Appendix 12. Layout and equipment of an ORP | Guías de práctica clínica MSF

Contenido

The following layout, along with the list of equipment and articles necessary for a standard ORP (i.e. that only provides oral treatment during the day) to function, are only given as an example and must always be adapted according to the context.

12.1 Layout of facility and installations

CHO-Annexe 12-1

Note: if the ORP is set up within the grounds of a health facility, put up a fence (posts + barrier netting or reed screens (or similar) depending on the context) to isolate the unit. One entry/exit point for patients and staff is sufficient.

Symbols	Installations	Remarks
	Potable water point	A jerrycan or bucket or container with a tap, placed on a stand.
	ORS point	A jerrycan or bucket or container with a tap, placed on a stand.
	Potable water reserve	A 120 litre container with a tap, placed on a stand. Adjust if insufficient.
	Latrines	2 latrines (men/women), adjust if insufficient (at least one latrine in a PRO).
	Hand-washing point(s)	At least one hand-washing point with 0.05% chlorine solution (120 litre container with a tap, placed on a stand + bucket under the tap to collect wastewater, to be regularly emptied). Adjust if insufficient.
	Dish washing area (cups and spoons)	If using basins, build an apron slab to drain wastewater. A draining board to dry dishes in the open air.
	Waste pit	A waste pit, protected by a fence to limit access.
	Stock of chlorine solutions	A jerrycan or bucket with a tap, placed on a stand, for 0.2% and 2% chlorine solutions (out of patients’ reach).
	Chairs for patients and attendants	One cholera (pierced) chair per patient. One normal chair per caregiver.
	Nurse’s post	A table, chair and shelf.

12.2. Supplies and equipment

Basic equipment	Remarks
Tent	A 27.5 m² tent for 11 patients + 1 nursing post A 45 m² tent for 20 patients + 1 nursing post
Plastic sheeting	To cover the ground (if the ground is not smooth, washable, concrete). To protect the inside of the ambulance.
Wooden stands for containers	Jerrycans, containers or buckets with a tap must not be placed on the ground.
Table + chair + shelves (nursing post)	Drugs and supplies must not be stored all mixed up (difficult to find and inventory) or placed in a box on the floor.
Chairs for cholera patients a Citation a. Pierced chairs are enough in a standard ORP. Nevertheless it may be useful to have 1 or 2 cholera beds if possible, for patients who need to lie down even if they do not present serious diarrhoea (elderly patients, pregnant women, etc.). If the ORP is intended to stabilise severe cases before transfer it must have 1 or 2 cholera beds (depending on needs) + means to hang infusion sets along with the necessary materials (RL, infusion sets, catheters, 10% polyvidone iodine, compresses/cotton wool, tourniquet, plasters, tray, sharps containers). Appendix 13	Number depends on the ORP’s capacity. Take into account chairs for both children and adults.
Chairs for attendants	Number depends on the ORP’s capacity (one attendant per patient).
Buckets b Citation b. The buckets should be different colours to differentiate contents and use (e.g. white for chlorine solutions, red for patient excreta, green or blue for ORS, etc.). The designated use (ORS, chlorine solution and %, patients) should always be marked on the bucket (or any container).	To prepare chlorine solutions + mixing utensils For wastewater (placed under hand-washing points) 2 buckets per patient (stools and vomit) c Citation c. Buckets for stools/vomit and waste bins must be cleaned/rinsed and disinfected when they are emptied. Taking into account the turnover of material, double the number of buckets for organic and inorganic waste. 1 bucket with lid (waste bin) c Citation c. Buckets for stools/vomit and waste bins must be cleaned/rinsed and disinfected when they are emptied. Taking into account the turnover of material, double the number of buckets for organic and inorganic waste. 1 bucket for cleaning A few buckets in stock
Jerrycans, buckets or containers with tap b Citation b. The buckets should be different colours to differentiate contents and use (e.g. white for chlorine solutions, red for patient excreta, green or blue for ORS, etc.). The designated use (ORS, chlorine solution and %, patients) should always be marked on the bucket (or any container).	For distribution of ORS to patients For distribution of potable water to patients
Recipients for covered storage + tap	1 x 120 litre container for potable water 1 x 120 litre container for 0.05% chlorine solution 1 jerrycan or bucket for 0.2% chlorine solution 1 jerrycan or bucket for 2% chlorine solution
Basins	To wash cups and spoons.
1 litre measuring glass	To prepare ORS.
Cups/small spoons	Number of cups depending on the ORP’s capacity. Double the number (1 cup for the attendant). Take also staff into account.
Personal Protective Equipment (PPE)	2 basic PPE per person (tunic, trousers, boots) 2 additional PPE for staff in charge of cleaning and waste management (Section 7.5.3)
Cleaning equipment	Broom, floor cloth, detergent, etc.
Communication	Mobile phone + credit or VHF radio
Other	Lighting: if the ORP is open after daylight hours, electric lamps or kerosene lamps + kerosene. Barrier netting/posts: if the ORP is within the grounds of a health facility.
Documents and record keeping	Pens, markers, cholera register, patient files, stocks cards or register Protocol on preparation and administration of ORS Protocol on preparation and use of chlorine solutions Basic hygiene rules in an ORP List of contacts (supervisor, ambulance, etc. depending on the set up)
ORS, sachet for 1 litre	Depending on the expected number of cases and/or consumption + buffer stock (15% d Citation d. The buffer stock (15%) needed is less than in a CTC or CTU given that the number of sachets of ORS/person (10) is probably higher than actual consumption as the ORP, in theory, receives mostly patients following Plan A. ). For example, 10 patients/day for a week: 10 (patients) x 10 (sachets of ORS) x 7 days = 700 sachets + 15% buffer stock (+ 100 sachets). The buffer stock may need to be increased (e.g. supply difficulties, area difficult to access).
Antibiotic	Depending on the expected number of cases (+ buffer stock 15%)
Zinc sulfate	1 blister of 10 tab/patient under 5 years (+ buffer stock 15%)
Soap	One per patient + soap for the staff
Chlorine-releasing compound	NaDCC or HTH (start with 50 g/patient/day, and later readjust according to consumption).
Disposable examination gloves	If the patient has soiled him/herself and needs to be changed by staff or if risk of accidental exposure to blood or carrying out stool tests or cut or lesion on hands. If the ORP is intended to stabilise severe cases before transfer it must have 1 or 2 cholera beds (depending on needs) + means to hang infusion sets along with the necessary materials (RL, infusion sets, catheters, 10% polyvidone iodine, compresses/cotton wool, tourniquet, plasters, tray, sharps containers).

Notas

(a)Pierced chairs are enough in a standard ORP. Nevertheless it may be useful to have 1 or 2 cholera beds if possible, for patients who need to lie down even if they do not present serious diarrhoea (elderly patients, pregnant women, etc.).
If the ORP is intended to stabilise severe cases before transfer it must have 1 or 2 cholera beds (depending on needs) + means to hang infusion sets along with the necessary materials (RL, infusion sets, catheters, 10% polyvidone iodine, compresses/cotton wool, tourniquet, plasters, tray, sharps containers).
(b) The buckets should be different colours to differentiate contents and use (e.g. white for chlorine solutions, red for patient excreta, green or blue for ORS, etc.). The designated use (ORS, chlorine solution and %, patients) should always be marked on the bucket (or any container).
(c) Buckets for stools/vomit and waste bins must be cleaned/rinsed and disinfected when they are emptied. Taking into account the turnover of material, double the number of buckets for organic and inorganic waste.
(d)The buffer stock (15%) needed is less than in a CTC or CTU given that the number of sachets of ORS/person (10) is probably higher than actual consumption as the ORP, in theory, receives mostly patients following Plan A.