Thursday 8 August 2013

Infection Prevention and Control measures for MERS..mostly as per other ARIs

Thanks to Mike Coston for help and tips.

Cases are few and details are incomplete but the authors of an article in the recent MERS-centric issue of the EMRO Journal, recommend following the basic protocols you would to suppress spread of any virus capable of causing an acute respiratory infection (ARI) with a leaning towards those that worked well to interrupt hospital-based spread of severe acute respiratory syndrome (SARS) coronavirus.

Some key points from the paper, of highest relevance to our current knowledge of the  MERS-CoV are  listed include (not in specific order or priority):

  1. Identify patients with ARIs and prevent them from transmisttign the agent to helathcare worklers and patients
  2. Droplet and contact precautions for people with ARIs
  3. Separate ARI patients by ≥1m from other patients and from HCWs
  4. Use personal protective equipment (PPE) including eye protection, gloves, long-sleeved gowns and surgical mask/procedure mask/particulate respirator if aerosol-generating procedures are to be performed (tracheal intubation alone or with cardiopulmonary resuscitation or bronchoscopy being notable risks)
Mike Coston's description of the mask debate is very helpful for #4 above.

If a particular infectious diagnosis can be made, then patients with that diagnosis, say MERS-CoV,  can be cohorted - co-located to minimize spread to uninfected patients and maximise specialised care and efficient use of available resources.

Specifically, the article includes a list of SARS-like IPC precautions listed include which may be useful for known MERS-CoV infections. Many of these apply to ARIs due to endemic respiratory viruses and novel influenza viruses in general though:

  • Good hand hygiene
  • Use of PPE (gloves, gown, eye protection and medical masks for HCWs, caregivers and the patient if oputside their room
  • Particulate respirator for aerosol generating procedures
  • Separate, adequately ventilated room
While the above is written for dealing with infection in a healthcare setting, the WHO have also just released a rapid advice document for those caring for mildly ill MERS-CoV-infected people without underlying conditions, or those recently discharged from hospital. A mashup of 16 distinct points (read the document to see the full language and exceptions) home IPC are:

  • Limit contact with the ill person - maintain distance (perhaps limit exposure time?). 
  • Do not allow people at increased risk to care for the ill person
  • Hand hygiene and respiratory hygiene are important as are appropriate (soap and water, bl;each as recommended) cleaning of all surfaces in contact with the person or their secretions - kitchen, bathroom, toilet, bedframe, bedside tables, furniture etc
  • Discard contaminated tissues, masks etc
  • Clean clothes
  • Do not share eating utensils food or drionk, towels or bed linen
  • Caregiver to wear a mask - discard after use and do not handle while in use
  • Ventilate shared spaces

Close medical supervision is recommended for symptomatic or probable MERS cases and their contacts.

The WHO home care advice also notes lack of evidence for transmission of MERS (the disease) from asymptomatic, pre-symptomatic or early-symptomatic people. Thus quarantine or isolation of asymptomatic cases is currently unnecessary but possibly exposed people should monitor their health for 14-days.

Key documents and official websites to be familiar with:

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