Training structure EFFO Ebola Safety and good quality work Module 1: Knowledge about Ebola Virus Disease Module 2: Community response Module 3: Standard pre-cautions Module 4: Triage & isolation Module 5: Personal protective equipment Module 6: Water, disinfection and cleaning Support from the community Support from the hospital administration Support from the population 20.05.2015

Water, disinfection and cleaning Module 6 20.05.2015

Learning objectives module 6 General objective To know the principles of decontamination and cleaning in an isolation area. Specific objectives To know how to use disinfectant solutions To know when and how to clean and disinfect contaminated areas. To know how to eliminate waste from an isolation site. To know how to manage laundry from an isolation site. To know the minimum water and sanitation requirements. To be familiar with the procedures and the responsibilities in the event of death. 20.05.2015

Essential elements for preventing the transmission of Ebola: Introduction Essential elements for preventing the transmission of Ebola: Standard precautions and PPE - We have already learned the importance of PPE and standard precautions in preventing the transmission of Ebola or other infections The role of health agents: Rigorously applying the standard precautions to all patients and at all times RKI 20.05.2015

Interhuman transmission via: blood other bodily fluids As well as via: Introduction Interhuman transmission via: blood other bodily fluids As well as via: contaminated objects - Furthermore, we already know that Ebola can be transmitted by blood and other bodily fluids. "Which bodily fluids can you name?" (urine, stools, sperm, etc.) as well as via contaminated objects “Which ones can you name?” (sheets, waste, waste water, bedroom, etc.) so it is very important to ensure that the environment is decontaminated: clean the site, dispose of the waste, the laundry and the waste water, etc. So: Preventing and fighting the illness caused by the Ebola is effective only if there is a coordinated multidisciplinary response OMS OMS 20.05.2015

Multidisciplinary response chlorine solution Cleaning Safe burials Water, disinfection and cleaning Waste disposal Water and sanitation Plan of this presentation; Bleach: To what should you pay attention? – Cleaning, waste, laundry: How should you dress? How is it done? Etc… - Water and purification - Risk-free burial As you will see, we will address topics that are not merely the responsibility of medical personnel. It is important to raise awareness of these themes to know what you have to take into consideration. Laundry 20.05.2015

Chlorine solution Before using chlorine solution Is it the right product? Which concentration? Correct production process? Correct storage? Safe use of chlorine solution Before using chlorine solution Discussion: which practices are in place at the hospital? Which disinfectants are used? Drills: Ebola is not very stable 20.05.2015

Chlorine solution - is it the right product? The label might use different names: "Bleach" "Sodium hypochlorite" "Aqueous solution of sodium hypochlorite" Products sold as “bleach" can sometimes contain other highly toxic chemicals. © shishiga – Fotolia.com Products sold as "bleach" can sometimes contain other highly toxic chemicals. Always read the label carefully! 20.05.2015

Chlorine solution - concentration Are you using the correct concentration for what you are doing? For disinfecting contaminated surfaces or objects, or for washing gloved hands, dead bodies For washing bare hands 0.5 % There is one exception! If there is contamination in the red zone, the skin areas affected must be disinfected using bleach at 0.5% concentration! 0.05 % 20.05.2015

Chlorine solution - production If it is prepared locally: chlorine solution must be prepared fresh every day. Label the recipients with the concentration and the date/time of production! Producing chlorine solution is not easy: quantities, products, controlling the pH, etc. → you have to learn the process and practise! CDC chlorine solution 0.5 % 14 April 2015, 08:00 20.05.2015

Chlorine solution - storage Replace the solutions when they are contaminated: the chlorine is no longer active! Keep solutions for a maximum of 24 hours - prepare a fresh solution every day. Always use a lid to cover buckets. Keep solutions out of sunlight. CDC 20.05.2015

Chlorine solution - using it safely Concentrated chlorine solution: avoid contact with skin Do not put chlorine solution in your eyes or mouth. When preparing and handling chlorine solution: always ware gloves, goggles, a mask and an apron. Avoid splashes. Never mix chlorine solution with soap or other solutions: the chlorine may be deactivated and it will no longer be able to disinfect sufficiently. 20.05.2015

Cleaning in the red zone High-risk area RED ZONE For cleaning in the red zone → Wear full PPE Anticipate contact with blood and bodily fluids: for example, by cleaning surfaces that have been heavily contaminated with vomit or blood or are under one metre away from a patient suffering from diarrhoeia, bleeding, vomiting, etc. Always follow the rules in the national plan! RKI Image: Cleaning during an exercise 20.05.2015

Cleaning in the red zone When should you clean? Immediate cleaning: Clean and disinfect all surfaces or objects contaminated by blood, bodily fluids, secretions or excretions as soon as possible. Regular cleaning: Routine cleaning of the site should be carried out regularly by a designated team. Final cleaning: Clean the site once the patient has been transferred. 20.05.2015

Cleaning procedure First: Clean Afterwards: Disinfect with chlorine solution at 0.5% Always clean from "cleaner" areas towards "dirtier" areas. Change the cleaning solution frequently. Dirty chlorine solution in particular must not be reused. First of all: Clean - Afterwards: Disinfect: To prevent the disinfectant being deactivated by organic matter. Reminder: never mix bleach and soap! Clean working from "cleaner" areas towards "dirtier" areas: to prevent the transfer of contaminants. Change the cleaning solution as it rapidly becomes contaminated. Disinfectants can be safely poured down the sink or down a drain. 20.05.2015

DO NOT CLEAN WITHOUT LIQUIDS! Cleaning - Warning! Never sweep or clean without liquids. Dusty cloths should never be shaken. DO NOT CLEAN WITHOUT LIQUIDS! Do not clean or sweep without liquids: Using a damp cloth for cleaning prevents the air and other surfaces being contaminated by particles transported in the air. Do not spray disinfectant in clinical points of care: This is a potentially dangerous practice that has no proven benefits in fighting infection. RKI 20.05.2015

Waste disposal For managing waste within the isolation site: → Wear full PPE infectious waste, for example: solid waste or any secretion or excretion with visible blood, even if from a part of the body that is supposed to be sterile. Safety goggles are more effective than visors in protecting against splashes, which may come from below when pouring liquid waste from a bucket. Always follow the rules in the national plan! RKI Image: Waste management during an exercise 20.05.2015

Waste disposal Principles The regulations are strict and very precise Process waste in accordance with local legislation Anyone generating waste is responsible for it until it has been eliminated completely Discuss the national plan/ the practices of the hospital? 20.05.2015

The different types of hospital waste: Separating waste The different types of hospital waste: Infectious waste Household waste Solid waste Organic waste (which may be solid or liquid) Liquid waste Household waste: miscellaneous waste: office, household, etc. Infectious waste: - solid waste: ...single-use laundry contaminated by bodily fluids, etc. pointed, sharpened or sharp-edged waste: needles, catheters, ampoules, syringes, glass objects, etc. Pointed, sharp or sharp-edged objects must be disposed of after use in separate containers. liquid waste: blood products, etc. ATTENTION: All waste of an isolation area is infectious! Also household articles! Sharps 20.05.2015

Waste management procedure Use a septic tank, respectively an incinerator for burning contaminated waste in the red zone Ensure that all waste has been completely burned Ensure that there is sufficient security at the waste disposal site Security on waste elimination sites: Supervise access to the waste storage and disposal area for animals, unqualified personnel and children. RKI OMS Image: Incinerator during a waste management exercise 20.05.2015

Waste – Be careful! Take care when handling inflammable materials with gloves: if the gloves catch fire, you are at risk from burns. Never carry waste bags against your body (over your shoulder, for example) Never recycle single-use items 20.05.2015

Laundry management The dirty laundry from an EVD patient is also contagious! Ideally, the laundry used in an isolation site will be processed as waste: Transport only while wearing full PPE Packaging in high-quality waste bags Incineration The laundry used by patients may be heavily contaminated by bodily fluids (blood or vomit, for example). It should then be burned in order to prevent unnecessary risks to the persons responsible for handling. Watch out for splashes during handling! Always follow the rules in the national plan! 20.05.2015

Water and purification Minimum requirements in health facilities: a sufficient supply of drinking water for the personnel, auxiliary staff and patients separate excreta (stools and urine) from sources of drinking water isolate excreta effectively so as to prevent any human contact separate toilets for suspected and confirmed cases Discuss hospital practices 20.05.2015

Safe burial procedures The body of a patient who has died from EVD is still highly contagious. Handling should be kept to a minimum! Consult the burial team for moving and burying deceased patients. If the corpse needs to be transported - e.g. to a secure site until the burial team arrives - wear full PPE! Do not wash or embalm human remains. 20.05.2015

Communication with the family of the deceased. Offer your condolences. Take account of cultural and religious practices. Explain to the families of victims that corpses are contagious and explain the idea of disinfection. Explain to them that they cannot wash or embalm the body. OMS 20.05.2015

Thank you for your attention! Copyright images © sdp_creations – Fotolia.com © HuHu Lin – Fotolia.com © theblackrhino – Fotolia.com © Jane Osina – Fotolia.com © Strezhnev Pavel – Fotolia.com ©Adam – Fotolia.com © andròmina – Fotolia.com © OMS © leremy – Fotolia.com © Antonio Gravante – Fotolia.com 20.05.2015

Discussion: Local waste management What are the local practices? Which categories for waste separation are available? How is waste processed (burned, etc.)? What are the waste regulations in the case of Ebola? RKI 20.05.2015