Posted on August 6, 2015
On May 20, 2015, the Republic of Korea (Korea) reported to the World Health Organization (WHO) a case of laboratory-confirmed Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection, the first case in what is now the largest outbreak of MERS-CoV outside of the Arabian Peninsula.1 The ongoing outbreak in Korea is similar to healthcare-associated outbreaks in other countries – as it resulted from a single exported case with travel history in the Middle East and subsequent human-to-human transmission to close family contacts, to patients who shared a room or ward with infected patients, and to health care workers providing care for patients before MERS was suspected or diagnosed.2
A consistent recommendation from the Centers of Disease Control and Prevention (CDC) calls for healthcare providers (HCPs) in the United States to be prepared to detect and manage MERS cases, which includes asking patients about travel history and healthcare facility exposure. Prompt triage and isolation of patients who should be evaluated for MERS is critical to ensure implementation of infection prevention measures.
Healthcare facilities ramped up their education programs after an Ebola patient was admitted to a Texas hospital. Should infection preventionists (IPs) implement additional programs to ensure that staff are educated about MERS? The simple answer is yes. The devil is in the details, however. In their Interim Infection Prevention and Control Recommendations for Hospitalized Patients with MERS-CoV3, the CDC makes these recommendations:
1. Minimize chance for exposures before and upon arrival and during the visit.
2. Ensure adherence to standard, contact, and airborne precautions: hand hygiene, personal protective equipment (PPE), eye protection, patient placement, aerosol generating procedures, and duration of precautions.
3. Manage visitor access and movement within the facility.
4. Implement engineering controls.
5. Monitor and manage ill and exposed HCPs.
6. Train and educate HCPs.
7. Implement environmental infection control.
8. Establish reporting within hospitals and public health authorities.
How can IPs implement these recommendations? MERS education can be combined with other routine education but has its own particulars. Integral is annual respiratory protection device fit testing; the correct use, donning, and removal of PPE (combined with other staff education); as well as prompt recognition and isolation of a potential MERS patient.
Dr. Tom Frieden, Director of the CDC, stated, “Hospitals can become amplification points. It’s the case in measles, it’s the case for drug-resistant tuberculosis, it’s the case for MERS and SARS and Ebola. That’s where sick people go and that’s where vulnerable people are. It really emphasizes the importance of good infection control in the health care system.”4
What should IPs do? Facilities do not want to be caught unprepared but the time and cost to educate on MERS alone is prohibitive.
To efficiently keep staff up-to-date on MERS, IPs can:
Provide information to emergency department staff and other areas where patients are first seen.
Utilize CDC’s Healthcare Provider Preparedness Checklist for MERS-CoV,5 Healthcare Facility Preparedness Checklist for MERS-CoV,6 and Information about MERS.7
Make rounds in the most affected areas to reinforce guidelines to staff, especially when MERS is in the news.
Consider having an IP liaison in each department so that person can be educated on IP issues and assist with education.
Enlist the help of the staff education department.
Develop a list of departments that need to be inserviced and ensure all HCPs get the information, not just the day shift.
There is a need for MERS education but it is difficult to divert resources for a disease that represents a very low risk to the general public in the United States. Only two patients in the U.S. have ever tested positive for MERS-CoV infection—both in May 2014—while more than 500 have tested negative.8
IPs and infectious disease physicians should keep staff aware by staying current on the latest developments and alerting HCPs to any changes. Perhaps the time has come to have an IP dedicated to HCP education. Do you know of a facility that has created this position?
1. Centers for Disease Control and Prevention Health Alert Network. Updated Information and Guidelines for Evaluation of Patients for Middle East Respiratory Syndrome Coronavirus (MERS-CoV) Infection. June 11, 2015. http://emergency.cdc.gov/han/han00380.asp
2. Middle East respiratory syndrome coronavirus (MERS-CoV). Summary of Current Situation, Literature Update and Risk Assessment 7 July 2015. WHO/MERS/RA/15.1 http://apps.who.int/iris/bitstream/10665/179184/2/WHO_MERS_RA_15.1_eng.pdf?ua=1
3. Centers for Disease Control and Prevention. Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV). Updated June 2015. http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html
4. Time online. Here’s the Difference Between MERS and Ebola. Alexandra Sifferlin. June 8, 2015.http://time.com/3910571/mers-ebola/
5. CDC. Healthcare Provider Preparedness Checklist for MERS-CoV. Retrieved from the Internet July 14, 2015. http://www.cdc.gov/coronavirus/mers/downloads/checklist-provider-preparedness.pdf
6. CDC. Healthcare Facility Preparedness Checklist for MERS-CoV. Retrieved from the Internet July 14, 2015http://www.cdc.gov/coronavirus/mers/downloads/checklist-facility-preparedness.pdf
7. CDC. Information about Middle East Respiratory Syndrome (MERS). Retrieved from the Internet July 14, 2015. http://www.cdc.gov/coronavirus/mers/downloads/factsheet-mers_en.pdf
8. CDC. MERS in the U.S. Retrieved from the Internet July 15, 2015. http://www.cdc.gov/coronavirus/mers/us.html