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Wang XT, Meng H, Pan DF, Zheng XY, Lu WW, Chen C, Su M, Su XY, Liu Z, Ma XJ, Liang PF. Multidrug-resistant organisms may be associated with bed allocation and utilization efficiency in healthcare institutions, based on national monitoring data from China (2014-2020). Sci Rep 2023; 13:22055. [PMID: 38087043 PMCID: PMC10716176 DOI: 10.1038/s41598-023-49548-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 12/09/2023] [Indexed: 12/18/2023] Open
Abstract
Analyzing the influence of the bed allocation and utilization efficiency in healthcare institutions on the isolation proportion of Multidrug-resistant organisms (MDROs) to provide data to support prevention and control of MDROs. In this study, the provincial panel data from 2014 to 2020 in China on health resource indicators, including the number of beds per 1,000 population, hospital bed utilization rate, and average hospital stay from 2014 to 2020 in China were used to analyze the relationship between bed allocation or utilization efficiency and MDROs by the panel data quantile regression model. It was shown that the number of beds per 1,000 population had a negative effect on the isolation proportion of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus faecalis, vancomycin-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, methicillin-resistant coagulase-negative Staphylococcus, and cefotaxime or ceftriaxone resistant Escherichia coli (regression coefficient < 0, P < 0.05). The utilization rate of hospital bed had a positive effect on the isolation proportion of methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative Staphylococcus, vancomycin-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, cefotaxime or ceftriaxone resistant Escherichia coli, carbapenem-resistant Escherichia coli, cefotaxime or ceftriaxone resistant Klebsiella pneumoniae, carbapenem-resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii (regression coefficient > 0, P < 0.05). The average hospital stay had a positive effect on the isolation proportion for several antibiotic-resistant organisms, including methicillin-resistant Staphylococcus aureus, methicillin-resistant coagulase-negative Staphylococcus, vancomycin-resistant Enterococcus faecalis, vancomycin-resistant Enterococcus faecium, penicillin-resistant Streptococcus pneumoniae, cefotaxime or ceftriaxone resistant Escherichia coli, carbapenem-resistant Escherichia coli, quinolone-resistant Escherichia coli, cefotaxime or ceftriaxone resistant Klebsiella pneumoniae, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii (regression coefficient > 0, P < 0.05). Bed allocation and utilization efficiency in healthcare institutions may affect the isolation proportion of MDROs in varying degrees.
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Affiliation(s)
- Xing-Tian Wang
- Department of Medicine Statistics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Hua Meng
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Dong-Feng Pan
- Department of Emergency Medicine, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Xiao-Yu Zheng
- Ningxia Chinese Medicine Research Center, Yinchuan, 750021, Ningxia Hui Autonomous Region, China
| | - Wen-Wen Lu
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Chen Chen
- Department of Medicine Statistics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Ming Su
- Yinchuan Stomatology Hospital, Yinchuan, 750002, Ningxia Hui Autonomous Region, China
| | - Xin-Ya Su
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Zhuo Liu
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Xiao-Juan Ma
- School of Public Health and Management, Ningxia Medical University, Yinchuan, 750004, Ningxia Hui Autonomous Region, China
| | - Pei-Feng Liang
- Department of Medicine Statistics, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750002, Ningxia Hui Autonomous Region, China.
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2
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Barzanji A, Abdi K, Yaghobi M, Roshani D, Karimian A. Triage Room Principles and Recommendations for 2019 Novel Coronavirus. Adv Biomed Res 2021; 10:24. [PMID: 34760806 PMCID: PMC8531736 DOI: 10.4103/abr.abr_127_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 09/16/2020] [Accepted: 04/26/2021] [Indexed: 12/02/2022] Open
Abstract
Triage becomes necessary when resources and time are not sufficient to provide the best possible services to all patients. This condition is more common in situations with a large number of casualties, like infectious epidemics. What is apparent is that, in the case of a widespread outbreak of infectious disease, hospitals are on the front lines of infected patient admission and treatment. Since the training of health-care workers is one of the most important pillars of preventive measures in controlling this pandemic, this study was conducted with the aim of expressing the principles of triage of infectious disease epidemic with a COVID-19 approach.
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Affiliation(s)
- Arvin Barzanji
- Department of Anesthesiology, Faculty of Paramedical Sciences, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Kamel Abdi
- Department of Nursing, Faculty of Medicine, Komar University of Science and Technology, Sulaymaniya, Iraq
| | - Mokhtar Yaghobi
- Clinical Care Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Daem Roshani
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran.,Department of Epidemiology and Biostatistics, Medical Faculty, Kurdistan University of Medical Sciences, Sanandaj, Iran
| | - Aram Karimian
- Social Determinants of Health Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
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3
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Ahmadi O, Nasr-Esfahani M, Azimi Meibody A, Ebrahimi M, Maghami-Mehr A. COVID-19 management in the emergency ward. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2021; 26:86. [PMID: 34760003 PMCID: PMC8548900 DOI: 10.4103/jrms.jrms_551_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/13/2020] [Accepted: 02/09/2021] [Indexed: 12/15/2022]
Abstract
The confirmed and suspected cases of the 2019 novel coronavirus disease (COVID-19) have increased in the entire world. There is still no vaccine or definitive treatment for this virus due to its unknown pathogenesis and proliferation pathways. Optimized supportive care remains the main therapy, and the clinical efficacy for the subsequent agents is still under investigation. Enormous demand for handling the COVID-19 outbreak challenged both the health-care personnel and medical supply system. As outbreaks of COVID-19 develop, prehospital workers, emergency medical services personnel, and other emergency responders are potentially asked to follow specific practice guidelines to mitigate the effects of an escalating pandemic. In this article, we have summarized the current guidance on potential COVID-19 management options. The recent experience with COVID-19 provided lessons on strategy and policymaking that the government and ministry of health should be on the alert and concentrate more on capacity to manage an outbreak like COVID-19. It is important to consider the new data that emerge daily regarding clinical characteristics, treatment options, and outcomes for COVID-19.
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Affiliation(s)
- Omid Ahmadi
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Azita Azimi Meibody
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran,Address for correspondence: Dr. Azita Azimi Meibody, Department of Emergency Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran. E-mail:
| | - Mehdi Ebrahimi
- Department of Emergency Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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4
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Sharififar S, Jahangiri K, Zareiyan A, Khoshvaghti A. Factors affecting hospital response in biological disasters: A qualitative study. Med J Islam Repub Iran 2020; 34:21. [PMID: 32551310 PMCID: PMC7293813 DOI: 10.34171/mjiri.34.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Indexed: 11/05/2022] Open
Abstract
Background: The fatal pandemics of infectious diseases and the possibility of using microorganisms as biological weapons are both rising worldwide. Hospitals are vital organizations in response to biological disasters and have a crucial role in the treatment of patients. Despite the advances in studies about hospital planning and performance during crises, there are no internationally accepted standards for hospital preparedness and disaster response. Thus, this study was designed to explain the effective factors in hospital performance during biological disasters. Methods: Qualitative content analysis with conventional approach was used in the present study. The setting was Ministry of Health and related hospitals, and other relevant ministries responsible at the time of biologic events in Islamic Republic of Iran (IR of Iran) in 2018. Participants were experts, experienced individuals providing service in the field of biological disaster planning and response, policymakers in the Ministry of Health, and other related organizations and authorities responsible for the accreditation of hospitals in IR of Iran. Data were collected using 12 semi-structured interviews in Persian language. Analysis was performed according to Graneheim method. Results: After analyzing 12 interviews, extraction resulted in 76 common codes, 28 subcategories, and 8 categories, which are as follow: detection; treatment and infection control; coordination, Resources; training and exercises; communication and information system; construction; and planning and assessment. Conclusion: Hospital management in outbreaks of infectious diseases (intentional or unintentional) is complex and requires different actions than during natural disasters. In such disasters, readiness to respond and appropriate action is a multifaceted operation. In IR of Iran, there have been few researches in the field of hospital preparation in biologic events, and the possibility of standardized assessment has be reduced due to lack of key skills in confronting biological events. It is hoped that the aggregated factors in the 8 groups of this study can evaluate hospital performance more coherently.
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Affiliation(s)
- Simintaj Sharififar
- Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,School of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Katayoun Jahangiri
- Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.,Department of Health in Disasters and Emergencies, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Armin Zareiyan
- Department of Health in Disasters and Emergencies, School of Nursing, Aja University of Medical Sciences, Tehran, Iran
| | - Amir Khoshvaghti
- Infectious Diseases Research Center, Aerospace and Subaquatic Medicine Faculty, Aja University of Medical Sciences, Tehran, Iran
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AlRuthia Y, Somily AM, Alkhamali AS, Bahari OH, AlJuhani RJ, Alsenaidy M, Balkhi B. Estimation Of Direct Medical Costs Of Middle East Respiratory Syndrome Coronavirus Infection: A Single-Center Retrospective Chart Review Study. Infect Drug Resist 2019; 12:3463-3473. [PMID: 31819541 PMCID: PMC6844224 DOI: 10.2147/idr.s231087] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 10/22/2019] [Indexed: 11/23/2022] Open
Abstract
Background Among the countries affected by Middle East respiratory syndrome (MERS), Saudi Arabia was impacted the most, with 2,058 cases reported as of June 2019. However, the impact of the MERS epidemic on the Saudi economy is unknown. Purpose The present study aimed to evaluate the direct medical costs associated with the management of MERS cases at a tertiary referral hospital in Riyadh, Saudi Arabia. Methods The study involved a retrospective chart review of confirmed cases of MERS coronavirus (MERS-CoV) infections in a tertiary care referral center in Riyadh, Saudi Arabia, from January 2015 to October 2018. The collected data included sociodemographic characteristics, medical information, and the cost of hospitalization of each patient as estimated by micro-costing. Results A complete set of relevant information was available only for 24 of 44 identified MERS-CoV cases. Patients were mostly females, and the mean age was 52 years. Diabetes, hypertension, and chronic kidney disease were the most frequent comorbidities. The length of hospital stay varied from 1 to 31 days, averaging 4.96 ± 7.29 days. Two of the 24 patients died. The total cost of managing a MERS case at the hospital ranged from $1278.41 to $75,987.95 with a mean cost of $12,947.03 ± $19,923.14. Conclusion The findings of this study highlight the enormous expenses incurred by the Saudi health care system due to the MERS-CoV outbreak and the importance of developing an enforceable nationwide policy to control MERS-CoV transmission and infection.
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Affiliation(s)
- Yazed AlRuthia
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ali M Somily
- Microbiology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Amal S Alkhamali
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Ohud H Bahari
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Raneem J AlJuhani
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alsenaidy
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Bander Balkhi
- Department of Clinical Pharmacy, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia.,Pharmacoeconomics Research Unit, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
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6
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Bernard-Stoecklin S, Nikolay B, Assiri A, Bin Saeed AA, Ben Embarek PK, El Bushra H, Ki M, Malik MR, Fontanet A, Cauchemez S, Van Kerkhove MD. Comparative Analysis of Eleven Healthcare-Associated Outbreaks of Middle East Respiratory Syndrome Coronavirus (Mers-Cov) from 2015 to 2017. Sci Rep 2019; 9:7385. [PMID: 31089148 PMCID: PMC6517387 DOI: 10.1038/s41598-019-43586-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 04/18/2019] [Indexed: 01/10/2023] Open
Abstract
Since its emergence in 2012, 2,260 cases and 803 deaths due to Middle East respiratory syndrome coronavirus (MERS-CoV) have been reported to the World Health Organization. Most cases were due to transmission in healthcare settings, sometimes causing large outbreaks. We analyzed epidemiologic and clinical data of laboratory-confirmed MERS-CoV cases from eleven healthcare-associated outbreaks in the Kingdom of Saudi Arabia and the Republic of Korea between 2015–2017. We quantified key epidemiological differences between outbreaks. Twenty-five percent (n = 105/422) of MERS cases who acquired infection in a hospital setting were healthcare personnel. In multivariate analyses, age ≥65 (OR 4.8, 95%CI: 2.6–8.7) and the presence of underlying comorbidities (OR: 2.7, 95% CI: 1.3–5.7) were associated with increased mortality whereas working as healthcare personnel was protective (OR 0.07, 95% CI: 0.01–0.34). At the start of these outbreaks, the reproduction number ranged from 1.0 to 5.7; it dropped below 1 within 2 to 6 weeks. This study provides a comprehensive characterization of MERS HCA-outbreaks. Our results highlight heterogeneities in the epidemiological profile of healthcare-associated outbreaks. The limitations of our study stress the urgent need for standardized data collection for high-threat respiratory pathogens, such as MERS-CoV.
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Affiliation(s)
- Sibylle Bernard-Stoecklin
- Formerly Outbreak Investigation Task Force, Centre for Global Health, Institut Pasteur, 75015, Paris, France.,Direction of infectious diseases, Santé publique France, Saint-Maurice, 94410, France
| | - Birgit Nikolay
- Mathematical Modelling of Infectious Diseases, Institut Pasteur, UMR2000, CNRS, 75015, Paris, France
| | | | - Abdul Aziz Bin Saeed
- Formerly Ministry of Health, Riyadh, Saudi Arabia.,Department of Family and Community Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Peter Karim Ben Embarek
- International Food Safety Authorities Network (INFOSAN) Management, Department of Food Safety and Zoonoses, World Health Organization, Geneva, Switzerland
| | | | - Moran Ki
- Department of Cancer Control and Policy, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Mamunur Rahman Malik
- Infectious Hazard Management Unit, Department of Health Emergencies, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Arnaud Fontanet
- Emerging Diseases Epidemiology Unit, Institut Pasteur, 75015, Paris, France.,Centre for Global Health, Institut Pasteur, 75015, Paris, France.,Conservatoire National des Arts et Métiers, Paris, France
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases, Institut Pasteur, UMR2000, CNRS, 75015, Paris, France
| | - Maria D Van Kerkhove
- Formerly Outbreak Investigation Task Force, Centre for Global Health, Institut Pasteur, 75015, Paris, France. .,Infectious Hazards Management, Health Emergencies Programme, World Health Organization, Geneva, Switzerland.
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7
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Al Knawy BA, Al-Kadri HMF, Elbarbary M, Arabi Y, Balkhy HH, Clark A. Perceptions of postoutbreak management by management and healthcare workers of a Middle East respiratory syndrome outbreak in a tertiary care hospital: a qualitative study. BMJ Open 2019; 9:e017476. [PMID: 31061009 PMCID: PMC6502063 DOI: 10.1136/bmjopen-2017-017476] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES This study examines perceptions of the operational and organisational management of a major outbreak of Middle East Respiratory Syndrome (MERS) caused by a novel coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia (KSA). Perspectives were sought from key decision-makers and clinical staff about the factors perceived to promote and inhibit effective and rapid control of the outbreak. SETTING A large teaching tertiary healthcare centre in KSA; the outbreak lasted 6 weeks from June 2015. PARTICIPANTS Data were collected via individual and focus group interviews with 28 key informant participants (9 management decision-makers and 19 frontline healthcare workers). DESIGN We used qualitative methods of process evaluation to examine perceptions of the outbreak and the factors contributing to, or detracting from successful management. Data were analysed using qualitative thematic content analysis. RESULTS Five themes and 15 subthemes were found. The themes were related to: (1) the high stress of the outbreak, (2) factors perceived to contribute to outbreak occurrence, (3) factors perceived to contribute to success of outbreak control, (4) factors inhibiting outbreak control and (5) long-term institutional gains in response to the outbreak management. CONCLUSION Management of the MERS-CoV outbreak at King Abdulaziz Medical City-Riyadh was widely recognised by staff as a serious outbreak of local and national significance. While the outbreak was controlled successfully in 6 weeks, progress in management was inhibited by a lack of institutional readiness to implement infection control (IC) measures and reduce patient flow, low staff morale and high anxiety. Effective management was promoted by greater involvement of all staff in sharing learning and knowledge of the outbreak, developing trust and teamwork and harnessing collective leadership. Future major IC crises could be improved via measures to strengthen these areas, better coordination of media management and proactive staff counselling and support.
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Affiliation(s)
| | - Hanan M F Al-Kadri
- College of Medicine, King Abdulaziz Medical City and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Mahmoud Elbarbary
- College of Public Health, King Abdulla International Research Center and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Yaseen Arabi
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Hanan H Balkhy
- Department of Pediatrics, King Abdullah International Medical Research Centre and King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Alex Clark
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Fischer D, Schlößer RL, Kempf VAJ, Wichelhaus TA, Klingebiel T, Philippi S, Falgenhauer L, Imirzalioglu C, Dahl U, Brandt C, Reinheimer C. Overcrowding in a neonatal intermediate care unit: impact on the incidence of multidrug-resistant gram-negative organisms. BMC Infect Dis 2019; 19:357. [PMID: 31035966 PMCID: PMC6489334 DOI: 10.1186/s12879-019-3981-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Accepted: 04/11/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Overcrowding, reduced nurse to patient ratio, limited distance between incubators and absence of microbiological surveillance have been shown to promote spread of multidrug-resistant gram-negative organisms (MDRGN) in patients with birthweight < 1500 g. Patients > 1500 g treated on an intermediate care unit are unrepresented in recent literature. We therefore intended to present data obtained from a short-term overcrowded neonatal intermediate care unit (NIMCU) at a level III (international categorization) perinatal center at University Hospital Frankfurt, Germany. METHODS During a 25 day overcrowding (OV) and 28 day post-overcrowding period (POST-OV) on NIMCU, epidemiological data obtained from continuously hold microbiological surveillance were investigated and compared to the last 12 months of ward-regular bed occupancy preceding OV (PRAE-OV). RESULTS During OV, the number of patients simultaneously treated at the NIMCU increased from 18 to 22, resulting in a reduced bed-to-bed space. Nurse: patient ratio was 4:22 during OV compared to 3:18 during PRAE-OV. Cumulative incidence of MDRGN was 4.7% in OV and 2.4% POST-OV compared to 4.8% to PRAE-OV, respectively, without any significant variations. During OV and POST-OV, septic episodes due to MDRGN were not observed. In one case, potential nosocomial transmission of Enterobacter cloacae resistant to Piperacillin and 3rd/4th generation cephalosporins was observed. CONCLUSIONS Prevention of nosocomial spread of MDRGN in an overcrowded NIMCU is based on staff's diligent training and adequate staffing. Concise microbiological surveillance should be guaranteed to escort through overcrowding periods. In our setting, impact of bed-to-bed distance on MDRGN transmission seemed to be less strong.
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Affiliation(s)
- Doris Fischer
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany.
| | - Rolf L Schlößer
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany
| | - Volkhard A J Kempf
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Thomas A Wichelhaus
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Thomas Klingebiel
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany
| | - Sabine Philippi
- Department of Pediatrics, Division of Neonatology, University Hospital Frankfurt, St. Vincenz Hospital, Auf dem Schafsberg, 65549, Limburg, Germany
| | - Linda Falgenhauer
- Justus Liebig University, Institute of Medical Microbiology, and German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Giessen, Germany
| | - Can Imirzalioglu
- Justus Liebig University, Institute of Medical Microbiology, and German Center for Infection Research (DZIF), Partner site Giessen-Marburg-Langen, Giessen, Germany
| | - Udo Dahl
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Christian Brandt
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
| | - Claudia Reinheimer
- Institute of Medical Microbiology and Infection Control, University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
- University Center for Infectious Diseases (UCI), University Hospital Frankfurt, 60590, Frankfurt at the Main, Germany
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9
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Adegboye O, Saffary T, Adegboye M, Elfaki F. Individual and network characteristic associated with hospital-acquired Middle East Respiratory Syndrome coronavirus. J Infect Public Health 2018; 12:343-349. [PMID: 30578142 PMCID: PMC7102844 DOI: 10.1016/j.jiph.2018.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/31/2018] [Accepted: 12/05/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND During outbreaks of infectious diseases, transmission of the pathogen can form networks of infected individuals connected either directly or indirectly. METHODS Network centrality metrics were used to characterize hospital-acquired Middle East Respiratory Syndrome Coronavirus (HA-MERS) outbreaks in the Kingdom of Saudi Arabia between 2012 and 2016. Covariate-adjusted multivariable logistic regression models were applied to assess the effect of individual level risk factors and network level metrics associated with increase in length of hospital stay and risk of deaths from MERS. RESULTS About 27% of MERS cases were hospital acquired during the study period. The median age of healthcare workers and hospitalized patients were 35 years and 63 years, respectively, Although HA-MERS were more connected, we found no significant difference in degree centrality metrics between HA-MERS and non-HA-MERS cases. Pre-existing medical conditions (adjusted Odds ratio (aOR)=2.43, 95% confidence interval: (CI) [1.11-5.33]) and hospitalized patients (aOR=29.99, 95% CI [1.80-48.65]) were the strongest risk predictors of death from MERS. The risk of death associated with 1-day increased length of stay was significantly higher for patients with comorbidities. CONCLUSION Our investigation also revealed that patients with an HA-MERS infection experienced a significantly longer hospital stay and were more likely to die from the disease. Healthcare worker should be reminded of their potential role as hubs for pathogens because of their proximity to and regular interaction with infected patients. On the other hand, this study has shown that while healthcare workers acted as epidemic attenuators, hospitalized patients played the role of an epidemic amplifier.
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Affiliation(s)
- Oyelola Adegboye
- Australian Institute of Tropical Health & Medicine, James Cook University, Townsville, QLD 4811, Australia.
| | | | | | - Faiz Elfaki
- Department of Mathematics, Statistics and Physics, Qatar University, 2713 Doha, Qatar
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10
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Al-Omari A, Rabaan AA, Salih S, Al-Tawfiq JA, Memish ZA. MERS coronavirus outbreak: Implications for emerging viral infections. Diagn Microbiol Infect Dis 2018; 93:265-285. [PMID: 30413355 PMCID: PMC7127703 DOI: 10.1016/j.diagmicrobio.2018.10.011] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 09/28/2018] [Accepted: 10/11/2018] [Indexed: 02/08/2023]
Abstract
In September 2012, a novel coronavirus was isolated from a patient who died in Saudi Arabia after presenting with acute respiratory distress and acute kidney injury. Analysis revealed the disease to be due to a novel virus which was named Middle East Respiratory Coronavirus (MERS-CoV). There have been several MERS-CoV hospital outbreaks in KSA, continuing to the present day, and the disease has a mortality rate in excess of 35%. Since 2012, the World Health Organization has been informed of 2220 laboratory-confirmed cases resulting in at least 790 deaths. Cases have since arisen in 27 countries, including an outbreak in the Republic of Korea in 2015 in which 36 people died, but more than 80% of cases have occurred in Saudi Arabia.. Human-to-human transmission of MERS-CoV, particularly in healthcare settings, initially caused a ‘media panic’, however human-to-human transmission appears to require close contact and thus far the virus has not achieved epidemic potential. Zoonotic transmission is of significant importance and evidence is growing implicating the dromedary camel as the major animal host in spread of disease to humans. MERS-CoV is now included on the WHO list of priority blueprint diseases for which there which is an urgent need for accelerated research and development as they have the potential to cause a public health emergency while there is an absence of efficacious drugs and/or vaccines. In this review we highlight epidemiological, clinical, and infection control aspects of MERS-CoV as informed by the Saudi experience. Attention is given to recommended treatments and progress towards vaccine development. 2220 laboratory-confirmed cases of MERS-CoV resulting in at least 790 deaths since 2012 MERS-CoV is on the WHO list of priority blueprint diseases Zoonotic and human-to-human transmission modes need further clarification. No specific therapy has yet been approved. There is a need for well-controlled clinical trials on potential direct therapies.
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Affiliation(s)
- Awad Al-Omari
- Critical Care and Infection Control Department, Dr. Sulaiman Al-Habib Medical Group, and Al-Faisal University, Riyadh, Saudi Arabia
| | - Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
| | - Samer Salih
- Internal Medicine Department, Dr.Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Medical Department, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Ziad A Memish
- College of Medicine, Al-Faisal University, Riyadh, Saudi Arabia
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Kinsman J, Angrén J, Elgh F, Furberg M, Mosquera PA, Otero-García L, Snacken R, Derrough T, Carrillo Santisteve P, Ciotti M, Tsolova S. Preparedness and response against diseases with epidemic potential in the European Union: a qualitative case study of Middle East Respiratory Syndrome (MERS) and poliomyelitis in five member states. BMC Health Serv Res 2018; 18:528. [PMID: 29976185 PMCID: PMC6034236 DOI: 10.1186/s12913-018-3326-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 06/25/2018] [Indexed: 11/23/2022] Open
Abstract
Background EU Decision 1082/2013/EU on serious cross-border health threats provides a legal basis for collaboration between EU Member States, and between international and European level institutions on preparedness, prevention, and mitigation in the event of a public health emergency. The Decision provides a context for the present study, which aims to identify good practices and lessons learned in preparedness and response to Middle East Respiratory Syndrome (MERS) (in UK, Greece, and Spain) and poliomyelitis (in Poland and Cyprus). Methods Based on a documentary review, followed by five week-long country visits involving a total of 61 interviews and group discussions with experts from both the health and non-health sectors, this qualitative case study has investigated six issues related to preparedness and response to MERS and poliomyelitis: national plans and overall preparedness capacity; training and exercises; risk communication; linking policy and implementation; interoperability between the health and non-health sectors; and cross-border collaboration. Results Preparedness and response plans for MERS and poliomyelitis were in place in the participating countries, with a high level of technical expertise available to implement them. Nevertheless, formal evaluation of the responses to previous public health emergencies have sometimes been limited, so lessons learned may not be reflected in updated plans, thereby risking mistakes being repeated in future. The nature and extent of inter-sectoral collaboration varied according to the sectors involved, with those sectors that have traditionally had good collaboration (e.g. animal health and food safety), as well as those that have a financial incentive for controlling infectious diseases (e.g. agriculture, tourism, and air travel) seen as most likely to have integrated public health preparedness and response plans. Although the formal protocols for inter-sectoral collaboration were not always up to date, good personal relations were reported within the relevant professional networks, which could be brought into play in the event of a public health emergency. Cross-border collaboration was greatly facilitated if the neighbouring country was a fellow EU Member State. Conclusions Infectious disease outbreaks remain as an ongoing threat. Efforts are required to ensure that core public health capacities for the full range of preparedness and response activities are sustained. Electronic supplementary material The online version of this article (10.1186/s12913-018-3326-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- John Kinsman
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, 901 87, Umeå, Sweden.
| | - John Angrén
- European CBRNE Centre, Umeå University, 901 85, Umeå, Sweden
| | - Fredrik Elgh
- Department of Clinical Microbiology, Umeå University, 901 85, Umeå, Sweden
| | - Maria Furberg
- Department of Clinical Microbiology, Umeå University, 901 85, Umeå, Sweden
| | - Paola A Mosquera
- Department of Public Health and Clinical Medicine, Epidemiology and Global Health Unit, Umeå University, 901 87, Umeå, Sweden
| | - Laura Otero-García
- Nursing Section, Faculty of Medicine, Autonoma de Madrid University, Madrid, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - René Snacken
- European Centre for Disease Prevention and Control, Granits väg 8, 171 65, Solna, Sweden
| | - Tarik Derrough
- European Centre for Disease Prevention and Control, Granits väg 8, 171 65, Solna, Sweden
| | | | - Massimo Ciotti
- European Centre for Disease Prevention and Control, Granits väg 8, 171 65, Solna, Sweden
| | - Svetla Tsolova
- European Centre for Disease Prevention and Control, Granits väg 8, 171 65, Solna, Sweden
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12
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Kang HS, Son YD, Chae SM, Corte C. Working experiences of nurses during the Middle East respiratory syndrome outbreak. Int J Nurs Pract 2018; 24:e12664. [PMID: 29851209 PMCID: PMC7165521 DOI: 10.1111/ijn.12664] [Citation(s) in RCA: 107] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 03/18/2018] [Accepted: 03/29/2018] [Indexed: 12/30/2022]
Abstract
Aims To explore working experiences of nurses during Middle East respiratory syndrome outbreak. Background Since the first case of Middle East respiratory syndrome was reported on May 20, 2015 in South Korea, 186 people, including health care workers, were infected, and 36 died. Design A qualitative descriptive study. Methods Seven focus groups and 3 individual in‐depth interviews were conducted from August to December 2015. Content analysis was used. Results The following 4 major themes emerged: “experiencing burnout owing to the heavy workload,” “relying on personal protective equipment for safety,” “being busy with catching up with the new guidelines related to Middle East respiratory syndrome,” and “caring for suspected or infected patients with caution.” Participants experienced burnout because of the high volume of work and expressed safety concerns about being infected. Unclear and frequently changing guidelines were 1 of the common causes of confusion. Participants expressed that they need to be supported while caring for suspected or infected patients. Conclusion This study showed that creating a supportive and safe work environment is essential by ensuring adequate nurse staffing, supplying best‐quality personal protective equipment, and improving communication to provide the quality of care during infection outbreak. What is already known about this topic?
Infectious disease outbreaks cause a significant level of distress and fear among nurses. Nurses are near to patients, even when they have life‐threatening infectious diseases. Little is known about the work experiences of nurses during the Middle East respiratory syndrome coronavirus outbreaks.
What this paper adds?
High volume of work and fear of infection appear to be the main concerns among nurses during the outbreak. Nurses were confused about best practices because of lack of clarity of the guidelines during the outbreak. However, sharing information on the new guidelines and job‐related information via text messages using smartphones was helpful for the nurses. Creating a supportive work environment and providing adequate training for nurses is essential.
The implications of this paper:
Nurse managers and hospital administrators should establish strategies to prevent nurses from burnout and to ensure their safety during the outbreak of infectious diseases. Clear and consistent practice guidelines and effective communication methods among nurses should be developed. Increasing awareness of health care workers about infectious diseases to enhance emergency preparedness is essential.
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Affiliation(s)
- Hee Sun Kang
- Red Cross College of Nursing, Chung-Ang University, Seoul, South Korea
| | - Ye Dong Son
- College of Nursing, Woosuk University, Seoul, South Korea
| | - Sun-Mi Chae
- College of Nursing, The Research Institute of Nursing Science, Seoul National University, Seoul, South Korea
| | - Colleen Corte
- College of Nursing, University of Illinois, Chicago, Illinois, USA
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13
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Bailey ES, Fieldhouse JK, Choi JY, Gray GC. A Mini Review of the Zoonotic Threat Potential of Influenza Viruses, Coronaviruses, Adenoviruses, and Enteroviruses. Front Public Health 2018; 6:104. [PMID: 29686984 PMCID: PMC5900445 DOI: 10.3389/fpubh.2018.00104] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/27/2018] [Indexed: 01/16/2023] Open
Abstract
During the last two decades, scientists have grown increasingly aware that viruses are emerging from the human–animal interface. In particular, respiratory infections are problematic; in early 2003, World Health Organization issued a worldwide alert for a previously unrecognized illness that was subsequently found to be caused by a novel coronavirus [severe acute respiratory syndrome (SARS) virus]. In addition to SARS, other respiratory pathogens have also emerged recently, contributing to the high burden of respiratory tract infection-related morbidity and mortality. Among the recently emerged respiratory pathogens are influenza viruses, coronaviruses, enteroviruses, and adenoviruses. As the genesis of these emerging viruses is not well understood and their detection normally occurs after they have crossed over and adapted to man, ideally, strategies for such novel virus detection should include intensive surveillance at the human–animal interface, particularly if one believes the paradigm that many novel emerging zoonotic viruses first circulate in animal populations and occasionally infect man before they fully adapt to man; early detection at the human–animal interface will provide earlier warning. Here, we review recent emerging virus treats for these four groups of viruses.
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Affiliation(s)
- Emily S Bailey
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, United States
| | - Jane K Fieldhouse
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, United States
| | - Jessica Y Choi
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, United States
| | - Gregory C Gray
- Duke Global Health Institute, Duke University, Durham, NC, United States.,Division of Infectious Diseases, Duke University School of Medicine, Durham, NC, United States.,Global Health Research Center, Duke-Kunshan University, Kunshan, China.,Emerging Infectious Diseases Program, Duke-NUS Medical School, Singapore
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14
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Rabaan AA, Alahmed SH, Bazzi AM, Alhani HM. A review of candidate therapies for Middle East respiratory syndrome from a molecular perspective. J Med Microbiol 2017; 66:1261-1274. [PMID: 28855003 PMCID: PMC7079582 DOI: 10.1099/jmm.0.000565] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
There have been 2040 laboratory-confirmed cases of Middle East respiratory syndrome coronavirus (MERS-CoV) in 27 countries, with a mortality rate of 34.9 %. There is no specific therapy. The current therapies have mainly been adapted from severe acute respiratory syndrome (SARS-CoV) treatments, including broad-spectrum antibiotics, corticosteroids, interferons, ribavirin, lopinavir–ritonavir or mycophenolate mofetil, and have not been subject to well-organized clinical trials. The development of specific therapies and vaccines is therefore urgently required. We examine existing and potential therapies and vaccines from a molecular perspective. These include viral S protein targeting; inhibitors of host proteases, including TMPRSS2, cathepsin L and furin protease, and of viral M(pro) and the PL(pro) proteases; convalescent plasma; and vaccine candidates. The Medline database was searched using combinations and variations of terms, including ‘Middle East respiratory syndrome coronavirus’, ‘MERS-CoV’, ‘SARS’, ‘therapy’, ‘molecular’, ‘vaccine’, ‘prophylactic’, ‘S protein’, ‘DPP4’, ‘heptad repeat’, ‘protease’, ‘inhibitor’, ‘anti-viral’, ‘broad-spectrum’, ‘interferon’, ‘convalescent plasma’, ‘lopinavir ritonavir’, ‘antibodies’, ‘antiviral peptides’ and ‘live attenuated viruses’. There are many options for the development of MERS-CoV-specific therapies. Currently, MERS-CoV is not considered to have pandemic potential. However, the high mortality rate and potential for mutations that could increase transmissibility give urgency to the search for direct, effective therapies. Well-designed and controlled clinical trials are needed, both for existing therapies and for prospective direct therapies.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
| | - Shamsah H Alahmed
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif 32654, Saudi Arabia
| | - Ali M Bazzi
- Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran 31311, Saudi Arabia
| | - Hatem M Alhani
- Maternity and Children Hospital, and Directorate of Infection Control at Eastern Province, Ministry of Health, Dammam, Saudi Arabia
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15
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Abstract
INTRODUCTION In the past five years, there have been 1,936 laboratory-confirmed cases of Middle East Respiratory Syndrome coronavirus (MERS-CoV) in 27 countries, with a mortality rate of 35.6%. Most cases have arisen in the Middle East, particularly the Kingdom of Saudi Arabia, however there was a large hospital-associated outbreak in the Republic of Korea in 2015. Exposure to dromedary camels has been recognized by the World Health Organization (WHO) as a risk factor in primary cases, but the exact mechanisms of transmission are not clear. Rigorous application of nationally defined infection prevention and control measures has reduced the levels of healthcare facility-associated outbreaks. There is currently no approved specific therapy or vaccine available. Areas covered: This review presents an overview of MERS-CoV within the last five years, with a particular emphasis on the key areas of transmission, infection control and prevention, and therapies and vaccines. Expert commentary: MERS-CoV remains a significant threat to public health as transmission mechanisms are still not completely understood. There is the potential for mutations that could increase viral transmission and/or virulence, and zoonotic host range. The high mortality rate highlights the need to expedite well-designed randomized clinical trials for direct, effective therapies and vaccines.
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Affiliation(s)
- Ali A Rabaan
- a Molecular Diagnostic Laboratory , Johns Hopkins Aramco Healthcare , Dhahran , Saudi Arabia
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16
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Rabaan AA, Al-Ahmed SH, Bazzi AM, Al-Tawfiq JA. Dynamics of scientific publications on the MERS-CoV outbreaks in Saudi Arabia. J Infect Public Health 2017. [PMID: 28625842 PMCID: PMC7102777 DOI: 10.1016/j.jiph.2017.05.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Middle East Respiratory Syndrome Coronavirus (MERS-CoV) is an emerging disease with a relatively high case fatality rate. Most cases have been reported from Saudi Arabia, and the disease epidemic potential is considered to be limited. However, human-human transmission has occurred, usually in the context of healthcare facility-associated outbreaks. The scientific and medical community depends on timely publication of epidemiological information on emerging diseases during outbreaks to appropriately target public health responses. In this review, we considered the academic response to four MERS CoV outbreaks that occurred in Al-Hasa in 2013, Jeddah in 2014 and Riyadh in 2014 and 2015. We analysed 68 relevant epidemiology articles. For articles for which submission dates were available, six articles were submitted during the course of an outbreak. One article was published within a month of the Al-Hasa outbreak, and one each was accepted during the Jeddah and Riyadh outbreaks. MERS-CoV epidemiology articles were cited more frequently than articles on other subjects in the same journal issues. Thus, most epidemiology articles on MERS-CoV were published with no preferential advantage over other articles. Collaboration of the research community and the scientific publishing industry is needed to facilitate timely publication of emerging infectious diseases.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Shamsah H Al-Ahmed
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif, Saudi Arabia
| | - Ali M Bazzi
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA.
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Rabaan AA, Bazzi AM, Al-Ahmed SH, Al-Tawfiq JA. Molecular aspects of MERS-CoV. Front Med 2017; 11:365-377. [PMID: 28500431 PMCID: PMC7089120 DOI: 10.1007/s11684-017-0521-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 01/23/2017] [Indexed: 01/19/2023]
Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) is a betacoronavirus which can cause acute respiratory distress in humans and is associated with a relatively high mortality rate. Since it was first identified in a patient who died in a Jeddah hospital in 2012, the World Health Organization has been notified of 1735 laboratory-confirmed cases from 27 countries, including 628 deaths. Most cases have occurred in Saudi Arabia. MERS-CoVancestors may be found in OldWorld bats of the Vespertilionidae family. After a proposed bat to camel switching event, transmission of MERS-CoV to humans is likely to have been the result of multiple zoonotic transfers from dromedary camels. Human-to-human transmission appears to require close contact with infected persons, with outbreaks mainly occurring in hospital environments. Outbreaks have been associated with inadequate infection prevention and control implementation, resulting in recommendations on basic and more advanced infection prevention and control measures by the World Health Organization, and issuing of government guidelines based on these recommendations in affected countries including Saudi Arabia. Evolutionary changes in the virus, particularly in the viral spike protein which mediates virus-host cell contact may potentially increase transmission of this virus. Efforts are on-going to identify specific evidence-based therapies or vaccines. The broad-spectrum antiviral nitazoxanide has been shown to have in vitro activity against MERS-CoV. Synthetic peptides and candidate vaccines based on regions of the spike protein have shown promise in rodent and non-human primate models. GLS-5300, a prophylactic DNA-plasmid vaccine encoding S protein, is the first MERS-CoV vaccine to be tested in humans, while monoclonal antibody, m336 has given promising results in animal models and has potential for use in outbreak situations.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia.
| | - Ali M Bazzi
- Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia
| | - Shamsah H Al-Ahmed
- Specialty Paediatric Medicine, Qatif Central Hospital, Qatif, 32654, Saudi Arabia
| | - Jaffar A Al-Tawfiq
- Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, 31311, Saudi Arabia.,University School of Medicine, Indianapolis, IN, 46202, USA
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18
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Rabaan AA, Alhani HM, Bazzi AM, Al-Ahmed SH. Questionnaire-based analysis of infection prevention and control in healthcare facilities in Saudi Arabia in regards to Middle East Respiratory Syndrome. J Infect Public Health 2017; 10:548-563. [PMID: 28215912 PMCID: PMC7102716 DOI: 10.1016/j.jiph.2016.11.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2016] [Revised: 10/24/2016] [Accepted: 11/18/2016] [Indexed: 11/02/2022] Open
Abstract
Effective implementation of infection prevention and control in healthcare facilities depends on training, awareness and compliance of healthcare workers. In Saudi Arabia recent significant hospital outbreaks, including Middle East Respiratory Syndrome Coronavirus (MERS-CoV), have resulted from lack of, or breakdown in, infection prevention and control procedures. This study was designed to assess attitudes to, and awareness of, infection prevention and control policies and guidelines among healthcare workers of different professions and institution types in Saudi Arabia. A questionnaire was administered to 607 healthcare workers including physicians (n=133), nurses (n=162), laboratory staff (n=233) and other staff (n=79) in government hospitals, private hospitals and poly clinics. Results were compared using Chi square analysis according to profession type, institution type, age group and nationality (Saudi or non-Saudi) to assess variability. Responses suggested that there are relatively high levels of uncertainty among healthcare workers across a range of infection prevention and control issues, including institution-specific issues, surveillance and reporting standards, and readiness and competence to implement policies and respond to outbreaks. There was evidence to suggest that staff in private hospitals and nurses were more confident than other staff types. Carelessness of healthcare workers was the top-cited factor contributing to causes of outbreaks (65.07% of total group), and hospital infrastructure and design was the top-cited factor contributing to spread of infection in the hospital (54.20%), followed closely by lack and shortage of staff (53.71%) and no infection control training program (51.73%). An electronic surveillance system was considered the most effective by staff (81.22%). We have identified areas of concern among healthcare workers in Saudi Arabia on infection prevention and control which vary between institutions and among different professions. This merits urgent multi-factorial actions to try to ensure outbreaks such as MERS-CoV can be minimized and contained.
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Affiliation(s)
- Ali A Rabaan
- Molecular Diagnostic Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
| | - Hatem M Alhani
- Specialty Paediatric Medicine, Maternity and Children Hospital, Dammam, Saudi Arabia; Directorate of Infection Control at Eastern Province, Ministry of Health, Dammam, Saudi Arabia,.
| | - Ali M Bazzi
- Microbiology Laboratory, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.
| | - Shamsah H Al-Ahmed
- Specialty Paediatric Medicine, Qatif Central Hospital, Ministry of Health, Qatif, Saudi Arabia.
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