Abstract
BackgroundIn 2015, South Korea experienced an outbreak of Middle East respiratory syndrome (MERS), and our hospital experienced a nosocomial MERS infection. We performed a comprehensive analysis to identify the MERS transmission route and the ability of our routine infection-prevention policy to control this outbreak.MethodsThis is a case–cohort study of retrospectively analysed data from medical charts, closed-circuit television, personal interviews and a national database. We analysed data of people at risk of MERS transmission including 228 in the emergency department (ED) and 218 in general wards (GW). Data of personnel location and movement, personal protection equipment and hand hygiene was recorded. Transmission risk was determined as the extent of exposure to the index patient: 1) high risk: staying within 2 m; 2) intermediate risk: staying in the same room at same time; and 3) low risk: only staying in the same department without contact.ResultsThe index patient was an old patient admitted to our hospital. 11 transmissions from the index patient were identified; 4 were infected in our hospital. Personnel in the ED exhibited higher rates of compliance with routine infection-prevention methods as observed objectively: 93% wore a surgical mask and 95.6% washed their hands. Only 1.8% of personnel were observed to wear a surgical mask in the GW. ED had a higher percentage of high-risk individuals compared with the GW (14.5% vs. 2.8%), but the attack rate was higher in the GW (16.7%; l/6) than in the ED (3%; 1/33). There were no transmissions in the intermediate- and low-risk groups in the ED. Otherwise 2 patients were infected in the GW among the low-risk group. MERS were transmitted to them indirectly by staff who cared for the index patient.ConclusionsOur study provide compelling evidence that routine infection-prevention policies can greatly reduce nosocomial transmission of MERS. Conventional isolation is established mainly from contact tracing of patients during a MERS outbreak. But it should be extended to all people treated by any medical employee who has contact with MERS patients.Trial registrationNCT02605109, date of registration: 11th November 2015.
Highlights
In 2015, South Korea experienced an outbreak of Middle East respiratory syndrome (MERS), and our hospital experienced a nosocomial MERS infection
Middle East respiratory syndrome (MERS) is a respiratory disease caused by a novel single-stranded beta-coronavirus, which was first reported in patients residing in Saudi Arabia in 2012 [1]
The analysis focused mainly on data for the index patient and all people treated in the emergency department (ED) and General wards (GW) during the pre-isolation period of the index patient
Summary
In 2015, South Korea experienced an outbreak of Middle East respiratory syndrome (MERS), and our hospital experienced a nosocomial MERS infection. A total of 186 patients were serologically confirmed as having MERS between May and July 2015 in Korea [11]. Most of these MERS infections were identified as having arisen from human-to-human transmission in the health care setting [12]. Given that the emergency department (ED) plays an important role in providing the main care for acutely ill patients, the ED can be an open portal for transmission of pathogens into a hospital system. Unrecognized patient who visited in the ED greatly contributed to wide spreading of MERS for less time [13]
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