2. OUTLINE
• Introduction
• Overview of epidemiology and virus characteristics
• Recent Lassa Fever Outbreaks in Nigeria
• Pathogenesis
• Clinical Features and Case Management of Lassa Fever
• SOP for managing Lassa Fever in UPTH
• Prevention
• The Nigerian response so far
• Conclusion
3. Introduction
• Viral Haemorrhagic Fevers (VHF) are a clinical
syndrome characterized by fever, bleeding tendency
and shock.
• VHFs are endemic in parts of Africa, South America,
the Middle East and Eastern Europe.
4. Introduction continued
VHFs are of particular public health importance because they:
• Spread within a hospital setting
• Have a high case-fatality rate
• Are difficult to recognize and detect rapidly
• Have no effective treatment
• Have a potential usage for bioterrorism
• Drain the healthcare system following an outbreak
5. Introduction continued
• Lassa fever is an acute viral hemorrhagic fever caused by the Lassa virus.
• Lassa virus has an unusual potential for human-to-human spread and has
resulted in many small epidemics in Nigeria, Sierra Leone, and Liberia.
• Medical workers in Africa and the United States have also contracted the
disease.
• Patients with acute Lassa fever have been transported by international
aircraft, necessitating extensive surveillance among passengers and crews.
6. Introduction condition
• Environmental conditions in Nigeria support the
natural reservoirs of Lassa fever virus and cases of
person to person transmission is presently been
reported.
9. Overview of the epidemiology of Lassa Fever
Disease Genus, Family Reservoir Vector Distribution Clinical
cases/year
Lethality
Lassa Fever Arenavirus Rodent
(lives in a
persistent
asymptomatic
state)
Rodent West Africa 300,000 2 – 20%
VHF of
Importance
Virus Characteristics Vector Infectivity
period
Mode of
Transmission
Lassa fever
virus
Enveloped , round,
pleomorphic virus
50-300nm(diameter)
SS genome with 2RNA
segments
Mastomys
natalensis
Urine: up to 32
days
Semen: 3 months
Contact with rodent
and their excreta;
aerosolized,
ingested
Virus Characteristics
10. Transmission of Lassa Fever
Rodent –to – human transmission Human –to – human transmission
Inhalation of aerosolized virus Direct contact with blood, tissues,
secretions or excretions of infected
humans
Ingestion of food or materials
contaminated by infected rodent
excreta
Needle stick or cut
Catching and preparing Mastomys as a
food source
Inhalation of aerosolized virus
11. Mastomys natalensis
• Reservoir of the Lassa virus
• Has a chain of breasts made up
of 10 – 12 nipples
• Tails longer than the body
12. Epidemiology – Lassa Fever
• Discovered in Nigeria, 1969
• Endemic in parts of West Africa; Liberia, Nigeria, Sierra Leone and
Guinea.
• Seasonal clustering: late rainy season and early dry season
• Affects all age groups
• Overall mortality is estimated to be about 1% but is around 15-20%
for hospitalized patients.
• However, during epidemics, mortality may be up to 50%.
13. Epidemiology – Lassa fever
• Lassa virus also causes high foetal mortality and high mortality in
pregnant women.
• The mortality rate is 92% for foetuses in early pregnancy
• 75% for foetuses in the third trimester
• 100% in the neonatal period for full-term babies
• The mortality rate for gravid women is 7% in the first two trimesters,
30% in the last trimester, and 50% for pregnant women who delivered
within one month.
14. Epidemiology
• The Lassa virus is transmitted to humans via at least 2 vector species;
M. huberti and M. erythroleucus. (State Deparment, 2003).
• These rodents reproduce at very high rates and like to live in very
close proximity to humans, especially where food is kept.
• There are 4 strains: Josiah (the most studied strain from Sierra Leone),
Nigeria, LP and AV.
16. Outbreak - Lassa fever in Nigeria
• First outbreak 1969 , 2 Nuns died in Bornu state.
• In March 2012 , the Fed MOH notified WHO – LF Outbreak. 623
suspected cases, including 70 deaths (CFR 11.2%) involving 19 of
the 36 States.
• 108 had been laboratory confirmed.
• 3 doctors and 4 nurses were reported to be among the fatalities.
Edo,ondo,Oyo,Lagos,Anambra,Ebonyi,Abia,Rivers,Taraba,Nasarawa, Kaduna, Kano, Adamawa, Yobe, Borno, FCT, Plateau, Gombe
17. Outbreak – Lassa fever
• In 2013: 1195/39 CFR: 3.26%
• In 2014: 989/36 CFR: 3.64%
• As of 16/01/2015 : 6 cases, no deaths
• Most recent outbreak started December 2015 till date.
18. Spot map showing cases of Lassa fever by state and LGA from Week 35 2015 – Week 2 2016
19. LASSA FEVER OUTBREAK IN NIGERIA Daily Situation Report No. 11: 19 January, 2016 Nigeria Centre for Disease Control (NCDC)
20. Lassa fever in Children
• 2.9-10% of admissions in Liberia.
• ? 3% of admissions in Nigeria.
• 20% of children in a village with an epidemic were sero-
positive although none was ill.
• Akpede et al. (2012) reported 5 cases of Lassa fever in children
who presented at the hospital.
22. • Although different pathophysiologic processes occur in different VHFs, the
following are common:
1. Vascular damage
2. Disorders of coagulation
3. Immunological impairment
4. End organ damage
Pathogenesis of Lassa Fever
24. Clinical Features
• A spectrum from asymptomatic (80%) to severe disease,
characterized by loss of plasma from small vessels (capillary
leakage) and bleeding.
• Liver involvement is common, including jaundice.
• Clinically, these infections can be confused with other causes of
febrile illness and a high index of suspicion is needful.
25. Symptoms of Lassa Fever
• Incubation Period
• Lassa Fever 10 (3 – 21) days
• Common symptoms:
• Fever, malaise, fatigue and body aches.
• Nausea; vomiting; diarrhoea; headache
• Diarrhoea; productive cough; proteinuria; low BP anaemia.
• Facial edema; convulsions; mucosal bleeding (mouth, nose, eyes);
• internal bleeding; confusion; disorientation; coma and death.
26. Case Definition for a suspected Lassa Fever
• Fever >380C for < 3weeks AND
• Absence of signs of local inflammation (ie. the sickness is systemic) AND
• Absence of a clinical response after 48hr of anti-malaria treatment &/OR
a broad spectrum antibiotic AND
• Two major or one major and two minor signs described below:
27. Case definition for suspected case continued
MAJOR SIGNS
• Bleeding
• Swollen neck or face
• Conjunctivitis or subconjunctival
haemorrhage
• Spontaneous abortion
• Petechial or haemorrhagic rash
• New onset tinnitus or altered hearing
• Persistent hypotension
• Raised transaminases esp. AST>ALT
• Known exposure to a Lassa fever case
MINOR SIGNS
• Headache
• Sore throat
• Vomiting
• Diffuse abdominal pain/ tenderness
• Chest/ retrosternal pain
• Cough
• Diarrhea
• Generalized myalgia or arthralgia
• Profuse weakness
• Proteinuria
• Leucopenia < 4000/L
28. Clinical Stages of severe Lassa Fever (adapted from McCarthy 2002)
STAGE SYMPTOMS
1
(days 1-3)
General weakness and malaise.
High fever, >39OC, constant with peaks of 40-41oC
2
(days 4-7)
Sore throat (with exudative patches) very common
Headache , back, chest, side or abdominal pain
Conjunctivitis
Nausea and vomiting
Diarrhea
Productive cough
Proteinuria
Low blood pressure (systolic <100 mmHg)
Anaemia
3
(after 7 days)
Oedema of the face and neck
Convulsions
Mucosal bleeding (mouth, nose, eyes)
Internal bleeding
Encephalopathy with confusion or disorientation
4
(after 14 days)
Coma
Death
29. LSHTM Jan- Feb 2015 online course materials on Ebola in context: understanding transmission, response and control.
30. Differential Diagnoses
• Severe Malaria
• Typhoid fever
• Shigellosis
• Leptospirosis
• Rickettsial diseases
• Viral hepatitis
• Cholera
• Meningococcaemia and Gram negative sepsis
• Other VHFs (Ebola/ Marburg , Rift Valley Fever,
Chikungunya, O’nyong-nyong, WNV, Zika)
31. Complications of Lassa Fever
• Deafness (1/3 of cases), permanent
• Spontaneous abortion
• Hypovolemic shock
• Respiratory distress resulting from airway obstruction, pleural
effusion, or congestive heart failure may occur.
• 10–20% of patients experience late neurologic involvement
characterized by intention tremor of the tongue and associated
speech abnormalities. In severe cases, there may be intention
tremors of the extremities, seizures, and delirium. The cerebrospinal
fluid is normal.
• Anuria
• Death
32. Laboratory investigations
• CBC:-mild Leucopaenia and Lymphopaenia / Mild thrombocytopaenia
• Urinalysis: Proteinuria
• Serum: High BUN
• High liver transaminases (AST>150 U/L)
• Definitive Tests:
• IgM ELISA, IgG ** (** occurs late)
• Lassa Virus Antigen
• RT-PCR (3
rd
day)
• Viral culture (7- 10 days)
• Post mortem – Immunohistochemistry on tissue specimens
33. Case Management of Lassa Fever
• Isolation
• Infection control – barrier nursing
• Ribavirin : shown to reduce mortality 5-10 fold if given intravenously
within 6 days of the clinical illness.
• Loading dose: IV 30mg/kg (max. 2g), followed by 15mg/kg 6hrly for 4
days (max. 1g), then 7.5mg/kg (max. 500mg) 8 hrly for 6 days
• Dilute Ribavirin in 150mls of 0.9%NS and infuse slowly.
• no convincing evidence that oral rivabirin delays or prevents Lassa
fever
35. SOP in UPTH for Management of Lassa Fever
If Healthcare staff sees any patient with features that meet the case
definition for suspected Lassa Fever in UPTH, the worker should do
the following:
Ensure use of Personal Protective Equipment (PPE)
Use the diagnostic criteria to ascertain the patient meets the case
definition
If patient meets the case definition, Notify the CMAC and the
Infection Control VHF Team, send the patient to Isolation Unit in A&E;
36. SOP in UPTH for Management of Lassa Fever
Collect a blood specimen ensuring adequate infection control
precaution for VHF Testing and case confirmation in EDTA Bottle
(4mls);
Test for Malaria, Widal, FBC, E/U/Cr and LFT;
Set up intravenous line with Normal Saline;
Recommend Oral Rehydration solution;
37. SOP in UPTH for Management of Lassa Fever
Treat for malaria;
Commence broad spectrum antibiotics – ceftriaxone 1gm daily and
Metronidazole 500mg 8 hourly;
If patient meets case definition for suspected VHF Lassa also
commence IV Ribavirin loading dose in line with outlined Protocol for
Ribavirin; and
Review management further based on screening results.
38. Lassa Fever Isolation Ward – Management Guidelines
• Strict barrier nursing with PPE
• Set up IV line
• Collect 10mls of whole blood from all patients into EDTA Bottle
• IV Fluids
• Analgesics
• Monitor vital signs
• If fever + conjunctivitis + petechial stat Ribavirin until test result is out.
• No visitors into the ward
• Obey strict movement guidelines in ISW
• Record all contacts
39. PPE – All Close Contacts
• Wear protective clothing always
• Wear mask and gloves always
• Stat prophylaxis with Ribavirin (400mg bd for 10days)
• All clothing used must be treated with 10% Bleach (Sodium hypo
chloride)
• Monitor temperature for 21 days, if > 380C, Report immediately for
blood test and prophylaxis.
40.
41. Flow chat for reporting VHF outbreaks in Rivers state
43. • Training of all health care workers in the use of PPE is vital.
• CDC recommends facilities use a powered air-purifying respirator
(PAPR) or an N95 or higher respirator in the event of an unexpected
aerosol generating procedure.
44. Recommended PPE
• PAPR or N95 Respirator
• Fluid resistant or impermeable
gown that extends to at least
mid calf or coverall without
integrated hood
• Nitrile examination gloves with
extended cuffs (2 pairs)
• Fluid resistant or impermeable
boot covers that extend to at
least mid calf or shoe covers
• Fluid resistant or impermeable
apron that cover torso to level of
mid-calf
• Face shield/ eye goggles/
surgical hood
45. Donning
• Remove personal clothing and
items
• Inspect PPE prior to Donning
• Perform Hand hygiene
• Put on inner gloves
• Put on boot or shoe covers
• Put on gown or coverall
• Put on outer gloves
• Put on respirator**
• Put on outer apron (if used)
• Disinfect outer gloves
• Verify***
Doffing
• Inspect for visible contamination
• Disinfect outer gloves
• Remove apron
• Inspect PPE for stains, cuts, tears
• Disinfect outer gloves
• Remove boot or shoe cover
• Disinfect and remove outer gloves
• Inspect & disinfect inner gloves
• Remove respirator/ face shield
• Disinfect inner gloves
• Remove surgical hood
• Disinfect inner gloves
• Remove gown or coverall
• Disinfect inner gloves
• Disinfect washable shoes
• Disinfect & remove inner gloves
• Perform hand hygiene
• Inspect
• showers and Scrub
** put on N95 respirator and surgical hood over it before apron and then outer gloves and lastly face shield
*** integrity of ensemble is verified by a trained observer
49. General Health Promotion
• Clean environment
• Good health seeking behavior
• Proper Hand Washing
• Health education via media, pamphlets, religious & social gatherings, etc
• Proper nutrition
50.
51. Specific Health Protection
• Fumigation – Rodents
• Proper storage of farm produce
• Avoidance of Bush burning practices
• Putting food away in rodent-proof containers
• Barriers preventing rodents from entering into houses
• Routinely clean and disinfect commonly touched surfaces like
bathroom surfaces, since some germs can stay infectious for hours or
days and lead to transmission.
• Early self referral
52. Specific Health Protection
• Regular hand washing with soap & water,
hand sanitizers
• Avoid contact with body fluid/secretions of infected or
dead persons
• Proper cooking/ avoidance of bush meat
• Report any suspected case to local authorities
53. Specific Health Protection
• Proper disposal of sharps & clothing of sick individuals (Incineration)
• Proper burial of corpse.
• Enact border laws to curb spread
• Avoid attending or hosting public gatherings/events unless strictly
indicated (in case of an outbreak).
54. Specific Health Protection
• Condom distribution for survivors
• Oral ribavirin for high risk / close contacts
• Training of health care staff
• Enhancement of disease surveillance
55. Specific Health Protection
• Avoid blood donation
• Standard precautions – (PPE – mask, gloves, gowns, goggles)and Infection
control measures – complete equipment sterilization and isolating infected
persons
• Barrier nursing
-Use of personal protective equipment (PPE)
-Infection control measures such as handwashing, handling and disposal
of sharps, reprocessing of reusable equipment and instruments, cough
etiquette, aseptic technique, waste management and handling of linen.
56. Transmission- based precautions
• Includes any or a combination of the following:
• Allocating a single room with closing door to patient with a suspected
or confirmed infection (isolation)
• Placing patients colonized or infected with the same infectious agent
and antibiogram in a room together (cohorting)
• Wearing a specific PPE
• Providing patient-dedicated equipment
• Using disinfectants with label claims specifying its effectiveness
against specific infectious organisms.
• Using specific air-handling techniques
• Restricting movement both of patients and healthcare workers.
57. Early Diagnosis & Prompt Treatment
• High index of suspicion
• Prompt dissemination of case definition
• Screening/ triaging / risk assessment
• Isolate/Quarantine
58. Early diagnosis & Prompt treatment
• Readily available & accessible diagnostic
• Provision of ribavirin
64. The Nigerian Response so far:
• Coordination
• NCDC/FMOH is taking leadership for coordination supported by partners
• Daily review meeting at the EOC
• Technical guidance is being provided to states based on available capacities
(coordination, surveillance, case management and IPC) within states
• Production of daily Situation report
65. The Nigerian Response so far
• Case Management and Infection Prevention and Control
• 71,000 tabs of Ribavirin, 20,750 vials of parenteral Ribavirin and 960 pieces of
PPE distributed to the affected states as of today.
• Isolation centers have been identified in most states
• NCDC/Niger state team supervised the safe burial of a suspected case today
• Surveillance
• Continuing outbreak investigation in the affected states
• Nationwide alert to SMOH on current situation and need for preparedness
• Contact tracing ongoing in affected states
• Clinician sensitization ongoing in affected states
66. The Nigerian Response so far
• Laboratory
• 5 National laboratories with PCR capability are currently conducting analysis
of samples
• 101 samples analyzed and 42 tested positive for Lassa fever, other VHFs were
negative
• Some laboratory results are currently awaited.
67. The Nigerian Response so far
• Communication and Social Mobilization
• Training for NCDC call centre operators conducted today
• Radio and television jingles are ongoing in the states
• Lassa fever information website ( www.lassaalert.org ) linked to the NCDC
website has been developed and has gone live.
• Community health education ongoing
• Challenges
• Coordination of laboratory network leading to delay in sending laboratory
results
• Logistics support for contact tracing in the states Logistics for sample
transportation for prompt laboratory diagnosis
68. The Nigerian Response so far
• Next steps
• Reinforce active surveillance, contract tracing and continue outbreak
investigation
• Continue clinician sensitization to ensure early detection and reporting
• Continue health education and community sensitization
• Capacity building at state level for coordination, surveillance, case
management and IPC, communication and social mobilization
• Coordinate laboratory network for prompt release of documented results.
69. CONCLUSION
• Lassa Fever is still present in our Country Nigeria.
• Diagnosis requires a high index of suspicion for every patient
presenting with a fever.
• Travel history to neighboring states still plagued by a Lassa
Fever and history of contact is pertinent.
• Treatment is mostly symptomatic.
• Prevention is KEY!
• NEVER LET DOWN YOUR GUARD.!!!!
70. References
• Akpede GO, Kayode-Adedeji BO, Dawodu SO(2012) Manifestations and
outcomes of lassa fever in Nigerian children: a case series. Arch Dis
Child 2012;97:A38-A39 doi:10.1136/archdischild-2012-301885.96
• Deborah UE, Danny AA, Jacqueline E, Peter OO et. Al (2012). Hospital based
surveillance for lassa fever in Edo state, Nigeria, 2005 – 2008. Tropical
Medicine and International health J. 2012; 17(8):1001-1004
• Nigeria Centre for disease control (NCDC). FMoH, Summary Table (IDSR
weekly report as at
16/01/2015).http://www.health.gov.ng/doc/EpidRpt_Wk_2
2015.pdf.accessed on 27/3/15.
• Durham, Jerry D. and Felissa R. Lashley. Emerging Infectious Diseases-
Trends and Issues. Springer Publishing Company. (2002)
71. References
• LASSA FEVER OUTBREAK IN NIGERIA Daily Situation Report No. 11: 19
January, 2016 Nigeria Centre for Disease Control (NCDC).
http://reliefweb.int/sites/reliefweb.int/files/resources/Lassa11.pdf
• LSHTM Jan- Feb 2015 online course materials on Ebola in context:
understanding transmission, response and control.
• Centers for Disease Control. Lassa Fever. Fact sheet.
http://www.cdc.gov/vhf/lassa/pdf/factsheet.pdf
• WHO (2010).Technical guidelines for Integrated Disease Surveillance and
Response in the African Region 2nd edition.
http://www.cdc.gov/globalhealth/dphswd/idsr/pdf/Technical%20Guideline
s/IDSR%20Technical%20Guidelines%202nd%20Edition_2010_English.pdf
accessed on 28/3/2015.
Notas do Editor
About 5000 deaths.
Transmission to man is through faecal-oral route, or respiratory tract by inhaling contaminated air containing the virus, or when infected blood touches bruised skin or by sexual intercourse. Infected persons represent serious threat to the environment.
Estimated 300,000 – 500,000 infections / year, with 5000 deaths
Rodent to human transmission ( the ‘multimammate rat’, Mastomys species-complex)
Secondary human-to-human transmission with the potential for nosocomial outbreaks with high case-fatality.
Overall mortality is estimated to be about 1% but is around 15% for hospitalized patients.
The virus has an affinity for the placenta and other vascular tissues. The fetus has only a one in ten chance of survival no matter what course of action is taken, hence focus is always on saving the mother. Following delivery women should receive same treatment as other lassa fever patients.
Abortion decreases the risk of death in the mothers.
1. Vascular damage, which may be due to direct viral invasion of endothelial cells, complement and cytokine activation and immune complex deposition.
2.Disorders of coagulation, which may be due to thrombocytopenia (caused by bone marrow suppression and increased consumption), abnormal platelet function, impaired production of clotting factors by the liver, and disseminated intravascular coagulation
3. Immunological impairment, which inhibits the immune response and allows uncontrolled viral replication.
4.End-organ damage, which is most often due to direct viral cytopathology (e.g. hepatic damage in yellow fever), or in some cases due to the host inflammatory response (e.g. nephritis in HFRS).
Incubation period: time elapsed between exposure to a pathogenic organism and the onset of clinical symptoms.
This slide simply depicts the non-specific symptomatology of EVD and other VHFs. Noteworthy is the much less frequency of bleeding as a presenting symptom. Thus a change in the name from EHF to EVD.
Enzyme Linked Immunosorbent Assay
(lassa)
- clinician sensitization
- surveillance and public education on preventive measures
*** There is no convincing evidence that oral rivabirin delays or prevents Lassa fever after exposure to the virus and it is therefore not generally recommended as post-exposure prophylaxis. However, it may be considered for high risk contacts of LF patients.
- Ribavirin can also be used for other VHF like CCHF, Venezuelan HF and Hantavirus infection.
IEDCR: Institute of disease, control and research.
NCDC – Nigeria Centre for Disease Control
Standard Precautions
Standard Precautions (also called Universal Precautions) are basic infection control measures, and are a minimum standard in every health structure. Standard precautions require that health care workers assume that the blood and body substances of all patients are potential sources of infection, regardless of the diagnosis, or presumed infectious status.
Wash hands
Before and after touching a patient.
After any contact with body fluids.
Prepare container of clean water, basin, soap-dish, waste bin, and disposable towel (or air-dry hands).
Wear gloves
If there is contact with body fluids, broken skin or mucous membranes.
Remove gloves, discard in waste bucket, and wash hands after each use.
Routine cleaning with soap or detergent
Of beds, bedside tables, examination tables.
Of floors, latrines and bathing areas, etc.
Handle needles and sharps safely.
Avoid separating needles from syringes.
Put needles and sharps in puncture resistant sharps container.
Do not re-cap needles.
Do not re-use needles or syringes.
Dispose of sharps container in sharps pit.
Safe disposal of spills and waste
Remove with cloth.
Wash area with soap and water or detergent or chlorine solution and leave to dry.
Wear mask & goggles
The eyes, nose, and mouth are the most vulnerable part of the body; therefore, protection is necessary especially if a splash is likely.
Isolate the VHF patient:
Limit patient movement and restrict access to one trained patient attendant.
Cover mattress with reusable plastic sheet.
Instruct attendant to avoid touching patient, and provide protective gear and training to attendant.
Avoid giving injections or taking blood.
Wear protective gear when touching/examining patient
Wear mask and goggles
Especially if splash is anticipated or patient is coughing.
Safely dispose of contaminated materials:
Use plastic bag receptacle for contaminated materials such as used latex gloves, or other disposable materials used by patient.
Discard and burn contaminated materials.
Use disinfection procedures:
Prepare 0.5% and 0.05% chlorine solutions.
Disinfect the following items in 0.05% chlorine solution:
Household gloves, aprons, goggles;
Medical equipment such as thermometers
Cups and dishes
Disinfect gloved hands after contact with patient in 0.5% chlorine
Disinfect patients excreta, vomit, urine:
Add 0.5% chlorine to the container to cover contents and discard in latrine.
Wash container with soapy water and discard in latrine.
Rinse container with 0.5% chlorine (container may then be re-used).
Disinfect spills of body fluids
Cover completely with 0.5% chlorine solution
Let stand for 15 minutes.
Remove with rag or paper towels.
Discard rag in plastic bag for infected waste
Wash area with soap and water.
Disinfect patient clothing and bedding before laundering:
Soak soiled clothing in 0.05% chlorine for at least 30 minutes.
Remove and place in a container of soapy water overnight, rinse thoroughly and dry on line.
Close laboratories and operating theatres to non-essential surgery until safe working is guaranteed.
Standard Precautions
Standard Precautions (also called Universal Precautions) are basic infection control measures, and are a minimum standard in every health structure. Standard precautions require that health care workers assume that the blood and body substances of all patients are potential sources of infection, regardless of the diagnosis, or presumed infectious status.
a. Wash hands
Before and after touching a patient.
After any contact with body fluids.
Prepare container of clean water, basin, soap-dish, waste bin, and disposable towel (or air-dry hands).
b. Wear gloves
If there is contact with body fluids, broken skin or mucous membranes.
Remove gloves, discard in waste bucket, and wash hands after each use.
c. Routine cleaning with soap or detergent
Of beds, bedside tables, examination tables.
Of floors, latrines and bathing areas, etc.
d. Handle needles and sharps safely.
Avoid separating needles from syringes.
Put needles and sharps in puncture resistant sharps container.
Do not re-cap needles.
Do not re-use needles or syringes.
Dispose of sharps container in sharps pit.
e. Safe disposal of spills and waste
Remove with cloth.
Wash area with soap and water or detergent or chlorine solution and leave to dry.
f. Wear mask & goggles
The eyes, nose, and mouth are the most vulnerable part of the body; therefore, protection is necessary especially if a splash is likely.
Additional precautions are required for diseases transmitted by air, droplets, and contact. These are termed “additional (transmission-based) precautions”, and specific precautions to reduce VHF transmission are described below.
Additional (transmission-based) Precautions to Reduce VHF Transmission in Health Structures
Precautions to reduce VHF transmission in health structures must be applied in all regular health facilities within the suspected epidemic area as soon as VHF is confirmed.
In the isolation unit, complete barrier nursing and infection control techniques will be used.
Additional precautions required for dealing with VHFs are as follows.
a. Isolate the VHF patient:
Limit patient movement and restrict access to one trained patient attendant.
Cover mattress with reusable plastic sheet.
Instruct attendant to avoid touching patient, and provide protective gear and training to attendant.
b. Avoid giving injections or taking blood.
c. Wear protective gear when touching/examining patient
d. Wear mask and goggles
Especially if splash is anticipated or patient is coughing.
e. Safely dispose of contaminated materials:
Use plastic bag receptacle for contaminated materials such as used latex gloves, or other disposable materials used by patient.
Discard and burn contaminated materials.
f. Use disinfection procedures:
Prepare 0.5% and 0.05% chlorine solutions.
i. Disinfect the following items in 0.05% chlorine solution:
Household gloves, aprons, goggles;
Medical equipment such as thermometers
Cups and dishes
ii. Disinfect gloved hands after contact with patient in 0.5% chlorine
iii. Disinfect patients excreta, vomit, urine:
Add 0.5% chlorine to the container to cover contents and discard in latrine.
Wash container with soapy water and discard in latrine.
Rinse container with 0.5% chlorine (container may then be re-used).
iv. Disinfect spills of body fluids
Cover completely with 0.5% chlorine solution
Let stand for 15 minutes.
Remove with rag or paper towels.
Discard rag in plastic bag for infected waste
Wash area with soap and water.
v. Disinfect patient clothing and bedding before laundering:
Soak soiled clothing in 0.05% chlorine for at least 30 minutes.
Remove and place in a container of soapy water overnight, rinse thoroughly and dry on line.
g. Close laboratories and operating theatres to non-essential surgery until safe working is guaranteed.