1. Lutte contre l’infection : leçons à retenir dans le contexte de l’épidémie Ebola 26 Novembre 2015 21eme Journée Romande d’Hygiène Hospitalière Dr Constanza Vallenas Medical officer Epidemic Clinical Management Unit Department of Pandemic and Epidemic Diseases

2. Outline ➔ Ebola Virus Disease (EVD) timeline ➔ Clinical management actions related to IPC ➔ Lessons learned for IPC

5. A variety of IPC practices with potential for creating confusion ➔ April 2014: Key issues from the field −PPE −hand hygiene −disinfection/spraying Photo credit: D. Brett-Major ! !

7. Brief timeline of key Clinical Management actions and outcomes related to IPC Pocket Guide for clinical management of VHF - ~Oct 2013 – Feb 2014 Deployment of clinical experts – intensive care and ID physicians – and IPC experts - Mar 2014 + Training strategy for improved quality care and safety of patients, HCWs, others – three phases, including mentoring – (Aug) Oct 2014 + PPE rapid guidance & technical specifications – June-Oct 2014 ABHR: ETU, CCC Country adaptations and translations (French and Spanish) of Pocket Guide – Mar 2014 +

8. © World Health Organization 2015 8 Training on Clinical management and IPC for EVD (Oct ‘14 – Mar ’15) CountryPhase 1 & 2Phase 3 Non-Ebola Hospital Training TOTAL Liberia2040679602779 Sierra Leone13712381131722 Guinea3700 4538

9. ➔ To be used by HWs providing clinical care for patients with filovirus infection ➔ Process started in June 2014 ➔ Published in October 2014 PPE - WHO recommendations and technical specifications http://apps.who.int/iris/bitstream/10665/137410/1/WHO_EVD_Guidance_PPE_14.1_eng.pdf

10.  It is most important to have PPE which protects the mucosae – mouth, nose and eyes – from contaminated droplets and fluids.  Hands are known to transmit pathogens to other parts of the body or face and to other individuals. Therefore, hand hygiene and gloves are essential, both to protect the health worker and to prevent transmission to others.  Provide the best possible protection against filovirus infection while allowing HCWs to provide the best possible care to patients with maximum ease, dexterity, comfort and minimal heat-associated stress. Guiding principles for PPE recommendations

11. Posters based on guidelines: “how to” http://who.int/csr/resources/publications/ebola/ppe-steps/en/

12. Key lessons learned for infection prevention and control (IPC) from the Ebola outbreak 1.Inadequate basic IPC measures and infrastructures both in the community and in health care settings −Inadequate culture of self-protection: community and HCWs

13. IPC assessments in 113 healthcare facilities in Liberia (February 2015) FP: focal point; IS: injection safety; WMS: waste management system 68% 32%

14. Key lessons learned for infection prevention and control (IPC) from the EVD outbreak 1.Inadequate basic IPC measures and infrastructures both in the community and in health care settings 2.Strong coordination is needed within and among institutions at all levels

16. Key lessons learned for infection prevention and control (IPC) from the EVD outbreak 1.Inadequate basic IPC measures and infrastructures both in the community and in health care settings 2.Strong coordination is needed within and among institutions at all levels 3.Fear is a key challenge for the development and implementation of evidence-based guidelines – especially when facing an unknown danger

17. Clarity about transmission was helpful

18. Key lessons learned for infection prevention and control (IPC) from the EVD outbreak 1.Inadequate basic IPC measures and infrastructures both in the community and in health care settings 2.Strong coordination is needed within and among institutions at all levels 3.Fear is a key challenge for the development and implementation of evidence-based guidelines – especially when facing an unknown danger 4.During outbreaks, health-care workers are at a higher risk of exposure than the general population

19. HCWs infected with EVD in main affected countries CountryCasesDeaths Incidence compared to non-HCWs Guinea19610042.2 times 1 Liberia*378192 Sierra Leone307221 ‡ 103 times 2 Total881513 © World Health Organization 2015 19 Data are confirmed cases and deaths only, apart from deaths in Sierra Leone, which include confirmed, probable, and suspected deaths. *Data are until 9 May. ‡ Data as of 17 February. 1 Grinnell M et al. MMWR Oct 2015. 64(38):1083-7 2 Kilmarx P et al. MMWR Dec 2014. 63(49);1168-1171 http://apps.who.int/ebola/current-situation/ebola-situation-report-21-october-2015

20. Key lessons learned for infection prevention and control (IPC) from the EVD outbreak 1.Inadequate basic IPC measures and infrastructures both in the community and in health care settings 2.Strong coordination is needed within and among institutions at all levels 3.Fear is a key challenge for the development and implementation of evidence-based guidelines – especially when facing an unknown danger 4.During outbreaks, health-care workers are at a higher risk of exposure than the general population 5.When an outbreak is declared it is too late to establish an IPC programme – and it may be an opportunity to place it high on the public health agenda

21. World Health Organization 20 Avenue Appia 1211 Geneva 27 Switzerland Department of Pandemic and Epidemic Diseases Epidemic Clinical Management unit Constanza Vallenas Medical officer Email vallenasc@who.int http://www.who.int/csr/disease/http://www.who.int/csr/disease/en Thank you! Merci !