Excreta Disposal
Excreta (faeces and vomit) from cholera patients are highly infective, as they contain up to 108vibrio per ml; their disposal in latrines is therefore crucial. However not all interventions will be feasible in an outbreak. Generally:
• Construction of family latrines at the start of an outbreak has poor impact on the epidemic spread as this takes too much time.
• Latrine construction in public locations e.g. markets, harbours, schools can be beneficial. However, public latrines may become a significant source of contamina- tion and therefore must be maintained correctly. In urban areas or camps, cleaning of existing latrines can be considered, including hiring additional staff specifically for this task.
• In refugee camps, if shared latrines are used, ensure that they are clean and main- tained.
• If needed, temporary measures such as defecation areas, trench latrines can be dis- cussed.
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Solid waste
Solid waste areas (garbage areas) can be a reservoir for vibrio cholera as well as a b reeding site for vectors as usually there is no functioning removal system. These sites become significant if the waste contaminates the human environment: a draina- ge system leading to water supplies, or when people use the waste area to find left over food.
Locations for targeted waste control interventions may include markets and har- bours, but solid waste management is difficult to manage and demands high levels of resources, therefore it is not likely to be an effective measure in reducing the epi- demic spread.
Waste water
Wastewater includes surface water runoff, domestic waste water (e.g. from kitchens) and sewage. If not contained properly (e.g. drainage ditches) or if overflowing, it can be a vehicle for contamination of drinking water. There f o re keeping drainage sys- tems open and flowing or providing alternative temporary water supply facilities can reduce the risks associated with waste water.
Waste water containing excreta used for irrigation can also be a major source of transmission: vegetables are often not cleaned properly before consumption.
Vector Control
Insects such as flies are not usually important vehicles of cholera transmission. Therefore only simple and specific measures are envisaged:
• covering food; flies are likely to be a significant source of transmission where warm food7 is stored and shared amongst many (e.g. in small market restaurants, street food vendors).
• reducing the fly population in waste areas by clearing the area and spraying insec- ticide at the specific breeding areas.
Table 12. Summary of potential water, hygiene and sanitation actions to reduce the spread of cholera
PUBLIC/COMMUNITY LEVEL POTENTIALACTIONS
WATERSUPPLY
Existing Water Supply • Repair pipelines/tapstands
Systems • In-line chlorination; batch chlorination • Additional temporary water points
Protected hand-pumps/ • Repair handpump/pipe
springs • Repair/ensure sanitary seal
(wells/boreholes lined) • Bucket chlorination of water to reduce secondary contamination in the home due to poor hygiene practices
Existing Trucking Systems • Chlorination of tankers; training in chlorination; quality monitoring;
• Improve efficiency, capacity and/or management of system
Unprotected Water Sources • Organising the stream/river for use – drinking upstream,
(stream, well, spring etc) bathing/washing downstream • Bucket chlorination
• Protect fully the spring/well
Where no water supply • Transport/trucking of water and chlorination
exists nearby (or not treatable) HYGIENE
Food • Cooking – food should be well cooked and served hot
(markets, street vendors) • Storage – protected from contamination/flies • Handling – hand-washing before preparation/eating • Washing – promote safe dishwashing after eating (3 bucket
system)
• Distribution of soap
Excreta Disposal • Promotion of containment in existing or temporarily provided facilities/sites
• Provision of hand-washing (with soap or chlorinated water) at public toilets
SANITATION
Excreta Containment • Mobile sanitation cleaning teams – residential areas or markets • Emergency public latrines (markets, schools, gathering points) –
must ensure cleaning and closure at end of epidemic • Keep exiting public latrines clean
Solid Waste Management • Support to existing system to ensure proper functioning • Clear existing waste public health hazard
• Spray insecticide on waste where flies are deemed a nuisance (only in CTCs) or are a major concern as a significant
transmission route
Waste Water • Clearing of drains – ensuring free flowing, removal of obstru c t i o n s • Construction of temporary channels
Burial Practices • Disinfection of cholera corpses and plugging of orifices with cotton in a 2% chlorine solution (Note: only effective for short period) Bury as soon as possible
• Discourage funeral feasts until the end of the cholera outbreak (or limit size)
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HOUSEHOLD LEVEL POTENTIALACTIONS
HYGIENE
Water • Distribution of appropriate water storage containers (narrow neck or tap)
• Promotion of correct drinking water storage
• Promotion of use of highest quality of water available • Promotion of boiling water if appropriate
• Bring water access closer to population
Food • Cooking – eat well cooked and served hot • Storage – protected from contamination/flies • Handling – hand-washing before preparation/eating
• Wa s h i n g – p romote safe dishwashing after eating (3 bucket system) • Distribution of soap for hand-washing
Excreta Disposal • Promotion of containment in existing or temporarily provided facilities/sites
• Promotion of hand-washing with soap (or other) after defecation • Distribution of soap
SANITATION
Excreta Containment • Assign defecation areas to ensure containment in one area
Burial Practices • Promotion of safe/adapted funeral ceremonies for cholera deaths • Ensure that those preparing the body do not prepare food • Minimise contact with corpse by mourners
• Promote hand-washing with soap after contact (if unavoidable)