title: Use of protective gear and the occurrence of occupational Marburg hemorrhagic fever in health workers from Watsa health zone, Democratic Republic of the Congo.
abstract: BACKGROUND
  Occupational transmission to health workers (HWs) has been a typical feature of Marburg hemorrhagic fever (MHF) outbreaks. The goal of this study was to identify cases of occupational MHF in HWs from Durba and Watsa, Democratic Republic of the Congo; to assess levels of exposure and protection; and to explore reasons for inconsistent use of protective gear.
  
  
  METHODS
  A serosurvey of 48 HWs who cared for patients with MHF was performed. In addition, HWs were given a questionnaire on types of exposure, use of protective gear, and symptoms after contact. Informal and in-depth interviews with HWs were also performed.
  
  
  RESULTS
  We found 1 HW who was seropositive for MHF, in addition to 5 cases of occupational MHF known beforehand; 4 infections had occurred after the introduction of infection control. HWs protected themselves better during invasive procedures (injections, venipuncture, and surgery) than during noninvasive procedures, but the overall level of protection in the hospital remained insufficient, particularly outside of isolation wards. The reasons for inconsistent use of protective gear included insufficient availability of the gear, adherence to traditional explanatory models of the origin of disease, and peer bonding with sick colleagues.
  
  
  CONCLUSIONS
  Infection control must not focus too exclusively on the establishment of isolation wards but should aim at improving overall hospital hygiene. Training of HWs should allow them to voice and discuss their doubts and prepare them for the peculiarities of caring for ill colleagues.
authors.affiliation: Epidemiology and Disease Control Unit, Institute of Tropical Medicine, Antwerp, Belgium. matthias.borchert@lshtm.ac.uk
authors.forename: Matthias
authors.initials: M
authors.lastname: Borchert
authors.forename: Sabue
authors.initials: S
authors.lastname: Mulangu
authors.forename: Pierre
authors.initials: P
authors.lastname: Lefevre
authors.forename: Antoine
authors.initials: A
authors.lastname: Tshomba
authors.forename: Modeste L
authors.initials: ML
authors.lastname: Libande
authors.forename: Amayo
authors.initials: A
authors.lastname: Kulidri
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Muyembe-Tamfum
authors.forename: Patrick
authors.initials: P
authors.lastname: Van der Stuyft
mesh_terms: D000818:Animals; D015023:Democratic Republic of the Congo / Q000453:epidemiology; D004196:Disease Outbreaks; D017575:Gloves, Protective; D006282:Health Personnel / Q000706:statistics & numerical data; D006801:Humans; D007407:Interviews as Topic; D008379:Marburg Virus Disease / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D009784:Occupational Diseases / Q000517:prevention & control / Q000821:virology; D011481:Protective Clothing