title: Ebola virus disease cases among health care workers not working in Ebola treatment units--Liberia, June-August, 2014.
abstract: West Africa is experiencing the largest Ebola virus disease (Ebola) epidemic in recorded history. Health care workers (HCWs) are at increased risk for Ebola. In Liberia, as of August 14, 2014, a total of 810 cases of Ebola had been reported, including 10 clusters of Ebola cases among HCWs working in facilities that were not Ebola treatment units (non-ETUs). The Liberian Ministry of Health and Social Welfare and CDC investigated these clusters by reviewing surveillance data, interviewing county health officials, HCWs, and contact tracers, and visiting health care facilities. Ninety-seven cases of Ebola (12% of the estimated total) were identified among HCWs; 62 HCW cases (64%) were part of 10 distinct clusters in non-ETU health care facilities, primarily hospitals. Early recognition and diagnosis of Ebola in patients who were the likely source of introduction to the HCWs (i.e., source patients) was missed in four clusters. Inconsistent recognition and triage of cases of Ebola, overcrowding, limitations in layout of physical spaces, lack of training in the use of and adequate supply of personal protective equipment (PPE), and limited supervision to ensure consistent adherence to infection control practices all were observed. Improving infection control infrastructure in non-ETUs is essential for protecting HCWs. Since August, the Liberian Ministry of Health and Social Welfare with a consortium of partners have undertaken collaborative efforts to strengthen infection control infrastructure in non-ETU health facilities.
authors.forename: Almea
authors.initials: A
authors.lastname: Matanock
authors.forename: M Allison
authors.initials: MA
authors.lastname: Arwady
authors.forename: Patrick
authors.initials: P
authors.lastname: Ayscue
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Forrester
authors.forename: Bethany
authors.initials: B
authors.lastname: Gaddis
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Hunter
authors.forename: Benjamin
authors.initials: B
authors.lastname: Monroe
authors.forename: Satish K
authors.initials: SK
authors.lastname: Pillai
authors.forename: Christie
authors.initials: C
authors.lastname: Reed
authors.forename: Ilana J
authors.initials: IJ
authors.lastname: Schafer
authors.forename: Moses
authors.initials: M
authors.lastname: Massaquoi
authors.forename: Bernice
authors.initials: B
authors.lastname: Dahn
authors.forename: Kevin M
authors.initials: KM
authors.lastname: De Cock
mesh_terms: D016000:Cluster Analysis; D058872:Epidemics; D006268:Health Facilities / Q000706:statistics & numerical data*; D006282:Health Personnel; D019142:Hemorrhagic Fever, Ebola / Q000175:diagnosis* / Q000453:epidemiology; D006801:Humans; D007988:Liberia / Q000453:epidemiology; D009784:Occupational Diseases / Q000175:diagnosis* / Q000453:epidemiology