CHOLERA OUTBREAK CONTROL PLAN

CHOLERA OUTBREAK CONTROL PLAN





CONTENTS



Introduction

Part I: About Cholera

-Etiology of Cholera

-Case definition

-Case notification

-Clinical Presentation

-Mode of Transmission



Part II: Epidemic Preparedness

-Routine Control of Diarrhoeal Diseases

-Water and Sanitation



Part III: Cholera Outbreak

-Public Awareness and Health Education

-Interventions at Health Facility Level

-Supplies and equipments

-Infection risk reduction and isolation

-Case Management



Part IV: Surveillance

-Epidemiological Surveillance

-Environmental Surveillance



Annexes

-Annex 1. Assessment of dehydration

-Annex 2. Case Management Guidelines for diarrheal diseases

-Annex 3. Minimum Supply for 100 patients in the 1st week

-Annex 4. Appropriate Oral Antibiotics

-Annex 5. Cholera Kit

-1. Medical Module

-2. Infusion Module

-3. Renewable Supply Module

-4. Logistic Supply Module

-5. Chlorination and water supply Module









1

INTRODUCTION

Cholera is an acute intestinal infection caused by ingestion of food or water

contaminated with the bacterium Vibrio cholerae. It has a short incubation

period, from less than one day to five days, and produces an enterotoxin that

causes copious, painless, watery diarrhoea that can quickly lead to severe

dehydration and death if treatment is not promptly given. Vomiting also occurs

in most patients. (WHO, 2006) In refugee populations, attack rates up to 6%

with case-fatality ratios (CFR) approaching 25% have occurred. Higher CFRs

have been found when protein energy malnutrition (PEM) is prevalent.



Cholera, however, is highly treatable and less than 1% of cholera patients will

die if appropriate case-management is used. Cholera deaths are almost

exclusively due to fluid and electrolyte loss. Providing early outreach and

treatment through traditional ORS replacements will significantly improve the

outcome of a cholera epidemic. Although early case identification and

appropriate case management is necessary to reduce the CFR, identifying

sources of infection and designing control measures are necessary to reduce the

magnitude of a cholera epidemic



Outbreak Preparedness and Response team



Community: One health committee member per camp

A religious leader or his representative per camp. To be

designated

Agencies: Care, 3 representatives:Timothy Ngiyai + 2 others

Oxfam 1 representative: Esther Kabahuma

NRC, 1 representative: Mutuku Mwema

NCCK 1 representative

UNHCR 2 representatives: Ann Burton, Willy Amisi

IRC, 2 representatives: Job Makoyo, Abdullahi Hussein

GIZ, 2 representatives:Nailah Kassim, Priscah Lihanda

MSF, 2 representatives: Yussuf Mwondwa, Gedi

MSF Spain – Emiliano Medical Team leader

CDC, 1 representative: Adan Tepo

Filmaid 1 representative: Steve Otieno

Ministry of Health: Provincial Disease Surveillance Officer

Dr Argata Guracha WHO





Roles of the team before an epidemic

 Meet once a month



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 Strengthen surveillance

 Procure and preposition contingency stocks

 Organize in-service training

 Produce and distribute relevant guidelines

 Mobilize human material and financial resources locally for epidemic

prevention and control

 Define the tasks of each member in managing an outbreak



Roles of team during an epidemic

 Meet daily to review the latest data on suspected cases/death and follow

up any alerts

 Implement the outbreak response plan

 Identify sources of additional human and material resources for

managing the outbreak

 Ensure the use of standard treatment protocols for the diseases and train

health workers if necessary

 To coordinate public information and education during the epidemics

 To coordinate assistance for epidemic prevention and control for

various partners

 Reinforce surveillance



Laboratory confirmation for Vibrio Cholerae

Stool swabs should be transported to the laboratory in Cary-Blair transport

medium. Stool culture is the gold standard for diagnosis of cholera but takes at

least a few days before results are known





Rapid tests are quick and easily done by non-technical staff, Rapid tests are

useful especially when outbreaks are suspected. These are available in small

numbers in all hospital laboratories.



Resources needed:

 Rectal swabs, Cary-Blair (Cary-Blair will be made at the CDC supported

laboratory in Hagadera and distributed to all centres that are handling

cholera cases)

 Screw-top tubes of Cary-Blair media (estimates: 80 tubes should be

maintained by each health agency and kept in the cholera stock)

 Dry, cotton-tipped rectal swab (estimate: 200 applicators-moisten in

sterile Cary-Blair media before inserting into anus.)



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 Designated cold chain for culture transport (estimate: 6) and an adequate

number of ice packs. The cholera kit should consist of at least one cold

box (e.g. vaccine carrier) and four ice packs.

 Readily available communication to Hagadera laboratory for

communication of results.

Cholera can be isolated from these stool samples up to 5-7 days later if kept

cool. Although cholera specimens do not require constant refrigeration during

transport, specimens should be sent in designated EPI cold packs. Vibrio

cholera should be isolated on TCBS media and serotyping should be done.



Samples should be transported as soon possible after collection to Hagadera

laboratory. Samples should be collected as soon as possible and before

administration of antibiotics for eligible patients. They should then be sent to a

designated focal person (Name to be communicated during a suspected

outbreak) at the Hagadera laboratory. Samples should be kept under

refrigeration. This designated person will be responsible for tracking of samples

and reporting results to the submitting Camp.

The CDC supported laboratory in Hagadera is located on the premises of the

IRC hospital in Hagadera. The laboratory in Hagadera will send samples to the

Kenya Medical Research Institute (KEMRI) for quality control. Tel. 2722541,

KEMRI is located in Kenyatta National Hospital





PART I. ABOUT CHOLERA



Etiology of cholera

Cholera is caused by a bacterium called Vibrio Cholerae. There are more that

60 species of cholera bacteria however recent infections in Africa have been

caused by El Tor biotype of Vibrio cholerae serogroup 01.



Case definition

Suspected cholera case:

– When cholera is not known to be present : Severe dehydration or

death from acute watery diarrhoea in a patient aged 5 years or

more

– When cholera is epidemic: Acute watery diarrhea, with or without

vomiting in a patient aged 2 years or more

Confirmed cholera cases: A case of cholera is confirmed when Vibrio cholerae

O1 or O139 is isolated from any patient with diarrhoea

An outbreak is declared when one case of cholera is confirmed by laboratory

culture and isolation of Vibrio cholera



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Case notification

When cholera is suspected the CDC Surveillance Officer

ATepo@kemricdc.org and tepoak@yahoo.com and UNHCR Senior Public

Health Officer (burton@unhcr.org) and Health Coordinator

(amisiw@unhcr.org) should be notified simultaneously. A suspected cholera

outbreak may be declared while awaiting laboratory confirmation

Once a case of cholera is confirmed then the local health authority (Provincial

Surveillance Focal Person) should be notified.



Clinical Presentation

Most cholera infections are asymptomatic or mild, and indistinguishable from

other mild diarrhea. In its severe form the following signs and symptoms

characterize cholera:



 Onset is typically sudden

 Diarrhea is profuse, painless and watery with flecks of mucus in the

stool (rice water stools). The presence of blood in the stool is not

characteristic of cholera, and absence of rice water stool does not

exclude cholera

 Vomiting may occur (usually early in the illness)

 Majority of patients are afebrile, children are more likely to be febrile

than adults,

 Dehydration occurs rapidly (up to 1000 ml/hour of diarrhea may be

produced)

 Most complications results from effects of loss of fluids and electrolytes

in the stool; and vomiting, muscle cramps, acidosis, peripheral

vasoconstriction and ultimately renal and circulatory failure, arrythmias

and death may occur if treatment is not given on time.





Mode of transmission

Vibrio Cholerae is spread mainly via the faecal-oral route. Some of the best

known sources of infections are as follows

 Drinking water that has been contaminated at its source, during storage,

or usage

 Contaminated foods e.g. vegetables that have been fertilized with human

excreta (night soil) or freshened with contaminated water

 Soiled hands can also contaminate clean drinking water and foods







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Since case fatality in cholera is largely determined by the urgency and the

adequacy of diarrhoeal management practices, prior training and continued

supervision of health workers in the assessment of diarrhea cases and the

promotion and use of ORT and continued feeding during diarrhea illness are

essential. It is therefore essential to educate all health workers regarding cholera

and to create an awareness of possible cholera cases. All hospitals, clinics,

mobile health teams and field workers such as CHWs must be retrained in

cholera outbreak management.



PART II. EPIDEMIC PREPAREDNESS



Routine Control of diarrhoeal diseases

A strong programme of control of diarrhoeal diseases is the best preparation

for the cholera epidemic. The health care system in Dadaab should strengthen

mechanisms of controlling diarrhoeal diseases at all the levels of care. These

mechanisms will enable health care providers to identify cholera, manage

patients, and report case.



Practical points:

 The community should be educated about sources of contamination and

ways to avoid infection. This should be done regularly through the

routine health education sessions and/or community outreach by

CHWs.

 Pay particular attention to sanitation by randomly inspecting sanitation

facilities especially in densely populated areas where lack of good

sanitation may lead to contamination of water sources. This may be done

by WASH members of the team

 High priority should be given to observing the basic principles of

sanitary human waste disposal and particularly the protection of water

sources

 Basic hygiene involving thorough hand washing following contact with

excreta and before handling food and eating should be encouraged for

adults, and infants. The hygiene promotion team members should

encourage this practice in the blocks



Training Needs

1. Case Management for health care workers and community health

workers (to be organized and conducted by each health agency)









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2. Water quality: for community health workers and newly recruited

personnel during the outbreak (to be organized and/or conducted

by CARE)

3. Cholera testing procedures: for laboratory personnel and health

care workers, this should include the correct procedures for

collecting rectal swabs (to be organized and/or conducted by

CDC)

4. Infection prevention: for health care workers, community health

workers and community leaders (to be organized by health

agencies in conjunction with UNHCR)

5. Hygiene Promotion: for community health workers and

community leaders. This training should include safe water

handling, sanitary waste disposal, food handling and body

management during a cholera outbreak. (to be organized by

Oxfam)

6. Disease Surveillance: for health care workers, WASH agencies

workers, community health workers. (to be organized by CDC)



Water and Sanitation

In long term, improvements of safe water supply and adequate sanitation are

the best means of preventing cholera. Where water supply is at risk of

contamination, households should be taught the necessity and the techniques

of sanitizing water at home. Chlorination of water at source is already done in

Dadaab. During an epidemic the need to rehcloriabte at household level will be

assessed. In that case chlorine tablets will be distributed by Care and Oxfam to

households in the affected areas.





PART III: CHOLERA OUTBREAK



When an initial cholera case is detected in the community, the person should

be brought to the health post/hospital immediately. Treatment with ORS at

community level should be started while waiting further assessment.



Stool for cultures should be obtained at the first opportunity. Specimens

should be taken before antibiotics are given



A line listing should be established at the time the first patient presents.



During an outbreak active case finding should be activated through community

health workers, hygiene promoters, community leaders.



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I. Public awareness and health education

In an outbreak the best control measures are early detection of cases and

prompt treatment of patients. Multi-sectoral teams will be established to

actively find cases of suspected cholera in the population. This can improve the

early case detection, the implementation of appropriate control measures, limit

the transmission of the disease and reduce case fatality. The community should

be informed and encouraged to report suspected cholera cases promptly. In

addition the following will be done;

 Develop appropriate communication strategies and engage the

community – Filmaid

 Intensify the free flow of information to avoid panic in the community –

CHW

 Health education activities for community members

- wash vegetables and fruits in clean water before use or peel

- keep food covered to prevent contamination by flies

- cook food thoroughly and eat it while still hot

- prevent contamination of food by covering it, and by avoiding

contact with flies

- wash hands thoroughly with soap after using the toilet and before

handling and eating food

- Use latrines and keep them clean

- Discourage eating from a communal food container

- Encourage breastfeeding of infants



Health education must also include information about disease transmission,

personal hygiene, symptoms and measures to be applied at home, such as

rehydration with ORS.

Schools are important vehicle for health education, even where sanitary

conditions are not ideal

In an outbreak schools should only be closed where there is a strong

epidemiological association between school attendance and infections

Assess vendors at markets and include food vendors in health education



II. Interventions at Health facility level



i. Supplies and equipments

Buffer and emergency stocks of essential supplies should already be in place

before an epidemic starts. It is essential to establish a system to monitor their





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use and ensure their prompt replacement. Emergency supply requirements

should be determined and individuals assigned to coordinate their procurement

and distribution. The supplies and equipment needed have been calculated on

an attack rate of 0.2, that is 200 cases may be expected to occur in a population

of 100 000. This is only for calculating initial stocks to cope with the beginning

of an epidemic of cholera. A review based on weekly actual figures will help to

reassess actual needs and prompt replacements (See annex 3)





ii. Infection risk reduction and isolation

When cholera patients are being treated in a health facility, they must be

isolated to limit the spread of the infection to the rest of the facility

population. Where this poses a challenge, a functioning Cholera Treatment

Centre (CTC) would relieve pressure on the hospital, allowing it to continue its

normal function in service to the population. It also would provide optimal

hygiene control, which is fundamental to cholera treatment. (see WHO

Communicable Disease Control in Emergencies. A Field Manual, Annex 7 page 236 for

organization of an isolation centre, essential rules in a CTC and , disinfectant preparation)

Standard precautions (hand-washing, safe disposal of contaminated articles)

must be applied as well as enteric precautions. Adapt form the following

website http://www.wsha.org/files/82/ContactEntericPrecautions.pdf



Funerals

 Funerals should be held quickly and near the place of death.

 Those who prepare the body for burial must be meticulous about

washing their hands with soap and clean water.

 Bodies should be disinfected with a 2% chlorine solution and the

orifices blocked with cotton wool soaked in chlorine solution; they

must then be buried in plastic sacks as soon as possible.

 Disinfect the clothing and bedding of the deceased by stirring them in

boiling water or by drying them thoroughly in the sun



iii. Case management

Clear patient management guidelines must be present and readily accessible in

all the facilities that are involved in cholera case management (See Annex 2)



Assess patient for dehydration (See Annex 1)









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Use of ORS is the most effective treatment for cholera and other watery

diarrhoeal diseases. The patient must be given ORS (if available) even before

transportation to the health facility.



Severely dehydrated patients should be treated with IV fluids - Ringers Lactate

solution is the first choice (See Annex, 2 step 3)



The use of antibiotics should only be restricted to severe cases, as misuse of

antibiotics can lead to the emergence of resistance. The choice of antibiotics

should take into account the local pattern of resistance. Antibiotic resistant

Vibrio cholerae 01 should be suspected if diarrhea continues after 48 hours of

antibiotic treatment. (Annex 4)



No anti-diarrhoeal, anti-emetic, anti-spasmodic or corticosteroid drugs should

be used to treat cholera patients.





PART IV. SURVEILLANCE



Epidemiological Surveillance

A technical public health professional will be responsible for the coordination

of the surveillance in all the three camps with clearly defined responsibilities

including epidemiological investigations and interpretation of the outbreak.



He/she should collect data about the persons affected by the outbreak – the

traditional epidemiological triad of “time, place, and person”. It may be useful

to collect additional data such as place of residence, recent movement in or out

of the camp and secondary attack rate.



All proven cases must be reported immediately through the line listing from the

camp to the local health authority and UNHCR.

At the beginning of the epidemic, an attempt must be made to establish a

bacteriological diagnosis from rectal swabs or stool specimen



When suspected cases of cholera are detected in the health facility the nearest

referral facility or designated health officer should be notified immediately



Environmental Surveillance

Identify communities at risk (e.g. inadequate sanitation, unsafe water supply)

and ensure that they are informed about sources of contamination and ways to

avoid infection.



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Investigate all proven bacteriological cases to identify sources of infection







ANNEX 1. Assessment of the Diarrhoea Patient for dehydration

No dehydration Some Severe

dehydratiom Dehydration

LOOK

Gen. Condition Well, Alert Restless* Lethargic*

Irritability* Unconscious,

floppy

EYES Normal Sunken Very sunken

TEARS Present Absent Absent

MOUTH Moist Dry Very dry

TONGUE

FEEL

SKIN PINCH Goes back Goes back slowly Goes back very

slowly

DECIDE

The patient has If patient has two If patient has two

no signs of or more signs or more signs

dehydration including at least including at least

one * sign, there one * sign, there

is some is Severe

dehydration dehydration



* In adults and children older than 5 years, other signs for severe dehydration

are absent radial pulse and low blood pressure). The skin pinch may be less

useful in patients with marasmus (severe wasting) or kwashiorkor (severe

malnutrition with oedema), or obese patients. Tears are a relevant sign only for

infants and young children









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ANNEX 2. Management guidelines for patients with No Dehydration,

Some dehydration and Severe Dehydration



Step 1: For No Sign of Dehydration



Patient observed to be without signs of dehydration could be treated at home.



 Give ORS packets to take home. Give enough ORS for 2 days.

 Instruct the patients or the care-giver to return if the patient

develops watery stool, marked thirst, repeated vomiting, fever and

bloody stool



Age Amount of solution after ORS packets needed

each loose stool

As much as wanted Enough for 2000ml/day



Step 2: For Some Dehydration



 Give ORS solution in the amount recommended in the table

below. If the patient passes watery stools or wants more ORS

solution than shown, give more.

 Monitor the patient frequently to ensure that ORS solution is

taken satisfactorily and to detect patients with profuse and

continuing diarrhea who will require closer monitoring.

 Reassess the patient after 4 hours:



 If signs of severe dehydration have appeared (this is rare),

treat as in step 1, above.

 If there is still Some dehydration, repeat the procedures for

some dehydration, and start to offer food and other fluids.

 If there are no signs of dehydration, go on to Step 4 to

maintain hydration by replacing continuing fluid losses.



Approximate amount of ORS Solution to give in the first 4 hours

Age* 30 kg

ORS 200-400 400-600 600-800 800-1200 1200- 2200-

Solution 2200 2400





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in ml



* Use the patient's age only when you do not know the weight. The approximate amount of

ORS requires (in ml) can also be calculated by multiplying the patient's weight (in kg) by 75



NB: Use Nasogastric tube if patient cannot drink and IV therapy not possible

at the facility. Regular urinary output (every 3-4 hrs) is a good sign that enough

fluids is being given



Step 3: For Severe Dehydration



 Give IV fluid immediately to replace fluid deficit. Use Ringer's

lactate solution or, if not available, normal saline.

 If the patient can drink give ORS by mouth simultaneously while

the drip is being set up.

 For patients aged 1 year and older, give 100 ml/kg IV in 3 hours,

as follows:



 30 ml/kg as rapidly as possible (within 30 minutes); then

 70 ml/kg in the next 2.5 hours



 For patients aged less than 1 year, give 100ml/kg IV in 6 hours, as

follows:



 30 ml/kg in the first hour; then

 70 ml/kg in the next 5 hours



 Monitor the patient very frequently. After the initial 30 ml/kg

have been given, the radial pulse should be strong and blood

pressure should be normal: If the pulse is not yet strong, continue

to give IV fluid rapidly

 Give ORS solution (about 5 ml/kg per hour) as soon as the

patient can drink, in addition to IV fluid

 Reassess the patient after 3 hours (infants after 6 hours), using

Table in Annex 2



 If there are still signs of severe dehydration (this is rare),

repeat the IV therapy

 If there are signs of some dehydration, continue as

indicated above for some dehydration

 If there are no signs of dehydration, go on to step 3 to

maintain hydration by replacing continuing fluid losses.



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Step 4: Maintain Hydration, Replace continuing fluid losses until

diarrhea stops

Age Amount of solution after each loose

stool

Less than 24 months 100 ml

2-9 years 200 ml

10 years and above As much as wanted



The amount of ORS solution varies from one patient to another. The greatest

amount of ORS solution is required within the first 24 hours, especially in

patients with severe dehydration. In the first 24 hours, such patients require an

average of 200 ml of ORS solution per kg of body weight.



Prompt fluid therapy with volumes of electrolyte solution, enough to correct

dehydration, acidosis and hypokalemia is the cornerstone to cholera therapy.

Oral administration of glucose-electrolyte solution (8 teaspoons sugar, half

teaspoon salt, mixed with 1 liter safe water) to patients with diarrhoea,

including patients with cholera, will save many lives.



Approximately 80 - 90% of patients can be successfully treated by oral

rehydration. It should be emphasised that all cases of diarrhoea showing signs

of dehydration must receive adequate oral rehydration immediately, before

transportation to hospital.



NB: Patients should be properly fed after vomiting has stopped









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ANNEX 3

ESTIMATED MINIMUM SUPPLIES NEEDED TO TREAT 100

PATIENTS DURING A CHOLERA EPIDEMIC

(1st WEEK OF EPIDEMIC)





 650 Packets Oral Rehydration Salt [For 1liter Each]

 120 Bags Ringers Lactate Solution

 10 Scalp Vein Set

 3 Nasogastric Tubes [Paediatric]

 3 Nasogastric Tubes Adults]

 50 Cannulae 18G

 50 Cannulae 20G

 50 Cannulae 22G

 50 Cannulae 24G

 100 giving sets



Other Treatment Supplies



 2 Large Water With Tap [Marked at 5-10liter Levels for Making]

 Oral Rehydration Solution in Bulk

 20 Bottles [1litre] for ORS. e.g. Empty IV Bottles

 40 Tumblers, 200ml

 20 Teaspoons

 5 kgs Cotton Wool

 3 Reels of Adhesive Tape









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ANNEX 4: APPROPRIATE ORAL ANTIBIOTICS

When is it useful to give antibiotics?

For cholera cases with severe dehydration only and only after the person

is rehydrated.



Patient classification First choice Second choice

Adult (non-pregnant) Doxycycline: 300 mg Tetracycline: 500mg 4

orally in one dose times a day for 3 days

Erythromycin: 500 mg 4

times a day for 3 days

Pregnant women Erythromycin: 500 mg 4

times a day for 3 days

Children > 12 months Erythromycin: 12.5/kg Tetracycline: 12.5 mg/kg

and capable of mg 4 times a day for 3 4 times a day

swallowing pills days

Doxycycline 2-4 mg in

one dose

Children < 12 months Azythromycin oral Tetracycline oral

suspension 20mg/kg in suspension: 12.5mg/kg 4

one dose times a day for 3 days

Erythromycin oral

suspension 12.5mg/kg 4

times a day for 3 days

Doxycycline oral

suspension 2-4 mg/kg in

one dose





ANNEX V: CHOLERA KIT



1. Medical Module

Items Quantity Unit

Water purification tablets 500 10

(sodium dichloroisocyanurate 8.5 mg, 1 tab/1 l)

(aquatabs)

Povidone iodine 10 % solution 200 ml 10 btls

Potassium chloride 100 mg/ml 10 100 amps

Oral rehydration salts, WHO formula, 27.9 gram 130 50

(for 1L)

Doxycycline hyclate 100 mg film coated 10 1000 tabs





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2. Infusions Module

Items Quantity Unit

Hartmann's solution (Ringer's lactate) 500 1 btl

intravenous infusion, 1000 ml

infusion giving set, with air release and needle 500 1 pcs

(for bags/bottles0

IV cannula 16 G x 1.75" (grey) 4 50 pcs

IV cannula 18 G x 1.75" (green) 4 50 pcs

IV cannula 22 G x 1" (blue) 6 50 pcs

IV cannula 24 G x 3/4" (yellow) 4 50 pcs

needle, hypodermic, Luer, 21 G x 1.5, 0.80 x 40 2 100

mm, disposable

needle, intraosseous, 18 G 5 1

scalp vein infusion sets 21 G (0.80 mm) 1 100





3. Renewable Supplies Module

Items Quantity Unit

Apron, surgical, plastic, heavy duty 100 1

Tourniquet, rubber 20 1

tube, feeding (nasogastric), CH 10, disposable, 2 40 pcs

sterile

tube, feeding (nasogastric), CH 16, disposable 20 1pce

sterile

tube, feeding (nasogastric), CH 6, disposable 20 1 pce

sterile

tube, feeding (nasogastric), CH 8, disposable 80 1 pce

sterile

gauze bandages, N17, 7.5 cm x 4.5 m 9 12 rolls

cotton wool, 500 g (100% pure cotton) 10 1 roll

zinc oxide plaster 2.5 cm x 5 m 5 10 rolls

Sharp boxes for used syringes and needles, 5 25 1 pce

litres

syringe, hypodermic, Luer, 2-part, 10 ml, 2 100

disposable

bodybag, with zipperlock 30 1

gloves, kitchen, rubber, size large, non 40 1

disposable

gloves, kitchen, rubber, size medium, non 30 1



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disposable

gloves, kitchen, rubber, size small, non 30 1

disposable

gloves, examination, latex, size large, 4 100

disposable, non-sterile

gloves, examination, latex, size medium, 3 100

disposable, non-sterile

gloves, examination, latex, size small, 3 100

disposable, non-sterile

gloves, surgical, latex, size 6.5, sterile 1 50

gloves, surgical, latex, size 7.5, sterile 20 1

razors, double blades, disposable 20 5



4. Logistic equipments module

Items Quantity Unit

boots, rubber, size 37 (UK size 4.5) 6 1 pairs

boots, rubber, size 39 (UK size 6) 4 1 pairs

boots, rubber, size 41 (UK size 7) 3 1 pairs

boots, rubber, size 42 (UK size 8) 4 1 pairs

boots, rubber, size 44 (UK size 10) 3 1 pairs

sheeting, plastic, 4 x 60 m, white/white 2 1 roll

rope, polypropylene, 100 metres 20 1 roll

bucket, plastic, 20 litres, metal handle, with lid 30 1

container, food proof plastic, 125 litres, with tap 20 1

lid

sprayer, insecticides, 10 l, stainless steel, 4 1

max. oper. press. 6 bar (Gloria 142T)

mug, drinking, plastic, 200 ml 100 1

ladle, large, stainless steel 10 1

waste bag, 65 x 80 cm, plastic 400 1



5. Chlorination and water quality module

Items Quantity Unit

bucket, plastic, 20 litres, metal handle, with lid 2 1 pce

jerrycan, foldable, 10 litres, with tap 6 1 pce

pool tester 3 1 pce

chlorine test tablets, DPD1 10 100 pcs

chlorine test tablets, DPD3 1 100 pcs

phenol red tablets, for chlorine testing 1 100 pcs

test tube, turbidity, 5-2000 NTU, plastic 1 1 pce



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jug, measuring, 1 litre, with ear and spout, 1 1 pce

hard plastic

measure, plastic, 20 ml, for calcium hypochlorite 30 1 pce

calcium hypochlorite 65-70%, 500 g 30 1 cont

(IMDG 5.1 II/UN 2208)

apron, surgical, plastic, heavy duty 1 1 pce

leaflet, chlorination, English 1 1 pce

syringe, catheter tip, 50/60 ml, disposable 1 1 pce

funnel, diameter 150 mm, polypropylene 1 1 pce









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