WASH activities at two Ebola treatment units in Sierra Leone

Abstract

PurposeThe 2014 outbreak of Ebola virus disease (EVD) in West Africa was the largest in history. Starting in September 2014, International Medical Corps (IMC) operated five Ebola treatment units (ETUs) in Sierra Leone and Liberia. This paper explores how future infectious disease outbreak facilities in resource-limited settings can be planned, organized, and managed by analyzing data collected on water, sanitation, and hygiene (WASH) and infection prevention control (IPC) protocols.Design/Methodology/ApproachWe conducted a retrospective cohort study by analyzing WASH/IPC activity data routinely recorded on paper forms or white boards at ETUs during the outbreak and later merged into a database from two IMC-run ETUs in Sierra Leone between December 2014 and December 2015.FindingsThe IMC WASH/IPC database contains data from over 369 days. Our results highlight parameters key to designing and maintaining an ETU. High concentration chlorine solution usage was highly correlated with both daily patient occupancy and high-risk zone staff entries; low concentration chlorine usage was less well explained by these measures. There is high demand for laundering and disinfecting of personal protective equipment (PPE) on a daily basis and approximately 1 (0–4) piece of PPE is damaged each day.Research limitations/ImplicationsLack of standardization in the type and format of data collected at ETUs made constructing the WASH/IPC database difficult. However, the data presented here may help inform humanitarian response operations in future epidemics.

The Impact of Water Sanitation and Hygiene (WASH) Improvements on Hand Hygiene at Two Liberian Hospitals during the Recovery Phase of an Ebola Epidemic

“…The main objective of WASH programs in disasters is to reduce exposure to disease-bearing pathogens or vectors, thus reducing the transmission of disease [ 4 ]. The Ebola virus disease (EVD) outbreak in West Africa that began in 2014 was the largest and most devastating since the Ebola virus was first discovered in 1976 in the Democratic Republic of the Congo [ 5 ]. The epidemic had a global impact; however, the hardest hit countries were Guinea, Liberia, and Sierra Leone in West Africa [ 6 , 7 ].…”

“…Healthcare facilities were ill-designed, poorly equipped, and not prepared to provide the necessary occupational and patient-safety practices required for the delivery of safe and effective health services. The outbreak placed an incredible strain on a system which lacked public-health infrastructure, including appropriate IPC measures, critical WASH infrastructure and supplies, accessible healthcare facilities, and well-trained infection control professionals [ 5 , 9 ]. The shortage of personal protective equipment (PPE) and IPC supplies, poor WASH infrastructure and services, and a lack of compliance with basic IPC measures contributed to 372 healthcare workers acquiring the Ebola virus disease in Liberia, of whom 184 died [ 10 ].…”