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Infection Control Manual Cover"Infection Control for Viral Haemorrhagic Fevers in the African Health Care Setting"

Français | Português

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About the Manual Go to top of page


In 1995, an outbreak of Ebola hemorrhagic fever (Ebola HF) affected more than 300 people in and around the city of Kikwit, Democratic Republic of the Congo (formerly, Zaire); approximately 80% of the patients died. More than one-fourth of all the patients were health care workers. After the outbreak, the DRC Ministry of Health, the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO) developed practical recommendations for carrying out viral hemorrhagic fever (VHF) isolation precautions in rural health facilities in Africa. These recommendations have been consolidated in a manual for the local health community.

VHF isolation areaAlthough there is still a great deal to learn about Ebola HF, two observations from the Kikwit outbreak strongly indicate that future outbreaks of this magnitude could be prevented:

  • The first case occurred in January 1995, but went unrecognized as Ebola HF by health-care workers. This one case started a chain of transmission of the virus that finally was recognized in April of that year, when many more cases appeared. The outbreak peaked in May. Thus, between January and April, there was a window of opportunity that could have allowed early detection and proper management of patients; the early response might have prevented widespread transmission of the virus.
  • After an international investigation team arrived in May 1995 and worked with Kikwit medical community to introduce VHF isolation precautions as well as standard precautions, no further nosocomial transmission of the virus was documented, indicating that although Ebola HF is highly infectious, the use of these measures is effective in preventing the spread of disease.

The observations sent a strong message to the public health and medical communities in Africa and internationally: combining early suspicion of VHF and isolation precautions can help to prevent another serious outbreak of Ebola HF or other VHF in the future. The only question remaining was how these goals could be achieved in a region where resources are scarce and the health care infrastructure is either underdeveloped or deteriorating. This manual, prepared collaboratively by CDC and WHO, attempts to address the issues of early provisional diagnosis and response within a limited infrastructure. It is designed for the following uses:

  • for prevention through preparedness--to help African health facilities make advance preparations for responding with appropriate precautions when a VHF case is suspected.
  • for planning and conducting in-service training to strengthen standard precautions and VHF isolation precautions.
  • as a rapid reference when a VHF case appears at a health facility where no previous VHF preparations have been made.

The recommendations in the manual make use of common, low-cost supplies, such as household bleach, water, cotton cloth, and plastic sheeting. Step-by-step instructions for implementing the recommendations are presented along with instructional aids for easy reference in health centers.

The manual is available in English, French, and Portuguese.

 
Viewing and Printing the Manual Go to top of page

The English Manual is available in both HTML format and Adobe Acrobat Reader format (PDF).

The French-language manual and Portuguese-language manual are available only in Adobe Acrobat Reader format (PDF).

The manual is viewable in portions or as a whole. Viewing by section is advisable if your connection to the Internet is slow or costly.

The PDF version of the manual has been formatted for paper size A4 (210 x 297 mm), not 8.5 x 11 inches. If printing the PDF manual, you may need to adjust the print size in Acrobat Reader, at Print>Print Setup.

 
Table of Contents for the Manual Go to top of page

Section Title PDF Version Formatted for PrintPDF Other Languages
French
PDF
Portuguese
PDF
Cover and Title Page Download
(104 KB/
3 pages)
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(110 KB/
3 pages)
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(400 KB/
2 pages)
Acknowledgements Download
(18 KB/
1 page)
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(18 KB/
1 page)
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(42 KB/
1 page)
Table of Contents Download
(28 KB/
5 pages)
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(35 KB/
6 pages)
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(91 KB/
2 pages)
Figure List Download
(18 KB/
3 pages)
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(20 KB/
3 pages)
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(85 KB/
3 pages)
Introduction
Provides an overview on viral haemorrhagic fevers; lists the contents, target audience, objectives, and suggested use of the manual.
Download
(78 KB/
8 pages)
Download
(1.86 MB/
10 pages)
Download
(360 KB/
8 pages)
Section 1: Use Standard Precautions with All Patients
Describes how to establish routine precautions for infection control. The section emphasizes the importance of using Standard Precautions consistently, especially handwashing before and after examining patients with fever.
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(103 KB/
10 pages)
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(105 KB/
10 pages)
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(447 KB/
9 pages)
Section 2: Identify Suspected Cases of VHF
Lists common signs and symptoms of VHF and the immediate precautions to take when a VHF is suspected.
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(93 KB/
10 pages)
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(113 KB/
12 pages)
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(377 KB/
10 pages)
Section 3: Isolate the Patient
Lists recommended supplies and describes how to set up an isolation area. It includes checklists that can be used in an emergency situation and practical suggestions for alternate equipment when recommended items are not available.
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(140 KB/
14 pages)
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(148 KB/
14 pages)
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(630 KB/
14 pages)
Section 4: Wear Protective Clothing
Describes the protective clothing that should be worn when VHF is present in the health facility. It also provides information about selecting appropriate items when recommended clothing is not available.
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(343 KB/
22 pages)
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(377 KB/
22 pages)
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(874 KB/
22 pages)
Section 5: Disinfect Reusable Supplies and Equipment
Describes the use of VHF Isolation Precautions during patient care and when disinfecting and cleaning contaminated surfaces, supplies and equipment. This section also presents recommended first aid for accidental exposures.
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(473 KB/
18 pages)
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(563 KB/
18 pages)
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(619 KB/
18 pages)
Section 6: Dispose of Waste Safely
Describes step-by-step procedures for disposing of VHF-contaminated waste. It also lists detailed instructions for building an incinerator from available material.
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(103 KB/
12 pages)
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(226 KB/
12 pages)
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(387 KB/
12 pages)
Section 7: Use Safe Burial Practices
Describes how to prepare bodies of deceased VHF patients safely for burial and how to prevent disease transmission through contact with the deceased patient.
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(62 KB/
6 pages)
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(116 KB/
6 pages)
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(167 KB/
6 pages)
Section 8: Mobilize Community Resources and Conduct Community Education
Provides guidance for involving the community in disease prevention and control activities when VHF is suspected. It also describes how to choose a VHF Coordinator.
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(80 KB/
12 pages)
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(132 KB/
14 pages)
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(465 KB/
12 pages)
Section 9: Make Advance Preparations to Use VHF Isolation Precautions
Lists steps for preparing in advance to use VHF Isolation Precautions. If advance preparations have been carried out, and a VHF is suspected, the supplies are ready and health facility staff are trained in recommended practices. When advance preparations are not possible, VHF Isolation Precautions must be implemented in an emergency situation.
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(107 KB/
19 pages)
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(124 KB/
22 pages)
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(1.00 MB/
20 pages)
Annex 1: Standard Precautions for Hospital Infection Control Download
(22 KB/
10 pages)
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(122 KB/
4 pages)
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(102 KB/
2 pages)
Annex 2: Specific Features of VHFs Download
(47 KB/
6 pages)
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(51 KB/
6 pages)
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(353 KB/
6 pages)
Annex 3: Planning and Setting up the Isolation Area Download
(37 KB/
4 pages)
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(37 KB/
4 pages)
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(155 KB/
4 pages)
Annex 4: Adapting VHF Isolation Precautions for a Large Number of Patients Download
(36 KB/
3 pages)
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(40 KB/
4 pages)
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(201 KB/
4 pages)
Annex 5: Making Protective Clothing Download
(69 KB/
4 pages)
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(132 KB/
4 pages)
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(114 KB/
4 pages)
Annex 6: Requirements for Purchasing Protective Clothing Download
(38 KB/
4 pages)
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(38 KB/
4 pages)
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(239 KB/
4 pages)
Annex 7: Disinfecting Water for Drinking, Cooking and Cleaning Download
(60 KB/
3 pages)
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(226 KB/
4 pages)
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(154 KB/
4 pages)
Annex 8: Preparing Disinfectant Solutions by Using Other Chlorine Products Download
(23 KB/
1 page)
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(25 KB/
2 pages)
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(65 KB/
2 pages)
Annex 9: Making Supplies: Sharps Container, Incinerator, and Boot Remover Download
(38 KB/
2 pages)
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(55 KB/
2 pages)
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(62 KB/
2 pages)
Annex 10: Sample Job-aids and Posters for Use in the Health Facility Download
(430 KB/
5 pages)
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(450 KB/
6 pages)
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(255 KB/
6 pages)
Annex 11: Laboratory Testing for VHFs Download
(31 KB/
2 pages)
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(28 KB/
2 pages)
Download
(87 KB/
2 pages)
Annex 12: Skin Biopsy on Fatal Cases for Diagnosis of Ebola Download
(96 KB/
7 pages)
Download
(105 KB/
8 pages)
Download
(396 KB/
8 pages)
Annex 13: Community Education Materials Download
(222 KB/
4 pages)
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(366 KB/
4 pages)
Download
(397 KB/
4 pages)
Annex 14: Conducting In-service Training for VHF isolation Precautions Download
(25 KB/
2 pages)
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(27 KB/
2 pages)
Download
(145 KB/
2 pages)
Annex 15: Local resources for community mobilization and education Download
(15 KB/
2 pages)
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(25 KB/
2 pages)
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(34 KB/
2 pages)
Annex 16: International and Regional Contacts Download
(31 KB/
3 pages)
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(27 KB/
3 pages)
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(100 KB/
4 pages)
References Download
(34 KB/
4 pages)
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(35 KB/
4 pages)
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(157 KB/
4 pages)
Index Download
(28 KB/
2 pages)
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(26 KB/
2 pages)
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(91 KB/
2 pages)
 
 
Download the Entire Manual Go to top of page

English ManualPDF(2.51 MB/210 MB)

French ManualPDF(5.13 MB/221 MB)

Portuguese ManualPDF(8.77 MB/208 MB)

 
Adobe Acrobat Reader Format (PDF) Go to top of page

To view or print the PDF files you must have Adobe Acrobat Reader (version 3.0 or higher) installed on your computer. If you have the reader, click on the PDF link of each section of the manual to open it.

If you do not already have Adobe Acrobat, you can download Acrobat for free from the Adobe website.

 Acrobat Some documents are available here in Adobe Acrobat Reader format (PDF). To view or print them, you must have Adobe Acrobat Reader (version 3.0 or higher) installed on your computer. If you do not have the reader, you can obtain it free from Adobe Corporation. Click on the icon below to download the program from their Web site.
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