7.7 Sanitation

7.7.1 Management of faeces and vomit

Stools and vomit are collected in buckets as patients cannot go to latrines due to the intensity of their often uncontrollable diarrhoea and vomiting. This is valid for all facilities (CTCs, CTUs and ORPs).

Usually 1 cm of 2% chlorine solution is poured into each bucket (125 ml into a 10 to 15 litre bucket). This precautionary measure is recommended to reduce the risk of contamination while handling the buckets, despite the absence of data on the volume of chlorine required, the contact time and the necessary concentration of chlorine to effectively disinfect the contents. Do not pour more than 1 cm of chlorine into the bottom of buckets, especially those reserved for vomit (risk of chlorine splashing the patient’s face).

Buckets need to be monitored and replaced when they are at most one third full. They must imperatively be replaced between each patient.
Stools and vomit are poured into excreta pits (Appendix 14) or latrines. The empty buckets are rinsed in clear water and disinfected with 0.2% chlorine solution.
Before returning the bucket to the patient, pour 1 cm of 2% chlorine solution again into the bucket.

If possible, use different coloured buckets for stools and vomit or label buckets indicating what they are to be used for. Do not use these buckets for clean activities (e.g. preparation of ORS, transport of potable water).

7.7.2 Management of waste

Waste should be evacuated every day, or as often as necessary, and destroyed on-site in a specifically designed and protected area.

Sharps
Sharps containers should be eliminated when they are three-quarters full. They should not be emptied or reused.

Soft waste
Each ward should have a covered 20 to 60 litre waste bin reserved for soft waste: empty ORS sachets, infusion bags, IV infusion set, used compresses, etc.
If possible, waste bins for soft waste should all be the same colour. They should be emptied when they are three-quarters full. Soft waste is burned. The waste bins are washed with a detergent available on the local market, rinsed, and disinfected with 0.2% solution.

Organic waste
In the event of a birth during hospitalisation, use a plastic bucket to transport the placenta to the organic waste pit. The bucket is washed with detergent, rinsed, and disinfected with 0.2% solution.
Food waste should also be emptied into this pit. Do not discard plastic bags into this pit.

Mats
If patients are placed on mats, burn them on discharge of the patient. Do not reuse them.

Staff responsible for the transport and elimination of waste must wear appropriate personal protective equipment (Section 7.5.3).

For more information, see Public health engineering in precarious situations, MSF.

7.7.3 Management of wastewater

All wastewater (showers, sinks, laundry, hand-washing points, ORS preparation, and kitchen) must be collected in a grease trap then infiltrated via a soak away pit.

If it is not possible to build a soak away pit (e.g. lack of space, nature of the soil), wastewater requires specific treatment before being discarded. Technical solutions must be discussed on a case by case basis with water and sanitation specialists.

For more information, see Public health engineering in precarious situations, MSF.

7.7.4 Vector control

Flies or mosquitos (attracted by waste, stagnant water or wastewater, food, ORS sugar) can be abundant and become a nuisance.
Waste and wastewater management may be enough to control vectors, but sometimes insecticides are required.

For more information, see Public health engineering in precarious situations, MSF.