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Infection prevention and control 

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  An unpublished assessment of infection prevention control in health facilities in Nigeria with Lassa fever treatment centres during the 2018 epidemic showed that other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

Resources

World Health Organisation: Lassa fever in Sierra Leone

This is an update on Lassa fever in Sierra Leone from the 14th June 1996. 

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Lassa fever: Epidemiology, clinical features, and social consequences

This resource describes the epidemiology of Lassa fever and its vector, as well as the clinical course and management of the disease. It then reports on current treatment efforts, surveillance and disease control before presenting community perspectives through a knowledge, attitude and practice survey and a qualitative study.  

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Nigeria Centre for Disease Control (NCDC): Standard operating procedures for Lassa fever case management

This resource describes the standard operating procedures for Lassa fever case management as outlined by the Nigeria Centre for Disease Control.

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Lassa fever

In a study of Lassa fever in Sierra Leone, West Africa, this paper identifies two variables associated with a high risk of death, and evaluates the efficacy of ribavirin and Lassa virus–convalescent plasma for the treatment of Lassa fever.

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Safe intensive-care management of a severe case of Lassa fever with simple barrier nursing techniques

This resource describes the case-management of Lassa fever in a specific patient and the difficulties encountered in repatriating her for diagnosis and management, which is unavailable in Sierra Leone, are described.The experience with this case has implications for the medical care and safe handling of Lassa fever in both endemic and nonendemic areas.

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