During Ebola and Marburg outbreaks, treatment centers are essential for patient care and controlling transmission. While clinical care advancements have been well-documented, the design of these centers has been less explored. This study addresses this gap by analyzing technical drawings of 48 treatment centers constructed between 2014 and 2023, using a reverse-engineering approach. The findings highlight a shift toward smaller, more manageable centers, with improved privacy and infection control features. This review offers a framework for the future development of treatment center designs to enhance outbreak management. Key contributions include the identification of trends in center size and layout, providing a foundation for future design standards that can be applied in managing infectious disease outbreaks. The study emphasizes the need for continuous adaptation in treatment center design to meet outbreak demands and calls for future research to develop indicators that measure the impact of design on health outcomes and patient experiences.

Objective In the context of filovirus outbreaks, chlorine spraying has been the standard for infection prevention and control. Due to potential occupational health risks, public health institutions now recommend wiping, which is labor-intensive and may increase the risk of heat stress for healthcare workers wearing personal protective equipment. This systematic review and meta-analysis quantified the health effects of occupational exposure to chlorine-based products compared to other disinfectants, and the effects of spraying compared to general disinfection tasks (GDTs) like wiping and mopping, in healthcare settings. Data sources, design and eligibility criteria MEDLINE, Scopus, and ScienceDirect were searched for studies addressing the association between exposure to disinfectants applied by different application methods and occupational diseases in healthcare settings. Risk of bias was assessed by two independent reviewers using a validated tool. Data extraction and synthesis Two reviewers independently screened and performed data extraction and synthesis. A third reviewer resolved disagreements. Meta-analyses were conducted using fixed- and random-effects models based on the Higgins I² statistic. Results 30 studies investigating chlorine-based products (7,123 participants), glutaraldehyde (6,256 participants), peracetic acid, acetic acid and hydrogen peroxide (4,728 participants), quaternary ammonium compounds (QACs) (9,270 participants), use of spray (4,568 participants) and GDTs (3,480 participants) were included. Most had a cross-sectional design and high risk of bias. Meta-analysis indicates a significant association between respiratory conditions and exposure to chlorine-based products (OR 1.71, 95%CI 1.41- 2.08), glutaraldehyde (OR 1.44, 95%CI 1.14-1.81), QACs (OR 1.30, 95%CI 1.06-1.60), use of spray (OR 25, 95%CI 1.61-3.14) and GDTs (OR 2.20, 95%CI 1.66-2.90). The relative odds ratio (ROR) of respiratory conditions for chlorine-based products compared to QACs was 0.76 (95%CI 0.62-0.94). The ROR for the use of spray compared to GDTs was 0.98 (95%CI 0.74-1.29). Strengths include evaluating respiratory health risks of disinfectants, applying a validated tool, using both fixed- and random-effects models, and comparing pooled effect sizes. Limitations include high risk of bias for the majority of included articles, varying confounder adjustments, underreported non-respiratory outcomes, and unspecified disinfectants and PPE use for spray and GDTs articles. Conclusion Chlorine-based disinfectants significantly increase respiratory risk compared to QACs. Sprays and general disinfection tasks present similar risks. Our findings advocate for using less hazardous products like QACs, rather than banning sprays in filovirus outbreak responses to enhance disinfection safety. Prospero registration number CRD42023479363 Article summary Strengths and limitations of this study The systematic review and meta-analysis provide a comprehensive comparison of the health effects of occupational exposure to various disinfectants and application methods in healthcare settings. The study includes a broad range of disinfectants and application methods, offering a detailed assessment that extends beyond filovirus treatment centers. The inclusion of both fixed- and random-effects models in the meta-analysis ensures a robust evaluation of the data, accounting for potential variability among studies. While this study focused on respiratory conditions, other outcomes such as skin and ocular conditions were underreported, limiting the comprehensiveness of the assessment. Variations in exposure assessment methods and the lack of information on specific disinfectant products, PPE use, and ventilation further complicate comparisons and limit the ability to attribute health effects to specific factors.