Nosocomial transmission of XXXX on pediatric and  maternity wards: Bombali and Tonkolili, Sierra Leone, 2014.

@entity1 @entity325 @entity2598
BACKGROUND: In the largest @entity2598 ( @entity2598 ) outbreak in history, nosocomial transmission of  @entity2598 increased spread of the disease. We report on 2 instances in Sierra Leone where @entity1 unknowingly infected with @entity2598 were admitted to a general hospital ward (1 pediatric ward and 1 maternity ward), exposing health care workers, caregivers, and other @entity1 to @entity2598 . Both @entity1 died on the general wards, and were later confirmed as being infected with @entity2598 . We initiated contact tracing and assessed risk factors for @entity325 to guide containment recommendations. METHODS: We reviewed medical records to establish the index @entity1 ' symptom onset. Health care workers, @entity1 , and caregivers were interviewed to determine exposures and personal protective equipment (PPE) use. Contacts were monitored daily for @entity2598 symptoms. Those who experienced @entity2598 symptoms were isolated and tested. RESULTS: Eighty-two contacts were identified: 64 health care workers, 7 caregivers, 4 @entity1 , 4 newborns, and 3 @entity1 of @entity1 . Seven contacts became symptomatic and tested positive for @entity2598 : 2  health care workers (1 nurse and 1 hospital cleaner), 2 caregivers, 2 newborns, and 1 @entity1 . The infected nurse placed an intravenous catheter in the pediatric index @entity1 with only short gloves PPE and the hospital cleaner cleaned the operating room of the maternity ward index @entity1 wearing short gloves PPE. The maternity ward index @entity1 's caregiver and newborn were exposed to her body fluids. The infected @entity1 and her newborn shared the ward and latrine with the maternity ward index @entity1 . Hospital staff members did not use adequate PPE. Caregivers were not offered PPE. CONCLUSIONS: Delayed recognition of @entity2598 and inadequate PPE likely led to exposures and @entity325 . Earlier recognition of @entity2598 and adequate PPE might have reduced direct contact with body fluids. Limiting nonhealth-care worker contact, improving access to PPE, and enhancing screening methods for pregnant @entity1 , @entity1 , and inpatients may help decrease @entity2598 transmission in general health care settings.
