Selected topics in hospital infection prevention and control in sub-Saharan Africa

Hospitals in sub-Saharan Africa have poor Infection Prevention & Control practices (IPC), contributing to high levels of healthcare-acquired infections. In DR Congo, poor IPC practices in hospitals have hampered the Ebola and COVID-19 responses. Recently, the National Institute of Biomedical Research (INRB) has extended its clinical bacteriology activities towards hospital IPC. My PhD proposal addresses IPC challenges specific to sub-Saharan Africa but hardly studied so far. First, there is Ebola virus disease. Bacterial bloodstream infections are suspected to complicate the treatment course of Ebola virus disease patients, but diagnostic bacteriology in Ebola virus disease care has not yet been implemented because of biosafety and complexity. ITM staff designed a biosafe and simple blood culture system for use in Ebola virus disease treatment centers. I participated to the proof-of-concept testing at ITM and was the site supervisor of the field validation in Beni, North-Kivu. I have planned surrogate virus experiments to assess viral persistence in the blood cultures and will perform structured risk analyses and usability surveys among the staff involved. Results will be compiled in Chapters I and II.Further, I aim to tackle two other IPC challenges which, despite being typical to sub-Sahara Africa, are overlooked by international IPC guidelines. First, I aim to demonstrate bacterial contamination of portable handwash stations which are widely deployed as part of the COVID-19 response. The study set-up will be a cross-sectional multicenter sampling of handwash stations in hospitals across DR Congo with quantitative bacterial culture (Chapter III). In Chapter IV, I intend to address IPC risks of a common nursing practice: as pediatric formulations of intravenous medicines and fluids are not accessible or affordable, young children are administered subsequent doses from a single adult vial. The practise of these multidose vials/intravenous fluids is however at risk for bacterial contamination and hospital-acquired infections. This study is set-up as a multicenter study with culture of multidose vials in collaboration with FA4-partners in Benin and Burkina.

Keywords:B780-tropical-medicine