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In the African Health Care Setting" Section 3: Isolate The Patient
This section describes how to:
Isolating the VHF
patient will:
Ideally,
an isolation area should already be available to admit patients requiring
isolation.
If a
single room is not available, select one of the following in order of
preference:
Make sure the selected
site has:
Restrict access. Tie a rope or line around the area outside the window to restrict the area and prevent entry through the window.
Make
use of the available space and design of the health facility to arrange
the isolation area. The diagram below shows an ideal arrangement for an
isolation area. The next page shows examples for a single patient's room
and for a ward with several patients.
Ideally, supplies
should be available to begin VHF Isolation Precautions. If a separate
emergency supply is not available when a VHF case is suspected, use supplies
from other services in the health facility. If a recommended
item is not available, or if the quantity is limited, make a substitute
item from available materials. For example, the manual recommends using
plastic sheeting to cover mattresses. If plastic sheeting is not available,
use plastic cloth normally used to cover kitchen tables. This is usually
available in the local market.
Ordinary household
bleach, soap and water are useful disinfectants against viruses causing
VHF.6 They are low in cost and commonly available. Ordinary Household Bleach: The viruses causing VHF are very sensitive to bleach solution. This manual describes a low-cost disinfection system using two bleach solutions: a solution of 1:10 and a solution of 1:100. Detailed instructions for preparing the solutions are in Section 5.1. Soap and Clean Water: Scrubbing with soap and water before disinfection removes infectious body fluids and other foreign matter from contaminated items. This makes bleach solutions more effective. Detailed instructions for preparing solutions of soapy water are in Section 5.2.
6
VHF viruses are lipid enveloped, and this feature makes them sensitive
to destruction by detergent
Obtain the following items for use in the patient's room: Bed and mattress or sleeping mat for each patient. Plastic sheeting to cover the mattress or sleeping mat. This is strongly recommended. Plastic sheeting will protect the mattress from contamination. It can be easily cleaned and disinfected if it becomes contaminated with infectious body fluids. Bedding for each bed -- at least 1 blanket and a bottom sheet. If necessary, the patient or the patient's family can bring the bedding from home. One thermometer,
one stethoscope, and one blood pressure cuff per patient. Keep them
in the isolation area for reuse with the same patient. If there is not
enough equipment to supply one each of these items per patient, assign
one piece of equipment for use only with the patients in the isolation
area. Covered container for alcohol or bleach solution used to disinfect thermometer and stethoscope after use with each patient. Puncture-resistant
container for collecting used disposable needles, syringes and other
sharp instruments. Puncture-resistant
tray with soapy water for collecting reusable needles, syringes and
instruments. Bedside table or shelf on which to place medical instruments, puncture-resistant container, and so on. Large wall clock with a second hand for measuring respiration rates and pulse. Bedpan for each patient. Screens or other
barriers to place around the VHF patients' beds. This will prevent
patient-to-patient transmission through spills or splashes of infectious
body fluids or from aerosol routes. Disinfection station
with buckets, sprayer, bleach solutions, soap and water, mop, and a supply
of one use towels. It is preferable to dispose of gloves after each use.
However, the reuse of gloves in many health facilities is a common practice.
Disinfect gloved hands between patients if there are not enough gloves
for health care workers to dispose of after each patient. Container with
soapy water for collecting discarded outer gloves. Boot sprayer
for disinfecting the boots before leaving the patient's room. Extra supply of
gowns and gloves.
Hooks, nails, or hangers for hanging reusable protective clothing. Roll of plastic
tape for taping cuffs and trousers of protective clothing. Disinfection station
with bleach solution for disinfecting gloved hands. Handwashing station
with bucket, soap, soap dish, clean water, and supply of one-use towels. Containers with soapy water for collecting:
Containers for collecting:
Shelf or box
with a lock for storing clean protective clothing. Supply of clean protective clothing. Container
for collecting noninfectious waste. Covered shelf
(or plastic bags which can be closed) to store disinfected boots and keep
them dry. The checklists at
the end of this section can be used to gather supplies for the isolation
area.
For patient-care
staff: Contaminated clothing and supplies remain in the changing room until cleaning staff trained to use VHF Isolation Precautions take the VHF-contaminated items to the laundry or disposal site. For laboratory,
cleaning, laundry, and waste disposal staff: The stations in the changing room should be set up so that traffic flow is from the least to most contaminated area.
Restrict access to the isolation area:
Place signs around the isolation area clearly stating that access is restricted. Or tie lines or ropes around the isolation area and hang plastic sheets from them. Prepare a list of health facility staff and family members authorized to enter the isolation area: List the medical, nursing, laboratory, cleaning staff, and, if appropriate, those family members who are trained in the use of VHF Isolation Precautions. If an accidental exposure or incident occurs, the list can help in the prompt identification of possible contacts. When there is
a large number of patients, station a guard at the entry to the isolation
area: In a large scale outbreak, station a security guard at the door
of the patient isolation area outside the changing room. The guard will
limit access to authorized health facility staff and family members only.
This is critical for maintaining strict isolation and protecting the community. Provide the guard
with the list of authorized persons and a sign-in sheet. The guard can
record who comes into the isolation area and note the time of entry and
departure.
Talk with family members and explain why the patient is being isolated. Tell them about the risk of transmission for VHF and why protective clothing is needed. Answer any questions they have. When there is a large
outbreak (more than one or two cases), identify a person to serve as a
liaison between health facility staff and the patients' families. Select
a health staff member, an experienced community member, or a convalescent
patient. If it is the custom
for family members to provide cleaning and washing of the patient while
the patient is in the health facility, help the family to select a caregiver.
Select as caregiver the family member who has already had the most contact
with the patient. Also select a second person who can do the patient care
activities when the other caregiver is resting. In areas where family
members participate in patient care, they are likely to help the patient
with:
When a VHF is suspected,
it is likely that health care workers trained in VHF Isolation Precautions
will do most of the direct patient care tasks. However, if there are family
members who will assist with direct patient care, give them information
and training about:
Make sure there is a changing room for family members to use that is separate from the changing room for health care workers. Provide a set of protective clothing for the family members to wear in the isolation room. At a minimum, make sure that the family members wear at least a pair of gloves.
Arrange to monitor
family members for signs of illness. Assist family members with:
Note: When
a breast-feeding mother has a suspected case of VHF, the child's breast-feeding
should not be interrupted. Help the family to decide how to continue the
child's breast-feeding when the mother is too ill to do so.
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This page last reviewed November 26, 2003 |
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National
Center for Infectious Diseases |
