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Quantifying the risk of nosocomial infection within Ebola Holding Units: a retrospective cohort study of negative patients discharged from five Ebola Holding Units in Western Area, Sierra Leone
Author(s) -
Arkell Paul,
Youkee Daniel,
Brown Colin S.,
Kamara Abdul,
Kamara Thaim B.,
Johnson Oliver,
Lado Marta,
George Viginia,
Koroma Fatmata,
King Matilda B.,
Parker Benson E.,
Baker Peter
Publication year - 2017
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12802
Subject(s) - sierra leone , medicine , ebola virus , cohort , emergency medicine , retrospective cohort study , outbreak , pediatrics , disease , virology , development economics , economics
Objectives A central pillar in the response to the 2014 Ebola virus disease ( EVD ) epidemic in Sierra Leone was the role of Ebola Holding Units ( EHU s). These units isolated patients meeting a suspect case definition, tested them for EVD , initiated appropriate early treatment and discharged negative patients to onward inpatient care or home. Positive patients were referred to Ebola Treatment Centres. We aimed to estimate the risk of nosocomial transmission within these EHU s. Methods We followed up a cohort of 543 patients discharged with a negative EVD test from five EHU s in the Western Area, Sierra Leone, and examined all line‐listed subsequent EVD tests from any facility in the Western Area to see whether the patient was retested within 30 days, matching by name, age and address. We defined possible readmissions as having the same name and age but uncertain address, and confirmed readmissions where name, age and address matched. Results We found a positive readmission rate of 3.3% (18 cases), which included 1.5% confirmed readmissions (8 cases) and 1.8% possible readmissions (10 cases). This is lower than rates previously reported. We cannot ascertain whether EVD was acquired within the EHU s or from re‐exposure in the community. No demographic or clinical variables were identified as risk factors for positive readmission, likely due to our small sample size. Conclusions These findings support the EHU model as a safe method for isolation of suspect EVD patients and their role in limiting the spread of EVD .