Enhancing Infection Prevention Measures in Health Facilities to Curb Ebola Spread

Weeks before the declaration of an Ebola outbreak in the Democratic Republic of the Congo’s Ituri Province, Dr Yves Tibamwenda, Medical Director of Bunia University Hospital, began to suspect that something was not right. More and more patients were presenting with high fevers, and there was a higher number of deaths than usual. He and his staff did not know yet that they were already on the frontline of an Ebola outbreak, and vital infection prevention and control (IPC) measures had not yet been stepped up. 

“When we’re not in an outbreak IPC can be a bit lacking,” he says. “And that’s what led to so many healthcare workers falling ill.” 
Dr Tibamwenda was not spared. After developing a fever, he tested positive for Ebola, just days after the outbreak was declared. 
“There was a lot of panic, both among the staff and within the family,” he says. “Compared with today when there’s a chance of recovery if treatment is started early, in the first week after the outbreak was declared quite a number of staff members died. Being a doctor, I knew exactly what it was. So emotionally, I was really down. But the medical team was very effective, and a week later, I tested negative.”

With patients and hospital staff falling ill, it was urgent to curb the spread of the virus by implementing proper infection prevention and control measures. In hospitals across Bunia, in partnership with government medical teams, WHO experts worked closely with the national health authorities and medical personnel, starting with an assessment of what was already in place, identifying and filling gaps as quickly as possible, to keep patients and staff safe. 

“What I saw then is different from what I'm seeing now,” says Dr April Baller, Infection Prevention and Control, and Water Sanitation and Hygiene (WASH) lead for WHO’s Health Emergency Programme. “There were a lot of risks, both for the health workers and for the other patients. Particularly things like not having the appropriate space, not having the ensuite toilets they need, the movement flow within the facility and the commodities. There wasn't availability of the personal protective equipment, there wasn't the hand hygiene that they needed. All these essential parts to keep them safe while they're still treating patients. These were some of the major issues that I saw when I came.”

Since then, WHO teams have been working to assess health facilities’ infection prevention and control capacity and support them to apply measures such as mandatory screening at all entry points, triage and isolation of any patients suspected of having Ebola, and proper use of personal protective equipment for healthcare workers in contact with patients and suspect patients. Non-medical staff, such as cleaners, hygienists, and mortuary staff have been trained in essential procedures and provided with personal protective equipment. All staff are also trained to reduce the frequency and duration of any potential exposure to pathogens. 
To date, WHO’s infection prevention and control teams have supported over 900 health facilities and trained more than 1000 health workers. 

Jean-Didier Lazo Calimini, WASH Supervisor for Bunia Health Zone, has been a key player in this surge. Right from the start of the response, he and other government workers started selecting supervisors for each health zone, setting up decontamination teams and using any available supplies for them to immediately start work. WHO supported the training of health zone supervisors and hygienists and provided decontamination kits and other supplies.  

Calimini and his teams work across the city, including in Kigonze, a site hosting tens of thousands of people displaced by the decades-long conflict, and where close-proximity living and lack of basic necessities such as clean water, hygiene and other basic services raise health risks.

“The idea was to transfer skills so that everyone could play their part in ensuring that this disease is truly eradicated”, Calimini says. 

“The response requires everyone to be trained. It is about ensuring that infection prevention and control becomes ingrained in our culture so that everyone can protect themselves.”

Dr Tibamwenda has since resumed work after recovering and is back doing his rounds in Bunia University Hospital. His facility now better prepared: there are handwashing stations throughout the facility and a mandatory temperature check for all who enter. The staff, from medics to cleaners, have been trained in infection prevention and control, and local government teams carry out regular inspections. 

“The disease is here, and we can only control it by working together,” says Tibamwenda “We’re adhering to IPC measures, particularly in healthcare settings. And this will spread from our healthcare settings out into the community. We don’t know what might happen, what other outbreak might occur. And with IPC, we are able to prevent almost all outbreaks.”
Distributed by APO Group on behalf of WHO Regional Office for Africa.