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• Infectious disease remains challenging to control

in austere environments with weak

infrastructure. Ebola, Anthrax, and the Plague

pose high levels of threat if left uncontained (1).

Personal Protective Equipment (PPE) utilized in

BSL-3 and BSL-4 type laboratories in the United

States can prove to be quite costly if employed

in austere environments such as East Africa (1).

• Essential knowledge, attitudes, and best

practices were taught to East African Clinicians

in an effort to combat the spread of infectious

disease without utilizing high level PPE. Through

the help of the United States Army Medical

Research Institute of Infectious Diseases

(USAMRIID), the Infectious Diseases Institute at

Makerere University (IDI) and the Ministries of

Health in Uganda and Kenya, a joint effort

helped to create the EDP training course. The

EDP course is founded on the MCBC training

course given at USAMRIID (2)

INTRODUCTION

• Primary focus is on improving clinician

preparedness in Austere environments through

the use of practical infection control knowledge.

• A survey was designed for quality control

purposes, but the data has now also been

analyzed to serve as a metric for clinician

preparedness.

• An ideal goal would be to have every clinician

prepared to deal with, and contain, an EDP

outbreak irrespective of environment.

• Inspiration comes from Dr. Innocent

Nkonwa, who managed to isolate an

Ebola outbreak without the use of PPE,

in an austere environment.

PRIMARY GOALS AND OBJECTIVES

• The program starts with

essential knowledge;

clinicians and hospital staff

were taught through

interactive lectures and

hands-on training with

donning/removing of PPE

METHODS

RESULTS AND DISCUSSION

SUMMARY AND CONCLUSIONS

REFERENCES

1. Diers J, Kouriba B, Ladan Fofana L, Fleischmann

E, Starke M, Diallo S, Babin FX, von Bonin J,

Wölfel R (2015) Mobile laboratories for rapid

deployment and their contribution to the

containment of emerging diseases in Sub-Saharan

Africa, illustrated by the example of Ebola virus

disease. Med. Sante. Trop. 25(3):229-233.

2. Medical Management of Chemical and Biological

Casualties Course -

http://www.usamriid.army.mil/education/

ACKNOWLEDGEMENTS

Danyas Sarathy is indebted to all the team members

who stimulated, encouraged, and supported him

throughout this study. Some notable individuals

include:

• Dr. Umaru Ssekabira, MD

• Ms. Barbara Kunihira

• Dr. Ian Njeru, MD

• Mr. Peter Lokomar

• Dr. Bernard Opar

• Dr. Shikanga O-tipo, MD

Danyas Sarathy2, MAJ Elena Kwon1, MAJ Michael D’Onofrio1, MAJ Matthew Chambers1, Dr. Solome Okware3

Dr. Joseph Walter Arinatwe3

Defense Against Especially Dangerous Pathogens (EDPs) in Low Infrastructure Environments: Preparedness Among East African Clinicians

32.53%

48.07%

55.81%

28.29%

44.84%

29.80%

64.93%

22.05%

30.97%

0.00% 10.00%20.00%30.00%40.00%50.00%60.00%70.00%80.00%90.00%100.00%

INFECTION CONTROL

MORTUARY DATA

INFECTION CONTROL TRAINING

RADIOLOGY DATA

TRAINING DATA

LAB ASSESSMENT

HAND HYGEINE

CHART REVIEW

AVERAGE PERCENTAGE 'CORRECT'

PERCENTAGE OF "CORRECT" ANSWERS BY SUBSECTION

• Posters were placed throughout

the facility to remind clinicians

of best practices and attitudes

• This served as practical

knowledge for the clinicians

and faculty.

• Following the EDP course,

participants took part in a

questionnaire to measure

knowledge retention; the

facility was also assessed

on biosafety and medical

records

USAMRIID1, The Pennsylvania State University2, Infectious Diseases Institute of Makerere University3

• Overall percentage of correct answers

(fig. 1) show that hand hygiene training

was comparatively successful (with

clinicians scoring ~30% higher than the

total average)

• Comparatively speaking, the “training”

sections (“Hand Hygiene, Infection

Control Training, and Training Data”)

scored higher than the “non training”

sections.

• “Correct” answers correspond to

responses that benefit personal

protection, and maximize overall safety.

Fig 1: Total percentages across each survey subsection

Fig 2: Total responses; blue are “correct responses”, red are “incorrect responses”

• Sustainable preventative measures need to be

employed, especially in low infrastructure

medical facilities, to combat the spread of

infectious disease

• The proliferation of EDPs can be prevented with

the correct training and mindset, and without

the need for advanced protective equipment.

• The use of a practical, self-contained, and

intensive training course may aid in teaching

clinicians proper containment techniques.

• This could potentially serve as a more

practical, sustainable method of

preventing the spread of EDPs in low

infrastructure environments

• This bypasses the need for cost-

inefficient methods, such as providing

costly PPE to austere medical locations.

• These data may suggest that EDP training can

impact overall clinician preparedness, and

infection control awareness.

• Low-scoring facility metrics (radiology data,

lab assessments, chart review) highlight

structural deficiencies; contrasting high

scoring personal safety metrics

• Free response post-course survey questions

indicate that clinicians feel “empowered to

identify and handle EDPs”

0 500 1000 1500 2000 2500 3000 3500

INFECTION CONTROL

MORTUARY DATA

INFECTION CONTROL TRAINING

RADIOLOGY DATA

TRAINING DATA

LAB ASSESSMENT

HAND HYGEINE

CHART REVIEW

NUMBER OF RESPONSES

CORRECT VS. INCORRECT TOTAL ANSWERS

Above are members of the USAMRIID and IDI team who developed the EDP course

The views expressed in this presentation are the opinions of the authors, and do not necessarily reflect the official position of the Department of Defense or the US Army