Prevention of viral hemorrhagic fever

VHF isolation precautions poster

Prevention of viral hemorrhagic fever is similar for the different viruses. There are a number of different viral hemorrhagic fevers including Ebola virus disease, Lassa fever, Rift valley fever, Marburg virus disease, Crimean-Congo haemorrhagic fever (CCHF) and yellow fever.[1] Lassa, Ebola, Marburg and CCHF can be spread by direct contact with the body fluids of those infected.[1] Thus the content here covers the prevention of Ebola.

Standard precautions

An example of a handwashing station in a low resource setting

The use of standard precautions is recommended with all patients in a healthcare environment.[1] This includes a minimum level of standard precautions for use with all people regardless of their infection status, routine handwashing practices, safe handling and disposal of used needles and syringes, and intensifying standard precautions. It also includes VHF isolation precautions when needed.[1]

Limited supplies and resources may prevent a health facility from using all the standard precautions all the time. However, health facilities should establish and maintain a basic, practical level of standard precautions that can be used routinely with patients in their health facility.[1] This requires a source of clean water, routine handwashing before and after any contact with a person who has fever, and safe handling and disposal of sharp instruments and equipment.[1]

Washing hands with soap and water eliminates microorganisms from the skin and hands. This provides some protection against transmission of VHF and other diseases.[1] This requires at least cake soap cut into small pieces, soap dishes with openings that allow water to drain away, running water or a bucket kept full with clean water, a bucket for collecting rinse water and a ladle for dipping, if running water is not available, and one-use towels.[1]

The handwashing technique that is recommended is to place a piece of soap in the palm of one hand, wash the opposite hand and forearm, rub the surfaces vigorously for at least 10 seconds, move soap to the opposite hand and repeat, use clean water to rinse both hands and then the forearms, dry the hands and forearms with a clean one-use towel, or let rinsed hands and forearms air-dry.[1]

Reusable needles and syringes are not recommended. If reusable needles and syringes are used, clean, disinfect and sterilize them before reuse. Needles and syringes used with VHF patients require special care. Cleaning staff should wear two pairs of gloves when handling needles and syringes used with any patient with a known or suspected VHF.[1]

Identifying suspected cases

In an outbreak situation, several cases occur around the same time. They may be grouped together, and there may be person-to-person transmission. An initial diagnosis of a VHF can be made based on the signs and symptoms of the specific VHF.

Suspecting a VHF during a non-outbreak situation in a single case is more difficult. The early symptoms of a VHF include high fever and headache. These are also symptoms for many infections seen at the health facility. Most people who present with fever do not have a VHF. Their fever is more often caused by malaria, typhoid fever, dysentery, severe bacterial infection or other fever-producing illnesses usually seen in the area.

The health worker probably will not suspect a VHF until more severe signs develop and the patient does not respond to recommended treatment for other illnesses. However, health workers should be aware of the possibility of VHF in a non-outbreak situation. As soon as a VHF is suspected, VHF isolation precautions should begin. This will help reduce the number of people exposed to the VHF.[1]

Isolation

A sample layout of an isolation area

Isolating the VHF patient will restrict patient access to health facility staff trained to use VHF isolation precautions. Establish a barrier between the VHF patient and uninfected patients, other health facility staff, and visitors.[1]

Protective clothing

When a VHF case is suspected in the health facility, the following protective clothing should be worn in the isolation area:

When protective clothing is not available or is in short supply, adaptations must be made and used.[1]

Putting on

Steps for putting on protective clothing

There are specific recommendation regarding the putting on of protective clothing including:[1]

Taking off

Steps for taking off protective clothing

There are also specific recommendations regarding the removal of protective clothing including:[1]

Disinfection of equipment

Disinfection kills almost all bacteria, fungi, viruses, and protozoa. It reduces the number of microorganisms to make equipment and surfaces safer for use. When VHF is suspected in the health facility, all medical, nursing, laboratory and cleaning staff should disinfect:[1]

Preparing bleach

Two strengths of solution are recommended.[1]

The dilutions mentioned pertain to a starting concentration of 5% active chlorine, so the 1:10 solution is 0.5% and the 1:100 is 0.05%.

These solutions must be prepared new each day as they lose their strength after 24 hours.[1]

Disposal of waste

A completed incinerator

Direct, unprotected contact during disposal of infectious waste can result in accidental transmission of VHF. For this reason, all contaminated waste produced in the care of the VHF patient must be disposed of safely. All non-reusable items should be destroyed so they cannot be used again. Burning should be carried out at least daily.[1]

Liquid waste, including patient excreta, can be disposed of in an isolated latrine or toilet set aside for VHF cases. Burning is the recommended method for disposal of other VHF-contaminated waste. A safe and inexpensive disposal system can be made by using an incinerator or a pit for burning. Use fuel to accelerate the burning and ensure that all waste is completely destroyed.[1]

Burial practices

Community education material regarding dead bodies and viral hemorrhagic fever

There is risk of transmission in the health facility when a VHF patient dies because the bodies and body fluids of deceased VHF patients remain contagious for several days after death. Family and community members are also at risk if burial practices involve touching and washing the body.[1]

Burial should take place as soon as possible after the body is prepared in the health facility. Health facility staff should prepare the body safely and instruct families on what is and is not safe.[1]

To prepare the body, protective clothing is recommended per usually with a second pair of thick rubber gloves. The body and the area around it is sprayed with 1:10 bleach solution. The body is placed in a “body bag” (mortuary sack) and it is closed securely. The body bag is sprayed with 1:10 bleach solution. The body is then transported to the burial site as soon as possible. Any person who must touch or carry the body during transport should wear the same protective clothing as is worn in the isolation area. The grave should be at least 2 meters deep. Viewing the body is not possible and the burial ceremony should be limited to family only. The interior of the vehicle where the body was carried should be rinsed with 1:10 bleach solution.[1]

Community education

Community education and involvement is an important part of the prevention of the spread of VHF.[1]

References

  1. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting (PDF). World Health Organization and Centers for Disease Control and Prevention. December 1998. Retrieved 20 October 2014.

External links

Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting (PDF). World Health Organization and Centers for Disease Control and Prevention. December 1998. Retrieved 20 October 2014. 

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