Duty of care and health worker protections in the age of Ebola: lessons from Médecins Sans Frontières

McDiarmid, Melissa; Crestani, Rosa

WHO-convened teams were guided primarily by IPC documents, 16 though by the time these were available in August 2014, more than 400 health workers had already been infected. Prior to this, existing IPC guidance for filovirus haemorrhagic fever was available. 17 In September 2014 WHO also issued a health and safety handbook for its deployed headquarters and country staff responders (clinical and non-clinical), which focused on personal measures staff could take to prevent exposure. 18 Although WHO-convened teams had essential IPC training, in its report on health worker Ebola infections, WHO found '…serious gaps in IPC standards… in the settings where transmission likely took place or where infected health workers were employed.' 6 The report identified other risk factors for caregiver infections, grouped into several domains. These included deficiencies in administrative controls or work organisation, lack of engineering and environmental controls related to isolation and hygiene and problems with availability and compatibility of PPE. Also listed were poor employment conditions (human resource issues). 6 Many of these domains are outside the confines of IPC but are addressed in MSF policies. They also mirror the classical occupational health exposure prevention approach of hazard anticipation, mitigation and control using engineering and administrative methods, work organisation and PPE. 19 20 While compliance with safety policies was not formally tracked, the desired safety behaviours were routinely reinforced, as described above. We believe that organisational commitment and robust adherence to both IPC and other safety policies help explain MSF's lower staff infection rates and suggest a roadmap for future pandemic planning. Specifically, occupational health approaches to identify and control hazards, assure safe work organisation through assigned safety roles and responsibilities and vigilant PPE use augment and fortify standard IPC practices. Together, these efforts form a more protective, comprehensive safety programme, as the MSF outcome demonstrates.