When preventing infection in health care settings there is an ideal hierarchy of interventions, beginning with the design of clinical spaces that reduce opportunities for spread of infection, followed by administrative controls such as safe work practices, and finally the use of Personal Protective Equipment (PPE) used to keep a barrier between the caregiver and patient. Especially in resource poor settings, most emphasis is on changing work practices and using PPE, which is not the most effective infection prevention control (IPC) measure but has the least initial capital expenditure. When PPE is the primary control measure, as in most settings where Lassa fever is endemic, it means that the effectiveness of infection prevention control depends on individual health care workers being trained properly and using PPE correctly every time.
Infection prevention and control is not only a technical matter it is also a behavioural issue. Protective equipment often has complex social meanings. It can symbolise protection, or modernity, but also can be a symbol of detachment. Patients can be frightened when they see clinical staff dressed in PPE and health workers are sometimes reluctant to use PPE when caring for their own colleagues because this can signal a lack of care. Social science research shows us that we need to understand both how PPE is used, and what it means in specific social contexts.
Insights from the Ebola epidemic and Lassa outbreaks in Nigeria have also shown that IPC investments are often focused on treatment centres and isolation wards where confirmed viral haemorrhagic fever patients are being treated, often within larger hospital settings. Other health care workers in the hospital are often at greater risk of being infected, because they don’t perceive themselves to be at as much risk as those working in specialist centres or wards, and don’t take us much care in the use of IPC, even though they are often the first point of care. An unpublished assessment of infection prevention control in health facilities in Nigeria with Lassa fever treatment centres during the 2018 epidemic showed that other workers in other parts of the hospitals were at higher risk of getting infected with Lassa fever compared to workers in the treatment centres, suggesting that universal precautions were not being practiced equally carefully in settings considered to be ‘lower risk’.
[INSERT REF FROM PROF JEGEDE] This study explores risks experienced by health workers during an outbreak of Lassa Fever in Nigeria in the early 1990s. It highlights lack of equipment and poorly resourced hospitals as causes of hospital-based infection