Water, Sanitation and Hygiene (WASH) Activities at Two Ebola Treatment Units in Sierra Leone: A Retrospective Cohort Study

Like other infectious disease interventions, Ebola virus disease (EVD) outbreak interventions require efficiently designed and operated treatment facilities to ensure a low risk of nosocomial infection and easy-to-maintain monitoring of WASH/infection prevention control (IPC) practices. International Medical Corps, in collaboration with Brown University, conducted a retrospective cohort study by analyzing WASH/IPC activity data routinely recorded on paper forms or white boards at Ebola treatment units (ETUs) during the outbreak and later merged into a database from two International Medical Corps-run ETUs in Sierra Leone between December 2014 and December 2015. The findings highlight parameters key to designing and maintaining an ETU: high-concentration chlorine solution usage was highly correlated with both daily patient occupancy and high-risk zone staff entries; low-concentration chlorine usage was less well explained by these measures. There is high demand for laundering and disinfecting of personal protective equipment (PPE) daily and approximately one (zero to four) piece of PPE is damaged each day. Even for organizations and individuals with significant humanitarian logistics and supply chain experience, the unique factors involved in managing an ETU during an EVD outbreak require special consideration. The key findings from this study, as well as lessons learned with regards to data collection, will inform the planning, organizing and managing of ETUs in future Ebola or other infectious disease outbreak. This research provides estimates on the amount of chlorine and personal protective equipment required to manage an ETU during a future Ebola epidemic, based on the anticipated size and staffing of the ETU.