Ebola virus disease nosocomial infections in the Democratic Republic of the Congo: a descriptive study of cases during the 2018–2020 outbreak

Baller, April; Padoveze, Maria Clara; Mirindi, Patrick; Hazim, Carmen; Lotemo, Jonathan; Pfaffmann, Jerome; Ndiaye, Aminata; Carter, Simone; Chabrat, Marie-Amelie Degail; Mangala, Samuel; Banzua, Berthe; Umutoni, Chantal; Niang, N'Deye Rosalie; Kabego, Landry; Ouédraogo, Abdoulaye; Houdjo, Bienvenue; Mwesha, Didier; Ousman, Kevin; Kolwaite, Amy; Blaney, David D.; Choi, Mary J.; Pallawo, Raymond; Legand, Anaïs; Park, Benjamin; Formenty, Pierre; Guèye, Abdou Salam; Allegranzi, Benedetta; Yao, N'da Kona Michel; Fall, Ibrahima Socé

doi:10.1016/j.ijid.2021.11.039

Cited by 7 publications

(5 citation statements)

References 26 publications

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“…Four of the 13 EVD patients treated in N’zérékoré were health workers, which confirms experience from previous Ebola outbreaks indicating a considerable infection risk during patient care in regular health facilities. 1 , 61 In regions potentially affected by Ebola epidemics, health workers therefore need to be vaccinated and safe working environments need to be established. 1 , 12 , 61 Importantly, a recent publication describes postexposure prophylaxis after high-risk contacts using Ebola-specific monoclonal antibodies.…”

Section: Discussionmentioning

confidence: 99%

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Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease

Paré

Camara

et al. 2023

Southern African Journal of Infectious Diseases

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Background: Experience from the Zaire Ebolavirus epidemic in the eastern Democratic Republic of the Congo (2018–2020) demonstrates that early initiation of essential critical care and administration of Zaire Ebolavirus specific monoclonal antibodies may be associated with improved outcomes among patients with Ebola virus disease (EVD).Objectives: This series describes 13 EVD patients and 276 patients with suspected EVD treated during a Zaire Ebolavirus outbreak in Guinea in 2021.Method: Patients with confirmed or suspected EVD were treated in two Ebola treatment centres (ETC) in the region of N’zérékoré. Data were reviewed from all patients with suspected or confirmed EVD hospitalised in these two ETCs during the outbreak (14 February 2021 – 19 June 2021). Ebola-specific monoclonal antibodies, were available 2 weeks after onset of the outbreak.Results: Nine of the 13 EVD patients (age range: 22–70 years) survived. The four EVD patients who died, including one pregnant woman, presented with multi-organ dysfunction and died within 48 h of admission. All eight patients who received Ebola-specific monoclonal antibodies survived. Four of the 13 EVD patients were health workers. Improvement of ETC design facilitated implementation of WHO-recommended ‘optimized supportive care for EVD’. In this context, pragmatic clinical training was integrated in routine ETC activities. Initial clinical manifestations of 13 confirmed EVD patients were similar to those of 276 patients with suspected, but subsequently non confirmed EVD. These patients suffered from other acute infections (e.g. malaria in 183 of 276 patients; 66%). Five of the 276 patients with suspected EVD died. One of these five patients had Lassa virus disease and a coronavirus disease 2019 (COVID-19) co-infection.Conclusion: Multidisciplinary outbreak response teams can rapidly optimise ETC design. Trained clinical teams can provide WHO-recommended optimised supportive care, including safe administration of Ebola-specific monoclonal antibodies. Pragmatic training in essential critical care can be integrated in routine ETC activities.Contribution: This article describes clinical realities associated with implementation of WHO-recommended standards of ‘optimized supportive care’ and administration of Ebola virus specific treatments. In this context, the importance of essential design principles of ETCs is underlined, which allow continuous visual contact and verbal interaction of health workers and families with their patients. Elements that may contribute to further quality of care improvements for patients with confirmed or suspected EVD are discussed.

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Section: Discussionmentioning

confidence: 99%

“…1 , 61 In regions potentially affected by Ebola epidemics, health workers therefore need to be vaccinated and safe working environments need to be established. 1 , 12 , 61 Importantly, a recent publication describes postexposure prophylaxis after high-risk contacts using Ebola-specific monoclonal antibodies. 42 …”

Section: Discussionmentioning

confidence: 99%

Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease

Paré

Camara

et al. 2023

Southern African Journal of Infectious Diseases

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“…Previous experience during other epidemics showed the limited preparedness of health facilities to respond to outbreaks in the DRC. For example, during the 2018–2020 Ebola in North Kivu and Ituri, a large proportion of the Ebola cases (20%) were nosocomial [ 15 ]. In the most recent large cholera outbreaks in Kinshasa, health facilities exhibited a low level of cholera preparedness despite previous experience [ 16 ].…”

Section: Discussionmentioning

confidence: 99%

The implementation of infection prevention and control measures and health care utilisation in ACF-supported health facilities during the COVID-19 pandemic in Kinshasa, Democratic Republic of the Congo, 2020

Altare,

Matadi Basadia,

Kostandova

et al. 2023

Global Health Action

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Background Infection prevention and control (IPC) was a central component of the Democratic Republic of the Congo’s COVID-19 response in 2020, aiming to prevent infections and ensure safe health service provision. Objectives We aimed to assess the evolution of IPC capacity in 65 health facilities supported by Action Contre la Faim in three health zones in Kinshasa (Binza Meteo (BM), Binza Ozone (BO), and Gombe), investigate how triage and alert validation were implemented, and estimate how health service utilisation changed in these facilities (April–December 2020). Methods We used three datasets: IPC Scorecard data assessing health facilities’ IPC capacity at baseline, monthly and weekly triage data, and monthly routine data on eight health services. We examined factors associated with triage and isolation capacity with a mixed-effects negative binomial model and estimated changes in health service utilisation with a mixed-model with random intercept and long-term trend for each health facility. We reported incidence rate ratios (IRRs) for level change when the pandemic began, for trend change, and for lockdown and post-lockdown periods (Gombe). We estimated cumulative and monthly percent differences with expected consultations. Results IPC capacity reached an average score of 90% by the end of the programme. A one-point increase in the IPC score was associated with +6% and +5% increases in triage capacity in BO and Gombe, respectively, and with +21% and +10% increases in isolation capacity in the same zones. When the pandemic began, decreases were seen in outpatient consultations (IRR: 0.67, 95% confidence interval (CI) [0.48–0.95] BM&BO-combined; IRR: 0.29, 95%CI [0.16–0.53] Gombe), consultations for respiratory tract infections (IRR: 0.48, 95%CI [0.28–0.87] BM&BO-combined), malaria (IRR: 0.60, 95%CI [0.43–0.84] BM&BO-combined, IRR: 0.33, 95%CI [0.18–0.58] Gombe), and vaccinations (IRR: 0.27, 95%CI [0.10–0.71] Gombe). Maternal health services decreased in Gombe (ANC1: IRR: 0.42, 95%CI [0.21–0.85]). Conclusions The effectiveness of the triage and alert validation process was affected by the complexity of implementing a broad clinical definition in limited-resource settings with a pre-pandemic epidemiological profile characterised by infectious diseases with symptoms like COVID-19. Readily available testing capacity remains key for future pandemic response to improve the disease understanding and maintain health services.

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“…Lessons learned from previous Ebola outbreaks showed that health workers (HW) are at highest risk of exposure to Ebola virus disease (EVD) [ 1 – 6 ]. During the 2018–2020 EVD outbreak in the Democratic Republic of Congo (DRC), a total of 3,481 Ebola cases were reported among which 160 (27.6%) were HW and 2,299 (66%) deaths, making this the second-largest documented Ebola outbreak after the 2014–2016 epidemic in West Africa, which resulted in 28,600 cases and 11,325 deaths [ 2 , 7 ]. A number of IPC strategies have been developed in Sierra Leone to strengthen health systems in order to keep the health facilities (HF) prepared against EVD outbreaks [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of multimodal strategies including a pay for performance strategy in the improvement of infection prevention and control practices in healthcare facilities during an Ebola virus disease outbreak

Kabego¹,

Kourouma²,

Ousman³

et al. 2023

BMC Infect Dis

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Background Strategy to mitigate various Ebola virus disease (EVD) outbreaks are focusing on Infection Prevention and Control (IPC) capacity building, supportive supervision and IPC supply donation. This study was conducted to assess the impact of a Pay for Performance Strategy (PPS) in improving IPC performance in healthcare facilities (HF) in context of the 2018–2019 Nord Kivu/ Democratic Republic of the Congo EVD outbreak. Methods A quasi-experimental study was conducted analysing the impact of a PPS on the IPC performance. HF were selected following the inclusion criteria upon informed consent from the facility manager and the National Department of Health. Initial and process assessment of IPC performance was conducted by integrating response teams using a validated IPC assessment tool for HF. A bundle of interventions was then implemented in the different HF including training of health workers, donation of IPC kits, supportive supervision during the implementation of IPC activities, and monetary reward. IPC practices in HF were assessment every two weeks during the intervention period to measure the impact. The IPC assessment tool had 34 questions aggregated in 8 different thematic areas: triage and isolation capacity, IPC committee in HF, hand hygiene, PPE, decontamination and sterilization, linen management, hospital environment and Waste management. Data were analysed using descriptive statistics and analytical approaches according to assumptions. R software (version 4.0.3) was used for all the analyses and a p-value of 0.05 was considered as the threshold for statistically significant results. Results Among 69 HF involved in this study, 48 were private facilities and 21 state facilities. The median baseline IPC score was 44% (IQR: 21–65%); this IPC median score reached respectively after 2, 4, 6 and 8 weeks 68% (IQR: 59–76%), 79% (71–84%), 76% (68–85%) and 79% (74–85%). The improvement of IPC score was statistically significative. Spearman’s rank-order correlation revealed the associated between proportion of trained HW and IPC score performance after 8 weeks of interventions (rs = .280, p-value = 0.02). Conclusion Pay for Performance Strategy was proved effective in improving healthcare facilities capacity in infection prevention and control practice in context of 2018 EVD outbreak in Nord Kivu. However, the strategy for long-term sustainability of IPC needs further provision. More studies are warranted on the HW and patients’ perceptions toward IPC program implementation in context of Nord Kivu Province.

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Ebola virus disease nosocomial infections in the Democratic Republic of the Congo: a descriptive study of cases during the 2018–2020 outbreak

Cited by 7 publications

References 26 publications

Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease

Ebola outbreak in Guinea, 2021: Clinical care of patients with Ebola virus disease

The implementation of infection prevention and control measures and health care utilisation in ACF-supported health facilities during the COVID-19 pandemic in Kinshasa, Democratic Republic of the Congo, 2020

Impact of multimodal strategies including a pay for performance strategy in the improvement of infection prevention and control practices in healthcare facilities during an Ebola virus disease outbreak

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