Are We Well Prepared? Occupational Infection Prevention and Epidemic Preparedness among Nurses and Laboratory Technicians Amidst Multiple Health Emergencies in Outbreak-Prone African Country, D.R. Congo

Millions of healthcare workers experience percutaneous exposure to bloodborne communicable infectious disease pathogens annually, with the risk of contracting occupationally-acquired infections. In this study, we aimed to assess the status of occupational safety and outbreak preparedness in Congolese nurses and laboratory technicians in Kongo central and Katanga area, amidst multiple ongoing public health emergencies in the Democratic Republic of the Congo (DRC). This was a multicenter analytical cross-sectional study conducted in five referral hospitals located in Kongo central province and Katanga area between 2019-2020 amidst Ebola, Yellow fever, Cholera and Chikungunya outbreaks. Participants were adult A0 grade nurses, A1 nurses, A2 nurses and medical laboratory technicians (N=493). They answered a structured, self-administered questionnaire related to hospital hygiene and standard precautions for occupational infection prevention. The majority of the respondents were females, 53.6%; of them, 30.1% have never participated in a training session on hospital infection prevention in their career. The proportions of those who have been immunized against viral hepatitis C (VHC) and viral hepatitis B (VHB) were markedly low, 3.45% and 16.5%, respectively. Of the respondents, 75.3% have been using safety engineered medical devices (SEDs), whereas 93.5% consistently disinfected medical devices after use. Moreover, 78% of the respondents used gloves during medical procedures and 92.2% wore mask consistently. A large majority of the respondents, 82.9%, have been recapping the needles after use. Regarding participation in outbreak response, 24.5% and 12.2% of the respondents were Chikungunya and Cholera epidemic responders, respectively; 1.8% have served in Ebola outbreak sites. The proportion of the respondents who sustained at least one percutaneous injury by needle stick or sharp device, blood/body fluid splash or both in the previous 12-month period was high, 89.3% (41.8% for injury, 59.2% for BBF event), and most of them (73%) reported over 11 events. Compared to laboratory technicians, nurses had higher odds for sustaining percutaneous injury and BBF events [OR=1.38 (0.16); p<0.01], whereas respondents with longer working experience were less likely to sustain those events [OR=0.47 (0.11); p<0.001]. Findings from this study suggest that Congolese nurses and laboratory technicians experience a high frequency of injury and BBF events at work, and remain at high risk for occupationally-acquired infection. There is a need for periodic capacity-building training for the healthcare workforce to improve infection prevention in health settings.