5 Things Healthcare Professionals Need to Do Now
In 2014 healthcare professionals found themselves on the front lines of a fast-moving Ebola outbreak in West Africa—the largest in history—that eventually claimed some 11,000 lives including more than 500 health workers.1
This summer, as Ebola cases continue to appear in West Africa, a MERS outbreak is posing a threat in South Korea, especially within hospitals, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is a potentially deadly virus that appears to be transmitted from virus-afflicted camels in the Middle East. Among similarities between MERS and Ebola is a high mortality rate.
At the time of this publication, there have been at least 185 MERS cases resulting in 33 deaths in South Korea. Symptoms range from mild respiratory complaints to possible organ failure.2
The virus was first reported in Saudi Arabia in 2012. In the South Korea outbreak in 2015, the first case was a businessman who had traveled to Bahrain, returned to South Korea, and visited several healthcare facilities before he was properly diagnosed. Before the outbreak in South Korea, most of the cases had been in the Arabian Peninsula (Middle East).3
Like other coronaviruses, MERS is thought to spread from respiratory secretions, though precise modes of transmission are not well understood. Infected individuals have spread MERS to others through close contact in healthcare settings including hospitals.4
There are four scientific peer-reviewed studies conducted in the past 13 years focusing on identifying and mitigating sterile packaging system-related risks (See Table 1). While each focuses on different aspects of sterility maintenance, all point to the following key considerations:
- When rigid containers are in use, there is potential for instruments to become contaminated during storage and transportation.
- Rigid containers become less effective at maintaining sterility of instruments over time.
- Visual inspection is not enough to identify sterile packaging system sterility risks. The water test is an effective and simple standardized functionality test that can be used in conjunction with visual inspection.
Take action to stay disease-free and protect your team.
1. Understand the symptoms. Patients typically present with fever, cough and/or shortness of breath, with pneumonia common on examination. Some patients have gastrointestinal symptoms including diarrhea. Severe cases can result in respiratory failure, organ failure (especially the kidneys) or septic shock.
The World Health Organization notes that is not always possible to identify patients with MERS early because initial symptoms are non-specific.5
2. Stay vigilant about infection prevention and control. Because early symptoms are non-specific, ensure adherence to standard, contact and airborne precautions. Strict hand hygiene protocols are essential. Standard precautions assume that every person is potentially infected or colonized with a pathogen that could be transmitted in the healthcare setting.
PPE should be selected according to OSHA’s PPE standards (29 CFR 1910 Subpart I). Healthcare workers should be trained on and demonstrate an understanding of proper selection of PPE and how to properly put on, use and remove equipment including gloves, gowns, respiratory protection and eye protection. Caution should be used when performing aerosol-generating procedures.
With exact modes of transmission not clearly defined, CDC recommends using standard, contact and airborne precautions including use of NIOSH-approved N95 respirators for suspected or confirmed MERS patients.6
3. Minimize the chance for exposure. CDC has published new guidance to minimize exposure to respiratory pathogens include MERS-CoV. CDC recommends that these measures be in place before patient arrival, upon arrival and throughout the stay. Make sure your hospital is taking steps like the following.
- Advise healthcare personnel prior to the arrival of a patient with respiratory infection so that they can take precautions such as wearing face masks or respirators.
- Post signage for patients and employees with instructions for hand hygiene, respiratory hygiene and cough etiquette.
- Provide space for these patients to sit as far from others as possible.
- Implement triage procedures to identify patients at risk for MERS-CoV and isolate those identified as at risk.
- Provide hand hygiene supplies to all patients upon arrival at the facility and throughout their stay.7
4. Understand who’s at risk. People thought to be at higher risk of contracting MERS-CoV include recent travelers from the Arabian Peninsula, close contacts of an ill traveler from the Arabian Peninsula, those recently in a healthcare facility in the Republic of Korea (South Korea) and close contacts of a confirmed MERS case.
Patients with co-morbidities such as diabetes; cancer; and chronic lung, heart, and kidney disease are considered at higher risk of severe disease from MERS-CoV. Patients with weakened immune systems are at higher risk for getting MERS or getting a severe case.8
While there have been only two U.S. cases (in 2014 in health workers who had recently traveled from Saudi Arabia), CDC says that with global air travel, it recognizes the potential for MERS-CoV to spread further and cause more cases globally and in the U.S.9
5. Be mindful of the risk in hospitals. While MERS in the general population does not appear to be a major consideration at present, the bigger concern is healthcare settings. Dr. Vincent Munster, chief of the Virus Ecology Unit at the National Institute of Allergy and Infectious Disease, told The Atlantic that the virus is of concern in the healthcare setting and added, “Hospitals have a lot of susceptible people inside. People should start thinking really carefully about hospital-hygiene practices and personal hygiene.”10
The virus does not seem to pass easily from person to person unless there is close contact, such as in the course of delivering unprotected care to a patient.11
According to CDC’s Healthcare Facility Preparedness Checklist for MERS-CoV, “All hospitals should be equipped and ready to care for a limited number of infected patients as part of routine operations and also to potentially care for a large number of patients in the context of escalating transmission.” The non-mandatory checklist includes these and other steps:
- Provide healthcare personnel with education and refresher training regarding MERS diagnosis, specimen testing, PPE and triage.
- Ensure infection control policies are consistent with CDC’s MERS guidance.
- Review policies and procures for screening and work restrictions for exposed or ill healthcare workers.
- Review procedures for lab submission of specimens for MERS testing.
- Designate certain individuals to communicate as needed with public health officials and others.
- Ensure that healthcare professionals who will provide patient care have been medically cleared, fit-tested and trained for respirator use.12
Looking for more support and information about infection prevention in light of MERS or other viral outbreaks? Halyard Health can help with infection prevention solutions tailored to your identified needs. For more information, contact your Halyard Rep or call us at 1-844-HALYARD (1-844-425-9273).
1 http://www.cdc.gov/vhf/ebola/outbreaks/2014-west-africa/ – Centers for Disease Control and Prevention. 2014
2 http://www.wpro.who.int/outbreaks_emergencies/wpro_coronavirus/en/ – World Health Organization. 2015
3 http://www.who.int/csr/disease/coronavirus_infections/situation-assessment/update-15-06-2015/en/ – World Health Organization. 2015
4 http://www.cdc.gov/coronavirus/mers/about/index.html – Centers for Disease Control and Prevention. 2015
5 http://www.who.int/csr/disease/coronavirus_infections/faq/en/ – World Health Organization. 2015
6, 7 http://www.cdc.gov/coronavirus/mers/infection-prevention-control.html – Centers for Disease Control and Prevention. 2015.
8 http://www.cdc.gov/coronavirus/mers/about/symptoms.html – Centers for Disease Control and Prevention. 2015.
9 http://www.cdc.gov/coronavirus/mers/about/ – Centers for Disease Control and Prevention 2015.
10 http://www.theatlantic.com/health/archive/2015/06/south-korea-mers-outbreak-contagious/395501/ – The Atlantic. 2015.
11 http://www.who.int/csr/disease/coronavirus_infections/faq/en/ – World Health Organization. 2015.
Image licensed for open use. NIAID in collaboration with Colorado State University. Sourced from Web. Accessed Sept 4, 2015
NIAID, CC BY 2.0 <https://creativecommons.org/licenses/by/2.0>, via Wikimedia Commons