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1. Communicable disease
Surveillance Programme

2. What is surveillance?

3. Why surveillance?

4. • Integrated Disease Surveillance Project
(IDSP) is a decentralized, state based
surveillance programme in the country. It is
intended to detect early warning signals of
impending outbreaks and help initiate an
effective response in a timely manner. It is
also expected to provide essential data to
monitor progress of on-going disease
control programmes and help allocate
health resources more efficiently.

5. 1 Syndromes under Surveillance:
• Fever
• Less than seven days duration without any localizing signs
• With Rash
• With altered sensorium or convulsions
• Bleeding from skin or mucus membrane
• Fever more than seven days with or without localizing signs
• Cough more than three weeks duration
• Acute Flaccid Paralysis
• Diarrhoea
• Jaundice
• Unusual Events causing death or hospitalization

6. Types of surveillance under
IDSP:
• Syndromic:
• Presumptive:
• Confirmed:

7. Symptoms, signs and syndrome
• Symptom is complaint perceived by the patient
or identified by the examiner (e.g. fever, loose
motions, headache, vomiting, cough etc.)
• Signs are findings on examination of patients
e.g. skin rash, yellow discoloration (jaundice).
•
• Syndrome is group of symptoms and/or signs
attributable to particular disease condition (e.g.
fever with skin rash indicative of measles).

8. Which are the reporting units?

9. Reporting units for disease
surveillance
• Public health sector
• Private health sector
• RuralSub-centers, PHCs, CHCs, District
HospitalsSentinel Private practitioners (SPPs)
and Sentinel hospitals.UrbanUrban Hospitals,
ESI / Railway / Medical college hospitalsSentinel
Private nursing homes, sentinel hospitals,
Medical colleges, Private and NGO laboratories

10. Data collection
Flow of information:

11. Weekly Information Flow under IDSP
C.S.U.
Sub-Centres
Programme
Officers
S.S.U.
P.H.C.s
C.H.C.s
Pvt. Practioners
D.S.U.
Dist.Hosp. Nursing Homes
Private Hospitals
Med.Col.
Private Labs.
P.H.Lab
Other Hospitals: Corporate
ESI, Municipal Hospitals
Rly., Army etc.

12. Transmission of data
Feedback

13. Laboratory confirmation

14. Syndrome Action
Only Fever Blood Smear for all patients
Inform PHC MO immediately to arrange for collection of stool samples
Two samples of stools taken at interval of 24 hours and transported to the MO
PHC in reverse cold chain
Acute Flaccid Paralysis
Take sample of stools in a filter paper or in a sterile bottle and send it by
reverse cold chain to the nearest District Laboratory (within two hours) or
Loose watery stools with dehydration in an use Cary-Blair medium for transport of the sample
adult
Fever with rash
Fever with altered sensorium
Fever with bleeding
Referred to the MO PHC for specific lab
Fever more than 7 days
action
Cough for more than three weeks
Unusual severe syndromes

15. COLLECTION, STORAGE & TRANSPORT OF
SPECIMENS
INTEGRATED DISEASE SURVEILLANCE PROJECT- TRAINING
FOR STATE AND DISTRICT SURVEILLANCE OFFICERS

17. Methods of Collection:
a) Venepuncture b) Finger prick
For serum & For peripheral blood
Blood culture smear

18. PERFORMING VENE PUNCTURE
Label the collection container before
commencement of venepuncture.
Gloves should be worn.
Use sterilized/sterile disposable syringes
and needles.
Clean the site well with spirit.
Tighten tourniquet.

19. - Perform venepuncture,and collect 5 ml of blood.
- After blood collection, remove tourniquet and withdraw
the needle .
- Remove the needle from the syringe.
- Carefully transfer blood from the syringe without
squirting, into a sterile screw capped plastic leak proof
specimen container.
- Any blood spill is wiped with 70% ethanol.
- All the swabs are placed in plastic bags for disposal.
- If the outside of the vial is visibly
contaminated with blood, it should be
cleaned with 10% freshly prepared
sodium hypochlorite solution.

20. EXTRACTION OF SERUM
 5ml of venous blood is collected remove the
needle before transferring to sterile dry test
tube.
 Let the specimen clot for 30 mins. at
ambient temperature. Do not shake.
 Then place in a cool box for clot retraction
at 4-8o C, for a minimum of 1-2 hours.
 If facilities for separation of serum are
not available, then it should be
refrigerated at 4o C. (NOT FROZEN).
 Otherwise centrifuge @ 1000 G for 10 mins.
 Separate the serum from the clot.
 Sera should be transported at 4-8o C and can
last at this temperature for upto 10 days.

21. SERUM………
Required for the diagnosis of the following diseases:
1) Typhoid- Paired sera
2) Leptospirosis- Paired sera
3) Measles- Paired sera
4) Dengue- Paired sera
5) Japanese encephalitis- Paired sera
6) Hepatitis – Single sample
7) Plague- Paired sera
Ideally blood should be collected within 5-7 days of
the start of illness. The second sample should be
collected with a gap of 10 days.(for paired sera)

22. BLOOD FOR CULTURE
How much?
Venous blood
0.5 – 2 ml for infants
2-5 ml for children
5-10 ml for adults
When?
As early as possible and before starting antibiotics
Transport:
-Collect into blood culture bottles (with Glucose
broth Or Bile salt broth).
--Should be transported at ambient temperature.

23. Preparation for collecting blood for culture:

24. Blood culture contd….

25. Blood culture contd….
SKIN PREPARATION (Very important)
After palpating the vein,
clean the site for
venepuncture with 70%
alchol for at least 30 secs
Next clean with iodine
(tincture iodine ) in
concentric circles away
from the puncture site
covering an area of 1-2” in
diameter

26. Collect required amount of
blood with a sterile needle and
syringe.
Transfer with the needle into
the blood culture bottle.
Shake the bottle properly to
prevent clotting.
Can be kept at room
temperature.
Always label the bottle and
with the patient details
mention time & date of
collection

27. Blood can also be collected in an
anticoagulant solution e.g. EDTA.
A second person wearing gloves should help
in shaking the vial for mixing the blood well
with the anticoagulants.
Usually collected for detection of malarial
antigen.

28. FINGER PRICK – Examination of bloodsmear
for malaria
# Peripheral blood smears are
prepared for the diagnosis of
malaria.
# Collect blood either during or 2-3
hours after the peak of
temperature.
# Sample should be taken before
administration of antimalarial drugs.
# Both thick and thin films should
be made.
# Thick film is used to detect the
parasite and thin film to determine
the species of the parasite.

29. Thick Films:
Take 3-4 drops of blood
and spread over a 1 cm
square area or in a 1cm
diameter circle. Allow to
dry,
Thin Films:
These are prepared by
taking a drop of blood on
one edge of the slide
and spreading it evenly
over the surface with
another slide.

30. Examination of blood samples for
leptospirosis, Dengue and chikun
gunya
• Serum from blood sample is prepared.
• Antibody detection – IgM ELISA method.
– Microplates precoated with inactivated antigen.
– Patient’s serum sample is added.
– Incubation at 37º C for a definite period.
– Addition of conjugates followed by aspiration and
washing many times.
– Results read by colorimetric method using
spectrometer.

31. Leptospirosis
year tested positive
2007 3036 271
2008 3955 345
2009 6917 567
2010 775 30 for january
Dengue
2007 3647 208
2008 3976 329
2009 7340 650
2010 810 72
ChikunGunya
2009 558 158 (2months)
2010 40 16 January
2010 54 15 feb

33. RESPIRATORY TRACT SPECIMEN COLLECTION
Specimens are collected from the upper or lower
respiratory tract, depending on the site of infection.
Upper respiratory tract pathogens
(viral and bacterial):
a) Throat swab.
b) Nasopharyngeal swab.
Lower respiratory tract pathogens:
a) Sputum specimens.

34. MATERIALS REQUIRED :
Transport media – bacterial and viral.
Throat swabs (Dacron and cotton swabs).
Tongue depressor Nasal speculum
20-50 ml syringe
Sterile screw-cap test tubes and wide-mouthed clean
sterile containers (minimum volume 25 ml.)

35. METHOD OF COLLECTING A THROAT SWAB :
* Hold the tongue down with the tongue depressor.
* Use a strong light source to locate areas of inflammation
and exudate.(posterior pharynx and the tonsillar region of
the throat behind the uvula) .
* Rub the area back and forth with a sterile cotton swab.
* Sample the posterior pharyngeal wall at the end to avoid
gagging by the patient.
•Withdraw the swab without touching
cheeks, teeth or gums and insert into
a sterile screw-cap test tube
containing appropriate transport
medium required.

36. METHOD OF COLLECTING PER-NASAL AND POST-
NASAL SWABS :
- Seat the patient comfortably, tilt the
head back and insert the nasal speculum.
-Insert a flexible cotton swab through the
speculum parallel to the floor of nose.
- 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 membrane a few
times, remove it carefully and insert it into a screw-cap
tube containing transport medium.
- Break off the top part of the stick without touching
the tube and tighten the screw cap firmly.
- Label the specimen tube.

37. METHOD OF COLLECTING NASOPHARNGEAL
WASH/ASPIRATE :
- Have the patient sit with the head tilted
slightly backward.
- Flush a plastic catheter or tubing with
2-3 ml of VTM/sterile normal saline.
- Instill 1-1.5 ml of VTM (viral transport
medium)/sterile normal saline into one
nostril.
- Insert the tubing into the nostril parallel
to the palate and aspirate nasopharyngeal
secretions.
- Repeat this procedure with the othe nostril.
- Collect 1-2 ml in a sterile VTM and transport
in cold chain at 2-8o C

38. COLLECTION OF SPUTUM SAMPLE
Materials required :
Select a good wide-mouthed sputum container,
which is disposable, made of clear thin plastic,
unbreakable and leak proof material.
Method of collection :
Collect an early morning sample after rinsing the mouth
with water.
Instruct the patient to inhale deeply 2-3 times, cough up
deeply from the chest and spit in the sputum container by
bringing it closer to the mouth.
This should be done in the open or away from other
people.
Make sure the sputum sample is of good quality. A good
sputum sample is thick purulent and sufficient in amount.

39. HANDLING AND TRANSPORT
- If the specimen is collected in the field and cannot
be immediately processed, it should be transported to
the laboratory within 3-4 days of collection.
- The specimen should be properly labelled and kept
away from the sun and heat. These can be placed in
a special box, which can withstand leakage of contents,
shocks and other conditions incident to ordinary
handling practices.
-These boxes should be kept &
transported in cool conditions.
- If delay is unavoidable, the specimens
should be refrigerated.

41. COLLECTION OF FAECES
ACUTE (WATERY) DIARRHOEA
Causative Agents :
Bacteria(eg.Cholera,Salmonella,Shigella,
E.coli)
Viruses (eg Rota virus)
and Parasites.
Which sample should be collected?
Stool sample is preferred incase of
infants rectal swabs can be collected.

42. When should it be collected?
Collect soon after onset of diarrhoea
For viruses : < 48hrs of onset,
For bacteria : < 4days after onset
of illness.
PREFERABLY BEFORE STARTING ANTIBIOTICS
If required two or three samples can be collected on
consecutive/alternate days.

43. In which container?
Clean dry leak proof container Container with spatula
CONTAINERS SHOULD NOT BE WASHED
WITH
DISINFECTANT SOLUTION

44. INSTRUCTIONS FOR COLLECTING FAECES
# Label the specimen container clearly with patients
name and date of collection. ( If a specimen container is
not available, a clean jar with a screw-top lid may be
used.)
# Pass faeces directly into the container. Do not
contaminate the faeces with urine/Or place a separate
clean container with a wide opening (for example, an ice-
cream container), or plastic wrap or newspaper in the
toilet bowl.Transfer enough faeces with spatula to at
least half fill the specimen container.
# Screw the lid on the specimen
container firmly. Place it in a sealed
plastic bag.

45. COLLECTION OF RECTAL SWAB
This method of sampling is less satisfactory than collecting
faeces. It is not appropriate for parasitology.
•Moisten a cotton swab with sterile saline.
•Insert it inside the anal sphincter and go
upto 2-4 cm inside the rectum .
•Gently rotate upto 90 degrees, so that faeces covers the
swab.
•Withdraw the swab
•Place it in transport medium, break off the top portion of
swab stick and discard
•Label the specimen and place it in a plastic bag with the
appropriate request slip attached

46. HANDLING AND TRANSPORT
• If delay of more than two hours is anticipated, inoculate
the specimen in a transport medium
• Cary Blair medium : for bacterial
pathogens(Salmonella , Shigella,
Esch coli and Vibrio). Should
reach laboratory in 2-3 days time.
Can keep at room temperature.
Rectal swab in Cary Blair medium
V.R. Fluid :For Cholera should
reach laboratory in 2-3 days time.
Can keep at room temperature.
For viruses keep in fridge (4ºC-8ºC)
DO NOT FREEZE.
Rice water stool in V.R. Fluid

48. When do we collect?
The specimen must be taken by a physician experienced in
the procedure.
CSF is used in the diagnosis of viral, bacterial, parasitic, and
fungal meningitis.
Also Dengue and Japanese Encephalitis.
Collect as early in the disease as possible, before antibiotics

49. MATERIALS REQUIRED:
Lumbar puncture tray which includes :
Sterile materials : gloves, cotton,
towels or drapes.
Local anaesthetic, sterilized needle,
syringe.
Skin disinfectants : 10% providone
iodine or 70% alcohol
Two lumbar puncture needles, small
bore with stylet (sterilized)
Six externally threaded sterile screw-
cap tubes and tube rack.
Gloves
Drapes

50. METHOD OF COLLECTION :
Only experienced clinicians should be involved in performing
A lumbar puncture.
CSF is collected directly into the separate screw-cap sterile
tubes. Separate tubes should be used for bacterial and viral
processing.
Step 1. Make the patient lie on the bed in left lateral
position. Ask the patient to flex the neck (so that the chin
touches the chest) hip and the knee joint.

51. Step2: Using the iliac crest as the reference
point, palpate the joint space between the 4th
and the 5th lumbar vertebrae and identify the
surface anatomy.
Step3; Disinfect the site meticulously with
10% povidone iodine or 70% isopropyl alcohol
by swabbing the skin concentrically from L4
the centre of the site outwards. Let the L5
disinfectant evaporate.
- Do not repalpate the site again.
Step 4: Infiltrate the local area with the
local anaesthetic and wait for 4-5 mins for
the effect to appear before performing
lumbar puncture.

52. Step5: Insert the sterile lumbar
puncture needle between the 4th and
5th lumbar vertebrae to a depth of 4-5
cm, withdraw the stylet. Fluid flows
freely through the needle.
Step 6: Between 1 and 2 ml of CSF is
collected in each of the 3 tubes,
a) one for culture,
b) one for biochemical analysis and
c) one for cytology.

53. HANDLING AND TRANSPORTATION :
 In general send the specimens to the laboratory and
process as soon as possible.
 Transport CSF specimens for bacteriology at ambient
temperature, generally without transport media. Never
refrigerate the CSF, as many of the bacterial pathogens
do not survive well at low temperatures.
 CSF specimens for virology do not need transport
medium. They should be transported at 4-8o C.

55. POST MORTEM SPECIMEN
COLLECTION
When, why & how?
# Need to be collected during
outbreak situation when causative
agent is not known.
# Strict precautions, including
respiratory protection from
aerosolized particles, must be taken
when carrying out post-mortem
specimen collection during outbreaks.
# Collect the specimens as soon as
possible, preferably within 24 hour
since viral titres decline while bacteria
multiply rapidly after death..

56. Materials Required :
- Barrier precautions : double gloves,
sterile gown, eye goggles, mask.
- Blood and other fluids, should be
collected as mentioned before.
- Aseptic surgical and biopsy
instruments for collecting tissue
specimens.
- For histology :saline formalin.
- For culture:Sterile saline/appropriate
viral and bacterial transport media.
- Sterile containers, sterile screw cap
tubes or vials, glass slides and slide
box.
- Disinfectant such as household
bleach diluted 1:10 in water.

57. Method of collection :
- Use a separate sterile instrument for each tissue
specimen from affected sites (several fragments with 1-2
grams of each is sufficient).
- Smaller, but adequate, specimens may be taken with a
biopsy needle.
- Place different tissues in separate sterile containers
containing the relevant medium
- Label all containers and tighten the screw caps firmly.
* Blood may be taken from the heart cavities.
* If cerebral malaria is suspected, make several smears
from the cerebral cortex on glass slides to detect
Plasmodium falciparum. Label the slides and transport in a
slide box.

58. Handling and Transportation :
- Fixed specimens can be stored and transported at
ambient temperature.
- Tissue specimens for isolation of bacterial pathogens
can be transported at ambient temperature in
transport media for upto 24 hours.
- Transport tissue specimens for isolation of viral
pathogens in viral transport medium or sterile saline at
3-8o C for 24-48 hours. For longer periods, freeze and
store at –70o C.
- If rabies is suspected and brain samples are
collected, freeze unfixed specimens immediately after
collection. Formalin-fixed samples are also useful and
may be transported at ambient temperature.

59. Some general principles
Effective diagnostic microbiology depends upon the
correct collection and timing of clinical specimens and
their proper transport to the laboratory under optimal
conditions.
- Specimen should be in adequate quantity.
- Must be collected before the administration of
antimicrobial agents.
- Contamination of specimen with externally present
organisms of normal flora of body must be prevented.
- Specimen must be collected at appropriate stage of
the diseases.
- Specimen should not get contaminated during storage.
- Specimen handling should not be risky to individual.

60. GENERAL RULES FOR COLLECTION AND
TRANSPORTATION OF SPECIMENS FOR
CULTUTRE:
• Apply strict aseptic techniques.
• Wash hands before and after the collection.
• Collect or place the specimen in a sterile
container.
• Ensure that the outside of the specimen
container is clean.
• Tightly close the container.
• Appropriately label and date the container and
complete the requisition form.
• Arrange for immediate transportation to the
laboratory.

61. UNIVERSAL PRECAUTIONS
• BARRIER PROTECTION
• HAND WASHING
• SAFE TECHNIQUE
• SAFE HANDLING OF SHARP
• SAFE HANDLING OF SPECIMEN
• SAFE HANDLING OF SPILLS
• USE OF DISPOSIBLE
• IMMUNISATION WITH HEP-B VACCINE

62. BARRIER PROTECTION
Gloves-
• Use well fitting, disposable / autoclaved
Change if visibly contaminated /
breached
Remove before handling telephones,
performing office work, leaving
workplace

63. BARRIER PROTECTION
• Facial protection – When splashing or
spraying of blood / blood fluids expected
• Gowns/Special uniforms – in high risk
areas
• Occlusive bandage – breach of skin
All skin defects must be covered with
water proof dressing.

65. HAND WASHING
An ideal safety precaution
Washing with soap and water
Hands must be washed-
• Immediately after contamination
• Before eating, drinking, leaving the
workshop
• After removing gloves
• At completion of days work

66. Hand wash

68. Sharps policy
• Reduce use
• Selection of devices
• Care in use
• Disposal

69. Handling of sharps
• Dispose your own sharps yourself.
• Never pass used sharps to another person.
• During exposure-prone procedures, minimize
the risk of injury by ensuring that the operator
has the best possible visibility. E.g. by
positioning the patient, adjusting good light
source and controlling bleeding.

70. Handling of sharps
• Protect fingers from injury by using forceps
instead of fingers for guiding suturing.
• Never recap, bend or break disposable
needles.
• Place used needles and syringes in a
rigid puncture resistant container
• Destroy using needle destroyer.

75. Chemical disinfectants effective
in inactivating HIV
• Ethanol 70% 3-5 min
• Povidone iodine 2% 15 min
• Formaline 4% 30min
• Gluteraldehyde 2%(cidex)30min
• Hydrogen peroxide 6% 30min

78. SAFE HANDLING OF SPECIMEN

83. MANAGEMENT OF BLOOD
SPILLS
• Spill on floor/ work surface should be
covered with paper towel / blotting paper /
newspaper / absorbent cotton.
• 1% Bleach solution should be poured on
an the spill and covered with paper for 30
minutes
• All the paper / cotton should be removed
with gloved hands

87. Occupational Exposure
• Contact of blood with skin
• mucous membrane
• non intact skin
• Percutaneous injury

88. On Exposure
• Wash needle stick injuries and cuts with
soap and water
• Flush splashes to nose, mouth or skin with
water
• Irrigate eyes with clean water, saline or
sterile irrigates

89. POST EXPOSURE
PROPHYLAXIS
• Assess risk of infection versus toxic side
effects of drugs
• PEP decision to be based on:
• (1) Degree of exposure to HIV
• (2) HIV status of the source of exposure

90. Standard Precautions
• All patients to be treated as potential
carriers of blood borne pathogens
• Use of appropriate personal protective
equipments
• Careful handling of sharps and
avoiding sharp injury
• Proper disposal of sharps and
infectious waste.

91. Thank You