Risk of transmission via medical employees and importance of routine infection-prevention policy in a nosocomial outbreak of Middle East respiratory syndrome (MERS): a descriptive analysis from a tertiary care hospital in South Korea
Risk of transmission via medical employees and importance of routine infection-prevention policy in a nosocomial outbreak of Middle East respiratory syndrome (MERS): a descriptive analysis from a tertiary care hospital in South Korea
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DOI：
10.1186/s12890-019-0940-5
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发表时间：
2019-10-30
影响因子：
3.1
通讯作者：
Park, Sang O.
中科院分区：
文献类型：
--
作者：
Ki, Hyun Kyun;Han, Sang Kuk;Park, Sang O.
背景资料：2015年，韩国爆发中东呼吸综合征（MERS）疫情，我院发生MERS院内感染。我们进行了全面的分析，以确定中东呼吸综合征的传播途径和能力，我们的常规感染预防政策，以控制此outbreak.Methods：这是一个病例队列研究的回顾性分析数据，从医疗图表，闭路电视，个人访谈和国家数据库。我们分析了MERS传播风险人群的数据，包括急诊科（艾德）的228人和普通病房（GW）的218人。记录人员位置和移动、个人防护设备和手卫生数据。结果：该患者为我院收治的一名老年患者，其传播风险为：1）高风险：在2 m范围内; 2）中风险：在同一时间同一病房; 3）低风险：仅在同一科室，无接触。确定了11例来自索引患者的传播; 4例在我们医院感染。客观地观察到，艾德的人员对常规感染预防方法的依从性较高：93%戴外科口罩，95.6%洗手。仅观察到1.8%的人员在GW中佩戴外科口罩。与GW相比，艾德的高危个体百分比更高（14.5% vs. 2.8%），但GW的发病率（16.7%; 1/6）高于艾德（3%; 1/33）。ED中、低危组无传播，低危组GW感染2例。MERS间接传播给他们的工作人员谁照顾索引patient.Conclusions：我们的研究提供了令人信服的证据表明，常规的感染预防政策可以大大减少MERS的院内传播。传统的隔离主要是通过在MERS爆发期间追踪患者的接触者来建立的。但它应该扩大到所有与MERS患者有接触的医务人员治疗的人。
Background: In 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.Methods: This 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.Results: The 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%; 1/6) 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.Conclusions: Our 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.