The key to controlling the hazard associated with the presence of the virus in the body fluids of infected individuals lies in the rigorous enforcement of protocols to separate and contain ALL body fluids (including faeces and urine). Faeces from suspected or confirmed Ebola cases must be treated as a biohazard and handled at a minimum. All direct human contact with excreta should be avoided and full PPE should be worn by all workers handling faeces. Such equipment includes heavy duty rubber gloves, impermeable gown, impermeable apron, closed shoes (e.g., boots), facial protection (mask and goggle or face shield) and ideally a head cover. Workers should be properly trained in putting on, using and removing PPE so that these protective barriers are maintained and not breached (WHO, 2014). Refer to WHO Guidance on PPE for further details (WHO, 2014).
If the patient is unable to use a latrine, excreta should be collected in a clean bedpan and immediately and carefully disposed of into a separate toilet or latrine used only by Ebola cases or ￼2 suspected cases. Full PPE should be worn at all times when handling fresh excreta from Ebola cases and great care should be taken to avoid splashing. See details above for latrines.
After collection and disposal of the excreta from the bedpan, the bedpan should be rinsed with 0.5% chlorine solution to disinfect the pan, disposing of the rinse water in drains or a toilet/latrine. Depending on the dirtiness of the pan, it may need to be rinsed twice.
If it is not possible to dispose of the excreta immediately, the following procedure can be used to accelerate the inactivation of the Ebola virus and to contain the faeces temporarily.
Assuming a 10-litre covered bucket, first add approximately 600 ml (three cups) of a 10% (i.e., 100 g of lime powder in 1 litre of water) slurry (suspension) of hydrated (slaked) lime to the bucket. Then, carefully add the excreta from the bedpan into the bucket, leaving sufficient space in the bucket to add safely at least an additional 400 ml (two cups) of lime slurry. Rinse and disinfect the bedpan as described above. The final product should continue to be treated with caution and be carefully disposed of in a toilet or latrine by a person wearing full PPE.
If excreta are on surfaces (linens, floor, etc.) they should be carefully removed and immediately disposed of in a toilet/latrine. If this is not possible immediately, temporary containment using a bucket and lime as detailed above is recommended. All surfaces in contact with excreta should be disinfected (see details below).
Chlorine is an ineffective means to disinfect media containing large amounts of solid and dissolved organic matter. Therefore, there will be limited benefit to adding chlorine solution to fresh excreta, and possibly, may introduce risks associated with splashing.
Source: WHO & UNICEF (Reviewed by MSF, CDC, and Tufts 2014) Ebola Virus Disease (EVD) Key questions and answers concerning water, sanitation and hygiene
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