Infection control 101 for temporary shelters

Infection control 101 for temporary shelters

Hand hygiene, cleaning, laundry, and garbage

In the wake of Hurricane Katrina, the Centers for Disease Control and Prevention recommends the following basic infection control measures to prevent transmission of infectious diseases in temporary community evacuation centers:

General Infection Prevention for Residential Evacuation Centers

Use of appropriate infection prevention measures by all staff and evacuees can reduce the spread of infectious diseases.

1. Staff and residents should wash their hands with soap and water frequently.
2. Children should be assisted in washing their hands with soap and water frequently.
3. Alcohol hand gels are an effective addition to hand washing, and a reasonable temporary substitute when soap and clean water are not readily available.
4. Alcohol hand gel should be positioned throughout the evacuation center, especially at the beginning of food service lines and outside of toilet facilities.
5. Encourage good personal hygiene practices including the following:

• Cover your cough with tissues, disposing of tissues in the trash, or with your hands. Wash your hands or use alcohol hand gel after coughing. If possible, tissues should be provided in evacuation center living areas.
• Follow good hygienic practices during food preparation.
• Do not share eating utensils or drinking containers.
• Do not share personal care items such as combs, razors, toothbrushes, or towels with any one else.

Facilities should be adequate to allow residents to bathe at least twice weekly. Laundry facilities should be available to allow appropriate laundering of clothes and bed linens.

Hand Hygiene

After an emergency, it can be difficult to find running water. However, it is still important to wash your hands to avoid illness. It is best to wash your hands with soap and water, but when water isn’t available, you can use alcohol hand gels made for cleaning hands. Here are some tips for washing your hands with soap and water and with alcohol hand gel:

When should you wash your hands or use an alcohol hand gel?

1. Before eating food.
2. After handling uncooked foods, particularly raw meat, poultry, or fish.*
3. After going to the bathroom.
4. After changing a diaper or cleaning up a child who has gone to the bathroom.
5. Before and after tending to someone who is sick.
6. Before and after treating a cut or wound.
7. After blowing your nose, coughing, or sneezing.
8. After handling an animal or animal waste.
9. After handling garbage.

* Food handlers should wash hands with soap and water before beginning work and before returning to work from any toilet visit or break. Alcohol hand gel should not be substituted in food handlers.

Cleaning the Living Area

Keeping surfaces and items clean helps to reduce the spread of infections to residents and staff.

1. Clean surfaces with a household detergent when visibly dirty and on a regular schedule:

• Kitchens and bathrooms should be cleaned daily and as necessary.
• Living areas should be cleaned at least weekly and more often if necessary.
• Bed frames, mattresses, and pillows should be cleaned/laundered between occupants.
• Other furniture should be cleaned weekly and as needed.
• Spills should be cleaned up immediately.

Sanitize (i.e., reduce microbial contamination to safer levels) high-risk surfaces using a household disinfectant (e.g., a product with a label stating that it is a sanitizer) or a mixture of 1 teaspoon of household bleach in 1 quart of clean water (mixed fresh daily). High-risk surfaces include:

• Food preparation surfaces.
• Surfaces used for diaper changing.
• Surfaces soiled with body fluid (e.g., vomitus, blood, feces).

Laundry

1. Garments heavily soiled with stool should be handled carefully, wearing gloves, and placed in a plastic bag for disposal. If stool can easily be removed using toilet paper, the garment may be laundered as described below.
2. Wash clothing in a washing machine using normal temperature settings and laundry detergent.
3. Household bleach can be used in the rinse water at normal concentrations.
4. Dry clothes in a dryer, if possible.
5. There is no need to disinfect the tubs of washers or tumblers of dryers if cycles are run until they are completed.
6. Make sure donated clothing is washed before distribution.

Garbage

1. Waste disposal should comply with local requirements including disposal of regulated medical waste such as syringes and needles.
2. Facilities should provide for proper disposal of syringes and needles used for medications. Containers designed for sharp waste disposal should be placed where sharp items are used. A heavy plastic laundry detergent bottle with a lid may be used if official sharps containers are not available.
3. Use trash receptacles lined with plastic bags that can be securely tied shut.
4. Trash bags should not be overfilled.
5. Place trash in an area separated from the living spaces, preferably in trash bins.
6. Have waste pickups scheduled frequently — daily, if possible.
7. Separate medical waste from household waste for pickup; follow local guidelines for pickup of medical waste.

Special Considerations for Nonresidential Evacuation Centers

Nonresidential evacuation centers such as stadiums and churches have limited capacity for providing sanitary and food preparation facilities. Bathing and laundry resources also are likely to be limited. In general, it is preferable for nonresidential facilities to only be used for very short-term evacuation. Food service and laundry should be provided from external sources rather than attempting to set up poorly controlled on-site alternatives or allowing residents to attempt these activities individually.

Because of the potentially high ratio of residents to toilets, nonresidential facilities have a particular need for frequent and supervised cleaning and maintenance of sanitary facilities. Designated evacuation center personnel should staff each restroom, controlling the number of individuals using the facility at one time, ensuring that surfaces are wiped down with disinfectant at least hourly, and that basic supplies such as hand soap, paper towels, and toilet paper are maintained.

The ability to clean surfaces in nonresidential settings may be limited by the size or other physical characteristics of the facility. This increases the importance of hand hygiene. However, such facilities also are likely to have limited availability of hand washing sinks. Thus, additional attention should be paid to positioning alcohol hand gel dispensers in convenient locations throughout the living areas and at the beginning of food-service lines, and ensuring that all arriving residents are instructed on their use and availability.

Open sleeping areas should be set up to prevent crowding, ideally with at least 3 feet separating each cot from the next.

Management of People with Infectious Diseases in Evacuation Centers

The arrival of evacuees who may have open wounds, symptomatic infections, and unrecognized or incubating infectious diseases, combined with potential for crowding and limited sanitary infrastructure, increases the risk of infections spreading among residents and between residents and staff. In particular, respiratory infections, diarrheal diseases and skin infections or infestations are prone to spread under these conditions.

Before entering an evacuation center, all residents should be screened for these conditions:

1. Fever
2. Cough
3. Skin rash or sores
4. Open wounds
5. Vomiting
6. Diarrhea

People with any of the above conditions should be admitted to the evacuation center only after appropriate medical evaluation and care. Residents of the center should be instructed to report any of the above conditions to the center staff. If a potentially infectious condition is identified in a person already residing at the evacuation center, the ill individual(s) should be separated from other residents or transferred to a special-needs evacuation center.

A separate area or room should be identified in advance to be used to house potentially infectious residents awaiting evaluation or transfer. If several residents with similar symptoms are identified, they may be housed together in one area. However, cots still should be separated by at least 3 feet.

A dedicated restroom should be identified if possible and reserved for use of the ill individuals only. More than one separate area may be needed if more than one illness is identified in the population, e.g., an area for people with diarrhea and another area for people with a cough and fever.

Such separate areas will need to have extra staff members dedicated to monitoring people housed there and ensuring that the area is kept clean and appropriately supplied.

Source: Centers for Disease Control and Prevention, Atlanta.