WHO Infection Prevention and Control Health Facility Rapid Assessment Tool for Ebola and Marburg Diseases: a validation mixed-method study

Abstract Introduction/Objectives: The global population continually faces pathogenic threats from multiple outbreaks annually. These outbreaks may challenge healthcare facilities’ (HF) capacity to provide care while maintaining patients’ and health workers’ safety. Effective infection prevention and control measures are the cornerstone to mitigating and controlling public health events. This study validates the World Health Organization (WHO) IPC health facility rapid assessment tool (RAT) designed for evaluating health facility IPC preparedness and response during Orthoebolavirus disease (EBOD) or Orthomarburgvirus disease (MARD) outbreaks. Methods: This operational research study used a mixed method, combining a prospective evaluation of inter-rater reliability assessment of HF and FGD of assessors. Three assessors applied RAT independently in 51 health facilities in Uganda during the 2022 Sudan virus outbreak. Results: The tool proved feasible to administer, with a median completion time of 62 minutes per facility. The IPC RAT exhibited good internal consistency and inter-rater reliability, with an average Fleiss’ Kappa of 0.4 across the 15 components, suggesting a moderate-to-high consistency among assessors. Recommendations for improving the tool included revising some items for clarity and relevance, adding items to cover additional IPC aspects, developing a user guide and training materials, enhancing the scoring system, data visualization, and analysis dashboard. Conclusion: The IPC EBOD-RAT is a reliable tool for rapidly assessing IPC in HF, during EBOD/MARD outbreaks. This study highlights the need to further refine the tool in various settings and contexts, and to develop user guidance and training materials. Competing Interest Statement The authors have declared no competing interest. Funding Statement The study was funded by the WHO CFE funds for the SVD outbreak. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Not Applicable The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study, approved by the Ugandan Ministry of Health (MoH), adhered to Uganda's ethical standards and respected principles of voluntary participation, informed consent, anonymity, confidentiality, harm prevention, and results dis-semination. Informed Consent Statement: Assessors and facility respondents voluntarily participated in the FGD and provided in-formed written consent. To ensure confidentiality, the trained research team (MoH and WHO) employed measures such as using codes for participants on all research documents and storing notes, interview records, transcriptions, and other participant information on secure servers managed by the MoH and the WHO. The confidentiality of participant data, including assessors and HF respondents, was maintained in all the research stages. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Not Applicable I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Not Applicable I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Not Applicable Footnotes patrick.mirindi{at}ubc.ca patrick.mirindi{at}gmail.com (P.M.); padoveze{at}usp.br (M.P.); willetv{at}who.int (V.W.); ballera{at}who.int (A.B.) staceymearns{at}gmail.com (S.M.); katwesigyee{at}gmail.com (E.K.); mutegekim{at}gmail.com (M.M.); bgmugisha{at}gmail.com (G.B.); alexwasomoka{at}gmail.com (A.W.); pkafeero2005{at}gmail.com (P.K.); dambae007.ed{at}gmail.com (E.D.); briankasuzi{at}gmail.com (B.O.); becksuubi{at}gmail.com (R.S.); hskyobe{at}gmail.com (K.H.); datwine1273{at}gmail.com (D.A.); numberonecar25{at}gmail.com (D.N.); dbyaruhanga14{at}gmail.com (D.B.); janeaceng{at}gmail.com (J.A.); olarocharles{at}gmail.com (C.O.) mmalikisi{at}idi.co.ug (M.M.); mlamorde{at}idi.co.ug (L.M.); aenane254.ae{at}gmail.com (A.E.); Barasa-debarasa{at}yahoo.com (D.B.); makamuret{at}who.int (T.M.); basendoye2{at}yahoo.fr (B.N.); cihambanyal{at}who.int (L.C.); 1 Kappa Paradox https://doi.org/10.1016/0895-4356(90)90159-M. Data Availability Statement The Ugandan MoH and the WHO shared the data ownership. Abbreviations - WHE - World Health Emergencies Program - H - Healthcare Facility - WHO - World Health Organization - IPC - Infection Prevention and Control - RAT - Rapid Assessment Tool - EBOD - Ebola Disease - MARD - Marburg Disease - FGD - Focus Group Discussion - WASH - Water, Sanitation, and Hygiene - EBOV - Ebola virus - SUDV - Sudan Virus - HCW - Healthcare Worker - PPE - Personal Protective Equipment - SDB - Safe and Dignifying Burial - HAI - Health-Associated Infection - DRC - Democratic Republic of the Congo - ODK - Open Data Kit - IQR - Inter Quartile Range - SOP - Standard Operating Procedure - HHSAF - Hand Hygiene Self-Assessment Framework - IPCAF - Infection Prevention and Control Assessment Framework - IRIS - Infection Risk Scan - CDC US - Center for Disease Control - US - United States of America