Richard Giardina RN, MPH, CIC, FACHE
Middle East Respiratory Syndrome (MERS) is a viral respiratory illness that is new to humans. It was first reported in Saudi Arabia in 2012 and has since spread to several other countries, including the United States. Most people infected with MERS-CoV developed severe acute respiratory illness, including fever, cough, and shortness of breath. Many of them have died.
As of June 19, 2015, 24 people have died in South Korea, and more than 6,700 are isolated at homes and medical facilities as officials continue their efforts to put the MERS outbreak under control. More than 160 people have been diagnosed with MERS nearly a month after the outbreak originated from a 68-year-old man who had traveled to the Middle East, according to Seoul's Health Ministry.
Doctors of the renowned hospital, the Samsung Medical Center in Seoul, were the first to confirm the disease, known as MERS, in another patient a week earlier but failed to make the connection between the two cases. Investigators now say the misdiagnosed patient, awaiting a vacant bed in a general ward upstairs, wheezed and expectorated in common areas with no oversight, turning into a MERS "superspreader."
The mistakes by the Samsung Medical Center are now the focus of much that has gone wrong to escalate the MERS crisis in South Korea, the worst outbreak beyond Saudi Arabia, where the disease first appeared in 2012. As of June 19, 2015, nearly half of all 165 confirmed MERS cases in South Korea have been traced to Samsung, historically regarded as the nation’s best hospital.
At Samsung, the system began faltering when the 35-year-old man, whom investigators called Patient No. 14, arrived at its emergency room on May 27, a week after Samsung discovered the first case. "What pains us the most is our failure to contain Patient No. 14 at the Samsung hospital," said Kwon Deok-Cheol, a senior official at the government’s MERS response headquarters1.
Our challenge is to ensure we have adopted CDC best practice for early identification and containment of infectious persons; be it MERS, influenza, or any respiratory virus. To prevent the transmission of all respiratory infections in healthcare settings, including MERS, the following infection control measures should be implemented at the first point of contact with a potentially infected person. The CDC calls this ‘Respiratory Hygiene/Cough Etiquette’. Your Infection Control team is already well aware of this best practice; however, it depends on consistent use for every suspected patient, and therefore may require some monitoring of staff practice.
Respiratory Hygiene/Cough Etiquette relies on these basic principles2:
1. Visual Alerts
Post visual alerts (in appropriate languages) at the entrance to outpatient facilities (e.g., emergency departments, physician offices, outpatient clinics) instructing patients and persons who accompany them (e.g., family, friends) to inform healthcare personnel of symptoms of a respiratory infection when they first register for care and to practice Respiratory Hygiene/Cough Etiquette.
2. Respiratory Hygiene/Cough Etiquette
The following measures to contain respiratory secretions are recommended for all individuals with signs and symptoms of a respiratory infection.
3. Masking and Separation of Persons with Respiratory Symptoms
MERS may appear to be a new emerging pathogen with new challenges; however, basic infection control practices such as Respiratory Hygiene/Cough Etiquette accompanied by hand hygiene are the best interventions to control spread of any respiratory virus.
1, 2 www.cdc.gov, last accessed 6/22/15
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