Professional Documents
Culture Documents
and do no necessarily reflect the views or policies of the Asian Development Bank
(ADB), or its Board of Governors, or the governments they represent. ADB does not
guarantee the accuracy of the data included in this paper/presentation and accepts no
responsibility for any consequence of their use. Terminology used may not necessarily
be consistent with ADB official terms.
Department of Health
RITM
Clinical
Trials
Tertiary
Training Healthcare for
Courses Infectious
Diseases
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5
1 9 8 9
*Diarrheal Diseases
*TB
1 9 8 9
Residence Hall
Grant-in-aid from the Government of japan
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0
0
2
Public
Health
Research
Biologicals
RITM Production
Clinical
Trials
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Training Tertiary National
Courses Reference
Healthcare Laboratories
▼ ▼ ▼ ▼ ▼ ▼ ▼
2014 Measles, MERS CoV, Henipah, Ebola?
2013 Pertussis, Measles
2012 Leptospirosis No H5N1, H7N9, Ebola
2011 Chikungunya
2010 Dengue
2009 Pandemic A H1N1
2008 Ebola Reston in pigs and humans/ Leptospirosis/ Salmonella typhi
▼
2006
2005
2004 Meningococcemia outbreak in CAR
▼
NORTH WING
NEGATIVE PRESURE
ISOLATION ROOMS
Exhaust System for the Air Handling Unit of the Negative Pressure Isolation Rooms
LABORATORY EAST WING
RESEARCH DIV
BIGGEST CHALLENGE
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FACILITY DESIGN
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General Principles Objectives
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HOW?
• Controlled and limited access to patients and contaminated
area ETU physically separate from outside and divided into
different risk zones with plastic mesh fences to let people
see through
• Controlled movement of staff Clearly defined gates for
entry and exit between risk zones and with outside with
unidirectional flow
• Access only to authorised and trained persons through
well-defined gates while using well-defined protocols
(disinfection, dressing)
• Disinfection facilities for people leaving contaminated area
(staff, visitors, and patients)
• Safe disposal of waste and corpse
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6 things to worry about
1. New patients/suspect cases
2. Probable/confirmed cases
3. Waste (of all kinds)
4. Staff
5. Materials
6. Dead bodies
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Risk Zones in ETUs
• LOW-RISK ZONE:
– Supportive activities such as chlorine preparation,
medical staff meetings, laundry of resuable materials,
pharmacy and stores
• HIGH-RISK ZONE
– Where patients are cared for, contaminated waste is
being treated, and corpse is being handled Subdivided
into suspects, probable, confirmed, waste
management Highly contaminated
• Between High and Low Risk Disinfection facilities
• There is no « no-risk » zone
• Between Low and High Risk Screening Area
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Flow
• Always move from the least to the most
contaminated zone, then to disinfection
facility Low risk suspect ward probable ward
confirmed ward morgue/waste management
disinfection low risk
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Examples of transferring material
• Buckets, bed covers, blankets, sheets, etc.
– All belong to high-risk area
• Food and food containers
– Disposable containers or use ‘tipping’
• Personal items
– Only items that can be reliably disinfected
• PPEs
– Heavy rubber gloves, boots, goggles, etc. can be
disinfected with 0.5% chlorine solution
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ETU Personal and groups
• Medical staff (doctors, nurses, psychologists,
social support staff)
• IPC support staff (cleaners,laundry staff etc. )
• Patients
• Family Members
• Logistic staff
• Coordination staff
• Epidemiologists
• Lab team
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High-Risk Zone
• NO emergency
• NO running
• Buddy system
• Limited amount of time inside
• Clear idea of what you will be doing
before entering
• All material ready before dressing
• What goes in DOESN’T get out
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Thank You
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Entrance to Ebola Treatment Unit, East Ward, 2014
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Ebola Treatment Unit, East Ward
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Entering and exiting
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Growing a facility over time
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Activity
Morgue
Supplies (clinical
and PPE), put on
PPE
after PPE
removed
Clean: Staff area,
medical records, break
room etc.
Suspected patient
room
Staff Exit
Staff Entry
Patient Entry