Abstract
In 2015, we experienced the largest in-hospital Middle East respiratory syndrome (MERS) outbreak outside the Arabian Peninsula. We share the infection prevention measures for surgical procedures during the unexpected outbreak at our hospital. We reviewed all forms of related documents and collected information through interviews with healthcare workers of our hospital. After the onset of outbreak, a multidisciplinary team devised institutional MERS-control guidelines. Two standard operating rooms were converted to temporary negative-pressure rooms by physically decreasing the inflow air volume (−4.7 Pa in the main room and −1.2 Pa in the anteroom). Healthcare workers were equipped with standard or enhanced personal protective equipment according to the MERS-related patient’s profile and symptoms. Six MERS-related patients underwent emergency surgery, including four MERS-exposed and two MERS-confirmed patients. Negative conversion of MERS-CoV polymerase chain reaction tests was noticed for MERS-confirmed patients before surgery. MERS-exposed patients were also tested twice preoperatively, all of which were negative. All operative procedures in MERS-related patients were performed without specific adverse events or perioperative MERS transmission. Our experience with setting up a temporary negative-pressure operation room and our conservative approach for managing MERS-related patients can be referred in cases of future unexpected MERS outbreaks in non-endemic countries.
Highlights
The Middle East respiratory syndrome (MERS) is a serious acute respiratory disease caused by the MERS coronavirus (MERS-CoV), and the mortality rates in infected patients are estimated at 20–40%1
Along with small and large outbreaks that persist in the Arabian Peninsula, MERS outbreaks may recur in any other regions, especially if a super spreader introduces a MERS infection to a
All patients were negative during two preoperative MERS screenings using real-time reverse transcription polymerase chain reaction[14]
Summary
The Middle East respiratory syndrome (MERS) is a serious acute respiratory disease caused by the MERS coronavirus (MERS-CoV), and the mortality rates in infected patients are estimated at 20–40%1. There is some literature regarding infection prevention during operative procedures for severe acute respiratory syndrome (SARS) coronavirus[12,13], guidelines or references for MERS prevention during perioperative patient care were very limited. We developed institutional guidelines for perioperative MERS infection prevention and we set up a temporary negative-pressure operating room. In this globalized era, along with small and large outbreaks that persist in the Arabian Peninsula, MERS outbreaks may recur in any other regions, especially if a super spreader introduces a MERS infection to a high-volume healthcare facility, which is how the previous South Korea outbreak occurred[11]. We share our experience of providing infection prevention and control measures for surgeries for MERS-related patients in our hospital
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