S.O. Martins and A.O. Osiyemi
Department of Family Medicine, University College Hospital, Ibadan, Nigeria
Introduction: Ebola virus disease (EVD) is a highly contagious viral infection that requires a high risk perception and practice of good hand hygiene by regular hand washing or use of hand sanitizers for infection control at all time. The declaration of Nigeria as an Ebola-free country by the World Health Organization on the 20th of October, 2014 has prompted many Nigerians, including healthcare workers, to discontinue the regular practice of good hand hygiene which was commonplace during the EVD outbreak.
Objectives: The study assessed hand hygiene practices for infection control after the West African Ebola virus disease outbreak in a Nigerian teaching hospital.
Methods: This study was cross-sectional in design. A total of 450 staff of the University College Hospital, Ibadan participated in the survey. Data was collected using a structured, self-administered questionnaire. Chi-square test and multivariate logistic regression were used to determine associations between predictors of good hand hygiene practice at 5% level of significance.
Result: The mean age was 42.2 ± 8.6 years. A higher proportion of respondents in this study had a good knowledge of the risk factors of EVD; good knowledge of the precautionary measures against EVD and a good risk perception towards EVD. However, the majority of respondents, 359 (80.0%), had a poor practice of hand hygiene for infection control. Having good knowledge of risk factors and precautionary measures against EVD was associated with practice of good hand hygiene. Respondents with good risk perception of EVD were 1.63 times more likely to practice good hand hygiene (OR= 1.63; 95% CI= 1.20 – 4.38; p= 0.019).
Conclusion: There was a good knowledge of risk factors and precautionary measures of EVD among staff of the University College Hospital, Ibadan. However, the majority of respondents had a poor practice of hand hygiene for infection control, Post EVD. Sensitization workshops to promote the regular practice of good hand hygiene is recommended for healthcare workers to control infection from EVD.
Keywords: Hand hygiene, Ebola virus disease, University College Hospital.
Dr. S.O. Martins
Department of Family Medicine,
University College Hospital,
Ibadan, Oyo State,
Telephone – 08032129690
Ebola virus disease (EVD) is an infectious viral disease characterized by a high case-fatality rate which may be as high as 90%.1,2 Ebola virus may be acquired during contact with blood or body fluids of an infected animal, commonly monkeys or fruit bats.2 Once human infection occurs, the disease may spread among humans usually associated with direct contact with infected persons (or the bodies of persons who have died from EVD). Also, direct contact with body fluids from EVD patients may result in the disease.2,3 Ebola virus disease typically occurs in outbreaks in tropical regions of Sub-Saharan Africa.4,5
In March 2014, the World Health Organization (WHO) reported a major EVD outbreak in West Africa; the largest ever documented.6 The first laboratory confirmed case of EVD in Nigeria was on the 23th July, 2014 and the country was officially declared free of EVD on 20th October, 2014 by the WHO.7 However, the threat posed by EVD is yet to be over as the disease is still present in West Africa. The Centers for Disease Control and Prevention (CDC) recently indicated on 14th June, 2016 that there were flare-ups of EVD in Sierra Leone, Guinea and Liberia, since the control of its initial outbreak which appear to be related to viral persistence in survivors.8
There is no Ebola virus-specific treatment as treatment is primarily supportive in nature.9 However, there a number of recommended precautionary measures to be taken by the caregivers of persons suspected to have EVD. These include isolation of the patient, good hand hygiene by regular hand washing or use of hand sanitizers and wearing personal protective equipment (PPE) for infection control.10,11 Most States in Nigeria established isolation and intensive care units in hospital facilities to manage cases of EVD during the outbreak. Health workers were also encouraged to practice the recommended precautionary measures against EVD, such as wearing of personal protective equipment (PPE), frequent hand washing or use of hand sanitizers at all times. These efforts served as part of emergency preparedness during the EVD outbreak such that hospitals could provide treatment of EVD cases and promote infection control. During the EVD outbreak, the prospective patients of the University College Hospital, Ibadan had an initial temperature at various entry points of the hospital while patients with fever and symptoms related to those noted among EVD patients were isolated and attended to in a temporary holding bay where they would undergo further blood screening for viral hemorrhagic fever. The management of the Hospital also organized several grand rounds, lectures and seminars on EVD to sensitize all workers.
Nevertheless, post-declaration of Nigeria as an Ebola free country by the WHO, many Nigerians, including health care workers discontinued the practice of recommended precautionary measures which were commonplace during the outbreak. Research however shows that hospital workers with a poor hand hygiene or those who do not wear appropriate PPE are particularly vulnerable as they are often the direct primary contacts of patients suspected with EVD.10,12 Nosocomial outbreaks of EVD are characterized by a relatively high proportion of deaths amongst healthcare workers and as of 28th June 2015, a total of 869 health workers have contracted EVD in Sierra Leone, Guinea and Liberia since the latest outbreak began, with 58% reported death.13
In addition to having deaths amongst healthcare workers, hospital-based outbreaks in settings with low standards of hygiene and sanitation are a source of EVD epidemic amplification, especially if barrier nursing techniques and universal hygiene measures are not adequately observed by healthcare workers.12 A knowledge gap exists about the level of hand hygiene for infection control following outbreak of Ebola virus disease among staff in hospital settings in Nigeria. The aim of the study therefore was to assess the level of hand hygiene following outbreak of Ebola virus disease among staff of the University College Hospital, Ibadan.