Ebola Holding Units at government hospitals in Sierra Leone: evidence for a flexible and effective model for safe isolation, early treatment initiation, hospital safety and health system functioning

Abstract

The 2014-2015 West African outbreak of Ebola Virus Disease (EVD) claimed the lives of more than 11,000 people and infected over 27,000 across seven countries. Traditional approaches to containing EVD proved inadequate and new approaches for controlling the outbreak were required. The Ministry of Health & Sanitation and King’s Sierra Leone Partnership developed a model for Ebola Holding Units (EHUs) at Government Hospitals in the capital city Freetown. The EHUs isolated screened or referred suspect patients, provided initial clinical care, undertook laboratory testing to confirm EVD status, referred onward positive cases to an Ebola Treatment Centre or negative cases to the general wards, and safely stored corpses pending collection by burial teams. Between 29th May 2014 and 19th January 2015, our five units had isolated approximately 37% (1159) of the 3097 confirmed cases within Western Urban and Rural district. Nosocomial transmission of EVD within the units appears lower than previously documented at other facilities and staff infection rates were also low. We found that EHUs are a flexible and effective model of rapid diagnosis, safe isolation and early initial treatment. We also demonstrated that it is possible for international partners and government facilities to collaborate closely during a humanitarian crisis.

The UK’s multidisciplinary response to an Ebola epidemic

“…By 19 January 2015 the five government medical centres, located in the urban Western Area, that were assisted by KSLP had seen over 2,500 patients, of whom over 1,200 were confirmed EVD positive. 30 Other British non-governmental organisations (NGOs), such as UK branches of Médecins du Monde and Médecins Sans Frontières, have long-standing experience of emerging or re-emerging infectious disease threats such as HIV/AIDS, Hepatitis C and tuberculosis. Smaller, niche charities, such as Merlin (now encompassed into Save the Children) have provided dedicated outbreak response.…”

What Do We Know About Controlling Ebola Virus Disease Outbreaks?

“…New models of integrating EVD isolation and testing within preexisting government facilities were shown to be successful. 56 These EHUs were cost-effective; rapidly constructed; isolated patients early, often when other facilities were not available; were safe for HCWs, both within the EVD facility and on the general wards, allowing the hospitals to remain operational; and were sustainable, using local staff who remain within the government system, with trained HCWs who can respond to future need. 25 Patients without EVD were then able to access care in the general hospital, but patients with EVD required transfer to dedicated ETCs, another vital component of the national and international response.…”

Ebola and Health Partnerships, Action in a Time of Crisis

“…They were cheap and quick to develop, with construction costs arriving at under $50,000 in total with one-week start-up times. We believe this model of care, detailed in Section 3 for Connaught Hospital, has significance for future outbreak control due to the rapidity of development and resilience for hospital functioning [11].…”

“…The EHU model aimed to "(1) reduce cases in the local community through rapid isolation of symptomatic and suspect EVD cases to prevent onward transmission, (2) prevent nosocomial transmission through patient separation and regular decontamination of surfaces and floors, (3) improve survival of isolated patients through provision of safe EVD and non-EVD medical care, (4) maintain general healthcare through prompt diagnosis of EVD and onward transfer of patients to dedicated ETCs, alongside exclusion of EVD and triage of negative patients into outpatient or inpatient facilities for general care, allowing hospitals to remain safe and functional, even during peak EVD transmission, and (5) reducing healthcare worker infections through staff training inside the EHU and infection prevention and control strengthening on general wards, avoiding closure of facilities" [11].…”