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Purpose: The 2014 outbreak of Ebola virus disease (EVD) in West Africa was the largest in history. Starting in September 2014, International Medical Corps (IMC) operated five Ebola treatment units (ETUs) in Sierra Leone and Liberia. This paper explores how future infectious disease outbreak facilities in resource-limited settings can be planned, organized, and managed by analyzing data collected on water, sanitation, and hygiene (WASH) and infection prevention control (IPC) protocols. Design/Methodology/Approach: We conducted a retrospective cohort study by analyzing WASH/IPC activity data routinely recorded on paper forms or white boards at ETUs during the outbreak and later merged into a database from two IMC-run ETUs in Sierra Leone between December 2014 and December 2015. Findings: The IMC WASH/IPC database contains data from over 369 days. Our results highlight parameters key to designing and maintaining an ETU. High concentration chlorine solution usage was highly correlated with both daily patient occupancy and high-risk zone staff entries; low concentration chlorine usage was less well explained by these measures. There is high demand for laundering and disinfecting of personal protective equipment (PPE) on a daily basis and approximately 1 (0–4) piece of PPE is damaged each day. Research limitations/Implications: Lack of standardization in the type and format of data collected at ETUs made constructing the WASH/IPC database difficult. However, the data presented here may help inform humanitarian response operations in future epidemics. [ABSTRACT FROM AUTHOR]

The supereruption of Los Chocoyos (14.6 ∘ N, 91.2 ∘ W) in Guatemala ∼84 kyr ago was one of the largest volcanic events of the past 100 000 years. Recent petrologic data show that the eruption released very large amounts of climate-relevant sulfur and ozone-destroying chlorine and bromine gases (523±94 Mt sulfur, 1200±156 Mt chlorine, and 2±0.46 Mt bromine). Using the Earth system model (ESM) of the Community Earth System Model version 2 (CESM2) coupled with the Whole Atmosphere Community Climate Model version 6 (WACCM6), we simulated the impacts of the sulfur- and halogen-rich Los Chocoyos eruption on the preindustrial Earth system. Our simulations show that elevated sulfate burden and aerosol optical depth (AOD) persists for 5 years in the model, while the volcanic halogens stay elevated for nearly 15 years. As a consequence, the eruption leads to a collapse of the ozone layer with global mean column ozone values dropping to 50 DU (80 % decrease) and leading to a 550 % increase in surface UV over the first 5 years, with potential impacts on the biosphere. The volcanic eruption shows an asymmetric-hemispheric response with enhanced aerosol, ozone, UV, and climate signals over the Northern Hemisphere. Surface climate is impacted globally due to peak AOD of >6 , which leads to a maximum surface cooling of >6 K, precipitation and terrestrial net primary production decrease of >25 %, and sea ice area increases of 40 % in the first 3 years. Locally, a wetting (>100 %) and strong increase in net primary production (NPP) (>700 %) over northern Africa is simulated in the first 5 years and related to a southward shift of the Intertropical Convergence Zone (ITCZ) to the southern tropics. The ocean responds with pronounced El Niño conditions in the first 3 years that shift to the southern tropics and are coherent with the ITCZ change. Recovery to pre-eruption ozone levels and climate takes 15 years and 30 years, respectively. The long-lasting surface cooling is sustained by an immediate increase in the Arctic sea ice area, followed by a decrease in poleward ocean heat transport at 60 ∘ N which lasts up to 20 years. In contrast, when simulating Los Chocoyos conventionally by including sulfur and neglecting halogens, we simulate a larger sulfate burden and AOD, more pronounced surface climate changes, and an increase in column ozone. By comparing our aerosol chemistry ESM results to other supereruption simulations with aerosol climate models, we find a higher surface climate impact per injected sulfur amount than previous studies for our different sets of model experiments, since the CESM2(WACCM6) creates smaller aerosols with a longer lifetime, partly due to the interactive aerosol chemistry. As the model uncertainties for the climate response to supereruptions are very large, observational evidence from paleo archives and a coordinated model intercomparison would help to improve our understanding of the climate and environment response. [ABSTRACT FROM AUTHOR]

Background: The need for increased attention to surgical safety in low- and middle-income countries invited organizations worldwide to support improvements in surgical care. However, little is written about issues in instrument sterilization in low- and middle-income countries including Ethiopia. Objective: The study aims to identify the impact of a sterile processing course, with a training-of-trainers component and workplace mentoring on surgical instrument cleaning and sterilization practices at 12 hospitals in Ethiopia. Method: A mixed-methods research design that incorporates both qualitative and quantitative research approaches to address issues in sterile processing was used for this study. The quantitative data (test results) were validated by qualitative data (hospital assessments, including observations and participant feedback). Twelve hospitals were involved in the training, including two university teaching hospitals from two regions of Ethiopia. In each of the two regions 30 sterile processing staff were invited to participate in a three-day course including theory and skills training; 12–15 of these individuals were invited to remain for a two-day training of trainers course. The collected quantitative data were analysed using a paired t-test by SPSS software, whereas comparative analysis was employed for the qualitative data. Results: Process, structural, and knowledge changes were identified following program implementation. Knowledge test results indicated an increase of greater than 20% in participant sterile processing knowledge. Changes in process included improved flow of instruments from dirty to clean, greater attention to detail during the cleaning and decontamination steps, more focused inspection of instruments and careful packaging, as well as changes to how instruments were stored. Those trained to be trainers had taught over 250 additional staff. Conclusions: Increased attention to and knowledge in sterile processing practices and care of instruments with a short, one-week course provides evidence that a small amount of resources applied to a largely under-resourced area of healthcare can result in decreased risks to patients and staff. Providing education in sterile processing and ensuring staff have the ability to disseminate their learnings to other health care providers results in decreasing risks of hospital associated infections in patients. [ABSTRACT FROM AUTHOR]