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Annexes 6-9

Annex 6 Requirements for Purchasing Protective Clothing Go to top of page

Specifications for Items of Protective Clothing:

This list describes the generic requirements for ordering or purchasing protective clothing from commercial vendors. Record the amounts needed on this list of specifications. The list can be photocopied and provided to donors to make sure that vendor specifications match the recommended specifications. Determine the quantities needed from the recommendations on the chart in Section 9.



Made from cotton cloth, cotton blend, or disposable fabric. The requirements are the same for both disposable and reusable gowns.

Gowns should have the following requirements:

  • Open at the back with ties at the neck, waist and middle of the back.

  • Ribbed or elasticized cuffs.

  • Be long enough to reach the knees.

  • If only large size is available, larger size can be cut and altered to fit smaller people.

If elasticized or ribbed cuffs are not available, attach thumb hooks to the end of the gown's sleeves. The thumb hooks can then be covered with the long wrist-sleeve of the gloves.

Quantity needed Number of disposable gowns _______ Number of reusable gowns _______



Aprons are worn if there is risk of direct exposure to body fluids. The aprons are worn by physicians, nurses, corpse carriers, and cleaners. The requirements for the apron are the same for disposable or reusable models.

Aprons should have the following requirements:

  • Rubber or plastic apron with hooks or ties around the neck and with ties at the back.

  • Made from disposable plastic or heavy plastic which can be disinfected for reuse.

  • Able to fit over gown.
Quantity needed Number of disposable aprons _______ Number of reusable aprons _______



To prevent contamination of hair and head from patient's vomit or blood:

  • Use disposable caps.

  • If disposable caps are not available, use cotton caps that can be laundered and reused
Quantity needed Number of disposable caps _______ Number of cotton caps _______



Worn to protect mouth and nose from splashes or droplets of patient's body fluids.

Masks should offer appropriate protection.

1. 3M HEPA or N Series Mask:

  • Has preferable exhalation valve
  • Lightweight
  • Easy to use

2. Biosafety mask that limits 0.3-um particles

3. Dust-mist masks

4. Surgical masks only protect from droplets splashed in the face. They are not HEPA rated.


Quantity needed HEPA mask _______ Biosafety mask _______ Dust-mist mask_____

Thin gloves


Thin gloves to permit fine motor function. They can be surgical glove quality but do not need to be sterile.

  • Must reach well above the wrist, preferably 10 to 15 cm (4" to 6") long,
    measuring from the wrist up along the arm.

  • Should be tested for pinholes.

  • May be powdered or non-powdered.
Quantity needed Number of pairs _______

Thick gloves


Thick gloves for handling bodies, disinfection, and disposal of infectious

  • Should be made from neoprene or other thick rubber material.

  • Must reach well above the wrist, preferably about 30 cm (12î), measuring from wrist up along the arm.
Quantity needed Number of pairs _______

Boots or overboots


The requirements are the same for both latex overboots which can stretch over street shoes, and regular rubber boots

  • Should be 30 cm (12") high and have textured soles.

  • Provide several sizes to meet size requirements of anyone who might use
    them (for example, obtain pairs of boots in sizes medium, and large).

Overboots are preferable to regular boots. They take up less space, fewer
sizes are needed, and they are less expensive.

Quantity needed

Total Number of pairs of overboots_______ (medium __________ large _____________)

Total Number of pairs of rubber boots_______ (medium __________ large _____________)

Protective eyewear


1. Use non-fogging goggles that are vented at the sides.

2. If non-fogging goggles are not available, purchase clear spectacles locally.

  • Should have ties extending from ear holders that can be tied around the back of the head so glasses will not fall off when health care worker leans over patient.

Quantity needed

Total Number of pairs of non-fogging googles_______

Total Number of pairs of clear spectacles__________


Other recommended equipment Quantity needed
Sprayers: backpack style with hose to use for cleaning and disinfecting spills, rinsing boots, and other decontamination procedures.  
Plastic sheets for mattresses and barriers: can be purchased locally.  
Waterproof mattresses  
Front lamps: to fit over the physician's head to provide light when physician is examining patients.  
Kerosene lamps  
Body bags  

Annex 7 Disinfecting Water for Drinking, Cooking and Cleaning Go to top of page

The Standard Precautions and VHF Isolation Precautions described in this manual recommend using a source of clean water. In an emergency situation, health facility staff may not have access to clean running water. For example, if the power supply is cut off, water cannot be pumped to the health facility. Other sources of water could be contaminated.

This Annex describes how to use household bleach to disinfect water when clean running water is not available in the health facility.

Adding a small amount of full strength household bleach to water will disinfect it enough so that it can be safely used for drinking, cooking, and cleaning.15

An example of a water container
An example of a water container

1. Locate several containers for storing the disinfected water. They should have:

  • A narrow mouth (to prevent hands being put into the water)

  • A screw top or attached lid

  • A spigot, if possible.

    Examples include jerry cans, large plastic jugs, or buckets with spigots and lids that can be firmly closed.

2. Make available:

  • At least 1 litre of full strength household bleach. Use the instructions on the package to prepare a full-strength concentration.

  • Pieces of bar soap or powdered soap.

3. Clean and disinfect the containers. To disinfect the containers, wash them with soap and water, or rinse them with 1:100 bleach solution.

4. Collect water from the available source (for example, a river, stream, or well used by the village).

5. Place the water into the disinfected containers, and add 3 drops of full strength household bleach per litre of water.

Preparing drinking water
Prepare drinking water

6. Mix the water and bleach drops together.

Let the water stand for 30 minutes. This water is now safe to drink and to use for preparing meals. Clearly label the containers so that the health facility staff will know that the water is for drinking and is available for use. Use a marking pen to write DRINKING WATER on the container, or put a sign on it that says DRINKING WATER.

Using stored clean water for handwashing
Using stored clean water for handwashing

7. Provide clean water for the:

  • Handwashing stations in areas where health workers are likely to have contact with patients who have fever or with infectious body fluids.

  • Disinfection station where reusable needles and syringes are cleaned and disinfected.

8. Assign the job of collecting and disinfecting water to a specific health facility staff person. Give the health staff person information about how to do the task and why it is important. Make a schedule for collecting and disinfecting water routinely.

To disinfect a large quantity of water:

1. Determine how many litres the container holds.

Example: 25 litres

2. Calculate the amount of bleach that is needed to disinfect the specified quantity of water.


Use 3 drops of bleach per litre of clear water.
3 drops x 25 litres = 75 drops.

3. Find a spoon, cup or bleach bottle cap that can be used to measure the required amount of bleach. Count the number of drops that the measuring spoon, cup or bottle cap will hold.

Example: 75 drops of bleach = 1 teaspoon

4. Use the measuring spoon or cup to measure the amount of bleach each time the large quantity of water is disinfected.

15 World Health Organisation: Cholera and other diarrhoeal diseases control -- technical cards on environmental sanitation. Document WHO/EMC/DIS/97.6. Geneva: 1997.

Annex 8 Preparing Disinfectant Solutions by Using Other Chlorine Products Go to top of page

The disinfectants recommended in this manual are made with household bleach. This table describes how to make 1:10 and 1:100 chlorine solutions from other chlorine products.

Preparation and Use of Chlorine Disinfectants

Use a chlorine product to make :

1:9 solution
For disinfecting:

  • Excreta
  • Cadavers
  • Spills

1:100 solution
For disinfecting:

  • Gloved hands
  • Bare hands and skin
  • Floors
  • Clothing
  • Equipment
  • Bedding
Household bleach 5% active chlorine 1 litre bleach per 9 litres of water 100 ml per 10 litres of water or 1 litre 1:10 bleach solution per 9 litres of water
Calcium hypochlorite powder or granules 70%
7 grams or ½ tablespoon per 1 litre of water 7 grams or ½ tablespoon per 10 litres of water
Household bleach 30% active chlorine 16 grams or 1 tablespoon per 1 litre of water 16 grams or 1 tablespoon per 10 litres of water

Annex 9 Making Supplies: Sharps Container, Incinerator, and Boot Remover Go to top of page

Making a Sharps Container:

If a puncture-resistant container is not available for collecting used disposable needles, syringes and other sharp instruments that have penetrated the patient's skin, make a container using these instructions.


  • Plastic bottle or container made from burnable material (empty plastic water bottles, for example)
  • Cardboard box to serve as a stand for holding the plastic bottle
  • Plastic tape.
  1. Gather several plastic bottles and boxes made from cardboard or other
    sturdy, burnable material.

  2. Tape the sides and lid of the cardboard box together so the top side is closed.

  3. Draw a circle on the top of the box that is the same diameter as the plastic bottle.

  4. Cut out the circle and leave a hole in the top of the box.

  5. An adapted sharps container
    An adapted sharps container
    Place the bottle inside the hole. Fill the bottle 1/3 full with 1:10 bleach solution.

  6. Place the bottle with its stand in the patient's room or where disposable skin-piercing equipment is used.

  7. At the end of the day, when disposable waste is collected, carry the bottle and its stand to the site for burning infectious waste. Place the bottle and box in the pit for burning.


Making an incinerator: See Annex 10.

Making a boot remover:

Making a boot remover
Please bring this picture to the local carpenter


Infection Control For VHFs Manual
 Return to Main Table of Contents
Sections on this page
 Annex 6 Requirements for Purchasing Protective Clothing
 Annex 7 Disinfecting Water for Drinking, Cooking and Cleaning
 Annex 8 Preparing Disinfectant Solutions by Using Other Chlorine Products
 Annex 9 Making Supplies: Sharps Container, Incinerator, and Boot Remover
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