Dr . Jameela Al-AjmiExecutive Director Corporate Infection Prevention & Control

Sr. Consultant Infectious Diseases -HMC

HMC-IHI INFECTIOUS DISEASES PREPARDNESS WORKSHOP

Before Arrival Upon Arrival After Arrival

• Instruct AS staff who accompany patient to:

• Call ahead upon arrival to hospital

• To take appropriate preventive actions such as

wear a facemask upon entry to contain cough

• Instructions should include adhere cough etiquette and hand hygiene

• Follow triage procedures throughout the duration of the visit

• Posting visual alerts (e.g., signs, posters) at the entrance and in

strategic places

• Immediately isolate those with positive CD triaging

screening

• Provide supplies such as PPE , H.H alcohol (e.g., at

entrances of facility, waiting rooms, at patient check-in)

Minimize Chance for Exposures

CDC-Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV. JUNE. 2015

• Potentially infectious patients entering to ED shall be promptly identified and isolated as soon as possible after patient arrival

Emergency Department ;Triage Area

MERSsuspected

RequiresUrgentInpatientAirborneandcontactIsolation

Donotwaitforresults.

RefertoMedicine/MICUforurgentadmissionto

airborneandcontactisolation.

DiscussBronchoscopy.

8hourslaterMedicine/MICUrepeatSTATswabs&sputumif

needed.

MERSnotlikely

Nostayrequiredunlessforotherclinicalreasons(nostayrequiredfor?H1N1)

Treatappropriatelyforotherconditions.

Takecontactdetails.

HomeisolatewithadvicesheetandfollowupbyMOPH.

StopanyisolationifnegativeresultsforMERS,

H1N1andTB.

STATrecalltoHGHEDifswabpositiveforMERSorTB.IfH1N1,continuehomeisolation.Patienttoreturnifsymptomsworsen.

*RiskFactorsthatmakeMERSmorelikely/suspected:• Contactwithconfirmed/suspectedMERS

Coronaviruscase• Contactwithfarm/barnanimal(esp.camelsand

camelproductsuchasrawmeat,milk,urine)• Age>60yearsold• Traveltocluster/endemicarea≤21days

Co-morbiditiesthatmakeMERSmoresevere:• Diabetes• OldAge,Hypertension• Asthma/COPD• Heart/Liver/RenalDisease• Immuno-compromised• Alcoholmisuse• Smoking,Cerebrovascularaccident

ConductinitialnursingassessmentincludingobservationsinRespiratoryAssessmentArea/Resus.DoctorconsiderschestX-Raybearinginmind:history,examination,riskfactors*andco-morbidities**below.

OrderportablechestX-Raywriting“queryMERS-urgentChestX-Ray”;maintainInfectionControlmeasuresatalltimes;patienttoX-Ray;informdoctorwhenpatientreturnsfromX-Ray.

Maskpatientwithsurgicalmaskandescorttopre-assessmentisolationunit:dropletPPEforstaff.NB–Ifrespiratorydistress/infectionissevere,transferdirectlytoResusroom:airborneisolation.

Patientpresentstoanyareawith:FEVER(≥38○)andCOUGHorFEVERandSHORTNESSOFBREATHorSEVEREACUTERESPIRATORYINFECTION

MERSveryunlikely

HomeisolationTreatappropriatelyforother

conditions.Swabsandsputumnotclinically

requiredbutusefulforsurveillanceonly.

Patienttoreturnifsymptomsworsen.

AirborneandcontactPPEforstaff.STATnasopharyngeal&oropharyngealswabs.Sputumifpossibleforrespiratorypathogensinc.MERSandTBifindicated.

(+/-induction)Aspirateifintubated.

Patienthas:• moderate-severepneumonia

OR• severeacuterespiratory

illness

Patienthas:• mild-moderatepneumonia,nohypoxiaOR• othermoderaterespiratoryillnessOR• clearchestx-rayANDmild-moderaterespiratoryillness

Patienthas:• nopneumoniaOR• othermildrespiratoryillness

e.g.flu,parainfluenza,RSV

Ø WithNoriskfactors⃰

WHO. Interim guidance Surveillance for human infection with (MERS-CoV)June.2018

A. Clinical clues:

A person with history of fever , cough and indications of pulmonary parenchymal disease (e.g. pneumonia or ARDS), based on clinical or radiological evidence with no other aetiology.

B. Epidemiological clues: Such as:

1.The person resides in the ME where human infections have been reported, and in countries where MERS-CoV is known to be circulating in dromedary camels

2.The patient is part of a cluster of acute respiratory illness that occurs within 14 days period

3.The disease occurs in a health care worker who has been working in an environment where patients with SARI are being cared

4.Close physical contact with a confirmed or probable case of MERS-CoVinfection, while that patient was ill

5.Direct contact with dromedary camels or consumption or exposure to dromedary camel products (raw meat, unpasteurized milk, urine)

Early Recognition, Isolation, Reporting, and Surveillance Of Episodes Of CD of Potential International Public Health Concern (MERS-COV)

History of travel to countries suffering from CD of potential concern

+Within known or suspected incubation Period

+Unprotected contact with animals and/or patients with CD within the known or suspected incubation period

+Possible occupational exposure to pathogens causing

CD

Patient enters triage with symptoms of suggestive of MERS-COV infection

Ø HCWs should use PPE (N95 mask , PAPR ,eye protection, gown, and gloves) and perform adequate hand hygiene

Ø Patient shall use surgical mask ,escort to the pre-assessment isolation unit and hand hygiene after contact with respiratory secretions

Ø Airborne precaution room or single well-ventilated room accommodation

Ø If single room is not possible, cohort patients with same etiological diagnosis.

Ø Portable HEPA filter machine shall be used if airborne isolation room is not available

plus clinical &epidemiological clues for

MERS-COV infection

Report to public healthauthorities

Patient

HMC-CL7279. INFECTION PREVENTION AND CONTROL PROGRAM FOR EMERGENCY PREPAREDNESS AND CONTROL FOR COMMUNICABLE DISEASES

Engineering & Environmental Infection Control Measures

Other Precaution Measures

ü Place signage, N95 masks ,thrash bin and alcohol based hand rub as close as

possible to all entrance of ED and patient rooms

ü Triage staff shall be educated about the CD screening questioner /Algorithm

ü Train and Educate staff on appropriate use of PPE

ü HCWs assigned for patients with ARDs of potential concern should be

experienced and should not “float” or be assigned also to other patient-care areas.

ü Exclude symptomatic healthcare workers from duty and sick leave shall be

provided according to the clinical evaluation of staff medical centre

ü Establish procedures for monitoring, managing and training visitors

ü Facilities should keep a log of all persons who care for OR enter the rooms or care area of these patients

ü Security personnel shall Restrict visitors from entering the MERS-CoV patient’s room

ü Inform the receiving department about patient’s isolation status

ü If transport or movement shall be necessary, minimize patient dispersal of droplet nuclei by placing a surgical mask on the patient.

ü Ensure regular cleaning and proper disinfection of common areas

Duration of Infection Control Precautions:

• Duration of precautions should be determined on a case-by-case basis

• Factors that should be considered include: presence of symptoms related to MERS-CoV , date symptoms resolved, other conditions such as available laboratory information

CDC-Interim Infection Prevention and Control Recommendations for Hospitalized Patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV. JUNE. 2015