My Journey to the IIM !!

Re: WORST CASE SOME ONE!!!

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ME WITH pROF ASHA KAUL (IIM-A)
 
Re: WORST CASE SOME ONE!!!

waaah beta.. bohot tarakki kar rahe ho .......... congrats....

Every1 who reads this thread is gona get inspired frm u man :D
 
Re: WORST CASE SOME ONE!!!

Wastewater generation and its management have become vital issues in sustainable development. It is not just the decreasing quality and quantity of fresh water available in rivers that is causing alarm, but also the harmful effects of polluted water on the health of humans and animals. A rapid increase in India’s population has resulted in growing consumption of water by irrigation systems and by domestic and industrial users. This increasing consumption has led to the generation of ever more quantities of sewage, which already far surpasses the installed wastewater treatment capacity available in major cities like Delhi. The question before policymakers, leaders, and civil society is therefore how to reduce and eliminate the yawning gap between wastewater generated and the shortfall in treatment capacity in the country.
 
Re: WORST CASE SOME ONE!!!

Different methods of waste management emit a large number of substances, most in small quantities and at extremely low levels. Raised incidence of low birth weight births has been related to residence near landfill sites, as has the occurrence of various congenital malformations. There is little evidence for an association with reproductive or developmental effects with proximity to incinerators. Studies of cancer incidence and mortality in populations around landfill sites or incinerators have been equivocal, with varying results for different cancer sites. Many of these studies lack good individual exposure information and data on potential confounders, such as socio-economic status. The inherent latency of diseases and migration of populations are often ignored. Waste management workers have been shown to have increased incidence of accidents and musculoskeletal problems. The health impacts of new waste management technologies and the increasing use of recycling and composting will require assessment and monitoring.
 
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Increasingly convinced of a link, however indirect, between employee communication and corporate wealth, organisations now expect more from their managers than ill-defined ‘interpersonal’ skills.

Much greater rigour is now required for relating to employees that includes an understanding of:

the principles of persuasion
the impact on communication of different ‘thinking styles’ and cultures
the range and impact of communication media
the ‘trilogy techniques’ of effective communications
 
Re: WORST CASE SOME ONE!!!

Traditionally a poor cousin of other functional areas, communicating with employees has, over the past decade, crystallised into an entire support function in its own right – International Communications. Why this growth?

the embarrassment that stems from empowerment: according to a MORI survey, one in six consumers are put off making a purchase by the way they are treated by staff; so employers are seeking to control this ‘loose cannon’ factor
growing reliance on virtual teams: the increasingly dispersed workforce that results from technological advances and structural change (e.g. outsourcing) calls for more co-ordinated communication
the rise of ‘stakeholder strategy’: employers now acknowledge the influence their individual stakeholder groups – customers, investors, employees, community – can have on each other and, as a result, are beginning to develop a more cohesive communication strategy to acknowledge it
link to bottom line: more and more research is now claiming correlations between the ‘feel good’ factor that results from effective internal communication and a company’s financial health – research: effective communication leads to increased employee loyalty leads to improved retention, productivity leads to an improved bottom line


Human Capital Index

Watson Wyatt: Human Capital Index (HCI) shows a relationship between the effectiveness of a company’s human capital and the creation of high shareholder returns. A number of communications practices are linked to human capital effectiveness:

- 51% of high-performing organisations have formal internal communications strategies

- 65% of high-performing organisations concentrate their comms programmes on educating employees about the organisation’s values and culture

- 1995 – 1999, firms that had communication skills as a promotion criterion had a 24% greater shareholder return

The ‘Communications’ function

Though convinced of the potential gains of a more cohesive approach to employee communication, the jury’s still out on the precise form this function should take.

Where’s the value-added? recent research – the communication function, in and out itself, does not add value to a business; how it does add value is by influencing:
clarity of business information
quality of interfaces
effectiveness of communications systems
communication behaviour of management

should it be centralised? can cut duplication and improve efficiency of info flow, but could turn into a control centre, and lapse back into one-way communication, leaving departments feeling one step removed from their audience
run by HR or PR? Biggest bone of contention – is it Internal Communication or Internal Marketing Internal marketing implies ‘sell’ rather than ‘tell’, is run by PR pros, expert in comms techniques, who may be seen to ‘spin’ stories to internal ‘customers’; if run by HR, implies “tell” over “sell”, and information over persuasion
 
Re: WORST CASE SOME ONE!!!

Yet, despite the evidence showing that improved communication can help:

motivate employees
secure employee buy-in
reduce the potential for conflict
… many managers remain reluctant or ineffective communicators for two main reasons.

(1)Wrong assumptions

Mistakenly, or arrogantly, some managers still think:

communication = conveying information give employees the bare bones, and that’s all that’s needed; this leaves the information wide open to misinterpretation
more information = better communication but the more you bombard employees with information, the more likely it is that the point will be lost
communication = more effective when it comes from the top true, there are times when employees need to hear the info from the CEO or senior management, but there are also times when this is inappropriate, and when it could make a situation seem more grave or alarming than it actually is
communication = communication team’s job the communications function is there to act in an advisory capacity on how to deliver information; however, at times employees need to hear it from, for example, other teams or the line manager who works with them most closely


(2)Fear

Largely spurred on by self-preservation, some managers are afraid of:

losing control information is power, so some leaders feel that by keeping their employees in the dark, they will maintain power; but in withholding information managers fuel the fear and suspicion of employees, which in turn leads to mistrust
admitting mistakes if you’re the boss, you’re meant to know what you’re doing; so many managers are reluctant to share information that may make them look weak or fallible
the unpredictable reaction of employees many managers have difficulty handling the ‘soft’ side of communication – how will employees react to the news? Instead, they prefer to focus on the non-emotional side of management – the tasks, deliverables, actions; but communication is about interacting with people, not just conveying information


EXCUSES, EXCUSES

Reasons managers fear communicating, and their unintended consequences:

‘too complex’: patronises employees
‘too confidential’: arouses curiosity of employees
‘too sensitive’: instils anxiety in employees
 
Re: WORST CASE SOME ONE!!!

 production management deals with preparation of production budget. Funds are provided for raw materials, wages, electricity, plant maintenance, etc. and expenditure is incurred as per budget allocation. Inventory control is one important function of production management. Here, the levels of inventories (spare parts, raw materials) are maintained at proper levels. This ensures regular production with minimum expenditure on inventories. Over and under-stocking are also avoided.
 
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HAPPY NEW YEAR

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Desire you: 365 days of happiness; 52 weeks of health and prosperity; 12 months of love and affection; 8760 hours of peace and harmony; That in this new year you it has 2007 reasons to smile

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Re: WORST CASE SOME ONE!!!

OUTBREAK INVESTIGATION IN DISASTER
COMMUNICABLE DISEASES AND NATURAL DISASTERS
Communicable diseases are relatively rare in the days immediately following a sudden natural disaster. However, with continuous lack of utilities (water supplies and sewage treatment), disrupted health services and poor environmental conditions (such as sanitation, emergency of new breeding sites, overcrowding in shelters and camps, and disruption of vector control activities), there is an increased risk of communicable disease outbreaks. Some of the common communicable diseases with outbreak potential include :
• Acute diarrheal diseases (including dysentery and cholera)
• Acute jaundice syndrome
• Acute respiratory infections
• Typhoid / Enteric fever
• Dengue
• Acute encephalitis
• Measles
• Acute pyogenic meningitis
• Malaria

Public health surveillance aims at collection, analysis and dissemination of health information to enable appropriate action to be taken. Surveillance therefore, is an important strategy for control and prevention of outbreaks due to outbreak-prone communicable diseases.

Laboratory support is an integral component of nay surveillance system. Laboratories can support the public health surveillance activities in disaster and emergency situations, including prevention and control of outbreaks due to communicable diseases, i.e.
• Early detection of outbreak and assistance in investigation (water borne disease outbreaks, meningococcal meningities etc.)
• Confirmation of etiology of the outbreak particularly in case of syndromic presentation (acute jaundice syndrome which could be due to acute viral hepatitis or leptospirosis, both of which have an outbreak potential)
• Tracing spread of infection using epidemiological markers
• Detection of carriers (human, animal)
• Detection of new agents introduced into the affected area e.g. by displaced persons or migrants from other location.
• Environmental monitoring (water/food bacteriology etc.)


LABORATORY SUPPORT TO DISEASE SURVEILLANCE IN DISASTER

Setting up Laboratory Support to disease surveillance.

Before setting up a laboratory for surveillance/outbreak investigation following a disaster, it is very important to identify the important communicable diseases, possible etiology causative agents and the tests to be performed at various levels of laboratories. (For details please refer Table-1)
• Identify priority communicable diseases of public health importance.
• Define the list of tests to be performed at each level of laboratories for the priority diseases (to be determined by the local situation).
• Map and assess the laboratory facilities (and available manpower) that can provide diagnostic support for these diseases. Make an inventory of referral laboratories that can provide a back up to the laboratory activity; ensure networking with these labs even during peacetime for its optimal use in an emergency situation.
• Identify a focal laboratory person at the district level to coordinate the activities.
• Flow of information should be defined.
• Standard guidelines, formats & common strategy for testing should be made available to all concerned including the samples to be collected for various syndromes/illnesses.
• Ensure supplies for collection, transport and storage of clinical samples.
• Proper collection, storage and transport should be the focus & not the final identification.
• Focus more on rapid test that require minimal expertise and have high sensitivity and are good even in adverse field conditions and should not be resource intensive so as to divert the resources from other essential activities.
• Outbreak investigation kits should be made available to the Rapid Response Teams (RRTs) and constantly replenished and restocked (Table-2.)
• During an outbreak only representative samples should be tested in order to avoid unnecessary burden on the laboratory services.
• Monitor the results, trends and unusual findings (early warning signals.)
• Ensure rapid communication and regular reporting of results to the epidemiologists for initiating action.

Table-1 : Possible etiology, laboratory tests to be performed and clinical specimen needed in various disease syndromes

Suspected outbreak of acute diarrheal disease Suspected outbreak of fever (Including fever with rash and acute hemorrhagic fever syndrome) Suspected outbreak of acute neurological syndrome Suspected outbreak of acute jaundice syndrome Suspected outbreak of acute respiratory infection
Possible disease pathogens Watery diarrhea
Cholera, viral gastroenteririts, enterotoxigenic Esch. Coli
Dysentery
Shigellosis, salmonellosis, Enterohaemorrhagic Esch. Coli, amoetic dysentery, Campylobacteriosis • Malaria
• Typhoid
• Measles
• Dengue and dengue hemorrhagic fever • Meningococcal meningitis
• Leptospirosis
• Viral/aseptic meningitis
• Viral encephalitis` • Acute viral hepatitis
• Leptospirosis • Influenza
• Diphtheria
• Streptococcal pharyngitis
Pertusis Bacterial pneumonias due to
• Streptococcus pneumoniae,
• Hemophilus influenzae
Specimen required • Freshly passed stool
• Rectal swab
• Fecal swab
• Environmental sampling especially water for available chlorine and bacteriological examination
• Blood
• Blood smear
• Serum
• Stool
• Urine
• Throat swab
• Environmental sampling especially water for available chlorine and bacteriological examination • Blood
• Blood smear
• Serum
• Stool
• Urine
• Throat swab
• Post mortem tissue
• Environmental sampling especially water for available chlorine and bacteriological examination • Blood
• Serum
• Urine
• Environmental sampling especially water for available chlorine and bacteriological examination Throat swab Per-nasal / nasopharyngeal swab • Sputum
• Blood for culture
Laboratory tests to be done In the field / peripheral lab:
• Hanging drop / iodine & wet mount of stool specimen
• OT test for available chlorine in water
• Rapid H2S test for bacteriological examination of water
At the district lab:
• Above tests plus
• Toxin detection test for cholera toxin (if kit available)
• MPN test for bacteriological examination of water
• Stool culture for enteropathogens; sensitivity testing, if available
• Referral of samples for further characterization and investigation, if required In the field / peripheral lab:
• Peripheral smear formalarial parasite, total leukocyte count, differential leukocyte count
• Platelet count
• OT test for available chlorine in water
• Rapid H2S test for bacteriological examination of water
At the district lab:
• Above tests plus
• Widal test / Thphoid test
• Rapid test for typhoid (Typhidot)
• MPN test for bacteriological examination of water
• Stool culture for enteropathogens; sensitivity testing, if available
• Blood culture and sensitivity
• Rapid diagnostic tests for diagnosis of dengue virus
• Referral of samples for further characterization and investigation, if required In the field / peripheral lab:
• Gram stain of CSF & CSF cytology
• India ink mount of CSF
• Dark ground microscopy of peripheral blood for leptospira
• OT test for available chlorine in water
• Rapid H2S test for bacteriological examination of water
At the district lab:
• Above tests plus
• MPN test for bacteriological examination of water
• Latex agglutination tests for detection of capsular antigen in CSF (if kit available)
• Rapid tests for detection of antibodies to Leptospira
• CSF for bacterial culture (if facilities available)
• Blood for bacterial culture
• ELISA for JEV
• Referral of samples for further characterization and investigation, if required In the field / peripheral lab:
• OT test for available chlorine in water
• Rapid H2S test for bacteriological examination of water
• Dark ground microscopy of peripheral blood for leptospirosis
• Rapid kit test for the diagnosis of viral hepatitis (HbsAg antigen detection and anti-HCV)
At the district lab:
• Above tests plus
• MPN test for bacteriological examination of water
• Urine microscopy
• Rapid tests for detection of antibodies to Leptospira
• Blood for bacterial culture
• Referral of samples for further characterization and investigation In the field / peripheral lab:
• Gram stain of throat swab and sputum*
• Albert’s stain of throat swab8
• Inoculation of blood culture bottles and swabs in appropriate transport media
At the district lab:
• Above tests plus
• Bacterial culture (& sensitivity, wherever applicable) from throat swab, sputum, blood
• Referral of samples for further characterization and investigation, if required

* For diphtheria & other org.


Table-2 : Generic Outbreak Investigation Kit

Proposed compounds of the kit :
• Disposable storage vials (5 ml)
• Disposable sample collection vials
• Stool culture bottle
• Throat swabs
• Blood culture bottles
• Viral transport medium
• Cary Blair medium / Stuart’s transport medium
• Vacutainer (plain and EDTA)
• Syringes and needles disposable (5 ml)
• Trouniquet
• Gloves
• Masks (triple layer surgical mask)
• Disposable gowns
• Puncture proof discarding bags (disposable)
• Spirit swabs / alcohol swabs
• Band-aid
• Vaccine carrier with ice-packs
• Spirit lamp / gas lighter
• Match box
• Test tube rack
• Centrifuge tubes
• Lancets
• Slides and cover slips
• Rubber bands
• Ziploc plastic bags
• Absorbent material (tissue paper, cotton wool, newspaper)
• Labels
• Glass marking pen
• Adhesive tape
• Scissors
• Scalpel / blade
• Spatula
• Forceps
• Loop holder
• Pasteur pipettes / pipettes and pipette aids (rubber teats)
• Rapid diagnostic kits
• Sodium hypochlorite concentrates (4%)
• Hand disinfectant
• Stationary (writing pads, pens, pencils, erasers, sharpeners, etc.)
• Calculator
• Torch with spare batteries / rechargeable batteries
• Laboratory request forms
• OT test kit
• Epidemiological survey formats
• Epidemiological reporting formats
• Outbreak investigation guide / module
Selected entomological equipment such as :
• Aspirator and flashlight for indoor / outdoor mosquito collection
• WHO susceptibility kit for adult and larvae with reagents
• Bioassay kit
• Kit for outdoor mosquito collection
• Ladle bottles for keeping larvae, strainer, dropper, trays and funnel net for wells
• Vector dissection equipment :
• Pyrethrum spray (0.02%) with flit gun
• White bed sheet to spread on floor
• Dissection needle
• Petridishes
• Slides, coverslips
• Physiological saline
• Dissecting microscope
• Staining equipment and material
• Filter paper
• Mosquito net
• Synoptic keys for identification of vectors
• Any other, as per therequirements of the outbreak
• The laboratories which have expertise in investigation ofoutbreaks are :
- National Institute of Communicable Diseases
22, Shamnath Marg, Delhi-110054
Tel: 011-23971272, 23971060, 23971344, Fax: 011-23972677,
email: [email protected]
- National Institute of Virology
20-A, Ambedkar Road, Pune-411001 (Maharashtra)
Tel: 020-26126302, 26126304, Fax: 020-26122669, email: [email protected]
- National Institute of Cholera & Enteric Diseases
P-33, CIT Road, Scheme XM, Beliaghata, Kolkatta-700010
Tel: 033-23501176, 23508493, Fax: 033-23505066, email: [email protected]



Laboratory support to outbreak investigation

• Laboratories support should be an important component of an epidemic-preparedness plan for epidemic-prone communicable diseases in a disaster situation and preparations should be made accordingly in the inter-epidemic period.
• Based on the preliminary information on the syndrome responsible for the outbreak, decide on the possible differential diagnosis for further investigations.
• The quantity and nature of the supplies required in the field such as containers, reagents, rapid kits, transport media etc. and the level of expertise of the laboratory personnel required in the field must be considered before setting out to investigate the outbreak. Keep outbreak investigation kit always ready with team.
• Once in the field, ensure proper collection, storage and transport of the specimen in leak-proof containers labeled properly and accompanied by complete patient information in standard formats.
• Ensure that appropriate bio-safety and waste management measure are followed.
• Inform the receiving laboratory about the tentative date and time of arrival of the specimen.
• The aim should be to reduce the time to confirmation so that timely public health actions can be taken. Only, a few initial cases need confirmation. Rest with similar clinical manifestations should be treated as confirmed.


Networking of Laboratories

Under the Integrated Disease Surveillance Programme (IDSP) of Government of India, a laboratory network has been established at various levels of health care as given below and this network is to be used for disease surveillance / outbreak investigqtion even during disaster. The network comprises of
• Peripheral Laboratories and Microscopy centers (L1 Labs)
• District Public Health Laboratories (L2 Labs)
• State Laboratories (L3 Labs)
• Regional and Quality Assurance Laboratories (L4)
• Disease based reference Laboratories (L5)

These laboratories will carry out below activities.

1. Peripheral Laboratory (L1 Labs)

Basic lab facilities like microscopy for TB and malaria, faecal contamination of water by rapid H2S Test etc. However these labs should be equipped to collect, store and transport the relevant clinical samples for the important communicable diseases.

2. District Laboratories (L2 Labs)

It is the backbone of the laboratory network. Besides carrying out all the activities of the L2 labs, these labs will also carry out cholera / typhoid culture, rapid test for HIV, viral hepatitis, antimicrobial sensitivity testing etc. Quality assurance for the L1 labs will also be carried out.

3. State Level Laboratories (L3)

These are mainly in the medical colleges and will carry out advanced laboratory investigations besides doing all the activities required at district level. It will carry out the quality assurance of the district and PHC laboratories. Some of the advanced tests performed at L3 labs are mycobacterium culture and sensitivity, serology for measles, leptospirosis, JE / Dengue, Anthrax culture, etc.

4. Regional and Quality Assurance Laboratories (L4)

There would be 4-5 such labs in the country, which would carry out quality assurance of district and state level labs besides carrying out advanced lab. tests like virus cell cultures, molecular techniques, etc.

5. National Reference laboratories (L5)

There are 8-10 laboratories of repute in the country which will be acting as National Reference Labs. These laboratories are National Institute of Communicable Diseases, Delhi; National Institute of cholera and Enteric Diseases, Kolkatta; National Institute of Virology, Pune; PGI Chandigarh; CMC, Vellore; NIMHAS, Bangalore; KIPM, Chennai; SGPGI, Lucknow and will carry out following additional work :
• Characterization of strains.
• Maintain a repository of microbial strains and reagents.
• Production of diagnostic antisera.
• Development of SOPM’s for the lower level of labs.
• Quality assurance of lower level of labs.


COLLECTION, TRANSPORT & STORAGE OF CLINICAL SPECIMEN

For any investigation of outbreak this is very important.


LABELLING AND IDENTIFICATION OF SPECIMENS

In a diagnostic investigation the information contained in the case investigation form is collected along with the specimen. Each patient should be assigned a unique identification number. This unique identification number and the patient name should be present on specimens, epidemiological data forms, and the laboratory transmittal forms.

Glass slides for microscopy must be labeled individually, using glass-making pencil. This should not interfere with the staining process.

Label on Specimen






Case Investigation Form

A laboratory request form must be completed for each specimen and contain information to interpret the necessary tests. This may include :
• Patient information : age (or date of birth), sex, complete address
• Clinical information : date of onset of symptoms, clinical and immunization history, risk factors or contact history where relevant, antimicrobial drugs taken prior to specimen collection, etc.
• Laboratory information : acute or convalescent specimen, other specimens from the same patient
• The receiving laboratory should record :
- Date and time when the specimen was received
- Name and initials of the person receiving specimen
- Record of specimen quality


TRANSPORT OF SPECIMENS

Maintain the transit temperature at 2-80C. The sample should be transported in vaccine carrier with ice packs and triple package box.

Note :

• Avoid repeated thawing and freezing of specimens.
• Freeze the specimen only if transport is assured at –200C.
• Store and transport all specimens at 2-80C, except CSF obtained from suspected cases of pyogenic meningitis.

BIOSAFETY AND DECONTAMINATION PROCEDURES

General bio-safety measures and universal precautions must be followed.


General Bio-safety Measures

• Use disposable gloves while collection of clinical specimen.
• Wear laboratory coats while collection and handling of specimen.
• Use protective eyewear of face shields if procedure is likely to generate aerosols.
• All laboratory waste should be handled with care to avoid injuries from sharps.
• As far as possible manual handling of waste should be avoided.
• The waste should be placed in appropriate leak-proof biobazard bags and autoclaved. Before disposal the clinical samples should be processed only in designated laboratory having the proper containment facility.
• A first aid kit is essential, and should b readily accessible at the site of specimen collection.
• Protective clothing, work premises, equipment, and materials may all become contaminated in the field. Disinfection of work areas and decontamination of spills of blood or infectious body fluids is generally achieved by chemical disinfection with chlorine-based solutions.
• It is generally not practicable to achieve adequate sterilization of contaminated materials in the field. As incompletely ‘sterilized’ material may expose both the participants in the investigation and the general public to a real risk of infection, the re-use of contaminated equipment or materials such as gloves or clothing is not recommended.
• Sharps and soiled glass slides should be discarded directly into a puncture-resistant container, which is then safely disposed.
• Work areas and surfaces should be organized and disinfected with 1% household bleach daily. Use 10% bleach to clean up spills after wiping the surface clean.
• Personnel carrying out cleaning or decontamination should wear a protective coat and thick rubber gloves.
• Contaminated non-disposable equipment or materials should be soaked in 1% household bleach for 5 minutes. Before use, wash in soapy water and sterilize if necessary.
• Heavily soiled disposable items should be soaked in 10% housuehold bleach before safe disposal.

Interpretation of Results

While reporting laboratory incharge should ensure that interpretation of test is incorporated. In general whenever any pathogentic organism is isolated from clinical specimen it indicates the causative agent. IgM antibody test positive against any organism gives evidence of acute infection while IgG antibody presence indicates exposure to that organism in past unless four fold rise in antibody titre in two blood samples collected at interval of 15 days is demonstrated which indicates acute infection.
REPORTING FORMATS

Case Investigation Form
(To be filled in by the Clinician / Epidemiologist)

Date : ____________

Patient’s Name: Patient’s I.D. No.:
Father’s / Husband’s Name: Age / Sex :
Address:
Date of onset of illness:
Date of hospitalization / reporting to the district level:
Occupation:
Clinical signs & symptoms (with duration):
Treatment history:
Results of previous investigations (if any):
Any other relevant information:

Specimen details:
Nature of Specimen(s) Date of Collection Investigation Required




Details of sender:
Signature:
Name of sender: Address of sender:
Fax: email:


(NOTE : Please complete all the columns. Always send the sample under cold chain unless specified otherwise)

Laboratory Reporting Form

Patient’s Name : Patient’s I.D. No.:
Age / Sex: Laboratory Reference No.:
Specimen details :
Type of Specimen Date of Collection Date of Receipt in lab Type of Test Result Remarks (if any)





Interpretation :
Details of Investigator :
Name: Signature:
Address: Telephone No.:


While reporting laboratory incharge should ensure that interpretation of test is incorporated.

















Bioterrorism








LABORATORY SUPPORT FOR OUTBREAK INVESTIGATION IN DISASTER:

Table 1 – Possible etiology, laboratory tests to be performed and clinical specimen needed in various disease syndromes
Suspected outbreak of acute diarrheal disease Suspected outbreak of fever Suspected outbreak of acute neurological syndrome Suspected outbreak of acute jaundice syndrome Suspected outbreak of acute respiratory infection
Possible disease pathogens Watery diarrhea
Cholera, Viral gastroenteritis, Enterortoxigenic Esch. Coli
Dysentery
Shigellosis, Salmonellosis, Enterohaemorrhagic Esch. Coli,
Amoebic dysentery,
Campylobacteriosis Malaria
Tyhoid
Measles
Dengue and dengue hemorrhagic fever Meningoccal meningitis
Leptospirosis
Viral/aspectic meningitis
Viral encephalitis Acute viral hepatitis
Leptospirosis Influenza
Diuphtheria
Streptoccoccal pharyngitis Pertussis Bacterial pneumonias due to
Streptococcus pneumonia,
Hemophilus influenzae
Specimen required Freshly passed stool
Rectal swab
Environmental sampling especially water for available chlorine and bacteriological examination Blood
Blood smear
Serum
Stool
Urine
Throat swab
Environmental sampling especially water for available chlorine and bacteriological examination

CSF
Blood
Serum
Stool
Urine
Throat swab
Post mortem tissue
Environmental sampling especially water for available chlorine and bacteriological examination Blood
Serum
Urine
Environmental sampling especially water for available chlorine and bacteriological examination Throat swab Per-nasal/ nasopharyngeal swab Sputum
Blood for culture
Laboratory tests to be done In the field/ peripheral lab:
Hanging drop/loading & wet mount of stool specimen
OT test for available chlorine in water
Rapid H@S test for bacteriological examination of water
At the district lab:
Above tests plus
Toxin detection test for cholera toxin (if kit available)
MPN test for bacteriological examination of water
Stool culture for enteropathogens; sensitivity testing, if available
Referral of samples for further characterization and investigation, if required
In the field/ peripheral lab:
Peripheral smear for malarial parasite, total leukocyte count, differential leukocyte count
Platelet count
OT test for available chlorine in water
Rapid H2S test for bacteriological examination of water
At the district lab:
Above tests plus
Widal test/ typhidot test Rapid test for typhoid (Typhidot) MPN test for bacteriological examination of water
Stool culture for enteropathogens; sensitivity testing, if available
Blood culture and sensitivity
Rapid diagnostic tests for diagnosis of dengue yirus
Referral of samples for further characterization and investigation, if required In the field/peripheral lab:
Gram stain of CSF & CSF cytology
India ink mount of CSF
Dark ground microscopy of peripheral blood for leptospira
OT test for available chlorine in water
Rapid H2S test for bacteriological examination of water.
At the district lab:
Above tests puls
MPN test for bacteriological examination of water
Latex agglutination tests for detection of capsular antigen in CSF (it kit available)
Rapid tests for detection of antibodies to Leptospira
CSF for bacterial culture (if Facilities available)
Blood for bacterial culture
ELISA for JEV
Referral of samples for further characterization and investigation, if required In the field/ peripheral lab:
OT test for available chlorine in water
Rapid H2S test for bacteriological examination of water
Dark ground microscopy of peripheral blood for Leptospirosis
Rapid kit test for the diagnosis of viral hepatitis (HBsAg antigen detection and anti-HCV)
At the district lab:
Above tests plus
MPN test for bacteriological examination of water
Urine microscopy
Rapid tests for detection of antibodies to leptospira
Blood for bacterial culture referral of samples for further characterization and investigation
In the field/ peripheral lab:
Gram’s stain of throat swab and sputum
Albert’s stain of throat swab
Inoculation of blood culture bottles and swabs in appropriate transport media
At the district lab:
Above tests plus Bacterial culture (& sensitivity, wherever applicable) from throat swab, sputum, blood
Referral of samples for further characterization and investigation, if reuired.






Table 2 Generic Outbreak Investigation Kit
Disposable storage vials (5 ml) Rubber bands
Disposable sample collection vials Ziploc plastic bags
Stool culture bottle Absorbent material (tissue paper, cotton wool, newspaper)
Throat swabs Labels
Blood culture bottles Glass marking pen
Viral transport medium Adhesive tape
Cary Blair medium/ Stuart’s transport medium Scissors
Vacutainer (plain and EDTA) Scalpel/ blade
Syringes and needles disposable (5 ml) Spatula
Toumiquet Forceps
Gloves Loop holder
Masks (triple layer surgical mask Pasteur pipettes/ pipettes and pipette aids (rubber teats)
Disposable gowns Rapid diagnostic kits
Puncture proff discarding bags (disposable) Sodium hypochlorite concentrates (4%)
Spirit swabs/alcohol swabs Hand disinfectant
Band-aid Stationary (writing pads, pens, pencils, erasers, sharpeners etc.)
Vaccine carrier with ice packs Calculator
Spirit lamp/gas lighter Torch with spare batteries/ rechargeable batteries
Match-box Laboratory request forms
Test tube rack OT test kit
Centrifuge tubes Epidemiological survey formats
Lancets Epidemiological reporting formats
Slides and cover slips Outbreak investigation guide/module
Selected entomological equipment such as:
Aspirator and flashlight for indoor/ outdoor mosquito collection
WHO susceptibility kit for adult & larvae with reagents
Bioassay kit
Kit for outdoor mosquito collection
Ladle bottle for keeping larvae, strainer, dropper, trays and funnel net for wells vector dissection equipment:
Pyrethrum spray (0.02%) with flit gun Physiological saline
White bed sheet to spread on floor Dissecting microscope
Dissection needle Staining equipment & material
Petridishes Filter paper
Slides, coverslips Mosquito net
Synoptic keys for identification of vectors
Any other, as per the requirements of the outbreak





Table 3: Summary of specimen collection, handling and transport
SPECIMEN COLLECTION HANDLING AND TRANSPORTATION
Blood for smears for hemoparasites Capillary blood from finger pick, Make smear, fix the same in methanol or other fixative Transport the slides within 24 hours
They must not be refrigerated
Blood for pyogenic culture Venous blood
0.5-2 ml for infants
2-5 ml for children
5-10 ml for adults Collect into blood culture bottles (with Glucose broth or Bile salt broth)
Transport in erect position, and with enough cushion to prevent lysis of cells. Wrap the samples with absorbent cotton to soak any spillage. Transport at room temperature to the testing laboratory within 24-48 hours. If further delay is expected, transport under cold chain at 4oC.

Serum for serology Venous blood is collected and placed in a sterile test tube. Lt the specimen clot for 30 minutes at ambient temperature. Then place in a cool box for clot retraction at 2-8oC for a minimum of 1-2 hours. This is ten centrifuged @ 1500 RPM for 5-10 mts. Separate the serum from the clot. Sera should be transported at 4-8oC and Can last at this temperature for up to 10 days
CSF for culture, microscopy and serology Lumber puncture under aseptic conditions by trained medical staff.
Collect the CSF in sterile tubes If bacterial etiology is suspected (turbid or cloudy CSF), then transport at ambient temperature. However, of viruses (clear and colourless CSF, transport at 4-8oC and the sample must reach the laboratory within 24-28 hours.
Faeces for culture Collect freshly passed stool (approx. 8 gm) in children, reactal swabs and may be collected Transport at 4-8oC, Process within 1-2 days. When bacterial etiology is suspected, samples can be transported in Cary Blair’s Medium at room temperature.
Respiratory samples (throat swab, per-nasal and post-nasal swab, nasopharyngeal aspirate, sputum) Throat Swab: - Using a tongue depressor and under strong light source, lacte areas of inflammation and exudates in the posterior pharynx and the tonsillar region of the throat behind the uvula, collect throat swab by rubbing the area back and forth with a cotton of Dacron swab.
Per nasal Swab – Using a nasal speculum and with the head titled backwards, insert a flexible calcium alginate/Dacron swab through the speculum parallel to the floor of nose without pointing upwards. Alternately, bend the wire and insert it into the throat and move the swab upwards into the nasopharyngeal space. Rotate the swab on the nasopharyngeal memberane a few times.
Post Nasal Swab – Flush a plastic catheter or tubing with 2-3 ml of VTM/sterile normal saline. With the head of the patient titled slightly backgward, instill 1-1.5 ml of VTM/sterile normal saline into one nostril. Inser the tubing into the nostril parallel to the palate and aspirate nasopharyngeal secretions. Repeat this procedure with the other nostril. Collect 1-2 ml in a sterile vival and transport
Sputum – Instruct patient to take a deep breath and cough up sputum directly into a wide-mouth sterile container. Avoid saliva or postnasal discharge. Minimum volume should be about 1 ml. All respiratory specimens expect sputum are transported in appropriate bacterial (Amie’s or Stuart’s transport medium)/Viral (Viral transport medium) media.
Transport as quickly as possible to the laboratory to reduce overgrowth by commensal oral flora.
For transit period up to 24 hours, transport specimens for bacterial isolation at ambient temperature and for viruses at 4-8oC in appropriate media.
Water sample for bacteriological examination collectt at least 200ml of water sample from the source (tap, a pump or a pump outlet, a watercourse or reservoir, dug wells) in sterile glass bottle (alternatively, autoclovalble plastic bottles with a tight screw capped lid) with securely fitting stoppers or caps having an overthanging rim. Test the water sample within 3 hours of collection during which time it can be kept at room temperature. If delay is expected, keep the sample at 2-8oC which should then be tested within 24 hours.
Post mortem samples Biopsy of relevant tissue
Place in formalin for histopathology
Place in Transport media sterile saline for microbiological testing Fixed specimens can be transported at ambient temperatures
Specimens in transport media may be transported within 24 hours at ambient temperature.
 
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