Infection Prevention and Control (IPC) Measures for Hemorrhagic Fevers in Rwanda

Introduction

Hemorrhagic fevers, such as the Marburg Virus Disease (MVD), pose significant health risks due to their high mortality rates and potential for rapid transmission. As highlighted by the Ministry of Health in Rwanda's recent advisory on MVD, the country is implementing stringent preventive measures to mitigate the spread of these deadly viruses in health facilities and the wider community.

Understanding Hemorrhagic Fevers

Viral Hemorrhagic Fevers (VHFs) are a group of illnesses caused by several distinct families of viruses, including Marburg and Ebola. These viruses cause severe, often fatal illnesses, with symptoms such as high fever, bleeding disorders, muscle aches, and organ failure.

Transmission occurs through direct contact with the blood, bodily fluids, or tissues of infected people or animals. As noted by the Ministry of Health in Rwanda, these infections are not airborne, but healthcare workers and the general public must remain vigilant and adhere to preventive measures, especially during outbreaks.

Core IPC Measures in Healthcare Settings

Effective IPC measures are critical in curbing the transmission of hemorrhagic fevers. Below are the essential IPC strategies that should be adopted:

1. Early Identification and Isolation

Screening: Health facilities must establish screening protocols at entry points to identify suspected cases of hemorrhagic fevers based on symptoms like high fever, muscle pain, vomiting, and unexplained bleeding.

Isolation: Suspected or confirmed cases must be promptly isolated in designated areas with restricted access to prevent nosocomial transmission.

2. Personal Protective Equipment (PPE)

Healthcare workers handling suspected or confirmed cases should wear full PPE, including gloves, masks, gowns, and face shields.

Special care should be taken during high-risk procedures like drawing blood, inserting catheters, and handling waste, which could expose workers to infectious fluids.

3. Hand Hygiene

Consistent hand hygiene remains one of the most effective IPC measures. Health workers must practice frequent handwashing with soap and water or use alcohol-based hand sanitizers, especially after contact with patients or contaminated surfaces.

4. Environmental Cleaning and Disinfection

All surfaces, medical instruments, and patient care equipment must be cleaned and disinfected regularly using approved disinfectants effective against viruses. This includes proper disposal of waste materials and contaminated PPE.

5. Waste Management

Proper disposal of contaminated waste (including blood-soaked materials) in leak-proof containers is crucial to prevent the spread of infection. Incineration or other approved methods should be used to dispose of biohazardous materials safely.

6. Safe Burial Practices

Handling bodies of deceased persons with hemorrhagic fever requires strict precautions. Trained teams should follow established protocols to prevent transmission during the burial process.

Community-Level IPC Measures

1. Public Awareness and Education

The public must be informed about the risks and symptoms of hemorrhagic fevers, as well as the importance of seeking prompt medical attention if symptoms arise. Educational campaigns should emphasize the need to avoid contact with bodily fluids of infected individuals or animals.

2. Contact Tracing

As part of enhanced preventive measures, Rwanda has initiated robust contact tracing mechanisms. Identifying and monitoring individuals who have been in contact with infected persons is crucial for early intervention and prevention of further spread.

3. Surveillance and Reporting

Health facilities must report suspected and confirmed cases of hemorrhagic fevers to national health authorities, enabling timely responses to outbreaks. Enhanced surveillance measures should be implemented, particularly in areas with confirmed cases.

Conclusion

The implementation of strict IPC measures is essential to control the spread of hemorrhagic fevers like Marburg Virus Disease in Rwanda. Healthcare facilities must ensure rigorous adherence to these protocols to protect both patients and healthcare workers. At the community level, public health education and timely reporting will play critical roles in preventing widespread transmission.

By maintaining a high level of vigilance, hygiene, and collaboration across health sectors, Rwanda is poised to effectively manage current and future outbreaks of hemorrhagic fevers.

This article was developed based on the following documents:

1. https://www.cdc.gov/viral-hemorrhagic-fevers/hcp/infection-control/index.html

2. https://rbc.gov.rw/IMG/pdf/cdc_ebola_handbook.pdf

3. https://iris.who.int/bitstream/handle/10665/205570/9789241549608_eng.pdf?sequence=1

4. https://africacdc.org/download/africa-cdc-event-based-surveillance-framework-2/

5. IDSR guideline - third edition: https://iris.who.int/bitstream/handle/10665/325015/WHOAF-WHE-CPI-05.2019-eng.pdf?sequence=