January 30, 2020

Health Care Workers, Most Vulnerable:

Advisory For Health Care Workers

In health-care settings, staff are most often exposed and referred to as the pointer to Lassa Fever. Therefore they should always apply standard infection prevention and control precautions when caring for patients, regardless of their presumed diagnosis. These include basic hand hygiene, respiratory hygiene, use of personal protective equipment (to block splashes or other contact with infected materials), safe injection practices and safe burial practices.

Health authorities at all levels to prioritise capacity-building of healthcare professionals on standard infection prevention and control measures.

Health-care workers caring for patients with suspected or confirmed Lassa fever should apply extra infection control measures to prevent contact with the patient’s blood and body fluids and contaminated surfaces or materials such as clothing and bedding. When in close contact (within 1 metre) of patients with Lassa fever, health-care workers should wear face protection (a face shield or a medical mask and goggles), a clean, non-sterile long-sleeved gown, and gloves (sterile gloves for some procedures).

According to Francis Faduyile, the President Nigeria Medical Association (NMA) in a signed statement, he appealed to health authorities at all levels to prioritise capacity-building of healthcare professionals on standard infection prevention and control measures.

Laboratory workers are also at risk. Samples taken from humans and animals for investigation of Lassa virus infection should be handled by trained staff and processed in suitably equipped laboratories under maximum biological containment conditions

Inappropriate use of personal protective equipment (PPE) such as gloves, masks and poor IPC practices, increase the risk of person to person transmission of Lassa fever. Other risk factors that can lead to health care worker infection include:

♣ Doctors, nurses and other health workers providing direct patient care without standard precautions.

♣ Hospital support staff cleaning or disinfecting contaminated surfaces, materials and supplies without adequate protective gear.

♣ Laboratory staff handling blood samples of patients without appropriate precautions.

♣ Medical or hospital support staff preparing and/or handling dead bodies of Lassa fever patients without appropriate precautions.

To reduce the risk of Lassa fever, the Nigeria Centre for Disease Control (NCDC) offers the following advice to all health care workers:

♣ Practice standard precautions at all times while handling patients and body fluids i.e. always perform hand hygiene at the designated five moments, wear the correct PPE based on the procedure to be performed, irrespective of provisional diagnosis of the patient.

♣ Appropriately dispose and disinfect items used by Lassa fever patients such as syringes, thermometers, beddings, clothing, cups, plates, spoons, etc. Ensure injectables and sharp items are disposed safely.

♣ Clean the hospital environment regularly using appropriate materials and methods.

♣ Dispose of all healthcare waste in a safe manner.

♣ Maintain a high index of suspicion for Lassa fever i.e. be vigilant and look out for Lassa fever symptoms. Remember, not all fevers are due to malaria.

♣ Test all suspected cases of malaria using Rapid Diagnostic Test (RDT). When the RDT is negative, other causes of febrile illness including Lassa fever should be considered and cases investigated accordingly.

Any febrile illness that has not responded to 48 hours use of anti-malaria or antibiotics should raise an index of suspicion for Lassa fever!

In 2019, Among 34 patients with Lassa fever, including 20 patients, six nurses, two surgeons, one physician, and the son of a patient, there were 22 deaths (65% fatality rate). Eleven cases were laboratory confirmed, five by isolation of virus. Most patients had been exposed in hospitals (attack rate in patients in one hospital 55%). Both outbreak hospitals were inadequately equipped and staffed, with poor medical practice. Compelling, indirect evidence revealed that parenteral drug rounds with sharing of syringes, conducted by minimally educated and supervised staff, fuelled the epidemic among patients. Staff were subsequently infected during emergency surgery and while caring for nosocomially infected patients. Conclusion—This outbreak illustrates the high price exacted by the practice of modern medicine, particularly use of parenteral injections and surgery, without due attention to good medical practice. High priority must be given to education of medical staff in developing countries and to guidelines for safe operation of clinics and hospitals. Failure to do so will have far reaching, costly, and ultimately devastating consequences.

In another case also, the infection of 14 health care workers that were not working in Lassa fever case management centers highlights the urgent need to strengthen infection prevention and control practices in all health care setting for all patients, regardless of their presumed diagnosis. Given the high number of states affected, the clinical management will likely happen in health centers that are not appropriately prepared to care for patients affected by Lassa fever and the risk of infection in health care workers will increase

Lassa fever is an acute viral haemorrhagic illness, transmitted to humans through contact with food or household items contaminated by infected rodents. Person-to-person transmission can also occur, particularly in hospital environment in the absence of adequate infection control measures. Health care workers in health facilities are particularly at risk of contracting the disease, especially where infection prevention and control procedures are not strictly adhered to.

Lassa fever can be prevented through practicing good personal hygiene and proper environmental sanitation. Effective measures include storing grain and other foodstuffs in rodent-proof containers, disposing of garbage far from the home, maintaining clean households, and other measures to discourage rodents from entering homes. Hand washing should be practiced frequently.

Health care workers are again reminded that Lassa fever presents initially like any other disease causing a febrile illness such as malaria; and are advised to practice standard precautions at all times, maintaining a high index of suspicion. Rapid Diagnostic Test (RDT) must be applied to all suspected cases of malaria. When the RDT is negative, other causes of febrile illness including Lassa fever should be considered. Accurate diagnosis and prompt treatment increase the chances of survival.

Family members who are providing care for patients with Lassa fever should take extra caution. In addition, States are encouraged to ensure safe and dignified burial practices for patients who die from Lassa fever.

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