Appendix 11. Layout of a CTC

BARRIERS

Fences

• Solid materials: wooden or bamboo posts; between the posts a barrier made of corrugated iron, branches, woven plant materials or plastic sheeting, depending on the context.
• 2 m high to keep patients out of view and to prevent intrusions.
• Placed at least 2 m away from shelters/buildings/tents.

Delimitation of sectors

Barrier netting is usually sufficient to separate the different sectors.
SHELTERS

Tents



Floors

Whatever the purpose of the tents (patients, stock, morgue, etc.):
• Set up on a 15-20 cm thick platform on compacted earth to protect the tents from runoff.
• Dig a trench approx. 20 cm x 20 cm to collect and evacuate rain water out of the CTC. If possible, try and connect to an existing external drainage system.
• For safety reasons (fire), leave a space of at least 3 m between each tent.
• Lay a PVC ground sheet on the floor.
Note: if the facilities are buildings (not tents), ensure - as for tents - drainage ditches and smooth washable floors (cement, concrete or plastic depending on the context).

LIGHTING

Generator

Electricity must be available 24 hours a day. Even if electricity is provided by a distribution network, install a 5 to 6 kVA generator (in the clean or “neutral” zone) and a lighting network.

POTABLE WATER

Central reserve of chlorinated water


Distribution points

• Build platforms for bladders (at least 1.5 m high).
• Install at least 2 bladders to ease batch chlorination and connect them to the water points.
• Provide at least 60 litres of water per patient per day.
• Have enough water in reserve to operate at least for 3 days.

Set up at least one potable water point per sector, on an apron slab to collect waste water and evacuate it to an infiltration system.

SANITATION

Latrines

• Build latrines (separate latrines for men/women) in each patient sector, for attendants and patients that can move around.
• Ensure they are lit at night.
• Minimum of one latrine for 20 people, adjust if necessary.
• Build at least one latrine for men and one latrine for women in the clean zone for staff.

Excreta pits for faeces and vomit

Build 1 or 2 excreta pits in each patient sector to avoid emptying buckets in the latrines.
See Appendix 14.

Infiltration of wastewater1

• Infiltration is the preferred technique.
• Build either soak away pits or infiltration trenches, depending on the nature of the ground, the amount of space available, the depth of the water table below the surface.
• Water containing soap must first pass through a grease trap.
Connection to an existing drainage system must be considered on a case by case basis (authorisation by local authorities, condition)

Hand-washing point

• Set up a hand-washing points:
– At patient entrance/exit,
– At the passage between the clean and contaminated zones,
– In front of each tent or each ward (several, if the wards are large and there is space),
– Next to the latrine blocks,
– In the morgue,
– In the waste storage and treatment area.
• A hand-washing point consists of:
– A 120 litre container of 0.05% chlorine solution, with a tap, on a stand;
– A bucket under the tap to collect wastewater. Depending on the nature of the ground, for the points outside in the open, the buckets to collect wastewater may be replaced by soakaway pits.

Showers

• Set up showers (men and women) for attendants and patients capable of moving around.
• At least one shower for 40 people, adjust if necessary.
• One shower for men and one for women in the clean zone for staff.
• Ensure wastewater (containing soap) passes through a grease trap before entering the infiltration system.
• Lighting for the evening, to be considered on a case by case basis.

Area for washing/drying laundry

• Place the laundry area in the contaminated zone but near the clean zone so that it is near the water reserve.
• Preferably install concrete laundry sinks (available locally). If laundry sinks are not available, use plastic basins/containers. In this event, build an apron slab (or plastic sheeting if not possible) to collect waste water.
• Ensure wastewater (containing soap) passes through a grease trap before entering the infiltration system.
• Put up washing lines nearby, on which to dry the laundry.
• A shelter is necessary in case of continuous or frequent rain.

Dish washing/drying area

• Place this area in the contaminated zone but near the clean zone so that it is near the water reserve.
• Preferably install a concrete sink.
• If using basins, build an apron slab to collect wastewater.
• Ensure wastewater (containing soap) passes through a grease trap before entering the infiltration system.
• Set up racks nearby to dry the dishes.

Kitchen

• Place the kitchen in the clean zone.
• Set up a sheltered facility consisting of:
– A cooking area with industrial type stoves,
– A sink,
– A rack for drying kitchen utensils,
– A work table with a washable surface,
– A store with a lock for food and equipment.
• Install a hand-washing point.
• Ensure wastewater (containing soap) passes through a grease trap before entering the infiltration system.

Morgue

• Set up the morgue away from the other sectors, in the contaminated zone, with a fence around it to limit access.
• Can be a tent or a temporary shelter.
• Install a hand-washing point and a water point.
• Set up an apron slab to collect the wastewater from washing bodies and evacuate into the infiltration system.

Chlorine solution
preparation point

• Set up:
– A covered, well ventilated shelter, or possibly a tent, in the clean zone,
– Strong stands for the 120 litre containers used for the preparation of chlorine solutions,
– Palettes to store, under dry conditions, chlorine for the daily preparation of solutions.

Waste storage and treatment zone

• To be set up away from the other sectors, in the contaminated zone, with a fence around it to limit access.
• Take into account the direction of the main winds for the release of smoke.
• An estimated 20 to 25 m2 is required for the following installations:
– A shelter to store waste before it is treated,
– A metal drum to burn waste,
– A pit for ashes,
– A pit for organic waste: mainly food, but also sometimes placentas and foetuses,
– A pit in concrete or "watertight" masonry work for sharps containers + a safety box reducer,
– An area to wash and disinfect waste bins,
– A hand-washing point,
– A water point.
• Ensure wastewater (containing soap) passes through a grease trap before entering the infiltration system.



Footnotes
Ref Notes
1 Wastewater is water that has been used to wash people (hands, shower, cleaning of corpses) and contaminated objects (dishes, laundry, floors and surfaces, buckets and basins, etc.).