Presentation is loading. Please wait.

Presentation is loading. Please wait.

©Jhpiego Corporation The Johns Hopkins University A Training Program on Community- Directed Intervention (CDI) to Improve Access to Essential Health Services.

Similar presentations


Presentation on theme: "©Jhpiego Corporation The Johns Hopkins University A Training Program on Community- Directed Intervention (CDI) to Improve Access to Essential Health Services."— Presentation transcript:

1 ©Jhpiego Corporation The Johns Hopkins University A Training Program on Community- Directed Intervention (CDI) to Improve Access to Essential Health Services CDI Module 16: RDT Training

2 Module 16 Objectives By the end of this module, learners will: Explain why the malaria control program has elected to use RDTs in the country/district Describe a rapid diagnostic test (RDT) Name appropriate actions for RDT positive, negative and invalid results Describe the steps in performing a malaria RDT 2

3 In Addition, Learners Will … Demonstrate the correct and appropriate skills for drawing blood safely and effectively with a finger prick State the universal precautions Correctly interpret different RDT outcomes Demonstrate the skills for performing RDT safely and effectively, using the job aid as a guide State appropriate treatment based on RDT results 3

4 Why Use RDTs? Most of the febrile illnesses share common signs and symptoms: Fever Headache Weakness Positive RDT results help to confirm malaria and thereby differentiate it from other febrile illness Giving anti-malarial drugs/artemisinin-based combination therapy (ACT) presumptively is expensive and might lead to drug resistance 4

5 Many Different RDT Products The World Health Organization and its partners have tested over 400 different types and brands of RDT RDTs are chosen by each countrys National Malaria Control Program (NMCP) based on factors like … Malaria prevalence Stable endemic, year- round Unstable, epidemic, seasonal Malaria type Plasmodium falciparum Plasmodium vivax 5

6 Key Similarities among RDTs Most all RDTs have: A lancet to draw blood A tube, pipette or straw to transfer blood A cassette to deposit blood and display results A buffer solution to add to the blood 6

7 Overall Steps for CHWs/CDDs When training community health workers (CHWs)/ community-directed distributors (CDDs), explain each step and provide an opportunity for them to: 1.Determine if signs and symptoms suggest malaria 2.Do RDT 3.Interpret the test 4.Take appropriate action (If RDT result is positive) treat appropriately, according to national standards (If RDT result is negative) seek further information, and either: –Treat for other conditions like pneumonia or diarrhea –Refer to the nearest health center, if severe (If RDT result is invalid) repeat test with a new cassette from a different batch 7

8 Prepare for Demonstration and Return Demonstration for CHWs/CDDs Assemble all needed materials Ensure that the RDTs used for the demonstration match those approved by your NMCP Make sure supportive materials like gloves, sharps box, etc. are available 8

9 Gather Materials Needed 9

10 Gather Additional Materials Needed 10 Biohazard safety box

11 Check Product Expiry Date Show CDDs where to look for expiry (expiration) date Explain that expired RDTs will not give correct result Pass around packets for CHWs to examine and find dates Discuss importance of planning ahead so RDT stocks do not expire or expired ones are replaced quickly 11

12 Wear Gloves Why is it important to wear gloves when doing the test? To protect: CHWs from possible infection with blood- borne diseases, including HIV/AIDS Patients from possible infection with blood- borne diseases, including HIV/AIDS 12

13 Open the Test Packet and Remove the Contents As you remove each item, hold it up so that everyone can see it Explain how it is used 13

14 Review Blood Transfer Devices Once the packet is opened, the desiccant sachet serves no purpose and should be discarded It may be harmful if swallowed, so it should be kept away from children 14

15 Examine the Test Cassette The square hole, labeled A, is where you add the blood The round hole, labeled B, is where you add the buffer The rectangular hole is the results window where you read the test results The results window is divided into two sections 15

16 How to Determine the Diagnosis The longer section near the letter T is where you determine the diagnosis If a line appears in this section, it means the patient has malaria If no line appears here, it means malaria was not detected in the patient Remember that the lines may be different for different brands/types of RDTso be sure to explain what is currently approved by the NMCP 16

17 Look for Lines to Appear The smaller section near the letter C tells you whether the test is working correctly A line must appear in this section for the test to be valid If no line appears here, the test is not working properly and the results are invalid If no line appears here, you must discard the cassette and test the patient again using a new test packet that has not been previously opened 17

18 Label the Test Cassette for Proper Identification Every patients test cassette must be clearly labeled for proper identification 18

19 Clean to Prevent Infection Clean the chosen finger with an alcohol swab This will help to prevent infection of the finger that could be caused by dirt 19

20 How to Draw Blood Prick the patients finger, preferably toward the side of the pulp (ball) of the finger Pricking the midline or tip is more painful Check to be sure the finger prick will produce enough blood Then discard the lancet in the sharps container 20

21 Follow Universal Precautions to Ensure Blood Safety When Using a Lancet Remind learners that every time they use a lancet, they must take all of the following steps to ensure blood safety: Discard the lancet in an appropriate sharps container immediately after using it Never set the lancet down before discarding it Never discard the lancet in a non-sharps container Never use a lancet on more than one person 21

22 Dispose of Used Materials Safely Ensure that used sharp objects like lancets and capillary tubes/test tubes are properly discarded immediately after use Even though it is called sharps container, we should dispose of all medical waste in it 22

23 How to Collect the Patients Blood On the next two slides, we show four blood collection devices You may show these devices to the CHWs, but give special attention to the device in the current RDT packet or kit 23

24 Examples of Blood-Collection Devices for RDT: Capillary Tube, Straw 24

25 Examples of Two More Blood-Collection Devices for RDT: Loop, Pipette 25 Loop:

26 Deposit Blood from Collection Device on Cassette and Then Dispose of Blood-Collection Device Safely 26

27 Dispense the Buffer Reagent Appropriately Dispense the appropriate number of drops of the buffer reagent to the appropriate hole (round hole) of the cassette Read out from packet insert the number of drops recommended for the type of RDT being used 27

28 Time the Test Properly Make sure the test stands for 15 minutes after adding the buffer, before reading the result Be sure to read the RDT packet insert because some types call for longer times 28

29 Dispose of Used Materials Safely Take care to remove and discard your gloves safely Plan a system for safe disposal of all RDT waste materials Decide whether CHWs will dispose of items in the village or bring these items to the health center for disposal 29

30 How to Interpret the RDT Results The square hole labeled A is where you add the blood The round hole labeled B is where you add the buffer The rectangular hole is the results window where you read the test results The smaller section near the letter C tells you whether the test is working correctly (it is also known as the control) 30 Test window Square hole (for blood) Round hole (for buffer) C control line T1 test line T2 test line

31 How to Interpret Results of RDTs Designed for More than One Type of Malaria Lines in T1 and T2 and a line in C means: The patient DOES have falciparum malaria monoinfection or a mixed infection 31 T1 T2 Pf or Mixed + NO LINE in T1 or T2 but a line in C means: C Negative T1 T2 C The patient DOES NOT have either falciparum malaria or non-falciparum malaria

32 How to Interpret the RDT Results (continued) 32 No line in T1 or T2 and NO LINE in C means: Invalid T1 T2 Line in T1 or T2 and NO LINE in C means: T1T2 Invalid The test is damaged. Results are INVALID. The test is damaged. Results are INVALID.

33 Review Different Possible Results 33 A line in T2 and a line in C means: Non-Pf + T1 T2 The patient DOES have non-falciparum malaria (P. vivax, P. ovale, P. malariae or a mixed infection of these).

34 Review Different Possible Results (continued) 34 T1T2 A line in T1 and a line in C means: Pf + The test is POSITIVE even if the line in T1 is very faint. T1 T2 The patient DOES have falciparum malaria.

35 RDT Interpretation Chart Control lineTest lines P. falciparum linePan-specific line P. falciparum/pan- specific RDT e.g., detects P. falciparum-specific and other species (P. vivax, P. malariae, P. ovale) NEGATIVE/ POSITIVE (P. falciparum only) // POSITIVE (P. falciparum and other species) /// POSITIVE non-P. falciparum (i.e., other species) // INVALID/ // / 35

36 Can You Interpret These Tests? 36

37 Interpretations for Test Results P. falciparum 2.Negative 3.Invalid (no control) 4.Non-falciparum (P. vivax, P. ovale, P. malariae, or a mixed infection of these) 5.P. falciparum 6.Non-falciparum (P. vivax, P. ovale, P. malariae, or a mixed infection of these) 7.Negative 8.P. falciparum 9.P. falciparum 10.P. falciparum or a mixed infection 37

38 38 Positive ( + )Negative (-)Invalid Pf Pf or Mixed Non-Pf How to Record Results 1 10 on a Chart

39 Demonstrate the RDT for Learners The facilitator will demonstrate the steps in performing an RDT for all to see He/she will ask questions of the learners as he/she performs the demonstration 39

40 Review and Questions Which RDT is currently used in your country? What are the main components of the test? How do we distinguish between a positive and negative test? How do we know if a result is invalid or unclear? What should we do with such results? How do we know what treatment is appropriate after conducting the RDT? 40

41 Learners Practice Performing an RDT Learners will form small groups Each learner will have a chance to practice the RDT Group members will give feedback after each person attempts the test Make copies of the checklist that follows for learners to observe each other 41

42 RDT Performance ChecklistProcedure 1 42 ProcedureTask 1. RDT preparation (four tasks) Assemble all materials required for the RDT test Read expiration date Use test with earliest expiration date Allow RDT to come to room temperature (if kept in cool storage)

43 RDT Performance ChecklistProcedure 2 ProcedureTask 2. Patient preparation (four tasks) Wash hands Identify patients details and record patients name on the RDT cassette Explain procedure to patient. Provide reassurance, as needed Wear gloves 43

44 RDT Performance ChecklistProcedure 3 ProcedureTask 3. Blood collection + dispensing (five tasks) Select site for blood collection. Clean site with alcohol swab and allow it to dry Prick site firmly with sterile lancet DO NOT squeeze finger excessively Collect an adequate volume of blood Dispense blood in correct well 44

45 RDT Performance ChecklistProcedure 4 ProcedureTask 4. RDT procedure + reading results (four tasks) Dispense correct volume of buffer Wait for correct time (according to manufacturers instructions) Verify internal test control Read results correctly 45

46 RDT ChecklistProcedures 5, 6, 7 ProcedureTask 5. Recording results (two tasks) Record results correctly (including mixed infections if a combo test is used) Record date and time of reporting results 6. Disposal of infectious material (two tasks) Dispose of used tests, and transfer devices and other contaminated material to plastic- lined bin Dispose of used lancet in a sharps container 7. Deliver the results (one task) Explain to the patient the results and what they mean 46

47 RDT Performance Checklist 47 After the small group practice sessions, bring the whole group back together Ask learners to talk about their experience Using the checklist findings, ask learners what steps were easy or difficultand why

48 Summary: RDT Results If RDT result is positive, treat according to national guidelines If RDT result is negative, seek further information and either: Treat for other conditions like pneumonia or diarrhea as seen in our modules, or Refer to the nearest health center, if severe (i.e., lethargic or unconscious) If RDT result is invalid, repeat test with a new cassette from a different batch 48

49 Summary: Safety and Precautions Employ universal precautions to ensure safety when handling blood: Always put on gloves before handling blood Avoid contacting any wound with blood (Wounds must be appropriately covered before conducting the RDT test) Wash hands appropriately with soap before and after conducting the RDT test Clean the finger to be pricked with an alcohol swab to prevent infection Never use a lancet or any blood collection device (loop, capillary tube, straw or pipette) on more than one person Dispose of all sharp objects appropriately (use a sharps box) Take care to remove and discard your gloves safely 49

50 Storing and Using RDTs in the Village In closing the session, ask CHWs/CDDs to discuss and plan the following: 1.How can we store RDTs in a safe and cool place in the village? 2.How can we safely dispose of sharps and medical waste from the RDTs in the village? 3.How can we explain to patients who believe they have malaria, but their RDT is negative? 4.What other concerns do you have? 50


Download ppt "©Jhpiego Corporation The Johns Hopkins University A Training Program on Community- Directed Intervention (CDI) to Improve Access to Essential Health Services."

Similar presentations


Ads by Google