WASH activities at two Ebola treatment units in Sierra Leone.

Michaela Mallow,Estifanos Debasu,Lee Gary,Miriam Tamar Aschkenasy,Bob Bongomin,Timmy Jeng,Peter Wallis,Adam C Levine,Hilarie H Cranmer,Tetsuro Ikegami

doi:10.1371/journal.pone.0198235

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.

Highlights

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
Using data collected as part of operational procedures at two Ebola treatment units (ETUs) in Sierra Leone in 2014 and 2015, this study provides insight for the planning, organizing and managing of future infectious disease outbreak facilities in resource-limited settings
This retrospective cohort study includes data on key WASH/Infection Prevention and Control (IPC) activities carried out in two ETUs in Sierra Leone operated by International Medical Corps (IMC) between December 2014 and December 2015 as part of its comprehensive response to the Ebola virus disease (EVD) epidemic in West Africa

Summary

Introduction

EVD is characterized by symptoms of fever, weakness and pain that may progress to internal and external bleeding, shock and death during the later stages of the infection.[8] Transmission of EVD can occur through broken skin or mucous membranes, when an individual has direct contact with the blood and/or bodily fluids of an Ebola positive patient.[9] As patients progress through the disease, they become increasingly infectious with higher viral loads and increased production of infectious bodily fluids.[10] family members, caretakers and health care workers of Ebola patients are especially at risk for contracting and transferring the virus. One of the most effective ways this was done was through providing care to sick patients in appropriate settings, such as Ebola treatment units (ETUs)

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Conclusion