Olu Olushayo, Kargbo Brima, Kamara Sarian, Wurie Alie H, Amone Jackson, Ganda Louisa, Ntsama Bernard, Poy Alain, Kuti-George Fredson, Engedashet Etsub, Worku Negusu, Cormican Martin, Okot Charles, Yoti Zabulon, Kamara Kande-Bure, Chitala Kennedy, Chimbaru Alex, Kasolo Francis
World Health Organization (WHO) Intercountry Support Team for Eastern and Southern Africa, Harare, Zimbabwe.
Ministry of Health and Sanitation, Freetown, Sierra Leone.
BMC Infect Dis. 2015 Oct 13;15:416. doi: 10.1186/s12879-015-1166-7.
Anecdotal evidence suggests that much of the continuing infection of health care workers (HCWs) with Ebola virus during the current outbreak in Sierra Leone has occurred in settings other than Ebola isolation units, and it is likely that some proportion of acquisition by HCWs occurs outside the workplace. There is a critical need to define more precisely the pathways of Ebola infection among HCWs, to optimise measures for reducing risk during current and future outbreaks.
We conducted a retrospective descriptive study of Ebola acquisition among health workers in Sierra Leone during May-December 2014. The data used were obtained mainly from the national Ebola database, a cross-sectional survey conducted through administration of a structured questionnaire to infected HCWs, and key informant interviews of select health stakeholders.
A total of 293 HCWs comprising 277 (95 %) confirmed, 6 (2 %) probable, and 10 (3 %) suspected cases of infection with Ebola virus were enrolled in the study from nine districts of the country. Over half of infected HCWs (153) were nurses; others included laboratory staff (19, 6.5 %), doctors (9, 3.1 %), cleaners and porters (9, 3.1 %), Community Health Officers (8, 2.7 %), and pharmacists (2, 0.7 %). HCW infections were mainly reported from the Western Area (24.9 %), Kailahun (18.4 %), Kenema (17.7 %), and Bombali (13.3 %) districts. Almost half of the infected HCWs (120, 47.4 %) believed that their exposure occurred in a hospital setting. Others believed that they were exposed in the home (48, 19 %), at health centres (45, 17.8 %), or at other types of health facilities (13, 5.1 %). Only 27 (10.7 %) of all HCW infections were associated with Ebola virus disease (EVD) isolation units. Over half (60 %, 150) of infected HCWs said they had been trained in infection prevention and control prior to their infection, whereas 34 % (85) reported that they had not been so trained.
This study demonstrated the perception that most HCW infections are associated with general health care and home settings and not with dedicated EVD settings, which should provide substantial reassurance to HCWs that measures in place at dedicated EVD facilities generally provide substantial protection when fully adhered to.
轶事证据表明，在塞拉利昂当前埃博拉疫情期间，医护人员持续感染埃博拉病毒的情况大多发生在埃博拉隔离病房以外的场所，而且医护人员感染的一定比例可能发生在工作场所以外。迫切需要更精确地界定医护人员感染埃博拉病毒的途径，以优化在当前及未来疫情期间降低风险的措施。
我们对2014年5月至12月期间塞拉利昂医护人员感染埃博拉病毒的情况进行了一项回顾性描述性研究。所使用的数据主要来自国家埃博拉数据库、通过对受感染医护人员进行结构化问卷调查开展的横断面调查以及对部分卫生领域利益相关者的关键信息访谈。
来自该国9个地区的293名医护人员参与了研究，其中277例（95%）为确诊感染埃博拉病毒病例，6例（2%）为疑似病例，10例（3%）为可能感染病例。超过半数受感染医护人员（153名）为护士；其他人员包括实验室工作人员（19名，6.5%）、医生（9名，3.1%）、清洁工和搬运工（9名，3.1%）、社区卫生官员（8名，2.7%）以及药剂师（2名，0.7%）。医护人员感染情况主要报告于西部地区（24.9%）、凯拉洪（18.4%）、凯内马（17.7%）和邦巴利（13.3%）地区。几乎半数受感染医护人员（120名，47.4%）认为他们是在医院环境中接触到病毒的。其他人认为他们是在家中（48名，19%）、卫生中心（45名，17.8%）或其他类型的卫生设施中（13名，5.1%）接触到病毒的。所有医护人员感染病例中只有27例（10.7%）与埃博拉病毒病（EVD）隔离病房有关。超过半数（60%即150名）受感染医护人员表示他们在感染之前接受过感染预防和控制方面的培训，而34%（85名）报告称他们没有接受过此类培训。
本研究表明，多数人认为医护人员感染与一般医疗保健和家庭环境有关，而非与专门的埃博拉病毒病环境有关，这应能让医护人员大为安心，即专门的埃博拉病毒病设施所采取的措施如能得到充分遵守，通常可提供充分保护。
