Assessing and Reducing Risk to Healthcare Workers in Outbreaks

Abstract

The 2014-2016 West African Ebola epidemic was devastating in many respects, not least of which was the impact on healthcare systems and their health workforce. Healthcare workers-including physicians, clinical officers, nurses, midwives, and community health workers-serve on the front lines of efforts to detect, control, and stop the spread of disease. Risk mitigation strategies, including infection prevention and control (IPC) practices, are meant to keep healthcare workers safe from occupational exposure to disease and to protect patients from healthcare-associated infections. Despite ongoing IPC efforts, steady rates of both healthcare-associated and healthcare worker infections signal that these mitigation measures have been inadequate at all levels and present a potential critical point of failure in efforts to limit and control the spread of outbreaks. The fact that healthcare workers continue to be infected or are a source of infection during public health emergencies reveals a weakness in global preparedness efforts. Identification of key points of failure-both within the health system and during emergencies-is the first step to mitigating risk of exposure. A 2-pronged solution is proposed to address long-term gaps in the health system that impact infection control and emergency response: prioritization of IPC for epidemic preparedness at a global level and development and use of rapid risk assessments to prioritize risk mitigation strategies for IPC. Without global support, evidence, and systems in place to support the lives of healthcare workers, the lives of their patients and the health system in general are also at risk.

Association Between Preparedness and Response Measures and COVID-19 Incidence and Mortality

“…The JEE tool may benefit from revisions based on lessons learned from the COVID-19 pandemic, particularly in developing a new technical area for safer health facilities, as we have proposed elsewhere. 16 Similarly, the JEE does not rigorously measure country health systems’ ability to provide essential services for both primary and advanced respiratory care. However, the JEE process and subsequent planning and implementation processes remain a critical component to objectively measure and improve country preparedness capacities and should be refined rather than rejected.…”

From lionizing to protecting health care workers during and after COVID‐19—systems solutions for human tragedies

“…Specifically, a new technical area for safe delivery of health care services should more effectively measure the ability to deliver adequate clinical care, as well as implementation of IPC and WASH in health facilities. 27 Understanding of the risks faced by HCWs is hampered by a lack of data on HCW infections and deaths during outbreaks, which should be collected by governments as part of a core set of indicators on human resources for health, with annual reporting to WHO and published by the Global Health Observatory.…”

“…At the global level, WHO, working with governments, should review existing indicators in the Joint External Evaluation and State Party Self‐Assessment Annual Reporting tool to ensure they adequately account for IPC and WASH. Specifically, a new technical area for safe delivery of health care services should more effectively measure the ability to deliver adequate clinical care, as well as implementation of IPC and WASH in health facilities 27 …”

How can we strengthen the Joint External Evaluation?

“…One indicator is not enough and, therefore, Wilkason and colleagues propose that a new technical area should be created for safe health facilities or IPC to emphasise the importance of healthcare worker safety in global preparedness efforts. 5 …”