5 Main actions to prevent outbreaks of Hand,Foot and Mouth diseases that need to be carried out at districts.

1. 5 Main Actions to prevent
outbreaks of HFMD
Dr Mohd Hafeez Bin Intiaz Hussein
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2. 5 main actions to prevent outbreaks of HFMD
1. Good Hygiene practices
2. Proper hand washing technique
3. Environmental Hygiene
4. Gate keeping screening at pre-school (Taska/Tadika/Tabika/Pra-
sekolah) and primary school
5. Disinfection of contaminated surfaces
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3. Good Hygiene Practice
• Bath at least twice a day
• Washing hands with soap and water
- Before and after food preparation
- before and after eating
- after going to the toilet.
- After touching any vesicles/rash on children
- After changing children diapers
• Covering the mouth and nose with a piece of tissue when coughing or sneezing.
• Avoid sharing food/drinks, eating utensils, toothbrushes , towels and toys with others
• Ensuring that toys or appliances that are contaminated by nasal or oral secretions are disinfected before
they are used again.
• Putting on a face mask when feeling unwell.
• Used tissue and diapers to be thrown in a closed rubbish bin 3

4. Proper Hand washing technique
• Washing hands with soap and water
- Before and after food preparation
- before and after eating
- after going to the toilet.
- After touching any vesicles/rash on children
- After changing children diapers
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5. 7 Steps of Hand washing
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6. 5 Steps for Hand Rub (Using alcohol-based
formulation
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7. Environmental Hygiene Practices
• Clean the floors of the pre-school, home, toilets and even the door
knobs
• Clean all toys with soap and water
• Throw away old diapers and rubbish in rubbish bin that is closed.
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8. Gate Keeping Screening
• Conducted by Pre-school and Primary School teachers before entering
to the classroom
- To be done daily every morning
- Better for pre-school children, that gate keeping done with parents or
guardian
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9. Students Arrive 4 STEPS SCREENING Symptomatic?
Enter class.
Isolated
Inform Parents
Send to Clinic for Treatment
Isolation/Quarantined at
homeInform CDC unit
GATE-KEEPING CHECKLIST
YES.NO.
Contagious?No
Yes 9

10. 4 Steps of gate keeping screening
• Look for blisters on the Hands. Ask the child to hold out the hands
and show his/her palms. Look for small pinkish/reddish bumps or tiny
blisters with fluids. Then check for the same on the back of the hands.
• Look for blisters on the Feet. Check for bumps/blisters on the upper
part of the feet first, then the soles
• Look for mouth Ulcers. Ask the child to open the mouth and say “Ah
…”. Shine a torch in the mouth and look for ulcers on the tongue,
inner sides of the mouth and on the lips.
• Take your child’s Temperature (either orally or via the ear).
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11. Gate-keeping screening by PKD Maran together with school teacher
at Primary School in Chenor, Maran
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12. Disinfection
• Disinfection is a destruction of pathogenic microorganisms or their
toxins or vectors by direct exposure to chemical or physical agents
• Act of disinfecting using specialized cleansing technique that destroys
and prevents growth of organisms capable of infection
• Type of Disinfection solution include:
- Sodium Hypochloride (Clorox)
- Sodium Dichloroisocyanurate (Chlorine)
- Lysol
- Chlorhexidine
- Cetrimide 12

13. Type of Disinfection Agents
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14. Disinfection Preparation
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15. Solution Formula
• Sodium Hipochloride (Clorox)
- 1: 10 (10,000 ppm Chlorine), disinfection for blood and bodily fluids
stains
- 1: 100 (1,000 ppm Chlorine), General disinfection that is required.
• Sodium Dichloroisocyanurate (Chlorine tablets)
- 10 tablets + 300ml water = 10,000 ppm for disinfection for blood and
bodily fluids stains
- 4 tablet +1 L water= 1,0000 ppm Chlorine for general disinfection that
is required
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16. Disinfection process
• Contaminated clothes/toys need to be soaked in disinfection solution
for one water and
• Washed with hot water (temp 85°C)
• After disinfection the items need to be dried up first before it can be
used.
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17. “1 cup of
disinfectant and
add with 9 cups
of water”
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18. “1 cup of
disinfectant
and add with
99 cup of
water”
- Use the same cup to measure
water and disinfectant
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19. “1 cup of
disinfectant with
500 cups of
water”
- Use the same cup to
measure the water
and the disinfectant.
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20. Definition of HFMD Outbreak
• Definitions
- Occurrence of two or more cases in same locality within
incubation period
- Organisation based outbreak when two or more cases with
onset in two weeks interval in group which makes
epidemiological sense
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21. Management of HFMD Outbreaks
I. Isolation infected children for at least 10 days
II. An assessment of the number of cases and susceptible population
involved shall be made, and the overall attack rate computed.
III. Active case detection shall be carried out among contacts in the institution
and family, and all those with illness shall be referred for treatment at the
nearest health clinics
IV. Where a case is observed or suspected to have unusual signs and
symptoms e.g. seizures, weakness of limbs, profound lethargy, refusal to
play, the case shall be immediately REFERRED TO HOSPITAL.
V. Swabs from oral ulcers and vesicular lesions on the hands and feet shall be
collected for virus isolation at identified laboratories. If these ulcers and
vesicles are no longer present, stool specimens shall be sent. 21

22. Management of HFMD Outbreaks (Con’t)
VI. Principals, teachers and supervisors shall be alerted to look out for
children with fever, rash / blisters on palms and soles and to isolate
them immediately. Screening before coming to class is
recommended.
VII. Health education of supervisors of institutions on the disease,
mode of transmission, importance of good personal hygiene and
isolation of infected children shall be carried out.
VIII.Close the premise closed for two incubation period (10 days) from
the date of onset of the last case. Supervision on disinfection
procedures shall be given to the premise operators.
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23. HFMD Guidelines (2007, MOH)

24. If the outbreak occurs in primary schools;
• Ensure that the infected students remain away from the institution for
at least ten days.
• Health education to the students on the disease, mode of transmission,
importance of good personal hygiene.
• Principals, teachers and supervisors shall be look for children with fever,
rash / blisters on palms and soles and to isolate them immediately.
Screening before coming to class is recommended (please refer Buku
Panduan Latihan Taska dan Prasekolah).
• If closure is necessary, just closed the affected class. Closure of the
whole school is unnecessary as HFMD in older children is usually very
mild and so far no complication has been documented from this age
group.
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25. 25

26. Plan of Action for HFMD at district level
I. Case Management based on the available SOP
II. Prevention and Control measures
-Inter-agency collaboration with JKM, JPN, KEMAS, Perpaduan, Jabatan
Agama Islam Negeri
- Information sharing regarding HFMD with the target population being
Parents, Pre-School Operators and teachers
- Town Hall Meeting at District Level
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27. Demonstration of Disinfection of Trolley at Supermarket at Super
Market U-Mart Jengka to store operators
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28. Town-hall meeting with teachers from Primary School in Chenor
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29. Inter agency meeting chaired by Maran
District Officer on Hand Foot Mouth Disease
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30. Health Education on HFMD to General Practitioners, Nurses and
health workers in Maran
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31. Town hall meeting with Principals and Vice Principals of schools in
Maran, Pahang
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32. Health education lecture on HFMD and hand washing demonstration
to Pre-school teachers of Maran
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33. Health Education and hand washing demonstration at Chenor, Maran to parents and teachers
and discussion with ADUN Chenor on HFMD Prevention
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34. References
Langkah Mencengah Penyakit HFMD.(2018) Bahagian Pendidikan
Kesihatan Ministry of Health Malaysia
Hand Foot and Mouth (HFMD) Guidelines (2007) Ministry of Health
Malaysia
A Guide to Clinical Management and Public Health Response for Hand,
Foot and Mouth Disease (HFMD) (2010) Western Pacific Regional Office
Wold Health Organization
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