Initiation of a ring approach to infection prevention and control at non-Ebola health care facilities - Liberia, January-February 2015

Abstract

From mid-January to mid-February 2015, all confirmed Ebola virus disease (Ebola) cases that occurred in Liberia were epidemiologically linked to a single index patient from the St. Paul Bridge area of Montserrado County. Of the 22 confirmed patients in this cluster, eight (36%) sought and received care from at least one of 10 non-Ebola health care facilities (HCFs), including clinics and hospitals in Montserrado and Margibi counties, before admission to an Ebola treatment unit. After recognition that three patients in this emerging cluster had received care from a non-Ebola treatment unit, and in response to the risk for Ebola transmission in non-Ebola treatment unit health care settings, a focused infection prevention and control (IPC) rapid response effort for the immediate area was developed to target facilities at increased risk for exposure to a person with Ebola (Ring IPC). The Ring IPC approach, which provided rapid, intensive, and short-term IPC support to HCFs in areas of active Ebola transmission, was an addition to Liberia's proposed longer term national IPC strategy, which focused on providing a comprehensive package of IPC training and support to all HCFs in the country. This report describes possible health care worker exposures to the cluster's eight patients who sought care from an HCF and implementation of the Ring IPC approach. On May 9, 2015, the World Health Organization (WHO) declared the end of the Ebola outbreak in Liberia.

FIGURE

Health care workers (HCWs) with exposure to eight Ebola patients at non-Ebola treatment units and targeted infection prevention and control (Ring IPC) initiation — Montserrado and Margibi counties, Liberia, January–February 2015 Abbreviations: IN = index patient for St. Paul Bridge cluster; 1A and 1D = other patients identified as first generation of cluster; 2D, 2E, 2G, and 2I = patients identified as second generation; 3C = patients identified as third generation. * A sister of patient 1A who worked at Clinic B was exposed in her role as family caregiver. ^† 3C, one of the 2 HCWs under quarantine at home, sought care at his place of employment while symptomatic. ^§ The home-based quarantine period was extended for 3 patients previously under home-based quarantine from exposure to 3C.