The outbreak of Ebola Viral Disease (EVD) in Nigeria was an enormous public health challenge in 2014. One of the important factors that ensured the successful treatment of infected persons and ultimate elimination of the EVD in Nigeria was the availability of a facility in Mainland Hospital, Yaba, Lagos State. Established in 2012 by the Lagos State Government with funding support from the United States Agency for International Development (USAID) and technical assistance from Family Health International (FHI 360) under the TBCARE project, the facility is an ultra-modern multi-drug resistance tuberculosis (MDR-TB) treatment center. It is a 40 bedded admission facility with 2 wards of 14 beds each for males, and a ward of 12 beds for females and children.
At the early hours of Friday, July 25, 2014, millions of Nigerians woke up to the shocking realization that EVD was indeed truly in-country and anybody irrespective of age, tribe, creed or gender was at risk of being infected. The fear of infection, as well as death from EVD, touched on the very core of people’s existence as individuals, families, communities and the entire nation. Everyone residing in Nigeria could no longer take for granted the simplest gesture of basic human relationships such as shaking hands, caring for loved ones and burying the dead in line with cultural norms. Nigeria had its fair share of the crisis, recording 21 cases of the disease and 9 deaths before being declared Ebola-free. Nigeria’s effort and ability to curtail further spread of the virus received international acclaim with the United States Center for Disease Control (CDC) and World Health Organization (WHO) calling on other countries battling the disease or at risk of an outbreak to replicate the actions and public health measures implemented in Nigeria.
With rising cases of EVD in Nigeria, the Government of Nigeria considered the MDR-TB treatment center in Lagos Mainland Hospital suitable for the containment and treatment of EVD, both in design and spatial alignment. Although originally designed for the highly infectious airborne MDR-TB disease, the facility played a positive role in the treatment and containment of the EVD spread. Whether the original design features of the facility had a significant impact on the EVD transmission rate or prognosis of the disease is beyond the scope of this article. This writeup therefore limits itself to exposing the ‘as built’ architectural features of the MDR-TB treatment center where all confirmed EVD cases in Lagos State were admitted and treated. The responsibility for determining any relationship between the design features of the facility and the successes recorded on EVD elimination from Nigeria is left to the reader.
The infection prevention and control (IPAC) enabled MDR-TB treatment center was purposely designed to ensure efficient and sustainable maintenance of maximum air exchange at an internationally acceptable rate per hour. This was achieved partly due to the IPAC principles introduced to the design of this center. The head rooms of the building were purposively designed to be above average height while windows were made large, evenly distributed and closely spaced throughout the building. The windows begin from as low as 750mm above the finished floor level of the building and goes as high as 2100mm, aligned with the prevailing dominant wind direction. Artificial cooling was purposefully not provided. This was based on assumptions that patients (and healthcare workers alike) may close the windows to achieve better cooling, thereby, preventing the evacuation of contaminated air from the wards/rooms.
Additionally, the ward design purposively excluded artificial ventilation systems (AVS) in order to minimize the need for constant uninterrupted power supply which is usually not tenable in a low income country like Nigeria; thereby, keeping the cost of maintenance low. Thus, only natural ventilation was ensured through averagely high head rooms and multiple, large windows; thereby, improving safety of patients and healthcare workers, management efficiency as well as sustainability of patient care in the facility and ultimately achieving maximum air exchange rate necessary for the treatment of highly infectious airborne diseases such MDR-TB. The floors are made of seamless sheets of linoleum, with upturns at the edges, to ease cleaning and prevent trapping dirt and infectious organisms. The walls have seamless finishes, coated with washable paints. Waste water (sewage) from the wards are channeled through closed system of drainages into large, properly sealed septic tanks and soak-away right within the treatment facility, to prevent infection spread. The structural arrangements also facilitate ward decontamination and make the ward environment non-conducive for microorganisms to thrive.
The spatial arrangement of the treatment center also took into consideration the satisfaction, safety and security of both patients and health care workers. The treatment center is highly secured within a perimeter fence, with a security checkpoint at the entrance gate. Entrance into each of the wards is restricted with automatic control buttons located at the Nurses’ station, to allow for only unidirectional access to the wards. Main access door from the Nurses’ station to the main wards have fixed glass windows that allow the nurses to directly observe their patients even while on their desks. The facility features allows for only authorized persons to be allowed in or out of the facility at any given time. There is a designated area with controlled access and barrier for patient relatives to wait and/or talk to their loved ones who are patients on admission in the facility.
The entire MDR-TB facility is well lighted, with backup power supply from the national grid, as well as a stand-by generator (powered occasionally, whenever necessary). The facility is well landscaped, creating a green and serene environment with beautiful waves of walkways. Recreational facilities such as table tennis and assorted indoor games are provided in the lawn and the beautifully made gazebos to create a home-like environment that facilitate longer term patient stay. Multiple hand washing bays with automatic controls are available both within the wards, lawns and the recreation areas, to promote hand washing practices by both healthcare workers and patients. Each of the wards are also equipped with modern toilet and bathroom suites, serving an average of 3 patients to a convenience. Healthcare workers’ stations are also equipped with similar sanitary facilities, for their maximum comfort, safety and security. The center has its own consulting rooms, state of the art digital X-ray facility, pharmacy unit and a well-furnished healthcare workers’ lounge.
The MDR-TB treatment center located at the Lagos Mainland Hospital remains one of the game changers in the celebrated successes of the Government of Nigeria and her international collaborators to wrestle down EVD in Nigeria. Establishing these type of centers in each state of the federation will go a long way in not only addressing the rising cases of MDR-TB in Nigeria, but will serve as a readily available facility for the containment of any complex infectious disease outbreak in any given state. Other MDR-TB treatment centers of similar capacity in Nigeria, established with funding from USAID and technical assistance from FHI 360 include Dr. Lawrence Henshaw Memorial Hospital, Calabar in Cross River State; Infectious Disease Hospital, Kano in Kano State and the Federal Medical Centre, Yola in Adamawa State.
Website: http://www.fhi360.org/countries/nigeria
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