John F. Kennedy Medical Centre, 1000 Monrovia, Liberia.
Emergency Medicine, School of Medicine, University of California, San Francisco, CA 94110, USA.
Int J Environ Res Public Health. 2021 Mar 25;18(7):3409. doi: 10.3390/ijerph18073409.
Fourteen years of civil war left Liberia with crumbling infrastructure and one of the weakest health systems in the world. The 2014-2015 Ebola virus disease (EVD) outbreak exposed the vulnerabilities of the Liberian health system. Findings from the EVD outbreak highlighted the lack of infection prevention and control (IPC) practices, exacerbated by a lack of essential services such as water, sanitation, and hygiene (WASH) in healthcare facilities. The objective of this intervention was to improve IPC practice through comprehensive WASH renovations conducted at two hospitals in Liberia, prioritized by the Ministry of Health (MOH). The completion of renovations was tracked along with the impact of improvements on hand hygiene (HH) practice audits of healthcare workers pre- and post-intervention. An occurrence of overall HH practice was defined as the healthcare worker practicing compliant HH before and after the care for a single patient encounter. Liberia Government Hospital Bomi (LGH Bomi) and St. Timothy Government Hospital (St. Timothy) achieved World Health Organization (WHO) minimum global standards for environmental health in healthcare facilities as well as Liberian national standards. Healthcare worker (HCW) overall hand hygiene compliance improved from 36% (2016) to 89% (2018) at LGH Bomi hospital and from 86% (2016) to 88% (2018) at St. Timothy hospital. Improved WASH services and IPC practices in resource-limited healthcare settings are possible if significant holistic WASH infrastructure investments are made in these settings.
十四年的内战使利比里亚的基础设施支离破碎，其卫生系统成为世界上最薄弱的系统之一。2014-2015 年埃博拉病毒病（EVD）疫情暴露了利比里亚卫生系统的脆弱性。疫情爆发的调查结果强调了感染预防和控制（IPC）措施的缺乏，而医疗机构缺乏水、环境卫生和个人卫生（WASH）等基本服务则使情况更加恶化。该干预措施的目的是通过在利比里亚的两家医院进行全面的 WASH 翻新来改善 IPC 实践，这些医院是卫生部（MOH）确定的优先医院。翻新的完成情况以及改进措施对医护人员 HH 实践审计的影响都进行了跟踪，即在干预前后对医护人员进行单次患者接触前后的 HH 实践进行审计。总体 HH 实践的发生定义为医护人员在为单个患者提供护理前后都遵守 HH 规范。利比里亚邦米政府医院（LGH Bomi）和圣提摩太政府医院（St. Timothy）达到了世界卫生组织（WHO）对医疗机构环境卫生的最低全球标准以及利比里亚国家标准。医护人员总体手部卫生合规性从 LGH Bomi 医院的 36%（2016 年）提高到 89%（2018 年），从圣提摩太医院的 86%（2016 年）提高到 88%（2018 年）。如果在这些环境中对 WASH 基础设施进行重大的整体投资，那么在资源有限的医疗机构中改善 WASH 服务和 IPC 实践是可行的。
