Infection Control Precautions in Cholera

OutbreakDr. Moustapha Ramadan

Infection Control Doctor- Al Adan HospitalOctober 2015

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.

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).

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.

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.

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.

WHO standard case definition

O A case of cholera is confirmed when Vibrio cholerae O1 or O139 is isolated from any patient with diarrhoea.

Infection Prevention Measures

TriagePatient Placement Isolation PrecautionsPatient equipment and deviceEnvironmental CleaningWaste managementLaundryHandling corps

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.

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.

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.

Isolation Precautions

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.

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.

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.,

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.

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

 

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.

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.

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).

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

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

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

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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