Infection, prevention and control interventions in primary health facilities to prevent the transmission of Ebola Virus Disease in Sierra Leone

Background:Of the three most affected countries in the 2014 Ebola viral disease (EVD) epidemic, Sierra Leone reported the highest number of cases. Healthcare providers were disproportionately infected and the utilization of primary healthcare services has decreased.  In partnership with the MoHS, CDC, UNICEF and the Ebola Response Consortium (ERC), an infection prevention and control (IPC) project was implemented to rapidly improve IPC in all primary health facilities in Sierra Leone over a two month period, during the height of the epidemic.

Methods:All staff from the 1,188 Peripheral Health Units (PHUs) were trained on IPC protocols and Ebola screening and provided with IPC supplies. Training teams conducted a quality assurance (QA) assessment which focused on three key areas: inventory supplies, structures and practices. The assessment identified breaches in IPC for rapid improvement and remedial training.  A QA assessment was repeated in a follow-up visit 5-7 days after the initial visit and training to assure IPC preparedness. Longitudinal QA assessments are ongoing for a follow-up six months.

Results:Pre-training, 20% of PHUs had the minimum IPC inventory and post-training, 96% of PHUs had the minimum PPE inventory in stock.  The presence of screening stations in PHUs increased from 26% to 81%, and having a designated screener increased from 23% to 83%. PHUs with an isolation area or process for isolation increased from 18% to 67%.  PHUs requiring urgent action to remediate IPC practices decreased from 40% to 10%.

Conclusions: A rapid IPC training and supply exercise was undertaken with positive results for IPC preparedness. In an epidemic that was defined in its early stages by loosely organized, geographically-localized responses, this centralized, standardized program improved rapid, interagency coordination for the Ebola response.