Doc. n. STD-COR-HSE-012-E CORPORATE STANDARD
Rev. 02
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CORPORATE STANDARD
MALARIA CONTROL PROGRAM
STD-COR-HSE-012-E
19/03/2004
02
Issued for update MED
Date
Revision
Description of Revision
Prepared
C. Chessa ORGA Checked
F. Mika MED
S. De Sanctis QHSE Approved
This document is property of Saipem, who will safeguard its rights according to the civil and penal provisions of the Law.
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Summary of Revisions
Code
Date
Revision
Description of Revision
HSE-012-E
27/08/2003
01
Issued for approval
HSE-012-E
19/03/2004
02
Prepared
Checked
Approved
MED
C. Chessa ORGA
F. Mika MED
S. De Sanctis QHSE
MED
C. Chessa ORGA
F. Mika MED
S. De Sanctis QHSE
Issued for update
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INDEX 1
SCOPE AND PURPOSE
4
2
REFERENCE DOCUMENTS
4
3
DEFINITIONS
4
4
RESPONSIBILITIES
5
4.1 4.2
CORPORATE RESPONSIBILITIES OPERATING COMPANIES’ RESPONSIBILITIES
5 5
5.
STANDARD
6
5.1 MALARIA INFORMATION AND AWARENESS COURSE 5.2 PRIMARY PROPHYLAXIS 5.2.1 Man’s Role in Malaria Control 5.2.2 Vector Control 5.2.3 CHEMO PROPHYLAXIS 5.2.3.1 Compulsory Chemo Prophylaxis 5.3 EARLY DIAGNOSIS AND PROMPT TREATMENT 5.3.1 Site Medical Facilities 5.3.2 Referrals 5.3.3 Severe / Complicated Cases of Malaria 5.3.3.1 Central Nervous System Involvement in P. Falciparum Malaria 5.3.3.2 Neurological Signs in Cerebral Malaria 5.3.3.3 Management of Cerebral Malaria 5.3.3.4 Treatment of Severe P. Falciparum Malaria 5.4 MALARIA CASE REPORTING
6 6 6 7 7 8 9 9 9 9 9 9 9 9 9
6
9
ATTACHMENTS
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1
SCOPE AND PURPOSE
The scope of this Standard is to provide Corporate guidelines and information to Management of Operating Companies for developing site-specific Malaria control program in order to: • •
minimize the risk of Malaria contamination to the lowest reasonably possible level for all employees working or accommodated on site; achieve a zero fatality rate among employees.
2
REFERENCE DOCUMENTS
•
Corporate Policy "Health Safety and Environment” (Doc. no. POL-COR-HSE-001-E)
•
Corporate Standard “Health Plan” (Doc. no. STD-COR-HSE 005-E)
•
“Management of the Health of Foreign and Expatriate Personnel" (Doc. no. WI-SPA-HSE-004-E)
•
“WHO Expert Committee on Malaria (Twentieth Report)”
•
“WHO International Travel and Health Recommendations”
3
DEFINITIONS
Chemo Prophilaxis
Regular intake of a specific drug regimen aimed to prevent the onset of illness even after exposure to the causative factor.
Malaria
Disease, distributed mainly in tropical areas of Africa, Asia, and Latin America caused by a parasite of the genus Plasmodium and is transmitted through a bite of an obligatory vector, a mosquito (Anopheles).
Non-immune Individual
Employees who do not live in Malaria endemic arias and witch did not developed partial immunity against the disease.
Primary Prophylaxis
Rules to follow and measures to be taken, collectively or by individuals, to defend against infectious diseases.
Semi-immune Individual
Person who has acquired partial immunity against a disease (Malaria) due to their longevity of exposure to the disease.
Vector Control
Specific measures in order to reduce or eliminate the presence of vectors (mosquitoes), and consequently prevent bites.
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4
RESPONSIBILITIES
Malaria is a parasitic disease, caused by one among four Plasmodium genus parasites to which the humans are susceptible. It is transmitted by a bite of infected mosquito (Genus Anopheles). It is a main cause of death among the population is Sub-Saharan Africa. Within the Oil and Gas industry it is the second cause of death among the work force related to the diseases, coming immediately after cardio-vascular incidents, and third or fourth as overall cause of death where the road traffic accidents lead. 4.1
CORPORATE RESPONSIBILITIES
Saipem Corporate Medical Department is responsible for: • • •
assuring that a Non-immune Individual going to visit or work in a Malaria endemic area is dully informed about the potential risks and methods of prevention prior to his departure; supplying of medicines, diagnostic equipment and devices not available locally; assuring a 24/7/365 on-the-phone counselling regarding Malaria prophylaxis and treatment.
It is the responsibility of Saipem Management to ensure that all the proper means are implemented to prevent the disease among the work force, both non- and Semi-immune Individuals, by assuring that: • • • • • • 4.2
all the employees are properly informed about the risks and possible consequences of the disease, as well as about the preventive measures to be applied; all the means of prevention are available and applied as reasonable as possible; adequate diagnosis facilities are available on sites; adequate and immediate treatment is available to each individual on site; counselling is made available for Saipem’s employees at all times even during the individual’s leave period; Subcontractors are informed about the Malaria prophylaxis requirements. OPERATING COMPANIES’ RESPONSIBILITIES
Saipem Medical Department in Operating Companies is responsible for: • • • • • • •
the development and implementation of the Malaria Prevention Program; the organisation and carrying out of information and training courses regarding Malaria; the hygiene surveillance, outdoor and indoor disinfections; the adequate quantities of Malaria prevention and treatment drugs are readily available on site; the immediate application of adequate treatment on site; the implementation and availability of quick diagnosis procedures on sites; the availability of written information to the employees’ family doctor and the hand-over of such information to all non-immune employees.
Saipem Site Managers’ responsibility is to assure that all necessary resource, human, material, financial, etc, are available to in order to implement and make efficient the prevention program. They also have to assure that the personnel is available for training and information courses. Saipem’s employees are responsible for: • • •
attending information and training courses regarding Malaria prevention; observing Saipem’s recommendations and requirements fro Malaria prophylaxis; strictly following the prescribed medical treatment in case of confirmed disease.
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5.
STANDARD
Malaria prevention program consists of information course, Primary Prophylaxis and Chemo-Prophylaxis. 5.1
MALARIA INFORMATION AND AWARENESS COURSE
All non-immune employees arriving on any of Saipem Projects will have to undergo Malaria awareness course. This course, developed, organised and carried out by Saipem Medical Personnel is focused on: • • •
information and education regarding prevention and vector transmission; motivation to change high risk behaviour, i.e. staying outdoors during dusk to dawn; behavioural skills for performing specific preventive acts.
Malaria prevention course is structured in a way to provide general information about Malaria (parasites, presence in the area, world wide distribution, etc), way of transmission, symptoms (both during incubation and during the various stages of disease), Primary Prophylaxis, Chemo Prophylaxis (methods, drugs, duration, benefits, risks if not taken, availability on site, possible side effects, etc.), diagnostic procedures and treatment. Once the presentation is over, and after all the questions from the attendees regarding the matter have been answered, a letter shown in the Annex F, is given to each of them. The purpose of this letter is to give more information to the employee’s family doctor regarding Malaria, its symptoms and available treatment. Furthermore, each attendee will be asked to sign a declaration of participation at the Malaria prevention course as shown in Annex E. The attendance at the information courses will be registered on the format (Annex G) and monthly submitted as part of medical reporting to the Saipem Managers and Saipem Corporate Medical Department. 5.2
PRIMARY PROPHYLAXIS
There are three determinants to be considered in an effective Malaria control program. These are: • • •
Man (the host); Plasmodia (the agent); Anopheles mosquito (the vector).
To achieve a sustainable outcome, Saipem is addressing control of the above three living beings and their environment. Man, the host, is a moving target and can take the disease with him far and wide. Mosquitoes are moving and highly adaptable. It is therefore important to target non-flying eggs and larvae. The parasite also is highly adaptable, hides in humans and mosquitoes and has also developed resistance to drugs. Therefore, for effective Malaria control, target man first, control mosquitoes next and keep trying to tackle the parasite with development of effective drugs. To promote an effective and long lasting program, it is imperative that all parameters concerned should be given adequate attention and enough support to attain and sustain the program in the long run yielding a positive long lasting effect. 5.2.1
Man’s Role in Malaria Control
Man is the most important link in the Malaria control chain. He can be made to understand the problem and he can help in breaking the chain at multiple points. For example, by taking personal protective measures, three things can be achieved – prevention of Malaria in the given individual, thus reduced parasite load and reduction in spread, and by denying blood meal to the mosquito the egg laying is also hampered. In the recent years, more emphasis is being laid on early diagnosis and treatment and on personal protective measures. By these means, it is intended to minimize the use of potentially harmful chemical insecticides. Person concerned should avoid exposure of any part of the body to mosquito bites. Positive behavioural patterns would include: •
not staying out between dusk to dawn;
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• • • •
proper choice of clothing materials, preferably thick clothes with long sleeves; avoiding areas notorious for mosquito infestation; interactive communication with the Medical Department and workers on matters pertaining to Malaria; simple but effective ways in controlling potential breeding areas like proper disposal of water retaining litters; i.e. bottles, cans, used tires, etc.
At each working site in a high-Malaria risk aria sufficient quantities of recognized quality repellents, creams or sprays, will be available in the clinic in order to be distributed to the workforce whenever needed/ asked. 5.2.2
Vector Control
It is impossible to control Malaria without controlling the anopheles mosquitoes, the vector for Malaria. But controlling these highly adapted, flying and hiding vectors is indeed a formidable task. Development of resistance to insecticides has compounded to the problem. The following are the steps in mosquito control: • • • • •
egg laying should be discouraged; development of laid eggs into larvae and adults should be prevented; grown adults should be killed; un-killed adults should not be let into places of human dwelling; mosquitoes that have already entered should not be allowed to bite human beings.
In order to control the vectors effectively, Saipem has taken the following steps: •
•
•
•
•
External and internal fumigation are regularly done on all areas of the camp. Fumigation is scheduled and a written notice is posted on the particular area a day before the procedure is carried out. Swing fogs using insecticides are used for external fumigation. It is performed by a trained safety personnel with prior approval from the Safety Coordinator, Medical Coordinator, and Camp Boss. Each area is fumigated at least once a month. Internal fumigation is occupant-based. Insecticide sprays are supplied to each room monthly and regular spraying is left at the prerogative of the room occupant. Mosquito magnets using propane gas attract mosquitoes and trap them inside a one-way net is provided. These are strategically placed around the camp in order to promote maximum coverage for mosquito attraction. This equipment effectively diverts mosquito movement by luring them to the nets preventing infestation of the camp. Accommodation rooms in the camp are designed to be mosquito proof. Rubber seals on doors and windows are placed to prevent entry of mosquitoes as well as other insects inside the rooms. All rooms are air conditioned and comfortably designed to discourage occupants from leaving their rooms open. In the sites, ergonomically designed caravans are used. They are tightly sealed, air conditioned for single occupancy provided with a toilet and bath. This offers both privacy and convenience to the occupant which results to less insect exposure when conveying from one caravan to the other (as in camps using common bath and latrine). Regular maintenance of the camp premises is a major activity. Tending and pruning of ornamental plants, maintenance of grass/weed height, and landscaping prevents insect proliferation and is visually gratifying. Daily cleaning and inspection of drainage is strictly implemented to assure continuous flow of both sewage and runoff water. A hygiene control program is being implemented to define and maintain standard of cleanliness within the camp. It is extensively discussed in a separate work instruction document.
5.2.3
CHEMO PROPHYLAXIS
To permit the employer to protect employees health, the employer reminds each employee that he shall take care of his own health and security assuring that the best practice is followed. Therefore, the medical team of the employer will provide to the employee a specific medical prescription for prophylactic therapy and the employee shall inform the employer, when such therapy is considered by the employer to be compulsory, if he decides not to take such therapy and the reason of such refusal.
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Throughout the years, a lot of research have proven chemoprophylaxis to be beneficial in preventing Malaria infection for people visiting known endemic areas, especially for expatriates who would be staying there on a short-term basis. Up to now there are no evidences as to the physiologic effectiveness and safety in longterm use. Prevention of Malaria through drug intake (chemoprophylaxis) is highly recommended but it is considered a voluntary act of the individual employee. Recent guidelines give emphasis to the importance of balancing the risk of adverse reactions against antiMalaria drugs. The main determinants of Malaria-risk are the geography, duration of stay, conditions of accommodation, work and social patterns of the site (particularly dusk to dawn activities). Saipem’s Medical personnel in charge of the worksites will provide pertinent information on disease prevention, and administer prophylactic drug regimens. The purpose of chemoprophylaxis is to prevent the onset of the illness in case of exposure. No matter being the best protection measure, it does not guarantee total protection from acquiring the disease, however, it can limit the illness to its less severe, uncomplicated form. Before starting the drug regimen, the following prerequisites are required: • • •
Thorough anamnesis should be taken form the individual. Special attention should be given to the cardiac and circulatory history, familial predisposition and personal history. History of allergic reactions, Cardiac arrhythmias, hypertension, past ECG abnormalities, present medications (if any). Complete physical examination with special attention to cardio-circulatory system. Laboratory examinations should include routine CBC, liver function tests (Transaminases), renal function tests, FBS.
These ancillary procedures are aimed to provide a baseline for future references. ECG recordings should be done prior to selecting the most appropriate prophylaxis among the ones pre-approved by Corporate Medical Department (Annex C). These drugs shall be available in all working sites. Prophylactic therapy should be started prior to exposure or travel to endemic areas. Strict coordination and compliance among the clinics from the country of origin and site clinic should be empowered. The prescription issued prior to departure shall be presented to the site medical doctor which will enable that the prescribed prophylactic therapy is continued by the site physician. The most common and anticipated problem which poses a threat to a successful prophylactic therapy is Compliance. A centralized way of administering the drug is the most effective in monitoring and ensuring that the schedule is strictly complied with. The use of Chemo Prophylaxis will be monitored by the site physician. 5.2.3.1 Compulsory Chemo Prophylaxis In certain cases and in base of the Health Risk Assessment carried out by its Medical Department, local laws and regulations, best international practice and/or Client’s contractual requirements, Saipem could ask both its own and Subcontractor’s non-immune employees to take the Chemo Prophylaxis compulsory during the assignment to a specific Project. In such case, each employee prior to his/her mobilisation shall be asked by the Personnel Department to sign an employee statement of understanding and compliance with the Malaria chemoprophylaxis requirements. This statement will include the employee’s agreement to be subject to unannounced, random and periodic testing to determine his/her compliance with the requirement that he/she is taking approved Malaria Chemo Prophylaxis. For this testing he/she will be asked to provide the urine sample for laboratory verification. This sample will be sent for analysis to an approved laboratory. The laboratory will provide the tests’ results, positive and negative, to the Saipem’s designated Medical Officer. Should the result show an individual’s non-compliance with the prescribed regimen, he/she will be invited, in a written manner, to fulfil the requirement. Should an individual result negative on two consecutive tests, his/her name shall be forwarded to the Project’s Management in order for them to eventually undertake any appropriate action.
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5.3 EARLY DIAGNOSIS AND PROMPT TREATMENT In case of a suspected illness, early diagnosis and prompt treatment of Malaria is the dictum on all the sites located in endemic areas to achieve zero fatality rate among employees. To attain this goal, the following requisites are put in place. 5.3.1
Site Medical Facilities
All Company sites located in Malarial areas (and barges when operating in such areas) must have the facilities to rapidly confirm or exclude the diagnosis of Malaria in a suspected case. These can include: • • •
standard laboratory equipment with adequate staining techniques, and/or advanced microscopic diagnosis facilities (QBC Rapid Malaria Identification Test), and/or ICT rapid diagnostic tests.
Medical personnel assigned to these locations have to be competent and trained, fully able to perform and interpret Malaria tests. Adequate anti Malarial drugs for treatment of severe Malaria must also be available on all sites. Corporate approved Malaria treatment protocols for uncomplicated and complicated cases as tabulated below is established and closely adhered to by site doctors (Annex B). 5.3.2
Referrals
All confirmed Malaria cases among non-immune employees have to be reported to the Saipem’s Medical site staff or directly to the Head Office . In case that the local medical support is not sufficient for the treatment of Malaria or its suspected related complications, the evacuation of the affected person should be done to the closest medical facility equipped for this purpose. 5.3.3
Severe / Complicated Cases of Malaria
The implementation of adequate prevention measures, the diagnosis and treatment of Malaria patients on time shall limit the occurrence of severe and complicated cases to practically “zero”. Nevertheless, such cases can not be completely ruled out and it is extremely important to recognise them on time and treat them correctly. Due to the specificity of Plasmodium species and drug resistance the general rule is to treat Malaria in the area where it has been acquired. In case local structures cannot meet the needs for a modern and adequate life support, necessary for the treatment of complicated cases, a non.-immune individual shall be evacuated using the resources and equipment of specialised MEDEVAC providers that Company has contracted for. 5.3.3.1 Central Nervous System Involvement in P. Falciparum Malaria This is the most common cause of death in severe P. falciparum Malaria. C.N.S manifestations in Malaria could be due not only to severe P. falciparum Malaria, but also high grade fever, anti Malarial drugs, hypoglycaemia, hyponatremia and severe anaemia. Therefore, it is extremely important to differentiate between these so as to avoid unnecessary anxiety and improper treatment. Focal neurological deficits, neck rigidity, photophobia, papilloedema, and neurological sequelae are very rare in P. falciparum Malaria and such a picture would therefore suggest other possibilities. Manifestations of cerebral dysfunction include any degree of impaired consciousness, delirium, abnormal neurological signs, and focal and generalized convulsions. In severe P. falciparum Malaria, the neurological dysfunction can manifest suddenly following a generalized seizure or gradually over a period of hours. A strict definition of cerebral Malaria has been recommended for sake of clarity and this requires the presence of unarousable coma, exclusion of other encephalopathies and confirmation of P. falciparum infection. However, all patients with P. falciparum Malaria with neurological manifestations of any degree
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should be treated as cases of cerebral Malaria. 5.3.3.2 Neurological Signs in Cerebral Malaria As per the definition, patient should have unarousable coma, not responding to noxious stimuli with a Glasgow coma scale of <7/15. Mild neck stiffness may be seen; however, neck rigidity and photophobia and signs of raised intracranial pressure are absent. Retinal haemorrhages occur in about 15% of cases, exudates are rare. Pupils are normal. Papilloedema is rare and should suggest other possibilities. A variety of transient abnormalities of eye movements, especially disconjugate gaze, are observed. Fixed jaw closure and tooth grinding (bruxism) are common. A pout reflex may be elicitable but other primitive reflexes are usually absent. The corneal reflexes are preserved except in case of deep coma. Motor abnormalities like decerebrate rigidity, decorticate rigidity and opisthotonus can occur. Deep jerks and plantar reflexes are variable. Abdominal and cremesteric reflexes are not elicitable. These signs help in distinguishing from behavioural problems due to fever of other causes. 5.3.3.3 Management of Cerebral Malaria •
• • • •
Nursing care: Meticulous nursing is the most important aspect of management in these patients: − Maintain a clear airway. In cases of prolonged, deep coma, endotracheal intubation may be indicated. − Turn the patient every two hours. − Nurse in semi-prone position with foot-ent elevated to prevent aspiration. − Maintain strict intake/output record. Observe for high coloured or black urine. − Monitor vital signs every 4-6 hours. − Changes in levels of sensorium, occurrence of convulsions should also be observed. − If the temperature is above 390C, tepid sponging must be done. − Naso-gastric aspiration to prevent aspiration pneumonia. Urethral catheter needs to be inserted for monitoring urine output. Phenobarbitone injection, 10-15mg/kg body weight should be given intramuscularly to prevent convulsions. And when convulsions do occur, they can be treated with Diazepam by slow intravenous injection, 0.15mg/kg, maximum of 10mg. Do not administer the following: corticosteroids; other anti-inflammatory drugs; anti-oedema drugs like mannitol; adrenaline; heparin; hyper baric oxygen etc. Antimalarial treatment: Parenteral Quinine has been the treatment of choice for cerebral Malaria. Artemisinin derivatives have been proved to be equally effective in treating cerebral Malaria.
5.3.3.4 Treatment of Severe P. Falciparum Malaria It is safer to treat cases of severe P. falciparum Malaria as chloroquine resistant. It is better to use two drugs, one rapid acting and one slower acting. Severe Malaria should always be treated with parenteral antimalarials to ensure adequate treatment. QUININE Intravenous
20mg of salt/kg diluted in 10ml/kg isotonic fluid, infused over 4 hrs; then 10mg of salt/kg over 4 hrs, every 8-12 hrs until patient can swallow.
Intramuscular
20mg of salt/kg diluted to 60mg/ml by deep i.m injection, (divided into two sites); then 10mg of salt/kg every 8 hours.
Oral
600mg of salt 3 times a day for 7 days (max. of 1800mg/day).
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In
areas
where
resistance
to
quinine
is
known
or
suspected,
add
single
dose
of
pyrimethamine/sulphadoxine OR Tetracycline or Doxycycline for 7 days.
ARTEMISININ DERIVATIVES Preparation
Dose and administration
Artemether (Availability: 80mg/ml inj. and
I.M: 3.2mg/kg as loading dose, followed by
40mg cap)
1.6mg/kg daily, until the patient is able to swallow or for 5 days. Oral: 160mg in two doses on the first day, then 80mg/day for total 5 days.
Artesunate (Availability: 60mg powder with
Injection: The powder should be reconstituted in
1ml of 5% sodium bicarbonate ampoule for
1 ml of 5% sodium bicarbonate and then further
injection and 50mg tablet)
diluted with isotonic saline or 5% dextrose (to a total of 3ml for i.m and 6ml for i.v use). DOSE: 2.4mg/kg on the first day (additional 1.2mg/kg after 4 hours in case of severe falciparum Malaria), followed by 1.2mg/kg daily until patient is able to swallow or for a maximum of 7 days. Oral: 100mg on the first day, followed by 50mg/day for 7 days.
OTHER DRUGS Drug
Dose
Mefloquine
15-25mg/kg (max. of 1500mg), given as two doses, 6-8 hrs apart
Tetracycline
250mg 4 times a day for 7 days
Doxycycline
100mg twice a day for 7 days
NOTE: • • •
Most blood schizonticidal drugs prevent the development of the forthcoming erythrocytic cycle of parasitic development and hence have no or little effect on the ongoing cycle that is already causing fever. Therefore, it would take at least 48 hours for the treatment to be effective. Artemisinin derivatives can be used in cases of hyperparasitaemia or life threatening complications on account of their ability to clear the parasitaemia earlier compared to other anti-malarial drugs. Most anti Malarial drugs have a long plasma half-life. Therefore, adding similar drugs half way through the treatment will only add to the adverse effects and not to the therapeutic benefit. The following combinations should therefore be avoided, concurrently or within a short interval: − Cloroquine + Quinine − Chloroquine + Mefloquine
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− −
Quinine + Mefloquine Quinine + Halofantrine
5.4 MALARIA CASE REPORTING In order to keep incidence of Malaria cases amongst non-immune population working at Saipem’s locations low Malaria awareness courses are regularly conducted with particular attention on preventive measures. For an accurate and complete evaluation of the situation regarding Malaria prevention issues and cases two specific forms from all project doctors/nurses working in the Malaria high-risk areas have to be sent to the Medical Coordinators/Overseas Health Manger on monthly basis. These two forms are: • •
Malaria Control Program Log (MCP log); Stewardship Malaria Case report.
The MCP Log monitors the following parameters: • • •
number of expatriate employees present on site (including those at home for leave period) who attended the MCP awareness course following Saipem’s standards; number of expatriate employees present on site (including those at home for leave period) who did not attended the MCP awareness course following Saipem’s standards; number of employees who attended the MCP awareness course and have signed the MCP course attendance Certificate.
Developing site/project specific MCPes this log, following particular local legislation, Client’s or contractual requirements other elements can be added, but the basic structure must remain the same. Stewardship Malaria Case report form contains 4 principal parameters registered for each employee group (non-immune, semi-immune and subcontractor’s personnel): • •
•
•
Number of Fatal Malaria Cases. Total Number Stewardable Malaria Cases. For the non-immune employees this parameter covers all Malaria fatalities and all confirmed Malaria cases. In semi-immune employees it includes confirmed cases with any of the following: − hospitalisation for treatment; − 5% parasitemia; − the patient meets the criteria for severe Malaria according to WHO standards. Hospitalisation should be interpreted as the confinement of a patient in a hospital or clinic for the purpose of administrating medically supervised treatment. Out patient and emergency room treatment where the patient is released after examination, observation only and/or provided medication to self-administer are not considered to be hospitalisation. Exposure hours monitor the man-hours worked. Wherever possible the table must be filled in with the actual man-hours worked for the indicated group. Where a breakdown of man-hours is not available for the indicated groups (e.g. non-immune, semi-immune and subcontractor’s personnel), the percentage composition of the work force to calculate (e. g. total contractor man-hours worked multiplied by the percentage of each employee group) shall be utilised. Malaria case rate (MCR). This indicator represents the total number of Stewardable Malaria Cases multiplied by 200 000 work-hours and divided by man-hours worked for particular work force. Malaria Case information is stewarded separately.
Except to the Medical Department Management the reports shall be sent monthly to the HSE Department and Mangers at local and Corporate levels. Malaria trends shall be observed and corrective action, if needed, implemented.
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ATTACHMENTS
The following documents are integral part of this Corporate Standard: • • • • • • • • •
Annex A: “Global Malaria Status” Annex B: “Reported Falciparium Drug Resistance Annex C: “List of Recommended Drugs for Chemoprophylaxis” Annex D: “List of Recommended Drugs for Chemotherapy” Annex E: “Declaration of Attendance and Comprehension” (Form: COR-HSE-064-E) Annex F: “Letter to Family / Attending Physician” (Form: COR-HSE-065-E) Annex G: “Attendance Sheet for Information Courses” (Form: COR-HSE-066-E) Annex F: “Malaria Control Program Log” (Form: COR-HSE-067-E, Pages 1-2) Annex H: “Malaria Cases Stewardship Report” (Form: COR-HSE-068-E)
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ANNEX A: GLOBAL MALARIA STATUS
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ANNEX B: REPORTED FALCIPARIUM DRUG RESISTANCE
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ANNEX C: LIST OF RECOMMENDED DRUGS FOR CHEMOPROPHYLAXIS
Drug Mefloquine (Lariam) * Proguanil+Atovaquon e (Malarone) ** Doxycycline **
Preparation 250mg tablet Proguanil 100mg + Atovaquone 250mg tablet Doxycycline 100mg cap
Dose 1 tablet once a week 1 tablet once daily
Route Oral
1 capsule daily
Oral
once
Oral
Duration of prophylaxis. Mefloquine: start two and a half weeks before travel, throughout the stay and continue four weeks after return. Doxycycline: start two days before travel, throughout the stay in the endemic area and continue for four weeks after return. Malarone: start two days before travel, throughout the stay in an endemic area and continue for one week after return.
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ANNEX D: LIST OF RECOMMENDED DRUGS FOR CHEMOTHERAPY
DRUG Chloroquine tablet and ampoule Sulfadoxine 500mg, Pyrimethamine 25mg tablet (Fancidar) Sulphamethoxypyrazine + Pyrimethamine tablet (Metakelfin) Artemether 80mg amp (Paluther)
Halofantrine hydrochloride 250mg tablet (Halfan) Quinine sulphate 300mg tablet and 600mg/2ml ampoule
Mefloquine 250mg tablet (Lariam) Proguanil 100mg +Atovaquone 250mg tablet (Malarone)
DOSE 600mg base initially, 300mg base in 6 hrs, then 300mg base at 24 and 48 hrs. 3 tablets in a single dose. 2 tablets in a single dose to adults with a body weight of 50-70kg; 3 tablets over 70kg. 3 Day Treatment: one ampoule containing 80mg twice a day by intra muscular injection (i.e. 160 mg/day) for 3 days 5 Day Treatment: 1 ampoule containing 80mg twice a day by intra muscular injection the first day (i.e. 160mg). Then one ampoule containing 80mg for the next 4 days. 2 tablets (i.e. 500 mg) every 6 hours for 3 doses, not with meals. Repeat dose in 7 days. 2 tablets (600mg) 3 times a day for 7 days. I/V Infusion: 20mg of salt/kg diluted in 10ml/kg isotonic fluid, infused over 4 hrs; then 10mg of salt/kg over 4 hrs, every 8-12 hrs until patient can swallow. 3 tablets (i.e. 750 mg) followed in 12 hrs by 2 tablets (i.e 500mg). 4 tablets (i.e 1000mg Atovaquone and 400 mg Proguanil) once daily for 3 days.
Doc. n. STD-COR-HSE-012-E CORPORATE STANDARD
Rev. 02
Date 19/03/2004
MALARIA CONTROL PROGRAM Page 18 of 27
ANNEX E: DECLARATION OF ATTENDANCE AND COMPREHENSION Company name / logo :
Form: COR-HSE-064-E
DECLARATION OF ATTENDANCE AND COMPREHENSION Page 1 of 1
DECLARATION
I, the undersigned hereby declare that on …………………………………(date) I attended the Malarial Preventive course as per Saipem program. During this course the following topics had been discussed. 1. Details regarding Malaria, signs and symptoms 2. Ways of transmission 3. Health risks related to Malaria 4. Presence of Malaria in specific area 5. Primary Prophilaxis 6. Chemo Prophilaxis – benefits and risk I state that I was fully informed regarding the subject. I confirmed that benefits of Chemo Prophilaxis were clearly explained and I don’t have further questions regarding this tropical disease. Furthermore, I was given a letter and to be given to the Doctor from my country of origin during the time of my vacation if something unusual symptoms related to such disease will occur. Signed by: ____________________________
Doc. n. STD-COR-HSE-012-E CORPORATE STANDARD
Rev. 02
Date 19/03/2004
MALARIA CONTROL PROGRAM Page 19 of 27
ANNEX F: LETTER TO FAMILY / ATTENDING PHISICIAN Company name / logo :
Form: COR-HSE-065-E
LETTER TO FAMILY / ATTENDING PHYSICIAN Page 1 of 1
MEDICAL DEPARTMENT TO THE FAMILY / ATTENDING PHYSICIAN Dear Colleague: I would like to inform you that the bearer, our employee, just arrived from a Malaria-endemic country in one of our worksites. In lieu of this, we send this letter to forewarn you on any untoward events that may occur during his vacation period. The most common problem we have encountered with our expatriate personnel is Malaria. Other tropical diseases like Typhoid, etc do occur seldom. P. falciparum has an incubation period of 48 hrs. Signs and symptoms usually involve a general sense of not being well, malaise, arthromyalgia, spiking fever, tremors, nausea, vomiting. No particular focus is present to attribute the symptoms. With our experience in the field, an early recognition of the illness can be contained with simple treatment regimens and does not require long-term hospitalisation. The drugs commonly used are: Chloroquine phosphate 250 mg tablet; 4 tablets as initial dose, 2 tablets after 6 hrs from initial dose, then 1 tablet every 12 hrs thereafter for 4 doses. However, for Cloroquine–resistant cases, Artemeter 80 mg ampule; 1 ampule deep IM every 12 hours for 6 doses can be given. If Artemeter is not available, Quinine 300 mg tablet; 2 tablets every 8 hours for 7 days, with regular monitoring of blood pressure and cardiac rate. Usual complications with Quinine therapy is hypotension and arrythmias. Anti-malaria regimen is usually coupled with antipyretics and antiemetics if indicated. For confirmation and monitoring, a peripheral smear is very helpful in determining the Malaria variant and efficacy of the treatment, but sometimes it can give false negative results. That is why, in suspected cases, it has to be repeated even several times. We would be glad to accommodate any query from you regarding this matter. You can get in touch with us thru “Pronto Dottore” telephone number +39–02–520–34777. We hope that this simple note would prove useful in the management of your patient. Thank you and best regards.
Cordially, Medical Coordinator
Doc. n. STD-COR-HSE-012-E CORPORATE STANDARD
Rev. 02
Date 19/03/2004
MALARIA CONTROL PROGRAM Page 20 of 27
ANNEX G: ATTENDANCE SHEET FOR INFORMATION COURSES Company name / logo :
Form: COR-HSE-066-E
ATTENDANCE SHEET FOR INFORMATION COURSES Page 1 of 1
COUNTRY
SITE/VESSEL
COURSE TITLE
CARRIED OUT IN
NR.
FROM _______________________
TO
_____________ O’CLOCK
TOTAL HOURS
CARRIED OUT FROM ______________
TILL
______________
LECTURER
NAME AND SURNAME
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15
BADGE N.
POSITION
NATIONALITY
LANGUAGE
WORK AREA
SIGNATURE
Doc. n. STD-COR-HSE-012-E CORPORATE STANDARD
Rev. 02
Date 19/03/2004
MALARIA CONTROL PROGRAM Page 21 of 27
ANNEX H: MALARIA CONTROL PROGRAM LOG Company name / logo :
Form: COR-HSE-067-E
MALARIA CONTROL PROGRAM LOG Page 1 of 2
MALARIA CONTROL PROGRAM Project
/
Site
/
Vessel:
Date: _________________________ Prepared by:
_____________________
Country and Client: _______________________________
No
1 2 3 4 5 6 7 8 9 10
Surname & Name
Signed Signed Attended Attestation form Declaration of the course (Yes/No)For attendance (Yes/No) ExxonMobile (Yes/No) Projects ONLY
__________________
Chemoprophylaxis taken (Name of medicines)
Position
Nationality
Company
Doc. n. STD-COR-HSE-012-E CORPORATE STANDARD
Rev. 02
Date 19/03/2004
MALARIA CONTROL PROGRAM Page 22 of 27
ANNEX H: MALARIA CONTROL PROGRAM LOG Company name / logo :
Form: COR-HSE-067-E
MALARIA CONTROL PROGRAM LOG Page 2 of 2
MALARIA CONTROL PROGRAM Project / Site / Vessel: _____________________
Date: ________________________
Country and Client: _________________________________
Prepared by: _________________
Nationality
Signed Attestation form ( for Exxon Mobile projects ONLY) No. of Personnel who No. of Personnel who did not attended the course attend the course
YES
NO
Nationality Nationality Nationalities ……………… ASIANS
……………… ……………… ……………….. ……………… 0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
Nationalities …………….. ……………… EUROPEANS
…………….. ……………. ………………. …………….. …………….. ……………. ……………… Nationalities
OTHERS
………….. ………… ………… …………..
GRAND TOTAL
Doc. n. STD-COR-HSE-012-E CORPORATE STANDARD
Rev. 02
Date 19/03/2004
MALARIA CONTROL PROGRAM Page 23 of 27
ANNEX I: MALARIA STEWARDSHIP REPORT Company name / logo :
Form: COR-HSE-068-E
MALARIA STEWARDSHIP REPORT Page 1 of 1
Project/Site/Vessel:
Date:
Country and Client: Enter the data in light blue cells. All yellow cells are formulas for this sheet. Duble click tab and rename as “in-country organization name” (The header will be corrected automatically)
Prepared by:
Ja n
Fe b
Marc h
Apri l
Ma y
Jun e
Jul y
Au g
Sep t
Oc t
No v
De c
1 q
2 q
3 q
4 q
Mid yea r
Year -end
YT D
Saipem’s Non-immune (Expat) Fatal N Malaria o Cases Total Stewardabl e Malaria Cases
N o
Exposure N Hours o Malaria Cases Rate Saipem’s Semi-immune (Nationals) Fatal N Malaria o Cases Total Stewardabl e Malaria Cases
N o
Exposure N Hours o Malaria Cases Rate Subcontractor’s Personnel Fatal N Malaria o Cases Total Stewardabl e Malaria Cases
N o
Exposure Hours Malaria Cases Rate
N o
Notes: 1.Stewardable Malaria Case • All Malaria fatalities. • All confirmed Malaria cases in non-immunes. • Confirmed cases in semi-immunes with any one of the following (consult physician): Hospitalization(4) for treatment, 5% parasitemia, Patient meets criteria for severe Malaria according to World Health Organization standards. 2.Man-Hours Worked. Wherever possible, use actual man-hours worked for indicated groups. Where a breakdown of man-hours is not available for the indicated groups (e.g., Non-Immunve and Semi-Immune), utilize the percentage composition of the workforce to calculate.(e.g., Total contractor man-hours multiplied by the percentage of Non-Immune and Semi-Immune personnel). 3.Malaria Case Rate (automatically calculated on this sheet). MCR = (Total number of Stewardable Malaria Cases x 200,000) divided by man-hours worked for particular workforce. The number of confirmed Malaria cases and the corresponding Malaria case rates are not to be combined with SHE stewardship data. Malaria case information is stewarded separately.
Doc. n. STD-COR-HSE-012-E CORPORATE STANDARD
Rev. 02
Date 19/03/2004
MALARIA CONTROL PROGRAM Page 24 of 27 4. Hospitalization: Hospitalization should be interpreted as the confinement of a patient in a hospital or clinic for the purpose of administering medically supervised treatment. Out-patient and emergency room treatment where the patient is released after examination, observation only and/or provided medication(s) to self-administer are not considered to be hospitalization.