper solid and liquid waste management

12. 12
What is CTC?
•AWD Therapeutic Centre (CTC)
•Case Treatment Centre
•Cholera Treatment Centre
•CTC is established during outbreak of cholera
•It is organized and being ready with all standard
equipment for case management
NB:- CTC! can become main sources of cholera
contamination and transmission if its hygiene and
isolation measures are inadequate

13. 13
CTC selection criteria
•Ideally CTC should be located inside the
existing health facility
•But it should be separated and isolated
from other departments
•The system should avoid contamination of
non cholera patients

14. 14
When affected area is far from the
Health facilities
•Communities should be involved in the
selection of CTC sites
•CTC should be accessible site for all
users
Consider access to CTCs by car
For regular supplies and supervision
Daily report collection
For water trucking etc

15. 15
CTC selection criteria continued …
•Should have good drainage
•Minimum distance from ground water
source is 40 m
•Should be 100 meter away from market
and dwellings
•Should have good ventilation
•Consider electric light ideally in towns
•Consider possible extension of the
structure

16. 16
Materials for CTC establishment
•Tents
• Different size plastic sheets
•Plastic buckets
•Pops
•Bleach of 5% or 10% chlorine
•Jerry can of 20 liters
•Mops
•Plastic cups to drink ORS solution

17. 17
Materials needed continued --
•Sponge for foot bath (60 cm by 60 cm)
•Rope for fencing
•Heavy duty glove for cleaners
•Boots for cleaner and spray men
• Battery, Candles, Matches and lumps
where there is no electricity
•Plastic sprayers

18. 18
Materials needed continued …
•Graduated Jug of 1 liter
•Soap and cleaning powder
• Plastic container for hand washing
•Dust bin with cover
•Plastic apron for janitors
•Medical gowns and supplies
•Registration books, line lists and
formats are very essential

19. 19
Having all these materials in mind ……
The CTC should be fenced to indicate
people
•where they are allowed to enter or not to
enter to the CTC
•To make sure that not every one enter the
CTC
•To control that every body follows hygiene
rules while entering and leaving the CTC

20. 20
Rooms in the CTC
•The screening room
•The observation room
•The isolation room
•Laundry .Recovery
•Showers .Special Attention unit
•Latrines
•Mortuary
•Staff room
•Store and
•Kitchen

21. 21
Isolation
Observation
Screening
Staff
Store Kitchen
Laundry
Spraying
Hand-washing
Showers
Toilets
F
o
o
t

b
a
t
h

22. Structure of CTC with
22

23. 23
Latrine +
Shower(A)
Shower + Laundry (C)
Admission
area (A)
Special
attention (C)
Morgue
(A)
Waste
disposal
(A)
Recover area
(B)
Latrine (A)
Shower (A)
Neutral area (Store, Kitchen,
Office)(C)
Observation/
ORS area (A)
Latrine (A)
Shower (A)
Screening & Registration
(A)
A= Mandatory, B= Second
priority, C= Third priority
Staff
Entry. &
Exit
Exit
Entrance

24. 24
CTC Made With Local Fence

25. 25
Standard CTC Compound

26. 26
Anferara CTC (Adola Rede - Guji)

27. 27
Guide for Simple Latrine and Bathing
•Latrines should be 5 -10 meters apart from
the tents where patients are admitted
•It should not be located in any channel
where water flows during heavy rain.
•Ideally a separate latrine should be
construct for both men and women
•A separate latrine for patients, caretakers
and staffs

28. 28
Guide for simple latrine continued..
•Floor area should be easily cleanable &
washable
•The pit should be as deep as possible not
to fill up quickly / 1.5 m / and above.
•Thick plastic sheets or locally available
materials should be used to serve as a
superstructure for privacy
•A free moveable door should be used

29. 29
Latrine and shower cleaning and
maintenance
•Latrines should be cleaned regularly with
0.2% chlorine solution
•Latrine before filling and left 50 cm to the
surface of the ground should be disinfected
and closed
•Another latrine should be dug immediately
•The shower unit should be screened to allow
privacy during bathing
•The floor of the CTC & shower should be
washable and be cleaned regularly with 0.2%
chlorine solution

30. 30
Job description of staffs in the CTC
1.The medical team
•Differentiate cholera cases from non
cholera patients
•Sever cases from mild case for case
management
• Prepare chlorine solution (0.05%,
0.2% , daily & 2% as needed)
•Prepare ORS daily

31. The medical team…
•Supervise cleaners to ensure whether
hygiene and sanitation rules are followed
in the CTC
•Hygiene education for community
members and care takers
•Be exempler for personal hygiene to
others
•E.g. Wash hands every time after having
contact with patients, wearing gowns etc.
31

32. 32
Job description continued…
2. Cleaners
•Cleaning floors with 0.2% chlorine solution, and
soaking pops in 2 % chlorine solution
•Clean showers, latrines and the CTC whenever
necessary
•Refill hand washing container, sprayers and foot
bath
•Collect wastes in bins with cover
•Clean buckets soiled with excreta and vomits

33. 33
Job description continued---
3. The Guards /spray men/
•Allow only one patient and one caretaker to the
CTC
•Following whoever exits the camp wash their
hands every time
•Making whoever enters the camp disinfect there
feet or shoes
•Make sure there is chlorine solution for spray,
hand washing & foot bath
•Spraying patients and care takers when they
arrive and leave

34. 34
Daily preparation of disinfectant solutions
2%
chlorine
solution
0.2%
chlorine
solution
0.05%
chlorine
solution
Excreta,
vomits
and dead
bodies
Floor
objects
beds and
foot path
Hands and
skin
Drinking water
Yellow bottle
5% chlorine
solution
10Lt
chlorine to
10 Lt water
(1:2)
1:25 1:100
Blue container
10% solution
1:4 1:50 1:200
Water guard
Wuha Agar
One cup only in 20
liters transparent water
Water maker
Bishan- gari
one sachet in 20 liters
of clean water
PUR 2 sachets in 20 liters of
turbid water

35. 35
•Available Chlorine at market is 5% or 10%
Formula used = Percentage of available chlorine -1
% tage of chlorine to be used
Eg. Prepare a 0.05% Chlorine solution from 5%
bleach/ Berekina/
Using the formula given above
5% chlorine -1
0.05% chlorine
(500/5)-1 = 99 part of water
1 part of 5% chlorine to 99 part of water is added
Ratio 1:100
Preparation of chlorine solution

36. 36
How much ml of 5% chlorine is used to be add in
20 liters of water for hand washing purpose?
•In the above example the ratio of 5%
chlorine to water for hand washing is
1 Part of 5% chlorine in :100 parts of
solution
1Lt of 5% chlorine = 100Lts of solution
? 20Lt of solution
1Lt 5% chlorine X20 Lt = 0.2 Lt = 200 ml

100Lts

37. 37
Prepare 0.2% chlorine solution from 5% bleach
5% Bleach - 1
0.2% chlorine solution
( 50/2 )-1= 24
1Part of berekina in 25 parts of solution
If 1 liter of 5% bleach is used for 25 liters solution
1Lt =25Lt , 1Lt X 20Lt = 0.800Lt of 5% chlorine

? = 20 Lt 25Lt

38. 38
Prepare 2% chlorine solution from 5%
Bleach
•Using the formula
5% bleach -1
2% chlorine solution
(5/2) -1 = 1.5
1: 2.5
The same formula applies to prepare 0.05%, 0.2%
and 2% chlorine solution from 10% bleach

39. High Test Hypochlorite 65-70%
Solution Preparation Utilization
0.05% 7.5 gm/10 Lt
½ soup spoon/10 Lt
Hand (skin) Clothes, washing up
objects
0.2% 30 gm/10 Lt
2 soup spoon/10 Lt
Floor , beds objects and for
spraying
2% 30 gm/1 Lt
2 Soup spoon/1 Lt
Sterilization of
equipment ,corpse cleaning
39

40. Summary
Types of solutions to be prepared
Original
Chlorine
Concentration
0.05% 0.2% 2%
5% 200ml in 20 Lt
solution

800 ml in 20 Lt solution1Lt in 2.5 Lt
solution
10 % 100 ml in 20 Lt
solution

400 ml in 20 Lt solution0.5Lt in 2.5 Lt
solution
40

41. 41
Disinfecting transportation and the house of
cholera patients
•Using 0.2% chlorine solution disinfect cars/
ambulances and carrying materials on arrival
before they leave (public transport)
•Use 0.2% chlorine solution for house spraying and
spray also latrines and vomits on the way

•Visiting of the affected household will be a good
opportunity to give hygiene education to family
members

•At the same time visiting is a way of surveillance
as you can detect new cases in the neighborhood

42. 42
Disinfecting patients in the CTC
•When patients arrive use 0.05% chlorine solution
for hand washing
•Spray their clothes with 0.2% chlorine solution
•During their stay, vomits and feaces should be
collected in pops with 2% chlorine solution
•Their waste must be left for 10 minutes in a strong
2 % chlorine solution ( clean bed pans with this
solution before empting them)
•Before they leave, their clothes should be
sterilized in boiled water, or immersed in 0.2%
solution for 10 minutes
•Patients and relative plates and every utincel
should be washed with 0.05% chlorine solution

43. 43
General hygiene in the CTC
•All people entering and exiting from the CTC
should walk through foot bath to disinfect the
bottom of their shoe
•Relatives should minimize contact with patients
waste
•In case of death the relatives must be advised to
take care during funeral ceremonies
•All persons handling the dead body should wash
their hands effectively

44. 44
Keeping the CTC clean
•Good solid waste management
•Waste that can be burn
•Sharps needles lancets and ampoules
cause injury and transmit disease if not
properly disposed
•Collect it in a safety box
•Disposed other wastes in a dug pit
•Disinfect & back fill pit of the latrine up on
closure of the CTC

45. 45
Keeping the CTC clean
Mortuary
•Take in to consideration that death may occur
•A closed tent or plastic material for a temporary
stay of dead body should be arranged
•Have suitable drainage for corpse cleaning
•The corpse should be moved as soon as
possible to the mortuary
•Convince families to take the dead body directly
to burial place
•After handling dead body be sure washing
hands and get disinfected

46. 46
Summary of essential principles
•Isolate sever cases from mild once
•Keep all excreta and vomits in a safe way
•Allow only one care taker per patient to the CTC
•Wash hands with 0.05% chlorine solution regularly
•Disinfect feet & wash hands when leaving the
center
•Disinfect cloth of patients before leaving the center
•Inform every body about the danger of cholera
•If people arrive by public transport, disinfect the
car/ ambulance
•During closure of the CTC disinfect all areas
including the latrine and materials used

47. 47
We can stop the Outbreak
working together

Thank you