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
Identifieur interne : 000400 ( Main/Exploration ); précédent : 000399; suivant : 000401Risk 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
Auteurs : Hyun Kyun Ki [Corée du Sud] ; Sang Kuk Han [Corée du Sud] ; Jun Seong Son [Corée du Sud] ; Sang O. Park [Corée du Sud]Source :
- BMC Pulmonary Medicine [ 1471-2466 ] ; 2019.
Descripteurs français
- KwdFr :
- Adulte, Adulte d'âge moyen, Centres de soins tertiaires, Chambre de patient, Coronavirus du syndrome respiratoire du Moyen-Orient (isolement et purification), Exposition professionnelle (), Facteurs de risque, Femelle, Flambées de maladies (), Humains, Incidence, Infection croisée (), Infection croisée (transmission), Infections à coronavirus (diagnostic), Infections à coronavirus (transmission), Infections à coronavirus (épidémiologie), Jeune adulte, Mâle, Personnel de santé (), République de Corée (épidémiologie), Service hospitalier d'urgences, Sujet âgé, Transmission de maladie infectieuse du professionnel de santé au patient, Études rétrospectives.
- MESH :
- diagnostic : Infections à coronavirus.
- isolement et purification : Coronavirus du syndrome respiratoire du Moyen-Orient.
- épidémiologie : Infection croisée, Infections à coronavirus, République de Corée.
- Adulte, Adulte d'âge moyen, Centres de soins tertiaires, Chambre de patient, Exposition professionnelle, Facteurs de risque, Femelle, Flambées de maladies, Humains, Incidence, Infection croisée, Jeune adulte, Mâle, Personnel de santé, Service hospitalier d'urgences, Sujet âgé, Transmission de maladie infectieuse du professionnel de santé au patient, Études rétrospectives.
English descriptors
- KwdEn :
- Adult, Aged, Coronavirus Infections (diagnosis), Coronavirus Infections (epidemiology), Coronavirus Infections (transmission), Cross Infection (prevention & control), Cross Infection (transmission), Disease Outbreaks (statistics & numerical data), Emergency Service, Hospital, Female, Health Personnel (statistics & numerical data), Humans, Incidence, Infectious Disease Transmission, Professional-to-Patient, Male, Middle Aged, Middle East Respiratory Syndrome Coronavirus (isolation & purification), Occupational Exposure (statistics & numerical data), Patients' Rooms, Republic of Korea (epidemiology), Retrospective Studies, Risk Factors, Tertiary Care Centers, Young Adult.
- MESH :
- geographic , epidemiology : Republic of Korea.
- diagnosis : Coronavirus Infections.
- epidemiology : Coronavirus Infections.
- isolation & purification : Middle East Respiratory Syndrome Coronavirus.
- prevention & control : Cross Infection.
- statistics & numerical data : Disease Outbreaks, Health Personnel, Occupational Exposure.
- transmission : Coronavirus Infections, Cross Infection.
- Adult, Aged, Emergency Service, Hospital, Female, Humans, Incidence, Infectious Disease Transmission, Professional-to-Patient, Male, Middle Aged, Patients' Rooms, Retrospective Studies, Risk Factors, Tertiary Care Centers, Young Adult.
Abstract
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.
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.
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%; 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.
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.
Url:
DOI: 10.1186/s12890-019-0940-5
PubMed: 31666061
PubMed Central: 6822455
Affiliations:
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Le document en format XML
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institution-id-type="GRID">grid.258676.8</institution-id><institution>Division of infectious diseases, Department of Internal Medicine, School of Medicine,</institution><institution>Konkuk University, Konkuk University Medical Centre,</institution></institution-wrap>120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029 Republic of Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Han, Sang Kuk" sort="Han, Sang Kuk" uniqKey="Han S" first="Sang Kuk" last="Han">Sang Kuk Han</name><affiliation wicri:level="3"><nlm:aff id="Aff2"><institution-wrap><institution-id institution-id-type="ISNI">0000 0001 2181 989X</institution-id><institution-id institution-id-type="GRID">grid.264381.a</institution-id><institution>Department of Emergency Medicine,</institution><institution>Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine,</institution></institution-wrap>108 Pyung-Dong, Jongno-Gu, Seoul, 110-746 Republic of Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>108 Pyung-Dong, Jongno-Gu, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Son, Jun Seong" sort="Son, Jun Seong" uniqKey="Son J" first="Jun Seong" last="Son">Jun Seong Son</name><affiliation wicri:level="3"><nlm:aff id="Aff3"><institution-wrap><institution-id institution-id-type="GRID">grid.496794.1</institution-id><institution>Division of Infectious Diseases, Department of Internal Medicine,</institution><institution>Kyung Hee University Hospital at Gangdong,</institution></institution-wrap>892, Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>892, Dongnam-ro, Gangdong-gu, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author><author><name sortKey="Park, Sang O" sort="Park, Sang O" uniqKey="Park S" first="Sang O" last="Park">Sang O. Park</name><affiliation wicri:level="3"><nlm:aff id="Aff4"><institution-wrap><institution-id institution-id-type="ISNI">0000 0004 0532 8339</institution-id><institution-id institution-id-type="GRID">grid.258676.8</institution-id><institution>Department of Emergency Medicine, School of Medicine,</institution><institution>Konkuk University, Konkuk University Medical Centre,</institution></institution-wrap>120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029 Republic of Korea</nlm:aff><country xml:lang="fr">Corée du Sud</country><wicri:regionArea>120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul</wicri:regionArea><placeName><settlement type="city">Séoul</settlement><region type="capital">Région capitale de Séoul</region></placeName></affiliation></author></analytic><series><title level="j">BMC Pulmonary Medicine</title><idno type="eISSN">1471-2466</idno><imprint><date when="2019">2019</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adult</term><term>Aged</term><term>Coronavirus Infections (diagnosis)</term><term>Coronavirus Infections (epidemiology)</term><term>Coronavirus Infections (transmission)</term><term>Cross Infection (prevention & control)</term><term>Cross Infection (transmission)</term><term>Disease Outbreaks (statistics & numerical data)</term><term>Emergency Service, Hospital</term><term>Female</term><term>Health Personnel (statistics & numerical data)</term><term>Humans</term><term>Incidence</term><term>Infectious Disease Transmission, Professional-to-Patient</term><term>Male</term><term>Middle Aged</term><term>Middle East Respiratory Syndrome Coronavirus (isolation & purification)</term><term>Occupational Exposure (statistics & numerical data)</term><term>Patients' Rooms</term><term>Republic of Korea (epidemiology)</term><term>Retrospective Studies</term><term>Risk Factors</term><term>Tertiary Care Centers</term><term>Young Adult</term></keywords><keywords scheme="KwdFr" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Centres de soins tertiaires</term><term>Chambre de patient</term><term>Coronavirus du syndrome respiratoire du Moyen-Orient (isolement et purification)</term><term>Exposition professionnelle ()</term><term>Facteurs de risque</term><term>Femelle</term><term>Flambées de maladies ()</term><term>Humains</term><term>Incidence</term><term>Infection croisée ()</term><term>Infection croisée (transmission)</term><term>Infections à coronavirus (diagnostic)</term><term>Infections à coronavirus (transmission)</term><term>Infections à coronavirus (épidémiologie)</term><term>Jeune adulte</term><term>Mâle</term><term>Personnel de santé ()</term><term>République de Corée (épidémiologie)</term><term>Service hospitalier d'urgences</term><term>Sujet âgé</term><term>Transmission de maladie infectieuse du professionnel de santé au patient</term><term>Études rétrospectives</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Republic of Korea</term></keywords><keywords scheme="MESH" qualifier="diagnosis" xml:lang="en"><term>Coronavirus Infections</term></keywords><keywords scheme="MESH" qualifier="diagnostic" xml:lang="fr"><term>Infections à coronavirus</term></keywords><keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term></keywords><keywords scheme="MESH" qualifier="isolation & purification" xml:lang="en"><term>Middle East Respiratory Syndrome Coronavirus</term></keywords><keywords scheme="MESH" qualifier="isolement et purification" xml:lang="fr"><term>Coronavirus du syndrome respiratoire du Moyen-Orient</term></keywords><keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Cross Infection</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Disease Outbreaks</term><term>Health Personnel</term><term>Occupational Exposure</term></keywords><keywords scheme="MESH" qualifier="transmission" xml:lang="en"><term>Coronavirus Infections</term><term>Cross Infection</term></keywords><keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Infection croisée</term><term>Infections à coronavirus</term><term>République de Corée</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Adult</term><term>Aged</term><term>Emergency Service, Hospital</term><term>Female</term><term>Humans</term><term>Incidence</term><term>Infectious Disease Transmission, Professional-to-Patient</term><term>Male</term><term>Middle Aged</term><term>Patients' Rooms</term><term>Retrospective Studies</term><term>Risk Factors</term><term>Tertiary Care Centers</term><term>Young Adult</term></keywords><keywords scheme="MESH" xml:lang="fr"><term>Adulte</term><term>Adulte d'âge moyen</term><term>Centres de soins tertiaires</term><term>Chambre de patient</term><term>Exposition professionnelle</term><term>Facteurs de risque</term><term>Femelle</term><term>Flambées de maladies</term><term>Humains</term><term>Incidence</term><term>Infection croisée</term><term>Jeune adulte</term><term>Mâle</term><term>Personnel de santé</term><term>Service hospitalier d'urgences</term><term>Sujet âgé</term><term>Transmission de maladie infectieuse du professionnel de santé au patient</term><term>Études rétrospectives</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Background</title><p id="Par1">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.</p></sec><sec><title>Methods</title><p id="Par2">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.</p></sec><sec><title>Results</title><p id="Par3">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%; 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.</p></sec><sec><title>Conclusions</title><p id="Par4">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.</p></sec><sec><title>Trial registration</title><p id="Par5"><ext-link ext-link-type="uri" xlink:href="https://clinicaltrials.gov/ct2/show/NCT02605109">NCT02605109</ext-link>, date of registration: 11th November 2015.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Zaki, Am" uniqKey="Zaki A">AM Zaki</name></author><author><name sortKey="Van Boheemen, S" uniqKey="Van Boheemen S">S van Boheemen</name></author><author><name sortKey="Bestebroer, Tm" uniqKey="Bestebroer T">TM Bestebroer</name></author><author><name sortKey="Osterhaus, Ad" uniqKey="Osterhaus A">AD Osterhaus</name></author><author><name sortKey="Fouchier, Ra" uniqKey="Fouchier R">RA Fouchier</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Al Tawfiq, Ja" uniqKey="Al Tawfiq J">JA Al-Tawfiq</name></author><author><name 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uniqKey="Park W">WB Park</name></author><author><name sortKey="Bang, Jh" uniqKey="Bang J">JH Bang</name></author><author><name sortKey="Kim, Es" uniqKey="Kim E">ES Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ki, M" uniqKey="Ki M">M Ki</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, Kh" uniqKey="Kim K">KH Kim</name></author><author><name sortKey="Tandi, Te" uniqKey="Tandi T">TE Tandi</name></author><author><name sortKey="Choi, Jw" uniqKey="Choi J">JW Choi</name></author><author><name sortKey="Moon, Jm" uniqKey="Moon J">JM Moon</name></author><author><name sortKey="Kim, Ms" uniqKey="Kim M">MS Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Cho, Sy" uniqKey="Cho S">SY Cho</name></author><author><name sortKey="Kang, Jm" uniqKey="Kang J">JM Kang</name></author><author><name sortKey="Ha, Ye" uniqKey="Ha Y">YE Ha</name></author><author><name sortKey="Park, Ge" 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Rashid</name></author><author><name sortKey="Booy, R" uniqKey="Booy R">R Booy</name></author><author><name sortKey="El Bashir, H" uniqKey="El Bashir H">H El Bashir</name></author><author><name sortKey="Haworth, E" uniqKey="Haworth E">E Haworth</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Hall, Aj" uniqKey="Hall A">AJ Hall</name></author><author><name sortKey="Tokars, Ji" uniqKey="Tokars J">JI Tokars</name></author><author><name sortKey="Badreddine, Sa" uniqKey="Badreddine S">SA Badreddine</name></author><author><name sortKey="Saad, Zb" uniqKey="Saad Z">ZB Saad</name></author><author><name sortKey="Furukawa, E" uniqKey="Furukawa E">E Furukawa</name></author><author><name sortKey="Al Masri, M" uniqKey="Al Masri M">M Al Masri</name></author></analytic></biblStruct></listBibl></div1></back></TEI><affiliations><list><country><li>Corée du Sud</li></country><region><li>Région capitale de Séoul</li></region><settlement><li>Séoul</li></settlement></list><tree><country name="Corée du Sud"><region name="Région capitale de Séoul"><name sortKey="Ki, Hyun Kyun" sort="Ki, Hyun Kyun" uniqKey="Ki H" first="Hyun Kyun" last="Ki">Hyun Kyun Ki</name></region><name sortKey="Han, Sang Kuk" sort="Han, Sang Kuk" uniqKey="Han S" first="Sang Kuk" last="Han">Sang Kuk Han</name><name sortKey="Park, Sang O" sort="Park, Sang O" uniqKey="Park S" first="Sang O" last="Park">Sang O. Park</name><name sortKey="Son, Jun Seong" sort="Son, Jun Seong" uniqKey="Son J" first="Jun Seong" last="Son">Jun Seong Son</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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