Annotated Bibliography

Ostergard, R. L. (2020). The West Africa Ebola outbreak (2014-2016): a Health Intelligence failure? Intelligence and National Security, 35(4), 477–492.

https://doi.org/10.1080/02684527.2020.1750136

This article takes a different perspective on the rationale behind why healthcare workers were becoming infected with Ebola during the 2014-2016 outbreak in that this article focuses on intelligence and the sharing of intelligence to aid the care being provided to these patients. The article identifies a lack of sharing information and a lack of trust among information being shared that could be the reason for an increase in healthcare worker infections due to the lack of information and increased distrust of information being shared. The intelligence community was gathering data and sharing the information in a silo rather than openly providing valuable information to the healthcare workers providing care to the patients. The lack of information and mistrust increases the risk of healthcare worker exposure due to lack of knowledge.

Saskia, D. B., Constanza, V., Mauricio, F., & Norris, S. L. (2018). Incorporating health workers’ perspectives into a WHO guideline on personal protective equipment developed during an Ebola virus disease outbreak. F1000Research, 7

https://doi.org/10.12688/f1000research.12922.1

This article takes the healthcare worker’s perspective on the World Health Organization’s personal protective equipment (PPE) guidelines for Ebola virus disease. The article gathers information from the healthcare workers perspective illustrating a lack of knowledge and understanding about the PPE and Ebola transmission. The article identifies a lack of adherence to guidelines based on feeling “removed” from the patient and the uncomfortable nature of the equipment being used. The article also identifies a lack of PPE available for use for healthcare workers providing care to Ebola patients. The healthcare workers identified that PPE was invaluable however, the uncomfortable nature of PPE and the lack of personal connection to patients led to lack in infection prevention practices.

MacIntyre, C. R., Chughtai, A. A., Seale, H., Richards, G. A., & Davidson, P. M. (2014). Respiratory protection for healthcare workers treating Ebola virus disease (EVD): Are facemasks sufficient to meet occupational health and safety obligations?

https://doi.org/10.1016/j.ijnurstu.2014.09.002

This article discusses the conflicting information provided by the world leaders for managing patients with Ebola in relation to respiratory protection. The authors identify the varying types of respiratory protection utilized by healthcare workers and compare this information to the known infection prevention practices for Ebola. The article references the World Health Organization and Centers for Disease Control and Prevention for healthcare worker and laboratory personnel and compare this information further with international practices and recommendations from Doctors without Boarders, Australia, the United Kingdom, Belgium, and South Africa. The authors identify varying practices for the management of patients with Ebola for healthcare workers. The authors conclude based on the information provided that healthcare workers should be utilizing respirators instead of masks to prevent the spread of Ebola to the healthcare workers while providing care to patients. The authors determine that the information associated with the cause of spread of Ebola and the risks associated with Ebola that healthcare providers should be in respirators to prevent healthcare exposure during patient care.

Forrester, J. D., Hunter, J. C., Pillai, S. K., Arwady, M. A., Ayscue, P., Matanock, A., Monroe, B., Schafer, I. J., Nyenswah, T. G., & De Cock, K. M. (2014). Cluster of Ebola Cases Among Liberian and U.S. Health Care Workers in an Ebola Treatment Unit and Adjacent Hospital — Liberia, 2014. MMWR. Morbidity and Mortality Weekly Report, 63(41), 925–929.

This article analyzed healthcare providers who acquired Ebola to determine how these providers may have contracted the infection. Three areas were identified as areas of concern that could have led to the spread of Ebola and the possible infection of the healthcare workers under investigation which included lack of screening for Ebola in the emergency department, symptom monitoring was not routine for staff providing direct patient care to the Ebola infected patients, and the last finding was contact between biocontainment workers and the rest of the hospital was not limited allowing biocontainment unit staff free access to the entire hospital and other staff members. The authors determined there was no evidence to support transmission of Ebola during direct patient care due to no lapses in personal protective equipment use or contact with potentially contaminated surfaces. Cleaning/ disinfecting practices to other areas in the hospital where biocontainment unit staff were allowed to access and go during working hours was not routinely cleaned and posed an increased risk for cross contamination and infection of other healthcare workers. Known areas of potential patient exposure such as in the emergency department were not cleaned according to the strict protocols that were adhered to in the biocontainment unit posing another source of possible cross contamination.

Gee, S., & Skovdal, M. (2017). Navigating ‘riskscapes’: The experiences of international health care workers responding to the Ebola outbreak in West Africa. Health & Place, 45, 173–180.

https://doi.org/10.1016/j.healthplace.2017.03.016

This article identifies the perception of risk among healthcare providers providing care to patients with Ebola during the 2014-2016 outbreak. The information identified in this article shines light on the potential risks associated with identification and management of Ebola patients among healthcare workers in that they do not feel at risk and often focus on other diseases as potential causes of illness rather than “jumping” to the conclusion that the patients could potentially have Ebola. This lack of risk leads to poor infection prevention practices and decreased identification of potential Ebola patients which leads to increased risk of exposure to Ebola among healthcare workers while diagnostics are pending.

Faye, O., Boëlle, P.-Y., Heleze, E., Faye, O., Loucoubar, C., Magassouba, N., Soropogui, B., Keita, S., Gakou, T., Bah, E. H. I., Koivogui, L., Sall, A. A., & Cauchemez, S. (2015). Chains of transmission and control of Ebola virus disease in Conakry, Guinea, in 2014: an observational study. The Lancet Infectious Diseases, 15(3), 320–326.

https://doi.org/10.1016/S1473-3099(14)71075-8

This article analyzes data from interviews with probable and confirmed Ebola patients to determine mode of transmission. The study takes a deep look into the epidemiological investigations associated with the 2014-2016 Ebola outbreak to determine how exactly the disease was spreading so quickly. The study reconstructs the epidemiological pathways to illustrate possible sources of exposure to help one understand further the transmission process of Ebola. The study identified multiple sources of possible transmission ranging from funerals to hospital visits/stays and patient management among healthcare workers. This study helps to provide an detailed explanation to the mode of transmission possibilities associated with the Ebola outbreak in 2014-2016.

Ratnayake, R., Ho, L. S., Ansumana, R., Brown, H., Borchert, M., Miller, L., Kratz, T., McMahon, S. A., & Sahr, F. (2016). Improving Ebola infection prevention and control in primary healthcare facilities in Sierra Leone: a single-group pretest post-test, mixed-methods study. BMJ Global Health, 1(4), e000103–e000103.

https://doi.org/10.1136/bmjgh-2016-000103

This is a mixed-method study looking into infection prevention and control measures among healthcare facilities providing care to Ebola patients in Sierra Leone. The study identifies multiple gaps in practices related to infection prevention. The study asked healthcare workers a series of questions related to personal protective equipment (PPE) donning and doffing practices, perceptions of PPE, and tested the knowledge base of the healthcare workers on Ebola transmission. The study identified multiple different perceptions and practices among healthcare workers even though a policy was in place. Many healthcare workers were identified as being complacent with practices due to being uncomfortable or lack of knowledge regarding transmission of Ebola. This study only looked at healthcare workers in Sierra Leone who did not become infected with Ebola during the 2014-2016 outbreak.