Potential Exposure to Ebola Virus from Body Fluids due to Ambulance Compartment Permeability in Sierra Leone.
BACKGROUND
Prehospital care, including patient transport, is integral in the patient care process during the Ebola response. Transporting ill persons from the community to Ebola care facilities can stop community spread. Vehicles used for patient transport in infectious disease outbreaks should be evaluated for adequate infection prevention and control.


OBJECTIVE
An ambulance driver in Sierra Leone attributed his Ebola infection to exposure to body fluids that leaked from the patient compartment to the driver cabin of the ambulance.


METHODS
A convenience sample of 14 vehicles used to transport patients with suspected or confirmed Ebola in Sierra Leone were assessed. The walls separating the patient compartment and driver cabin in these vehicles were evaluated for structural integrity and potential pathways for body fluid leakage. Ambulance drivers and other staff were asked to describe their cleaning and decontamination practices. Ambulance construction and design standards from the National Fire Protection Association, US General Services Administration, and European Committee on Standardization (CEN) were reviewed.


RESULTS
Many vehicles used by ambulance staff in Sierra Leone were not traditional ambulances, but were pick-up trucks or sport-utility vehicles that had been assembled or modified for patient transport. The wall separating the patient compartment and driver cabin in many vehicles did not have a waterproof seal around the edges. Staff responsible for cleaning and disinfection did not thoroughly clean bulk body fluids with disposable towels before disinfection of the patient compartment. Pressure from chlorine sprayers used in the decontamination process may have pushed body fluids from the patient compartment into the driver cabin through gaps around the wall. Ambulance design standards do not require a waterproof seal between the patient compartment and driver cabin. Sealing the wall by tightening or replacing existing bolts is recommended, followed by caulking of all seams with a sealant.


CONCLUSIONS
Waterproof separation between the patient compartment and driver cabin may be essential for patient transport vehicles in infectious disease outbreaks, especially when chlorine sprayers are used for decontamination or in resource-limited settings where cleaning supplies may be limited.
1Epidemic Intelligence Service,Centers for Disease Control and Prevention (CDC),Atlanta,GeorgiaUSA.
Megan L
ML
Casey
1Epidemic Intelligence Service,Centers for Disease Control and Prevention (CDC),Atlanta,GeorgiaUSA.
Duong T
DT
Nguyen
4Bombali District Health Management Team,Sierra Leone Ministry of Health and Sanitation,Makeni,Bombali,Sierra Leone.
Barrie
B
Idriss
2Sierra Leone Ebola Response Team,Centers for Disease Control and Prevention (CDC),Atlanta,GeorgiaUSA.
Sarah
S
Bennett
1Epidemic Intelligence Service,Centers for Disease Control and Prevention (CDC),Atlanta,GeorgiaUSA.
Angela
A
Dunn
3Division of Respiratory Disease Studies,National Institute for Occupational Safety and Health,Centers for Disease Control and Prevention (CDC),Atlanta,GeorgiaUSA.
Stephen
S
Martin
D000328:Adult; D000552:Ambulances; D001826:Body Fluids / Q000821:virology*; D003140:Communicable Disease Control / Q000379:methods*; D003666:Decontamination / Q000379:methods*; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D029043:Ebolavirus; D006282:Health Personnel; D019142:Hemorrhagic Fever, Ebola / Q000517:prevention & control / Q000635:transmission*; D006801:Humans; D008297:Male; D016273:Occupational Exposure / Q000517:prevention & control*; D012807:Sierra Leone
CEN European Committee on Standardization; Ebola; NFPA National Fire Protection Association; PPE personal protective equipment; Sierra Leone; ambulances; disinfection