Infection prevention and control practice for Crimean-Congo hemorrhagic fever—A multi-center cross-sectional survey in Eurasia

Abstract

BackgroundCrimean Congo Hemorrhagic Fever (CCHF) is a life threatening acute viral infection that presents significant risk of nosocomial transmission to healthcare workers.AimEvaluation of CCHF infection prevention and control (IP&C) practices in healthcare facilities that routinely manage CCHF cases in Eurasia.MethodsA cross-sectional CCHF IP&C survey was designed and distributed to CCHF centers in 10 endemic Eurasian countries in 2016.ResultsTwenty-three responses were received from centers in Turkey, Pakistan, Russia, Georgia, Kosovo, Bulgaria, Oman, Iran, India and Kazakhstan. All units had dedicated isolation rooms for CCHF, with cohorting of confirmed cases in 15/23 centers and cohorting of suspect and confirmed cases in 9/23 centers. There was adequate personal protective equipment (PPE) in 22/23 facilities, with 21/23 facilities reporting routine use of PPE for CCHF patients. Adequate staffing levels to provide care reported in 14/23 locations. All centers reported having a high risk CCHFV nosocomial exposure in last five years, with 5 centers reporting more than 5 exposures. Education was provided annually in most centers (13/23), with additional training requested in PPE use (11/23), PPE donning/doffing (12/23), environmental disinfection (12/23) and waste management (14/23).ConclusionsStaff and patient safety must be improved and healthcare associated CCHF exposure and transmission eliminated. Improvements are recommended in isolation capacity in healthcare facilities, use of PPE and maintenance of adequate staffing levels. We recommend further audit of IP&C practice at individual units in endemic areas, as part of national quality assurance programs.

Seroprevalence of Crimean–Congo hemorrhagic fever among health care workers in a hospital in an endemic region of Turkey

“…The healthcare personnel providing care to CCHF patients are at a risk of acquiring the infection [14,15]. The first case of a healthcare worker acquiring CCHF infection was reported in Pakistan in 1976 [14].…”

“…Similar to the study in Iran, one of the healthcare workers in the present study, who was anti-CCHV IgG positive, was a laboratory worker. In a 23-centered study investigating the prevention and control [23] of CCHF infection, it was emphasized that all health personnel, including laboratory workers, are at a risk [15]. In a study conducted in Turkey, it was reported that although the nurses had a relatively adequate knowledge of CCHF nosocomial transmission, it is not yet at the level desired [35].…”

Crimean–Congo haemorrhagic fever virus: Past, present and future insights for animal modelling and medical countermeasures

“…As many nosocomial outbreaks of CCHFV have occurred in endemic areas (Burney, Ghafoor, Saleen, Webb, & Casals, ; Conger et al., ; Naderi, Sheybani, Bojdi, Khosravi, & Mostafavi, ; Pshenichnaya & Nenadskaya, ; Van de Wal, Joubert, van Eeden, & King, ), isolation rooms for CCHF have been established in treatment units throughout Turkey, Iran, Pakistan, Russia, Georgia, Bulgaria, India, Kazakhstan and Kosovo. In addition, adequate training for the use of personal protective equipment and effective waste management and disinfection in the hospital setting have been implemented (Fletcher et al., ). However, as CCHF cases often enter healthcare facilities with non‐specific flu‐like symptoms, late recognition and diagnosis of CCHF cases may hinder the effectiveness of these measures in reducing the occurrence of hospital‐acquired CCHFV infection (Fletcher et al., ).…”

“…In addition, adequate training for the use of personal protective equipment and effective waste management and disinfection in the hospital setting have been implemented (Fletcher et al., ). However, as CCHF cases often enter healthcare facilities with non‐specific flu‐like symptoms, late recognition and diagnosis of CCHF cases may hinder the effectiveness of these measures in reducing the occurrence of hospital‐acquired CCHFV infection (Fletcher et al., ).…”

The importance of vector abundance and seasonality

“…Conversely, grubbing out a habitat and turning it into arable farmland negatively impacts persistence of the pathogen. [54] or transmission through milk, e.g. TBEV [55].…”