In 2014–2016, the Republics of Guinea, Liberia and Sierra Leone faced the most deadly Ebola Virus Disease (EVD) outbreak in history. WHO declared a Public Health Emergency of International Concern (PHEIC) on August, 8th, 2014, which was lifted on March 29th, 2016. A total of 28,616 confirmed, probable and suspected cases and 11,310 deaths were reported during the outbreak, mostly in Guinea, Liberia and Sierra Leone [1].
In Guinea, there was a total of 3811 probable and confirmed EVD cases, and 2543 deaths [1]. Ratoma, the largest municipality of the capital, Conakry, reported a total of 179 EVD cases (7 probable and 172 confirmed), including 92 deaths (CFR 51.4%). This municipality experienced at least two waves of cases: the second had a peak in July 2015 (22 confirmed cases and 1 probable case) and ended by October 2015 (Fig. 1).
This EVD outbreak highlighted the weaknesses of health care systems across the three countries, including the lack of reliable public health surveillance systems [2]. Prior to the EVD outbreak, Infection Prevention Control (IPC) activities in Liberia were found to be basic: there was no national IPC guidance and no dedicated staff at any level of government or healthcare facility to ensure the implementation of IPC best practices [3]. In Sierra Leone and Guinea, the need for IPC was recognised at all levels of health care delivery as soon as EVD transmission episodes occurred in healthcare facilities [4, 5].
To overcome this unprecedented epidemic, the World Health Organization (WHO) coordinated an international response. The Global Outbreak Alert and Response Network mobilised Operational Support Team including international expertise in clinical case management, surveillance and epidemiology, data management, IPC, outbreak logistics, social mobilisation, risk communications and medical anthropology [6].
Several strategies were implemented to contain and prevent the outbreak to spread to other countries, i.e. prevention through risk and behavioral change, safe case management in Ebola Treatment Units (ETUs), epidemic surveillance by contact tracing, IPC implementation in all health care settings to promote good hand hygiene for patients and health care professionals, safe and dignified burials and implementation of health control at borders. IPC measures included the delivery of personal protective equipment (PPE) (gloves, gowns, mask, and boots) and infection control supplies (chlorine, buckets, disposable rags, soap, etc.). The importance of training and assessing IPC practices in healthcare facilities that were not serving as ETUs was recognised by the US Centres for Disease Control and Prevention (CDC) as a priority [7]. The ‘Ring IPC strategy’ - which consists of providing rapid, intensive and short-term (21-days) support to healthcare facilities and communities in areas of active Ebola transmission - had a good impact in Guinea and Liberia [8, 9].
Throughout the EVD outbreak in Guinea, individual healthcare workers (usually 1 or 2 per healthcare facility) were selected to take part in an intensive five-day IPC training with a focus on EVD, organised by the Ministry of Health and partners (WHO, CDC and others). The participants were strongly encouraged to organise cascade training, i.e. training to other medical staff within their respective healthcare structures, following guidelines developed by the Ministry of Health and as previously described [10].
The purpose of this research was to evaluate healthcare personnel training in healthcare facilities and the subsequent impact on the quality of IPC performance in healthcare facilities within Ratoma municipality.
Two hypotheses were tested in this research:
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1)
There is a positive association between the health care structure IPC performance and the number of IPC-trained staff.
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2)
Within an health care facility, IPC cascade training by IPC-trained staff, compared to no cascade training, is more likely to result in higher IPC performance, regardless of the type of health care structure and whether the structure is certified or not (i.e. whether it has government permission to provide health care).