Infection prevention and control measures for Ebola disease and their outcomes from the perspective of health care workers: a mixed-methods study

BACKGROUND: This study assessed health care workers (HCWs) perspectives related to eight infection prevention and control (IPC) measures (three personal protective equipment (PPE) and five decontamination and disinfection) for Ebola disease discussed during WHO guideline development. METHODS: We conducted a mixed-methods study guided by the Evidence to Decision framework, targeting HCWs involved in managing patients. We assessed: (1) the value of preventing transmission of Orthoebolavirus, adverse effects of PPE and chlorine exposure; (2) perspectives on resource, health equity, feasibility, and acceptability of IPC measures. RESULTS: Analysis included 73 survey respondents and 16 interviews. Preventing risk of transmission was critical (90%), due to high fatality. Side effects of chlorine (49%) and PPE (38%) were critical due to irritation and heat stress, but benefits outweighed harms. Covering head, neck, and mucous membranes was more acceptable (72%) than covering mucous membranes only as it enhances safety but is more costly (49%). Use of disposable PPE versus reusable raised equity concerns (62%) due to supply sustainability. Goggles under vs. over the hood was less feasible (55%) as they restrict visibility for those wearing glasses. Spraying was less acceptable (67%) than wiping as the latter is more effective. Spraying HCWs during doffing was less acceptable (57%) due to risk of transmission. Out of four options, removing outer and inner glove was less acceptable (70%) to avoid exposing the skin. Hand hygiene trade-offs between alcohol-based hand rub (ABHR), chlorine, and soap & water varied, 45% found ABHR more acceptable, less pungent and kills the virus, but is resource-intensive (58%). Incineration was more acceptable (59%) and feasible (58%) than disinfection, but incinerator is costly. CONCLUSION: This study highlighted variability in acceptability, feasibility, and equity concerns for IPC measures. Discussion of those findings during guideline development was crucial to increase applicability and acceptability by end users.