Lifesaving Training Protects West Africa’s Healthcare Workers and Patients

During the 2014-2015 Ebola epidemic, more than 600 Liberian and Sierra Leonean healthcare workers were infected with the virus. Tragically, more than 250 of them died while heroically trying to save lives and stop the epidemic. The main reason this happened was that health facilities in the area lacked infection prevention and control (IPC) practices and supplies to prevent the spread of Ebola and save lives.

In many of West Africa’s healthcare facilities, workers could not wash their hands regularly, patients shared beds, gloves were not changed between patients, and personal protective equipment was not available. This led to the virus spreading to patients and healthcare workers within health facilities. The already fragile and overstretched healthcare systems in Liberia and Sierra Leone were rapidly overwhelmed by the epidemic – putting not only the local population but also the world at risk as Ebola spread beyond the countries’ borders.

Training in challenging places

CDC experts trained healthcare workers in Liberia and Sierra Leone during the epidemic, teaching them basic IPC practices. Today, CDC is helping to strengthen countries’ capacity by building on the progress made during the response. More than 23,000 healthcare workers in the two countries have been trained in IPC practices, and both countries have national IPC units, staff, and policies within their Ministries of Health.

These IPC programs are being implemented under very challenging conditions. Only one in four people in Liberia has access to safe drinking water, and half do not have access to a toilet. As many as one in five deaths in Liberia is due to conditions related to lack of clean water and proper sanitation.

The healthcare system is not immune to these issues, which can make implementing IPC practices challenging. Health facilities in remote areas lack running water, forcing staff to walk to wells as far as a quarter of a mile away, or to haul water for handwashing and cleaning from a local waterfall. A shortage of supplies leads to healthcare workers limiting how many gloves they use per shift or rewashing the same pair.

Overcoming IPC obstacles

Despite the challenges, progress has been made in improving IPC in Liberia and Sierra Leone.

In Liberia, CDC helped develop the nation’s first IPC training curriculum, the “Safe and Quality Health Services Package” (SQS). All hospitals have received training and supply kits to implement IPC recommendations. Through a partner, ACCEL, CDC continues to provide on-site mentorship at 25 hospitals to implement IPC.

With CDC support, the Sierra Leone Ministry of Health and Sanitation (MoHS) developed National IPC Policy and Technical Guidelines, and all 25 government hospitals and 14 districts now have IPC focal persons. These advocates help reinforce trainings and overcome challenges by working one-on-one with healthcare workers to find practical solutions.

To protect people and animals from dangerous medical waste, mixed dump piles are being replaced with a simple three-bin system for infectious waste, trash, and sharp objects. Healthcare workers are encouraged to wash their hands through facility-wide competition; whoever has the most “I washed my hands” stickers at the end of each shift wins a prize.

Making a difference, saving lives

An important indicator of the progress made is that, while there have been flare-ups of Ebola in Liberia and Sierra Leone since the initial epidemic, no healthcare workers have been newly infected. With support from CDC and IPC colleagues in South Africa and Zimbabwe, the Ministries of Health are working to develop IPC certification programs to increase expertise and build a trained workforce.

Stronger IPC standards and practices will help protect healthcare workers, patients, and people around the world by preventing the next infectious disease outbreak from spreading throughout healthcare facilities and becoming an epidemic.

About this story

CDC is working with 31 priority countries to develop global health security capabilities, which protect Americans and people around the world from disease threats. CDC continues to work in Liberia and Sierra Leone to enhance IPC in healthcare facilities to protect healthcare workers, patients, and communities from the spread of infectious diseases. This work ensures that West Africa, and therefore the world community, is safer from disease threats.