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Level of IPC Knowledge and Practice in Hospitals Still Low in Sierra Leone after the 2014-2015 Ebola Outbreak

Majority of the people infected during the West Africa Ebola outbreak in Sierra Leone in 2014-2015 were health care service providers and majority of the Ebola incidence among health care workers were as a result of lack of personal safety gears such as personal protective equipment (PPE) or their improper use, as well as the poor handling and management of health care wastes. Because health care wastes are produced during the course of the duty by health care workers (HCWs), it is believed that these HCWs can play a major role in its management and disposals. Effective health care waste management and disposal includes the separation of the waste into groups in order to reduce its size for suitable handling and hence disposal. This segregation and containerization of wastes also reduces handling cost and hence reduce the risk of infection and accidental exposure. Three government referral hospitals based in the provinces and one government referral hospital based in the capital city (Free town) were selected for this study. All hospitals that took part in this study served as either an Ebola holding center or treatment center during the 2014-2015 West African Ebola outbreak. Four hundred and eighty-six nurses from four government referral hospitals in Sierra Leone were interviewed about IPC practice in their hospitals, health waste management and handling after the 2014 West Africa Ebola outbreak. The 486 nurses were recruited from the Bo Government Hospital (136), Kenema Government Hospital (140), Makeni Government Hospital (58) and Connaught Hospital (152) in Freetown. We interviewed HCWs about IPC practice, health care waste management and handling in their hospital using structured questionnaire. Majority (57%) of the HCWs were females and 80.45% were State Community Nurses. Majority (31%) of the HCWs interviewed worked at Connaught government hospital in Freetown. One hundred and seventeen (24%) CHWs said health care waste management and disposal are not relevant for breaking the infection chain while majority (83%) confirmed that health care wastes storage site was cleaned frequently. Three hundred and thirty-one (68%) indicated that CHWs’ waste management and disposals training are done through workshops and seminars, while only 1% say such training is done at only degree level. Majority (76%) of CHWs interviewed said health care waste management and disposal is not relevant to breaking infection chain. which is a worrying disclosure considering the fact that most nosocomial outbreaks in the hospitals could be traced to improper or lack of health care waste management and disposal system. This finding could be attributed to lack of policy implementation and or lack of IPC logistics in the health care facilities sampled considering the high knowledge relating to the sources of health care wastes among the CHWs interviewed. This study highlights the need for regular training of HCWs in the area of IPC as well as the emphasizes the significance of adequate clinical practice and health care waste management and disposal information dissemination in Sierra Leone hospitals. This study could serve as an important resource on clinical practice, IPC and health care waste management and disposal since health care wastes accounts for most injuries and infection amongst CHWs.

Author(s): Sulaiman Mandoh, Alhaji B Gogra, Isata Victoria Mandoh and Jia Bainga Kangbai

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