Crisis prevention and management by infection control nurses during the Middle East respiratory coronavirus outbreak in Korea
Identifieur interne : 000A45 ( Pmc/Corpus ); précédent : 000A44; suivant : 000A46Crisis prevention and management by infection control nurses during the Middle East respiratory coronavirus outbreak in Korea
Auteurs : Jeong Sil Choi ; Kyung Mi KimSource :
- American Journal of Infection Control [ 0196-6553 ] ; 2016.
Abstract
A Middle East respiratory coronavirus (MERS-CoV) outbreak occurred in Korea between June 20 and July 28, 2015. A total of 186 patients were confirmed as being infected with MERS-CoV, 36 of whom died. Infection control nurses referred to hospital guidelines to address the screening and isolation needs of patients and instigated a variety of infection control activities to prevent MERS-CoV transmission at the frontlines of patient care. Their concerted effort is believed to have been instrumental in ending the outbreak.
Url:
DOI: 10.1016/j.ajic.2015.10.032
PubMed: 27038394
PubMed Central: 7132658
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Crisis prevention and management by infection control nurses during the Middle East respiratory coronavirus outbreak in Korea</title><author><name sortKey="Choi, Jeong Sil" sort="Choi, Jeong Sil" uniqKey="Choi J" first="Jeong Sil" last="Choi">Jeong Sil Choi</name><affiliation><nlm:aff id="af0010">College of Nursing, Gachon University, Incheon, South Korea</nlm:aff></affiliation></author><author><name sortKey="Kim, Kyung Mi" sort="Kim, Kyung Mi" uniqKey="Kim K" first="Kyung Mi" last="Kim">Kyung Mi Kim</name><affiliation><nlm:aff id="af0015">College of Nursing, The Catholic University of Korea, Seoul, South Korea</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">27038394</idno><idno type="pmc">7132658</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7132658</idno><idno type="RBID">PMC:7132658</idno><idno type="doi">10.1016/j.ajic.2015.10.032</idno><date when="2016">2016</date><idno type="wicri:Area/Pmc/Corpus">000A45</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000A45</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Crisis prevention and management by infection control nurses during the Middle East respiratory coronavirus outbreak in Korea</title><author><name sortKey="Choi, Jeong Sil" sort="Choi, Jeong Sil" uniqKey="Choi J" first="Jeong Sil" last="Choi">Jeong Sil Choi</name><affiliation><nlm:aff id="af0010">College of Nursing, Gachon University, Incheon, South Korea</nlm:aff></affiliation></author><author><name sortKey="Kim, Kyung Mi" sort="Kim, Kyung Mi" uniqKey="Kim K" first="Kyung Mi" last="Kim">Kyung Mi Kim</name><affiliation><nlm:aff id="af0015">College of Nursing, The Catholic University of Korea, Seoul, South Korea</nlm:aff></affiliation></author></analytic><series><title level="j">American Journal of Infection Control</title><idno type="ISSN">0196-6553</idno><idno type="eISSN">1527-3296</idno><imprint><date when="2016">2016</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p>A Middle East respiratory coronavirus (MERS-CoV) outbreak occurred in Korea between June 20 and July 28, 2015. A total of 186 patients were confirmed as being infected with MERS-CoV, 36 of whom died. Infection control nurses referred to hospital guidelines to address the screening and isolation needs of patients and instigated a variety of infection control activities to prevent MERS-CoV transmission at the frontlines of patient care. Their concerted effort is believed to have been instrumental in ending the outbreak.</p></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Centers For Disease Control And Prevention" uniqKey="Centers For Disease Control And Prevention">Centers for Disease Control and Prevention</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Lee, H Y" uniqKey="Lee H">H.Y. Lee</name></author><author><name sortKey="Oh, M N" uniqKey="Oh M">M.N. Oh</name></author><author><name sortKey="Park, Y S" uniqKey="Park Y">Y.S. Park</name></author><author><name sortKey="Chu, C S" uniqKey="Chu C">C.S. Chu</name></author><author><name sortKey="Son, T J" uniqKey="Son T">T.J. Son</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Korea Centers For Disease Control And Prevention" uniqKey="Korea Centers For Disease Control And Prevention">Korea Centers for Disease Control and Prevention</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Ministry Of Health And Welfare" uniqKey="Ministry Of Health And Welfare">Ministry of Health and Welfare</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Korea Centers For Disease Control And Prevention" uniqKey="Korea Centers For Disease Control And Prevention">Korea Centers for Disease Control and Prevention</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="The Korean Society Of Infectious Diseases Korean Society For Healthcare Associated Infection Control And Prevention" uniqKey="The Korean Society Of Infectious Diseases Korean Society For Healthcare Associated Infection Control And Prevention">The Korean Society of Infectious Diseases, Korean Society for Healthcare-associated Infection Control and Prevention</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="World Health Organization Who" uniqKey="World Health Organization Who">World Health Organization (WHO)</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Oh, H S" uniqKey="Oh H">H.S. Oh</name></author><author><name sortKey="Lee, S E" uniqKey="Lee S">S.E. Lee</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Kim, K M" uniqKey="Kim K">K.M. Kim</name></author><author><name sortKey="Jeong, J S" uniqKey="Jeong J">J.S. Jeong</name></author><author><name sortKey="Park, H R" uniqKey="Park H">H.R. Park</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Choi, J S" uniqKey="Choi J">J.S. Choi</name></author><author><name sortKey="Kim, K M" uniqKey="Kim K">K.M. Kim</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Centers For Disease Control And Prevention" uniqKey="Centers For Disease Control And Prevention">Centers for Disease Control and Prevention</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="World Health Organization Who" uniqKey="World Health Organization Who">World Health Organization (WHO)</name></author></analytic></biblStruct></listBibl></div1></back></TEI><pmc article-type="research-article"><pmc-dir>properties open_access</pmc-dir>
<front><journal-meta><journal-id journal-id-type="nlm-ta">Am J Infect Control</journal-id><journal-id journal-id-type="iso-abbrev">Am J Infect Control</journal-id><journal-title-group><journal-title>American Journal of Infection Control</journal-title></journal-title-group><issn pub-type="ppub">0196-6553</issn><issn pub-type="epub">1527-3296</issn><publisher><publisher-name>Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc.</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">27038394</article-id><article-id pub-id-type="pmc">7132658</article-id><article-id pub-id-type="publisher-id">S0196-6553(15)01118-9</article-id><article-id pub-id-type="doi">10.1016/j.ajic.2015.10.032</article-id><article-categories><subj-group subj-group-type="heading"><subject>Article</subject></subj-group></article-categories><title-group><article-title>Crisis prevention and management by infection control nurses during the Middle East respiratory coronavirus outbreak in Korea</article-title></title-group><contrib-group><contrib contrib-type="author" id="au0010"><name><surname>Choi</surname><given-names>Jeong Sil</given-names></name><degrees>PhD, MPH, RN, ICAPN</degrees><xref rid="af0010" ref-type="aff">a</xref></contrib><contrib contrib-type="author" id="au0015"><name><surname>Kim</surname><given-names>Kyung Mi</given-names></name><degrees>PhD, RN, ICAPN</degrees><email>icpkim@catholic.ac.kr</email><xref rid="af0015" ref-type="aff">b</xref><xref rid="co0010" ref-type="corresp">*</xref></contrib></contrib-group><aff id="af0010"><label>a</label>College of Nursing, Gachon University, Incheon, South Korea</aff><aff id="af0015"><label>b</label>College of Nursing, The Catholic University of Korea, Seoul, South Korea</aff><author-notes><corresp id="co0010"><label>*</label>Address correspondence to Kyung Mi Kim, PhD, RN, ICAPN, College of Nursing, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 137-701, South Korea. (K.M. Kim). <email>icpkim@catholic.ac.kr</email></corresp></author-notes><pub-date pub-type="pmc-release"><day>30</day><month>3</month><year>2016</year></pub-date><pmc-comment> PMC Release delay is 0 months and 0 days and was based on .</pmc-comment>
<pub-date pub-type="ppub"><day>1</day><month>4</month><year>2016</year></pub-date><pub-date pub-type="epub"><day>30</day><month>3</month><year>2016</year></pub-date><volume>44</volume><issue>4</issue><fpage>480</fpage><lpage>481</lpage><permissions><copyright-statement>Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.</copyright-statement><copyright-year>2016</copyright-year><copyright-holder>Association for Professionals in Infection Control and Epidemiology, Inc.</copyright-holder><license><license-p>Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.</license-p></license></permissions><abstract id="ab0010"><p>A Middle East respiratory coronavirus (MERS-CoV) outbreak occurred in Korea between June 20 and July 28, 2015. A total of 186 patients were confirmed as being infected with MERS-CoV, 36 of whom died. Infection control nurses referred to hospital guidelines to address the screening and isolation needs of patients and instigated a variety of infection control activities to prevent MERS-CoV transmission at the frontlines of patient care. Their concerted effort is believed to have been instrumental in ending the outbreak.</p></abstract><kwd-group id="kwd9010"><title>Key Words</title><kwd>MERS-CoV</kwd><kwd>Nurse</kwd></kwd-group></article-meta></front><body><p id="p0010">Middle East respiratory syndrome (MERS) is an emerging infectious disease caused by a coronavirus that gives rise to respiratory infection. MERS was first discovered in Saudi Arabia in 2012, and cases of this disease have mainly occurred in the Middle East region, but the number of countries with reported cases has been increasing.<xref rid="bib0010" ref-type="bibr"><sup>1</sup></xref> On May 20, 2015, the first case of MERS coronavirus (MERS-CoV) infection was diagnosed in Korea.<xref rid="bib0015" ref-type="bibr"><sup>2</sup></xref> During the period May 20-July 28, 2015, 186 patients were definitely diagnosed with MERS-CoV infection, 36 (19.4%) of whom died.<xref rid="bib0020" ref-type="bibr"><sup>3</sup></xref> More than 16,000 people exposed to MERS patients were self-isolated or isolated in hospitals.<xref rid="bib0025" ref-type="bibr"><sup>4</sup></xref> Patients with MERS were admitted to or visited 98 hospitals across the country, exposing all regions of Korea to the risk of MERS infection.<xref rid="bib0030" ref-type="bibr"><sup>5</sup></xref> Fifteen hospitals stopped regular medical services and were placed under the government's control for isolation purposes because many of their health care workers and patients had been exposed to patients with MERS-CoV infection.<xref rid="bib0025" ref-type="bibr"><sup>4</sup></xref> Thirty-nine health care workers (21%) were infected with MERS-CoV, 8 of whom were doctors and 15 of whom were nurses.<xref rid="bib0020" ref-type="bibr"><sup>3</sup></xref> To date, this outbreak of MERS-CoV infection was the second largest worldwide, and the largest outbreak of this disease outside of the Middle East.<xref rid="bib0035" ref-type="bibr"><sup>6</sup></xref> Unlike in other regions, Korea's MERS-CoV infection outbreak presented no evidence of community transmission, and the epidemiologic pattern was that of health care-associated outbreaks.<xref rid="bib0040" ref-type="bibr"><sup>7</sup></xref> Additionally, MERS-CoV transmission was accelerated by interhospital infection.<xref rid="bib0035" ref-type="bibr"><sup>6</sup></xref> The outbreak posed a critical threat to the work of infection control nurses (ICNs), who played key roles in keeping the disease from spreading further.</p><p id="p0015">Since ICNs were first deployed in Korea in 1991,<xref rid="bib0045" ref-type="bibr"><sup>8</sup></xref> the Medical Service Act has ruled that hospitals with 200 or more beds should have infection control committees and infection control departments.<xref rid="bib0050" ref-type="bibr"><sup>9</sup></xref> However, even large hospitals have only 1-2 ICNs.<xref rid="bib0045" ref-type="bibr">8</xref>, <xref rid="bib0055" ref-type="bibr">10</xref> Although the struggle to stop the transmission of MERS-CoV infection was beyond the capabilities of these ICNs, they nonetheless worked diligently to limit the outbreak. A number of difficulties were encountered during the early stages of the MERS-CoV infection outbreak. The Korea Centers for Disease Control and Prevention distributed MERS-CoV response guidelines based on those from the Centers for Disease Control and Prevention and the World Health Organization. Unfortunately, the contents of these Korea Centers for Disease Control and Prevention documents were too general; those working in hospitals needed more detailed guidelines. Thus, the Korean Society for Infectious Disease, the Korean Society for Healthcare-Associated Infection Control and Prevention, and the Korean Association of Infection Control Nurses (KAICN) jointly released more detailed MERS-CoV infection control guidelines. However, each hospital's unique environment made the application of these guidelines complicated on an organization level. Accordingly, KAICN members who were ICNs sought answers to urgent questions about infection control using social networking services and built each individual hospital's manual using shared experiences and ideas. Based on these communication processes and the guidelines of the Korean Society for Infectious Disease, Korean Society for Healthcare-Associated Infection Control and Prevention, and KAICN, ICNs provided information on how to wear personal protective equipment (PPE) and determined the routes of access to the negative pressure rooms. Further, ICNs prepared hospital manuals addressing the screening and isolation of patients, hospital environment cleaning and disinfection, medical waste disposal, laundry management, specimen collection and delivery methods, patient transportation methods, patient admission and discharge, powered air purifying respirator management and cleaning, and the safe disposal of dead patients. Moreover, because standard, contact, and airborne precautions had to be applied to patients infected with MERS-CoV and patients suspected of infection,<xref rid="bib0060" ref-type="bibr"><sup>11</sup></xref> the use of PPEs increased rapidly in hospitals, and the supply of N95 masks was insufficient. In addition to providing education on the proper methods of donning and doffing PPEs in hospitals, ICNs checked their institutions' PPE inventories and were involved in maintaining sufficient PPE quantities via contact with public health centers and suppliers. Although it was known that MERS-CoV had not undergone mutations that would have made it more transmissible,<xref rid="bib0040" ref-type="bibr"><sup>7</sup></xref> its infectivity was still much stronger than assumed. Patients with confirmed MERS-CoV infection were isolated in negative pressure rooms, and the health care workers attending these patients accessed the rooms in protective whole-body suits (including a full-length gown, goggles, N95 mask, gloves, shoe covers, and other components) that were labeled “Level D.” Because most of the health care workers had no experience using Level D PPEs, ICNs provided instruction on how to put on the PPEs, monitor the manner in which the health care workers donned and removed the PPEs, and provided guidance on how to remain free from infection during the donning and doffing processes. Furthermore, ICNs communicated with local public health centers about tasks related to patients with confirmed MERS-CoV, delivered the government's MERS-CoV-related guidelines to hospitals, and implemented the gathering of MERS-CoV infection-related data requested by the government.</p><p id="p0020">In addition to the ICNs' in-hospital activities, some participated in the Immediate Response Task Force for MERS, which was launched by the Korean government in early June of this year. The task force provided MERS outbreak hospitals with updated and adapted scientific guidelines for patient care, infection control, and laboratory handling for medium- and small-sized hospitals. The Immediate Response Task Force for MERS was composed of 17 experts in infection control, including 2 nursing professors who were former ICNs, and its members made about 300 visits to hospitals with patients with confirmed MERS-CoV infection.<xref rid="bib0035" ref-type="bibr"><sup>6</sup></xref> The nursing professors visited small- and medium-sized hospitals that did not have infection control departments, as well as hospitals experiencing large outbreaks. During these visits, they provided instruction on infection control guidelines, such as PPE use and environment decontamination, and offered advice on the practice of infection control. Further, they monitored the degree to which infection control guidelines were being observed in the field, participated in tabletop exercises, and provided monitoring and advice when patients were transported. In another important role, the nursing professors informed the government of difficulties and problems related to MERS infection control in hospitals, so that these problems would be resolved and there would be support for the necessary resources.</p><p id="p0025">On July 28, 2015, the World Health Organization and the Korean government declared the end of the MERS-CoV infection outbreak.<xref rid="bib0065" ref-type="bibr"><sup>12</sup></xref> The transmission of an emerging infectious disease like MERS-CoV brought the entire society of Korea to a state of crisis. Problems were reported not only in the Korean quarantine system, but also in health care delivery and infection control systems. The transmission of MERS-CoV may have been assisted by the ease of access to the hospital system in Korea, as well as by the practice of seeking care at multiple hospitals (so-called doctor shopping).<xref rid="bib0040" ref-type="bibr"><sup>7</sup></xref> Additionally, the extremely crowded emergency rooms and multibed rooms of large metropolitan hospitals in Korea led to an unexpectedly major outbreak, in comparison with the outbreak in Saudi Arabia.<xref rid="bib0035" ref-type="bibr">6</xref>, <xref rid="bib0040" ref-type="bibr">7</xref> Many hospitals experienced heavy financial losses due to the outbreak. Academic societies related to infection control had earlier suggested establishing persistent infection control infrastructures, activating health care-associated infection surveillance, and constructing an infection control system for small- and medium-sized hospitals. However, the course of this outbreak shows that these suggestions had not been fully implemented.</p><p id="p0030">Although ICNs were faced with the first outbreak of MERS-CoV in a setting with poor infection control infrastructures, they nevertheless wrestled with the disease for more than a month, working both day and night. 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xlink:href="http://www.wpro.who.int/mediacentre/releases/2015/20150728/en/" id="iw0045">http://www.wpro.who.int/mediacentre/releases/2015/20150728/en/</ext-link><year>2015</year><comment>Accessed August 20, 2015</comment></element-citation></ref></ref-list><fn-group><fn id="d32e227"><p id="np0010">Conflicts of Interest: None to report.</p></fn></fn-group></back></pmc></record>Pour manipuler ce document sous Unix (Dilib)
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