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 : 000194 ( Pmc/Checkpoint ); précédent : 000193; suivant : 000195Risk 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.
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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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">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</title><author><name sortKey="Ki, Hyun Kyun" sort="Ki, Hyun Kyun" uniqKey="Ki H" first="Hyun Kyun" last="Ki">Hyun Kyun Ki</name><affiliation wicri:level="3"><nlm:aff id="Aff1"><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>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. 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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></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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<front><journal-meta><journal-id journal-id-type="nlm-ta">BMC Pulm Med</journal-id><journal-id journal-id-type="iso-abbrev">BMC Pulm Med</journal-id><journal-title-group><journal-title>BMC Pulmonary Medicine</journal-title></journal-title-group><issn pub-type="epub">1471-2466</issn><publisher><publisher-name>BioMed Central</publisher-name><publisher-loc>London</publisher-loc></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">31666061</article-id><article-id pub-id-type="pmc">6822455</article-id><article-id pub-id-type="publisher-id">940</article-id><article-id pub-id-type="doi">10.1186/s12890-019-0940-5</article-id><article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject></subj-group></article-categories><title-group><article-title>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</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>Ki</surname><given-names>Hyun Kyun</given-names></name><address><email>kihkdr@kuh.ac.kr</email></address><xref ref-type="aff" rid="Aff1">1</xref></contrib><contrib contrib-type="author"><name><surname>Han</surname><given-names>Sang Kuk</given-names></name><address><email>sk01.han@samsung.com</email></address><xref ref-type="aff" rid="Aff2">2</xref></contrib><contrib contrib-type="author"><name><surname>Son</surname><given-names>Jun Seong</given-names></name><address><email>isonjs@naver.com</email></address><xref ref-type="aff" rid="Aff3">3</xref></contrib><contrib contrib-type="author" corresp="yes"><contrib-id contrib-id-type="orcid">http://orcid.org/0000-0003-2663-9366</contrib-id><name><surname>Park</surname><given-names>Sang O</given-names></name><address><email>empso@kuh.ac.kr</email></address><xref ref-type="aff" rid="Aff4">4</xref></contrib><aff id="Aff1"><label>1</label><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>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</aff><aff id="Aff2"><label>2</label><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</aff><aff id="Aff3"><label>3</label><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</aff><aff id="Aff4"><label>4</label><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</aff></contrib-group><pub-date pub-type="epub"><day>30</day><month>10</month><year>2019</year></pub-date><pub-date pub-type="pmc-release"><day>30</day><month>10</month><year>2019</year></pub-date><pub-date pub-type="collection"><year>2019</year></pub-date><volume>19</volume><elocation-id>190</elocation-id><history><date date-type="received"><day>11</day><month>11</month><year>2018</year></date><date date-type="accepted"><day>16</day><month>9</month><year>2019</year></date></history><permissions><copyright-statement>© The Author(s). 2019</copyright-statement><license license-type="OpenAccess"><license-p><bold>Open Access</bold>This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/licenses/by/4.0/">http://creativecommons.org/licenses/by/4.0/</ext-link>), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (<ext-link ext-link-type="uri" xlink:href="http://creativecommons.org/publicdomain/zero/1.0/">http://creativecommons.org/publicdomain/zero/1.0/</ext-link>) applies to the data made available in this article, unless otherwise stated.</license-p></license></permissions><abstract id="Abs1"><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></abstract><kwd-group xml:lang="en"><title>Keywords</title><kwd>Middle East respiratory syndrome coronavirus</kwd><kwd>Nosocomial infection</kwd><kwd>Infection control</kwd><kwd>Isolation</kwd><kwd>Hand hygiene</kwd></kwd-group><custom-meta-group><custom-meta><meta-name>issue-copyright-statement</meta-name><meta-value>© The Author(s) 2019</meta-value></custom-meta></custom-meta-group></article-meta></front></pmc><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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