• Personal protective equipment: all healthcare professionals who enter the room of a patient with suspected or confirmed MERS-CoV should practice standard, contact, droplet and airborne precautions including: o Hand hygiene: wash hands with soap and water or apply an alcohol-based hand rub o Gloves o Gowns
• Respiratory protection: use a fit-tested National Institute for Occupational Safety and Health (NIOSH)-certified disposable N-95 filtering face-piece respirator or equivalent respiratory protection upon entry to the patient or care area
• Eye protection (goggles or face shield): use upon entry to the patient room or care area
• Patient placement: patients suspected of MERS-CoV infec- tion should be placed in airborne infection isolation. Room should be at negative pressure to the surrounding areas with a minimum of six air changes per hour (12 air changes per hour are recommended). o If an airborne isolation room is not available, the patient should be transferred as soon as possible to a facility where airborne infection isolation rooms are available.
o Only essential personnel should enter the patient’s room. Facilities should keep a log of all persons who care for the patient or enter the patient’s room.
o Once the patient vacates a room, no one should enter the room without protection until sufficient time has elapsed for enough air changes to remove potentially infectious particles. The room should also receive appropriate clean- ing and surface disinfection.
• Use caution when performing aerosol-generating proce- dures and only perform these procedures if they are medical- ly necessary and cannot be postponed. Procedures include cough-generating procedures, bronchoscopy, sputum induc- tion, intubation and extubation, cardiopulmonary resuscita- tion and open suctioning of airways. o Healthcare workers should wear gloves, a gown, either a face shield that fully covers the front and sides of the face or goggles, and respiratory protection (N-95 filtering face-piece respirator).
o Unprotected healthcare workers should not enter the room where an aerosol-generating procedure has taken place until sufficient time has elapsed to remove infectious particles.
o Environmental surface cleaning should be done following the procedure.
• Duration of infection control precautions: There is not enough information available to define a recommended duration for keeping patients in isolation precautions. Du- ration should be determined on a case-by-case basis with input from local, state and federal authorities.
3. Manage Visitor Access and Movement Within the Facility • Restrict visitors from entering the MERS-CoV patient’s room o Visitors who have been in the contact with the patient before hospitalization may be a possible source of MERS- CoV for other patients, visitors and staff.
4. Healthcare Worker Education • Nurses, physicians and other healthcare workers need to be aware of the risk related to recent travelers from MERS-CoV affected areas (e.g., the Arabian Peninsula).
They need to communicate any suspect findings to the healthcare team.
• They should be able to recognize the symptoms of MERS and the need to isolate any traveler returning from the Arabian Peninsula promptly.
• Importation of MERS cases can be expected in the U.S. because of travelers who visit the Middle East and the U.S. The outbreak in South Korea has underlined the need for MERS awareness among healthcare professions for early detection and appropriate infection control precautions.
• Because MERS early symptoms are non-specific, healthcare workers should maintain a high level of suspicion in appropri- ate cases and consistently use standard, contact, and airborne precautions for suspected or confirmed MERS patients.
5. Environmental Infection Control • Ensure that correct cleaning and disinfection procedures are followed carefully
• Follow standard cleaning and disinfection procedures prior to applying an EPA-registered disinfectant for appropriate contact times (see product’s label). Disinfectant should have a label claim against human coronaviruses. Use according to label instructions
6. Establish Reporting Within the Hospital and to Public Health Authorities • Communicate with key facility staff including infection control, hospital leadership occupational health, clinical laboratory and frontline healthcare providers about suspected or known MERS-CoV patients
• Promptly notify public health authorities • Facilities should designate specific persons within the facility who are responsible for communication with public health and dissemination of information to healthcare personnel. 7. Monitor and Manage Exposed Healthcare Personnel • Healthcare workers who care for patients with MERS-CoV should be monitored for any signs (e.g., fever) or symptoms (e.g., cough, shortness of breath) for 14 days after the last known contact with a patient with MERS-CoV, regardless of personal protective equipment (PPE) use.
• Healthcare workers who have had an unprotected exposure to a patient with MERS-CoV should be excluded from work for 14 days to watch for signs and symptoms of respiratory illness and fever.
In the U.S., MERS infections are not likely to be a risk for the
general public. Only two patients in the U.S. have ever tested pos- itive for MERS-CoV infection; both infections occurred in 2014. However, as the number of MERS cases continue to increase in the Middle East, it is likely that the disease will continue to be exported to other countries by tourists, travelers and workers who may have acquired the infection. Early detection of MERS-CoV infection in travelers returning from countries with MERS cases remains essential to prevent nosocomial transmission of the virus. Nurses and physicians, who are more likely to encounter patients presenting with suspect symptoms and travel histories, are key in preventing the spread of the infection through knowledge and communication. •
Connie C. Chettle, MS, MPH, RN, is an epidemiologist living in St. George, Utah. Catherine J. Swift, MT, (ASCP), is laboratory technology editor for OnCourse Learning.
To see the references and take the test, go to
CE.Nurse.com/Course/CE747 2016 • Visit us at
NURSE.com 35
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