Protecting a healthcare facility during the Ebola outbreak: preparedness, mitigation, and continuity of care in Sierra Leone

Abstract

Background: The indirect effects of epidemics on healthcare systems may cause harm equal to or greater than that of the pathogens themselves, as observed in both the COVID-19 pandemic and outbreaks of Ebola virus disease (EVD). Preparedness and the timely implementation of prevention and mitigation measures are therefore essential to limit indirect morbidity and mortality and to ensure the continuity of essential healthcare services during epidemics.

Methods: This retrospective observational before-during-after study was conducted at the EMERGENCY Surgical and Paediatric Centre in Goderich (Freetown, Sierra Leone) to assess the effectiveness of control and mitigation measures in preventing Ebola virus disease (EVD) transmission among patients and healthcare workers, as well as in maintaining hospital operational capacity during the outbreak.

Results: Between July 2014 and June 2015, 31,473 patients were screened before accessing the hospital. 88 were identified as suspected EVD cases, 19 of whom were subsequently confirmed, including one surgical emergency treated in isolation, and referred to an Ebola Treatment Centre. Paediatric and surgical services continued with only limited reductions; the outbreak mainly led to reduced access to outpatient services. In the post-EVD period, hospital activity returned to or exceeded pre-EVD levels. No undiagnosed EVD patients were admitted, no secondary transmission occurred within the hospital, and no healthcare workers (0/406) acquired EVD.

Conclusions: The EMERGENCY Surgical and Paediatric Centre in Goderich was kept Ebola-free at a time when many hospitals in the country were forced to close or substantially reduce activity. Timeliness, leadership, rapid implementation of comprehensive prevention and mitigation measures, and sustained attention to the health and retention of healthcare workers were key to success. These measures enabled the continuity of essential surgical and paediatric services while preventing in-hospital transmission. This field-validated approach identifies that hospitals can remain operational during epidemics in high-risk settings and informs preparedness programmes.