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LETTER TO EDITOR
Year : 2015  |  Volume : 20  |  Issue : 4  |  Page : 526-527

Ebola disease: Infection prevention and control in hospital and community settings


Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai, Chennai, Tamil Nadu, Karnataka, India

Date of Web Publication17-Jul-2015

Correspondence Address:
Dr. Saurabh R Shrivastava
3rd floor, Department of Community Medicine, Shri Sathya Sai Medical College and Research Institute, Ammapettai village, Thiruporur-Guduvancherry Main Road, Sembakkam Post, Kancheepuram - 603 108, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1735-9066.161010

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How to cite this article:
Shrivastava SR, Shrivastava PS, Ramasamy J. Ebola disease: Infection prevention and control in hospital and community settings. Iranian J Nursing Midwifery Res 2015;20:526-7

How to cite this URL:
Shrivastava SR, Shrivastava PS, Ramasamy J. Ebola disease: Infection prevention and control in hospital and community settings. Iranian J Nursing Midwifery Res [serial online] 2015 [cited 2019 Jul 20];20:526-7. Available from: http://www.ijnmrjournal.net/text.asp?2015/20/4/526/161010

Dear Editor,

The World Health Organization (WHO) has announced the 2014 outbreak of Ebola virus as an international public health emergency.[1] This outbreak originated in Guinea in the month of March, and gradually involved five nations in the West Africa (viz. Sierra Leone, Liberia, Nigeria, Senegal, and the Democratic Republic of Congo).[2] The outbreak was caused by the Zaire species of Ebola virus which is generally associated with high case fatality rate.[3] The disease estimates suggest that the magnitude of the Ebola virus disease was way beyond the previous similar outbreaks and magnitude, and has grown at an exponential rate, with the number of new cases getting doubled every 20–30 days.[4],[5]

Ebola virus belongs to the Filoviridae family, which persists in a reservoir species (viz. apes, man, and perhaps other mammalian species), and has been classified as Category A potential bioterrorism agent.[2],[6] It can be easily eliminated by heat, alcohol-based products, and sodium or calcium hypochlorite.[7] Humans acquire Ebola infection through close contact with various body fluids of infected reservoir species or through direct contact (viz. broken skin or mucus membranes) with different body fluids of infected or deceased people/with the surfaces and materials contaminated with these fluids.[6],[7] Humans cannot transmit the disease until they develop symptoms (viz. incubation period varying from 2 to 21 days); it, however, remains a potential source of infection till their body fluids contain the virus.[6],[7]

Although multiple reasons (viz. lack of preparedness, delayed initial response, weak public health care delivery system, disruption in the ecology of forests, poverty, migration and international travel of infected persons, human resource constraints, poor awareness among people, minimal trust on public authorities, development of a sense of fear among people, non-utilization of the public health sector, funeral rituals involving intense body contact with the deceased, existence of no specific treatment or vaccine) have been identified, absence or insufficient implementation of adequate infection prevention and control measures in both hospital and community settings has allowed the disease to go beyond epidemic proportions.[1],[2],[5],[6],[8] In fact, strengthening of infection prevention and control, along with other measures has eventually enabled Senegal and Nigeria to achieve the Ebola-free status.[9],[10]

The WHO has released multiple recommendations such as safe processing of laboratory samples,[6] employing standard precautions for all patients regardless of the their clinical presentation,[7] isolation of the confirmed/suspected cases in isolation wards,[7] regulating the movement of health workers and family members in isolation rooms,[5] ensuring continuous usage of personal protective equipments by health professionals and caretakers,[11] promoting safe handling of biomedical wastes,[6] encouraging use of appropriate disinfectants for the decontamination of surfaces and equipments,[7],[8] maintaining hand hygiene,[12] prompt assessment of any health professional or individual exposed to any infectious body fluid,[7] appropriate management of confirmed cases to prevent further transmission,[13] and constitution of a committee to supervise the overall activities in both hospital and community settings[14] to enable comprehensive implementation of infection prevention and control measures in hospital settings.

At the same time, absence of appropriate prevention and control measure in community settings has extensively contributed toward increase in the number of cases (as more than the diagnosed cases, it is the undetected patients/contacts who have transmitted the infection at an unprecedented rate).[2],[5] Thus, measures like contact tracing and follow-up of the identified contacts for a period of 21 days,[15] sensitizing the health workers to take appropriate precautions at the time of contact tracing (using alcohol-based hand rub solutions, etc.),[7] educating people about the precautions needed while taking care of patient in a family or during travel or at times of burial of deceased,[6],[7] avoiding contact with the reservoir species (fruit bats, apes, etc.),[1],[2] and maintaining good personal and hand hygiene[6],[12] should be implemented in community settings to further decrease the incidence of disease.

To conclude, implementation of appropriate infection prevention and control measures in both hospital and community settings will not only reduce the magnitude of the disease but also significantly interrupt the chain of transmission in the affected regions.

 
  References Top

1.
Briand S, Bertherat E, Cox P, Formenty P, Kieny MP, Myhre JK, et al. The international Ebola emergency. N Engl J Med 2014;371:1180-3.  Back to cited text no. 1
    
2.
Baize S, Pannetier D, Oestereich L, Rieger T, Koivogui L, Magassouba N, et al. Emergence of Zaire Ebola virus disease in Guinea. N Engl J Med 2014;371:1418-25.  Back to cited text no. 2
    
3.
Lefebvre A, Fiet C, Belpois-Duchamp C, Tiv M, Astruc K, Aho Glele LS. Case fatality rates of Ebola virus diseases: A meta-analysis of World Health Organization data. Med Mal Infect 2014;44:412-6.  Back to cited text no. 3
    
4.
Centers for Disease Control and Prevention. Outbreaks chronology: Ebola virus disease. Atlanta: CDC; 2014. Available from: http://www.cdc.gov/vhf/Ebola/outbreaks/history/chronology.html [Last accessed on 2014 Oct 30].  Back to cited text no. 4
    
5.
World Health Organization. Ebola in West Africa: Heading for catastrophe?; 2014. Available from: http://www.who.int/csr/disease/Ebola/Ebola-6-months/west-africa/en/[Last accessed on 2014 Oct 30].  Back to cited text no. 5
    
6.
World Health Organization. Ebola virus disease-Fact sheet N°103; 2014. Available from: http://www.who.int/mediacentre/factsheets/fs103/en/[Last accessed on 2014 Oct 22].  Back to cited text no. 6
    
7.
World Health Organization. Interim infection prevention and control guidance for care of patients with suspected or confirmed filovirus haemorrhagic fever in health-care settings, with focus on Ebola. Geneva: WHO Press; 2014.  Back to cited text no. 7
    
8.
Chan M. Ebola virus disease in West Africa-no early end to the outbreak. N Engl J Med 2014;371:1183-5.  Back to cited text no. 8
    
9.
World Health Organization. WHO congratulates Senegal on ending Ebola transmission; 2014. Available from: http://www.who.int/mediacentre/news/statements/2014/senegal-ends-ebola/en/[Last accessed on 2014 Nov 5].  Back to cited text no. 9
    
10.
World Health Organization. WHO declares end of Ebola outbreak in Nigeria. Available from: http://www.who.int/mediacentre/news/statements/2014/nigeria-ends-ebola/en/[Last accessed on 2014 Oct 30].  Back to cited text no. 10
    
11.
Cheng Y, Li Y, Yu HJ. Ebola virus disease: General characteristics, thoughts, and perspectives. Biomed Environ Sci 2014;27:651-3.  Back to cited text no. 11
    
12.
World Health Organization. Five moments for hand hygiene; 2014. Available from: http://www.who.int/gpsc/tools/Five_moments/en/[Last accessed on 2014 Oct 30].  Back to cited text no. 12
    
13.
World Health Organization. Clinical management of patients with viral haemorrhagic fever: A pocket guide for the front-line health worker. Geneva: WHO Press; 2014.  Back to cited text no. 13
    
14.
World Health Organization. Interim manual-Ebola and Marburg virus disease epidemics: Preparedness, alert, control, and evaluation. Geneva: WHO Press; 2014.  Back to cited text no. 14
    
15.
World Health Organization. Contact tracing during an outbreak of Ebola virus disease: Disease surveillance and response programme area disease prevention and control cluster. Republic of Congo: WHO Press; 2014.  Back to cited text no. 15
    



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