Viral hemorrhagic fever primary prevention: Difference between revisions
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==Primary Prevention== | ==Primary Prevention== | ||
With the exception of yellow fever and Argentine hemorrhagic fever, for which vaccines have been developed, no vaccines exist that can protect against these diseases. Therefore, prevention efforts must concentrate on avoiding contact with host species. If prevention methods fail and a case of VHF does occur, efforts should focus on preventing further transmission from person to person, if the virus can be transmitted in this way.Because many of the hosts that carry hemorrhagic fever viruses are rodents, disease prevention efforts include | With the exception of yellow fever and Argentine hemorrhagic fever, for which vaccines have been developed, no vaccines exist that can protect against these diseases. Therefore, prevention efforts must concentrate on avoiding contact with host species. If prevention methods fail and a case of VHF does occur, efforts should focus on preventing further transmission from person to person, if the virus can be transmitted in this way.Because many of the hosts that carry hemorrhagic fever viruses are rodents, disease prevention efforts include | ||
===Controlling rodent populations=== | |||
*Discouraging rodents from entering or living in homes or workplaces. | *Discouraging rodents from entering or living in homes or workplaces. | ||
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For those hemorrhagic fever viruses that can be transmitted from one person to another, avoiding close physical contact with infected people and their body fluids is the most important way of controlling the spread of disease. Barrier nursing or infection control techniques include isolating infected individuals and wearing protective clothing. Other infection control recommendations include proper use, disinfection, and disposal of instruments and equipment used in treating or caring for patients with VHF, such as needles and thermometers. | For those hemorrhagic fever viruses that can be transmitted from one person to another, avoiding close physical contact with infected people and their body fluids is the most important way of controlling the spread of disease. Barrier nursing or infection control techniques include isolating infected individuals and wearing protective clothing. Other infection control recommendations include proper use, disinfection, and disposal of instruments and equipment used in treating or caring for patients with VHF, such as needles and thermometers. | ||
===Caring for persons with suspected VHF=== | |||
*Patients who are hospitalized or treated in an outpatient healthcare setting should be placed in a private room and Standard, Contact, and Droplet Precautions should be initiated. Patients with respiratory symptoms also should wear a face mask to contain respiratory droplets prior to placement in their hospital or examination room and during transport. | *Patients who are hospitalized or treated in an outpatient healthcare setting should be placed in a private room and Standard, Contact, and Droplet Precautions should be initiated. Patients with respiratory symptoms also should wear a face mask to contain respiratory droplets prior to placement in their hospital or examination room and during transport. | ||
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*Although transmission by the airborne route has not been established, hospitals may choose to use Airborne Precautions for patients with suspected VHF who have severe pulmonary involvement or who undergo procedures that stimulate coughing and promote the generation of aerosols (e.g. aerosolized or nebulized medication administration, diagnostic sputum induction, bronchoscopy, airway suctioning, endotracheal intubation, positive pressure ventilation via face mask [e.g., biphasic intermittent positive airway pressure ventilation, continuous positive airway pressure ventilation], and high-frequency oscillatory ventilation) to prevent possible exposure to airborne particles that may contain virus. | *Although transmission by the airborne route has not been established, hospitals may choose to use Airborne Precautions for patients with suspected VHF who have severe pulmonary involvement or who undergo procedures that stimulate coughing and promote the generation of aerosols (e.g. aerosolized or nebulized medication administration, diagnostic sputum induction, bronchoscopy, airway suctioning, endotracheal intubation, positive pressure ventilation via face mask [e.g., biphasic intermittent positive airway pressure ventilation, continuous positive airway pressure ventilation], and high-frequency oscillatory ventilation) to prevent possible exposure to airborne particles that may contain virus. | ||
===Specimen Handling=== | |||
*Alert laboratory staff to the nature of the specimens prior to sending them to the clinical laboratory. Specimens should remain in the custody of designated laboratory personnel until testing is completed. Due to the potential risks associated with handling infectious materials, laboratory testing should be limited to the minimum necessary for essential diagnostic evaluation and patient care. | *Alert laboratory staff to the nature of the specimens prior to sending them to the clinical laboratory. Specimens should remain in the custody of designated laboratory personnel until testing is completed. Due to the potential risks associated with handling infectious materials, laboratory testing should be limited to the minimum necessary for essential diagnostic evaluation and patient care. | ||
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*Routine cleaning and disinfecting procedures can be used for automated analyzers; analyzers should be disinfected after use as recommended by the manufacturer or with a 500 parts per million solution (1:100 dilution) of sodium hypochlorite (1/4 cup of household bleach to 1 gallon water). | *Routine cleaning and disinfecting procedures can be used for automated analyzers; analyzers should be disinfected after use as recommended by the manufacturer or with a 500 parts per million solution (1:100 dilution) of sodium hypochlorite (1/4 cup of household bleach to 1 gallon water). | ||
===Environmental Infection Control Procedures=== | |||
*Environmental surfaces or inanimate objects contaminated with blood, other body fluids, secretions, or excretions should be cleaned and disinfected using standard procedures (See See: Guideline for Environmental Infection Control in Healthcare Facilities). | *Environmental surfaces or inanimate objects contaminated with blood, other body fluids, secretions, or excretions should be cleaned and disinfected using standard procedures (See See: Guideline for Environmental Infection Control in Healthcare Facilities). | ||
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[[Category:Viral diseases]] | [[Category:Viral diseases]] | ||
[[Category:Hemorrhagic fevers]] | [[Category:Hemorrhagic fevers]] | ||
[[Category:Needs overview]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
Revision as of 01:02, 10 December 2012
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Viral hemorrhagic fever primary prevention On the Web |
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Risk calculators and risk factors for Viral hemorrhagic fever primary prevention |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Primary Prevention
With the exception of yellow fever and Argentine hemorrhagic fever, for which vaccines have been developed, no vaccines exist that can protect against these diseases. Therefore, prevention efforts must concentrate on avoiding contact with host species. If prevention methods fail and a case of VHF does occur, efforts should focus on preventing further transmission from person to person, if the virus can be transmitted in this way.Because many of the hosts that carry hemorrhagic fever viruses are rodents, disease prevention efforts include
Controlling rodent populations
- Discouraging rodents from entering or living in homes or workplaces.
- Encouraging safe cleanup of rodent nests and droppings.
- For hemorrhagic fever viruses spread by arthropod vectors, prevention efforts often focus on community-wide insect and arthropod control. In addition, people are encouraged to use insect repellant, proper clothing, bednets, window screens, and other insect barriers to avoid being bitten.
For those hemorrhagic fever viruses that can be transmitted from one person to another, avoiding close physical contact with infected people and their body fluids is the most important way of controlling the spread of disease. Barrier nursing or infection control techniques include isolating infected individuals and wearing protective clothing. Other infection control recommendations include proper use, disinfection, and disposal of instruments and equipment used in treating or caring for patients with VHF, such as needles and thermometers.
Caring for persons with suspected VHF
- Patients who are hospitalized or treated in an outpatient healthcare setting should be placed in a private room and Standard, Contact, and Droplet Precautions should be initiated. Patients with respiratory symptoms also should wear a face mask to contain respiratory droplets prior to placement in their hospital or examination room and during transport.
- Caretakers should use barrier precautions to prevent skin or mucous membrane exposure of the eyes, nose, and mouth with patient blood, other body fluids, secretions (including respiratory droplets), or excretions. All persons entering the patient's room should wear gloves and gowns to prevent contact with items or environmental surfaces that may be soiled. In addition, face shields or surgical masks and eye protection (e.g., goggles or eyeglasses with side shields) should be worn by persons coming within approximately 3 feet of the patient.
- Additional barriers may be needed depending on the likelihood and magnitude of contact with body fluids. For example, if copious amounts of blood, other body fluids, vomit, or feces are present in the environment, plastic apron, leg, and shoe coverings also may be needed.
- Nonessential staff and visitors should be restricted from entering the room of patients with suspected VHF. Maintain a log of persons entering the patient’s room.
- Before exiting the room of a patient with suspected VHF, safely remove and dispose of all protective gear, and clean and disinfect shoes that are soiled with body fluids as described in the section on environmental infection control below.
- To prevent percutaneous injuries, needles and other sharps should be used and disposed of in accordance with recommendations for Standard Precautions.
- If the patient requires a surgical or obstetric procedure, consult your state health department and CDC regarding appropriate precautions for these invasive procedures.
- Although transmission by the airborne route has not been established, hospitals may choose to use Airborne Precautions for patients with suspected VHF who have severe pulmonary involvement or who undergo procedures that stimulate coughing and promote the generation of aerosols (e.g. aerosolized or nebulized medication administration, diagnostic sputum induction, bronchoscopy, airway suctioning, endotracheal intubation, positive pressure ventilation via face mask [e.g., biphasic intermittent positive airway pressure ventilation, continuous positive airway pressure ventilation], and high-frequency oscillatory ventilation) to prevent possible exposure to airborne particles that may contain virus.
Specimen Handling
- Alert laboratory staff to the nature of the specimens prior to sending them to the clinical laboratory. Specimens should remain in the custody of designated laboratory personnel until testing is completed. Due to the potential risks associated with handling infectious materials, laboratory testing should be limited to the minimum necessary for essential diagnostic evaluation and patient care.
- While obtaining clinical laboratory specimens from the patient, use infection control precautions for patient care outlined in this document. Place specimens in sealed plastic bags, then transport them in a clearly labeled, durable, leak-proof container directly to the specimen handling area of the laboratory. Care should be taken not to contaminate the external surfaces of containers.
- Process clinical specimens in a class II biological safety cabinet following biosafety level 3 practices. If possible, pretreat serum used in laboratory tests with the combination of heat-inactivation at 56° C and polyethylene glycol p-tert-octylphenyl ether (Triton(®) X-100)*; treatment with 10 uL of 10% Triton(®) X-100 per 1 mL of serum for 1 hour reduces the titer of hemorrhagic fever viruses in serum, although 100% efficacy in inactivating these viruses should not be assumed. For tests in which the validity is affected by the presence of a detergent in the serum, heat inactivation alone may be of some benefit in reducing infectivity.
- Blood smears (e.g., for malaria) are not infectious for VHF after fixation in solvents.
- Attempts to isolate or cultivate the virus should not be part of routine clinical laboratory diagnosis when VHF is suspected. If such procedures are done on specimens where VHF is suspected, biosafety level 4 facilities and procedures are required.
- Routine cleaning and disinfecting procedures can be used for automated analyzers; analyzers should be disinfected after use as recommended by the manufacturer or with a 500 parts per million solution (1:100 dilution) of sodium hypochlorite (1/4 cup of household bleach to 1 gallon water).
Environmental Infection Control Procedures
- Environmental surfaces or inanimate objects contaminated with blood, other body fluids, secretions, or excretions should be cleaned and disinfected using standard procedures (See See: Guideline for Environmental Infection Control in Healthcare Facilities).
- Disinfection can be accomplished using a U.S. Environmental Protection Agency (EPA)-registered hospital disinfectant or a 1:100 dilution of household bleach (1/4 cup bleach to 1 gallon water). For grossly soiled surfaces, (e.g., vomitus or stool), use a 1:10 dilution of household bleach.
- Soiled linens should be placed in clearly labeled leak-proof bags at the site of use, transported directly to the laundry area, and laundered following routine healthcare laundry procedures.
- Liquid medical waste such as feces and vomitus can be disposed of in the sanitary sewer following local sewage disposal requirements (www.cdc.gov/ncidod/hip/enviro/guide.htm). Care should be taken to avoid splashing when disposing of these materials.
- When discarding solid medical waste (e.g., needles, syringes, and tubing) contaminated with blood or other body fluids from VHF patients, contain the waste with minimal agitation during handling. Properly contained wastes should be managed according to existing local and state regulations for ensuring health and environmental safety during medical waste treatment and disposal. On-site treatment of the waste in an incinerator or a gravity-displacement autoclave for decontamination purposes will help to minimize handling of contaminated waste. Alternatively, off-site medical waste treatment resources may be used.