Efforts to Reduce Nosocomial Ebola Transmission in the DRC

In this outbreak, 18% of Ebola cases have been tied to health care transmission. How can we prevent this from continuing?

The outbreak of Ebola virus disease in the Democratic Republic of the Congo (DRC) continues to grow, with cumulative case counts reaching 3130 as of September 16, 2019. Response efforts have struggled in the affected areas as conflict and instability threaten the area. Tedros Adhanom Ghebreyesus, PhD, director-general of the World Health Organization (WHO) has visited the area several times to help guide efforts on the frontline. In an article in Nature, Amy Maxmen wrote that “A deep-seated skepticism of outsiders comes from more than a century of conflict, exploitation and political corruption in the region. And wars over the past 25 years have destroyed any semblance of a reliable, regulated health system.”

In the wake of this outbreak, the threat of health care-associated infections has grown and thus far 18% of the outbreak cases are nosocomial. The ability for hospitals and treatment centers to act as amplifiers in the middle of an outbreak is not a novel concept. Unfortunately, this number is deeply concerning and represents critical breakdowns in infection control measures. In addition to the avoidable cases, the high number of nosocomial cases is also a driving factor for many to avoid care within the treatment centers. Consider an already skeptical community, and now include the fact that nearly 1 out of 5 cases occur as a result of exposure within a medical setting. Not only can this fuel fear and apprehension to seek care within the community, but it also can put health care workers in danger.

In response to this trend, the WHO is partnering up with agencies like the United Nations Children’s Fund, and the US Centers for Disease Control and Prevention (CDC) to help boost health care response and infection prevention in the 3000 nurses, physicians, and health care workers responding to the outbreak.

On September 6, 2019, the WHO released a press release stating that “with funding from the United States Agency for International Development, the UK Department for International Development and the World Bank, the training package provides a standardized approach to practices and procedures for health facilities and integrates measures related to water management, sanitation and hygiene, which are essential for preventing the spread of infectious disease. The guidelines and training package will be rolled out over the next three months, beginning in Goma and targeting health care workers and other actors involved in primary response. This will enforce the universal application of infection prevention and control standards throughout the health care chain.”

The goal of this “care package” is to provide not only infection control training, but also help strengthen health care as a critical infrastructure. Officials will gauge the efficacy of the training over the next year through monitoring and evaluation.

A painful truth is that infection control for Ebola virus disease is extremely challenging and taxing to even the most skilled health care workers. The extensive personal protective equipment (PPE) that is required and the management of waste are challenging tasks within the United States. It’s difficult to imagine managing such efforts in a conflict zone fraught with social skepticism.

Ebola tests infection control and outbreak response efforts in unique ways and no outbreak is like a previous one, meaning that once we’ve gotten the process down… something will change. The incidence of nosocomial infections in the DRC is concerning. Hopefully, the efforts by the WHO and its partners to help will not only bolster infection control, but also health care stability.