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Haward R, G R, Kalyan M. The Impact of Personal Protective Equipment on Healthcare Workers on COVID-19 Duty in a Tertiary Care Hospital in South India. Cureus 2023; 15:e41910. [PMID: 37583728 PMCID: PMC10425167 DOI: 10.7759/cureus.41910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
Context The proper usage of personal protective equipment (PPE) must be prioritised for health care workers (HCWs), where shortages and prolonged use of personal protective equipment can threaten safety in essential health services. Aims To evaluate the effect of personal protective equipment on the health and well-being of HCWs, physicians, nurses, and technicians on duty for COVID-19 rotational postings. Settings and design This cross-sectional study was done by simple random sampling. Methods and materials This study was conducted at a tertiary care centre in South India to assess the utilisation of personal protective equipment (PPE) during the second wave of COVID-19. A physical questionnaire was distributed to a total of 266 healthcare workers, aged 20 to 50, who had worked for a minimum of three consecutive days between May and August 2021. The objective of the study was to evaluate the effectiveness of PPE use among healthcare workers during the second wave of the COVID-19 pandemic. Statistical analysis The data analysis in this study was conducted using IBM Statistical Package for Social Sciences (SPSS) version 19 (IBM Corp., Armonk, New York). The mean and standard deviation, or median, were used to present continuous variables, while frequency and percentage were used to present categorical variables. Furthermore, the minimum sample size required for this study was calculated to be 246 participants. Results The survey included 266 healthcare workers. The mean+/-SD of age was 28.18+/-5.64 and consisted of females (54.51%) and males (45.48%). The postings were in emergency (13.15%), intensive care unit (30.82%), and ward (56.01%), respectively. The HCWs who used PPE for four to seven days reported more symptoms than those who used it for one to three days. Discomforts experienced while wearing PPE were chest suffocation (49.62%), difficulty in performing intubation (36.09%), difficulty in seeing clearly (68.79%), dizziness (49.62%), excessive sweating (75.56%), micturition desire (52.63%), nausea (42.48%), retro-auricular pain (56.76%), stomach burns (27.44%), and thirst or dry throat (78.57%). The symptoms suffered after doffing were tiredness (69.17%), dry mouth (67.29%), dizziness (43.60%), headache (55.63%), chest suffocation (36.46%), dry skin (57.14%), reduced ability to concentrate (48.12%), dark-coloured urine (55.63%), reduced alertness (42.48%), and stomach burns (28.94%). The first thoughts after doffing were to drink water (68.42%), eat something (36.09%), clean yourself (61.27%), urinate (33.08%), and have some rest (29.32%), respectively. 81 (30.45%). The HCWs suffered skin injuries while wearing gloves. The time for restoring after a shift was 12 hours (37.59%), 24 hours (34.21%), 36 hours (11.65%), and 48 hours (16.59%). Pressure sores were reported on the forehead by 53 (19.92%) participants, the nose by 54 (20.30%), the cheek by 31 (11.65%), and behind the ear by 77 (65.71%) participants. The optimal size of PPE was experienced only by 76 (28.57%) participants, while 73 (27.44%) of them felt tight and 117 (43.98%) felt loose. Conclusions To minimise discomfort while managing infectious diseases, HCWs can adopt several practices like taking regular breaks, ensuring humane working hours, utilising high-quality PPE, and wearing properly fitting gear. By implementing these measures, HCWs can enhance their ability to handle infectious diseases effectively while prioritising their comfort and well-being.
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Affiliation(s)
- Raymond Haward
- Medical School, Vydehi Institute of Medical Science and Research Centre, Bangalore, IND
| | - Ridhima G
- Medical School, Vydehi Institute of Medical Science and Research Centre, Bangalore, IND
| | - Meenakshi Kalyan
- Internal Medicine, Vydehi Institute of Medical Science and Research Centre, Bangalore, IND
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Rahman S, Ullah S, Shinwari ZK, Ali M. Bats-associated beta-coronavirus detection and characterization: First report from Pakistan. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2023; 108:105399. [PMID: 36584905 PMCID: PMC9793958 DOI: 10.1016/j.meegid.2022.105399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/22/2022] [Accepted: 12/26/2022] [Indexed: 12/28/2022]
Abstract
Bats remains as reservoirs for highly contagious and pathogenic viral families including the Coronaviridae, Filoviridae, Paramyxoviruses, and Rhabdoviridae. Spill over of viral species (SARS-CoV, MERS-CoV & SARS-CoV2) from bats (as a possible potential reservoirs) have recently caused worst outbreaks. Early detection of viral species of pandemic potential in bats is of great importance. We detected beta coronaviruses in the studied bats population (positive samples from Rousettus leschenaultia) and performed the evolutionary analysis, amino acid sequence alignment, and analysed the 3-Dimentional protein structure. We detected the coronaviruses for the first time in bats from Pakistan. Our analysis based on RdRp partial gene sequencing suggest that the studied viral strains are closely related to MERS-CoV-like viruses as they exhibit close structure similarities (with few substitutions) and also observed a substitution in highly conserved SDD in the palm subdomain of motif C to ADD, when compared with earlier reported viral strains. It could be concluded from our study that coronaviruses are circulating among the bat's population in Pakistan. Based on the current findings, we suggest large scale screening procedures of bat virome across the country to detect potential pathogenic viral species.
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Affiliation(s)
- Sidra Rahman
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan.
| | - Sana Ullah
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan; Natural and Medical Sciences Research Center, University of Nizwa, Oman.
| | | | - Muhammad Ali
- Department of Biotechnology, Quaid-i-Azam University, Islamabad, Pakistan.
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Hoteit R, Yassine HM. Biological Properties of SARS-CoV-2 Variants: Epidemiological Impact and Clinical Consequences. Vaccines (Basel) 2022; 10:919. [PMID: 35746526 PMCID: PMC9230982 DOI: 10.3390/vaccines10060919] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/18/2022] [Accepted: 05/21/2022] [Indexed: 02/06/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a virus that belongs to the coronavirus family and is the cause of coronavirus disease 2019 (COVID-19). As of May 2022, it had caused more than 500 million infections and more than 6 million deaths worldwide. Several vaccines have been produced and tested over the last two years. The SARS-CoV-2 virus, on the other hand, has mutated over time, resulting in genetic variation in the population of circulating variants during the COVID-19 pandemic. It has also shown immune-evading characteristics, suggesting that vaccinations against these variants could be potentially ineffective. The purpose of this review article is to investigate the key variants of concern (VOCs) and mutations of the virus driving the current pandemic, as well as to explore the transmission rates of SARS-CoV-2 VOCs in relation to epidemiological factors and to compare the virus's transmission rate to that of prior coronaviruses. We examined and provided key information on SARS-CoV-2 VOCs in this study, including their transmissibility, infectivity rate, disease severity, affinity for angiotensin-converting enzyme 2 (ACE2) receptors, viral load, reproduction number, vaccination effectiveness, and vaccine breakthrough.
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Affiliation(s)
- Reem Hoteit
- Clinical Research Institute, Faculty of Medicine, American University of Beirut, Beirut 110236, Lebanon;
| | - Hadi M. Yassine
- Biomedical Research Center and College of Health Sciences-QU Health, Qatar University, Doha 2713, Qatar
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Razavi-Termeh SV, Sadeghi-Niaraki A, Choi SM. Coronavirus disease vulnerability map using a geographic information system (GIS) from 16 April to 16 May 2020. PHYSICS AND CHEMISTRY OF THE EARTH (2002) 2022; 126:103043. [PMID: 35637755 PMCID: PMC9133353 DOI: 10.1016/j.pce.2021.103043] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 04/05/2021] [Accepted: 05/29/2021] [Indexed: 06/15/2023]
Abstract
In recent months, the world has been affected by the infectious coronavirus disease and Iran is one of the most affected countries. The Iranian government's health facilities for an urgent investigation of all provinces do not exist simultaneously. There is no management tool to identify the vulnerabilities of Iranian provinces in prioritizing health services. The aim of this study was to prepare a coronavirus vulnerability map of Iranian provinces using geographic information system (GIS) to monitor the disease. For this purpose, four criteria affecting coronavirus, including population density, percentage of older people, temperature, and humidity, were prepared in the GIS. A multiscale geographically weighted regression (MGWR) model was used to determine the vulnerability of coronavirus in Iran. An adaptive neuro-fuzzy inference system (ANFIS) model was used to predict vulnerability in the next two months. Results indicated that, population density and older people have a more significant impact on coronavirus in Iran. Based on MGWR models, Tehran, Mazandaran, Gilan, and Alborz provinces were more vulnerable to coronavirus in February and March. The ANFIS model findings showed that West Azerbaijan, Zanjan, Fars, Yazd, Semnan, Sistan and Baluchistan, and Tehran provinces were more vulnerable in April and May.
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Affiliation(s)
- Seyed Vahid Razavi-Termeh
- Geoinformation Tech. Center of Excellence, Factulty of Geomatics, K.N. Toosi University of Technology, Tehran, Iran
| | - Abolghasem Sadeghi-Niaraki
- Geoinformation Tech. Center of Excellence, Factulty of Geomatics, K.N. Toosi University of Technology, Tehran, Iran
- Dept. of Computer Science and Engineering, and Convergence Engineering for Intelligent Drone, Sejong University, Seoul, Republic of Korea
| | - Soo-Mi Choi
- Dept. of Computer Science and Engineering, and Convergence Engineering for Intelligent Drone, Sejong University, Seoul, Republic of Korea
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Factors Preventing Nosocomial Outbreak Following a Single case of COVID-19 Diagnosed During Hospitalization: A Retrospective Review. Disaster Med Public Health Prep 2022; 17:e107. [PMID: 35000646 PMCID: PMC8886090 DOI: 10.1017/dmp.2022.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Our hospital experienced a hospital shutdown and 2 week quarantine after a case of COVID-19 was diagnosed during hospitalization. We analyzed the reopening process following hospital closure and possible factors that prevented hospital spread. METHODS We retrospectively reviewed the confirmed patient's medical records and results of epidemiological survey available from the infection control team of our hospital. RESULTS A total of 117 hospital staff members were tested, 26 of whom were self-isolated. Of the 54 inpatients tested, 28 on the same floor, and 2 close contacts in the endoscopic room were quarantined in a single room. Finally, all quarantined hospital staff, inpatients and outpatients were tested for COVID-19 on the 14th day of close contact. The results were all negative, and the hospital work resumed completely. CONCLUSION Although closing and isolating the hospital appeared to have played a useful role in preventing the spread of COVID-19 inside the hospital and to the local community, it is still debated whether or not the duration of hospital closure or quarantine was appropriate. The lessons from the 2-week hospital closure suggest that wearing a mask, hand hygiene and the ward environment are important factors in preventing nosocomial outbreaks of COVID-19.
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Data science. DATA SCIENCE FOR COVID-19 2022. [PMCID: PMC8989132 DOI: 10.1016/b978-0-323-90769-9.00001-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Since the outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan, China, in late December 2019, the disease has already affected over 200 countries and territories in less than 4 months. On March 11, 2020, the WHO declared the outbreak as a pandemic. As of April 25, 2020, the contagious disease has already infected over 2,919,404 people and the number of deaths reached nearly 206,482. As the disease is spreading rapidly, very less information is available regarding the spread of the novel virus and its effect over various countries. With the help of data science and its latest applications, this chapter aims to explain the rapid spread and impact of the novel coronavirus infection over individual countries. In this chapter, we have first explained about the evolution and transmission of viral diseases from animals to humans, next discussed about the various statistical methods used for the analysis of the spread of the disease, and finally come up with a comparison of the past 2 months of the pandemic (March and April). This chapter will give an insight of the application of data science in analyzing the latest COVID-19 pandemic and its impact.
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Kuru B, Kale A, Basol G, Gundogdu EC, Yildiz G, Mat E, Usta T. Is it safe to perform elective gynaecologic surgery during the two peaks of COVID-19 pandemic? Int J Clin Pract 2021; 75:e14816. [PMID: 34486805 PMCID: PMC8646615 DOI: 10.1111/ijcp.14816] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/10/2021] [Accepted: 09/03/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE In December 2019, the COVID-19 pandemic started in China and spread around the World. Operations were postponed in most surgical clinics to reduce the risk of contamination and increase the number of beds available in hospitals. We investigate whether elective gynaecologic surgery is safe or not under safety measures. METHODS A total of 765 patients were operated on electively between 15 March and 30 October 2020 at our inpatient gynaecology clinic. We took the SARS-CoV-2 Reverse Transcriptase (RT) Polymerase Chain Reaction (PCR) test of the nasopharyngeal swab before and after the surgery. Patients were questioned for COVID-19 symptoms by phone calls on the 7th, 15th, 30th and 60th days postoperatively. RESULTS The average age of patients was 45.6 ± 11(19-81). Sixty-two (8.1%) operations were performed due to gynaecologic malignancies. Three patients (0.39%) were detected as SARS-CoV-2 RT PCR positive within 7 days after surgery. The patients did not need ICU admission or any further treatments. CONCLUSION Our study offers a novel perspective on elective surgery during a pandemic. The risk assessment of patients should be meticulously done and substantiated on objective variables. According to our study, in a carefully selected patient population, operating under appropriate precautions, elective gynaecologic surgical procedures during the two peaks of the COVID-19 pandemic do not pose a risk to the patients.
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Affiliation(s)
- Betul Kuru
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Ahmet Kale
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Gulfem Basol
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Elif Cansu Gundogdu
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Gazi Yildiz
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Emre Mat
- Department of Obstetrics and GynecologyUniversity of Health Sciences TurkeyIstanbul Kartal Dr. Lütfi Kirdar City HospitalIstanbulTurkey
| | - Taner Usta
- Department of Obstetrics and GynecologyUniversity of Acibadem HospitalIstanbulTurkey
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Yun JH. Experiences of Emergency Surgical Treatment for a COVID-19 Patient with Severe Traumatic Brain Injury at a Regional Trauma Center: A Case Report. JOURNAL OF TRAUMA AND INJURY 2021. [DOI: 10.20408/jti.2021.0073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
<p>Various medical scenarios have arisen with the prolonged coronavirus disease 2019 (COVID-19) pandemic. In particular, the increasing number of asymptomatic COVID-19 patients has prompted reports of emergency surgical experiences with these patients at regional trauma centers. In this report, we describe an example. A 25-year-old male was admitted to the emergency room after a traffic accident. The patient presented with stuporous mentality, and his vital signs were in the normal range. Lacerations were observed in the left eyebrow area and preauricular area, with hemotympanum in the right ear. Brain computed tomography showed a contusional hemorrhage in the right frontal area and an epidural hematoma in the right temporal area with a compound, comminuted fracture and depressed skull bone. Surgical treatment was planned, and the patient was intubated to prepare for surgery. A blood transfusion was prepared, and a central venous catheter was secured. The initial COVID-19 test administered upon presentation to the emergency room had a positive result, and a confirmatory polymerase chain reaction (PCR) test was administered. The PCR test confirmed a positive result. Emergency surgical treatment was performed because the patient’s consciousness gradually deteriorated. The risk of infection was high due to the open and unclean wounds in the skull and brain. We prepared and divided the COVID-19 surgical team, including the patient’s transportation team, anesthesia team, and surgical preparation team, for successful surgery without any transmission or morbidity. The patient recovered consciousness after the operation, received close monitoring, and did not show any deterioration due to COVID-19.</p>
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Cho SI, Ko JI, Kim Y, Yeo W, Lee K, Cho W, Moon S, Park T. Response to the COVID-19 Outbreak in The Emergency Department Designed for Emerging Infectious Diseases in Korea. Infect Chemother 2021; 53:84-95. [PMID: 34409782 PMCID: PMC8032914 DOI: 10.3947/ic.2020.0143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/17/2021] [Indexed: 12/28/2022] Open
Abstract
Background According to the recent coronavirus disease 2019 (COVID-19) pandemic experience, many emergency departments experience difficulties in responding to emerging infectious diseases and this has led to a public health crisis. Our emergency department (ED) is designed to respond to mass outbreaks of infection. Three major preparations were taken to respond to infectious disease; first, to improve the emergency department facilities; second, to created programs to respond to each phase of an epidemic of COVID-19; lastly, to implemented education and training to promote the safety of medical staff. We would like to share the actual responses and statistics of patients visiting emergency department during COVID-19 periods of pandemic. Materials and Methods This research was conducted through a retrospective chart analysis provided by a public medical center with 502 beds since the first report of a COVID-19 confirmed case on January 19, 2020 to June 15, 2020 in Seoul, the capital of Korea. Our emergency department was designed based on Korean Regional Emergency Center Facility Standards, and modified throughout each phases of COVID-19 outbreak. Patients suspected to be infectious are screened in the triage, separating them from general patients, and then receive isolation treatment in isolated wards. Results A total of 4,352 patients visited the ED. 3,202 screenings were conducted with 5 confirmed cases. Another 1,150 patients were treated with general emergent symptoms. There were no problems such as closure of the emergency department or isolation of medical staff while managing COVID-19 confirmed patients. Conclusion Improving emergency department facilities, create an operational program to respond to each phase of COVID-19 outbreak and implement educational programs enabled large number of screening tests and hospitalization for COVID-19 suspected patients while maintaining general medical services. Research in emergency department designs and operational programs should increase to combine research data with better ideas to respond not only during regular periods but also during periods of pandemic.
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Affiliation(s)
- Soo Im Cho
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Jung In Ko
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Yeonjae Kim
- Division of Infectious Diseases, National Medical Center, Seoul, Korea
| | - Woonhyung Yeo
- Department of Emergency Medicine, Seongnam Citizens Medical Center, Seongnam, Korea
| | - Kangeui Lee
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Wonjin Cho
- Department of Emergency Medicine, National Medical Center, Seoul, Korea
| | - Sungwoo Moon
- National Emergency Medical Center, National Medical Center, Seoul, Korea.,Department of Emergency Medicine, College of Medicine, Korea University, Seoul, Korea
| | - Taejin Park
- Department of Emergency Medicine, National Medical Center, Seoul, Korea.
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Lee SS, Kim SJ, Jung JE, Kim GH, Kwon MY, Yun MJ. Infection control in operating rooms for COVID-19 patients. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2021. [DOI: 10.5124/jkma.2021.64.7.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Surgeries performed for patients with coronavirus disease 2019 (COVID-19) place the medical staff at very high risk of infection. We suggest recommendations for appropriate operation preparation, anesthetic management, and infection control for COVID-19 patients in operating rooms.Current Concepts: Surgeries must be performed in an airborne infection isolation room, such as a negative-pressure operating room. It is recommended that scheduled surgeries for COVID-19 patients be postponed to an acceptable extent, with the exception of emergency cases. Moreover, the number of medical staff participating in the surgery should be minimized. Medical staffs should practice proper hand hygiene and wear an appropriate level of personal protective equipment depending on the infection risk. While performing surgery and inducing anesthesia in COVID-19 patients, endotracheal intubation should be performed by trained anesthesiologists with a video laryngoscope, preferably using high-efficiency viral filters, which can prevent contamination in the anesthesia machine. Use of disposable equipment or COVID-19 patient-specific devices is recommended to prevent the spread of infection, but instruments that require sharing among multiple patients must be thoroughly cleaned and disinfected before their use for the next patient.Discussion and Conclusion: Medical staff performing surgeries for COVID-19 patients are at very high risk of infection. Therefore, the use of appropriate personal protective equipment, high-efficiency viral filters in breathing circuits during anesthesia, and disinfection of contaminated equipment after the operation are mandatory.
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The protective effect of tight-fitting powered air-purifying respirators during chest compressions. Am J Emerg Med 2021; 49:172-177. [PMID: 34118785 DOI: 10.1016/j.ajem.2021.06.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/29/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Airborne personal protective equipment is required for healthcare workers when performing aerosol-generating procedures on patients with infectious diseases. Chest compressions, one of the main components of cardiopulmonary resuscitation, require intense and dynamic movements of the upper body. We aimed to investigate the protective effect of tight-fitting powered air-purifying respirators (PAPRs) during chest compressions. METHODS This single-center simulation study was performed from February 2021 to March 2021. The simulated workplace protection factor (SWPF) is the concentration ratio of ambient particles and particles inside the PAPR mask; this value indicates the level of protection provided by a respirator when subjected to a simulated work environment. Participants performed continuous chest compressions three times for 2 min each time, with a 4-min break between each session. We measured the SWPF of the tight-fitting PAPR during chest compression in real-time mode. The primary outcome was the ratio of any failure of protection (SWPF <500) during the chest compression sessions. RESULTS Fifty-four participants completed the simulation. Overall, 78% (n = 42) of the participants failed (the measured SWPF value was less than 500) at least one of the three sessions of chest compressions. The median value and interquartile range of the SWPF was 4304 (685-16,191). There were no reports of slipping down of the respirator or mechanical failure during chest compressions. CONCLUSIONS Although the median SWPF value was high during chest compressions, the tight-fitting PAPR did not provide adequate protection.
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Yang TU, Noh JY, Song JY, Cheong HJ, Kim WJ. How lessons learned from the 2015 Middle East respiratory syndrome outbreak affected the response to coronavirus disease 2019 in the Republic of Korea. Korean J Intern Med 2021; 36:271-285. [PMID: 32872738 PMCID: PMC7969075 DOI: 10.3904/kjim.2020.371] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/13/2020] [Indexed: 12/13/2022] Open
Abstract
The Republic of Korea (ROK) experienced a public health crisis due to Middle East respiratory syndrome (MERS) in 2015 and is currently going through the coronavirus disease 2019 (COVID-19) pandemic. Lessons learned from the disastrous MERS outbreak were ref lected in the preparedness system, and the readiness capabilities that were subsequently developed enabled the country to successfully flatten the epidemic curve of COVID-19 in late February and March 2020. In this review, we summarize and compare the epidemiology and response of the ROK to the 2015 MERS outbreak and the COVID-19 epidemic in early 2020. We emphasize that, because further COVID-19 waves seem inevitable, it is urgent to develop comprehensive preparedness and response plans for the worst-case scenarios of the COVID-19 pandemic. Simultaneously strengthening healthcare capacity to endure the peak demand and implementing smart strategies to sustain social distancing and public hygiene are necessary until safe and effective therapeutics and vaccines against COVID-19 are available.
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Affiliation(s)
- Tae Un Yang
- Department of Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Ji Yun Noh
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Joon-Young Song
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Hee Jin Cheong
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Woo Joo Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
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Mental Health Status of Healthcare Professionals and Students of Health Sciences Faculties in Kuwait during the COVID-19 Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042203. [PMID: 33672372 PMCID: PMC7926878 DOI: 10.3390/ijerph18042203] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/15/2022]
Abstract
Objectives: This study aimed to assess the impact of the COVID-19 pandemic on the mental health status of healthcare professionals (HCPs) and undergraduate students in the health sciences center (HSCUs). In addition, it explored the factors associated with the increased levels of mental health burden among the study population. Methods: A cross-sectional study was performed using two online-administered questionnaires: the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder 7-item (GAD-7), which were distributed in parallel to HCPs and HSCUs in Kuwait. These instruments are validated assessment scales to assess mental health status: depression (PHQ-9) and anxiety (GAD-7). Statistical analyses were carried out using SPSS- version 25. Results: A total of 857 individuals (559 HCPs and 298 HSCUs) participated in this study. The prevalence of moderately severe depression or severe depression (PHQ-9 total score of ≥15) among respondents was 66.6%. The median (interquartile range, IQR) PHQ-9 score was significantly higher among HSCUs (20 {11.5}) compared to HCPs (17 {8}). The prevalence of severe anxiety (GAD-7 total score of ≥15) among respondents was 36.7%. There were no significant differences between the median (IQR) GAD-7 scores among the HCPs (14 {7}) and HSCUs (13 {8}). Binary logistic regression analysis revealed that three variables were significantly and independently associated with severe depression among HCPs. The prevalence of severe depression was found to be greater among females compared to males. In addition, it was significantly lower among those who were aged ≥50 years, and those who reported that they were not in direct contact with COVID-19 patients. Among HSCUs, females showed greater depression than males. In contrast, those aged >29 years and who had no history of chronic disease showed lower depression compared to their counterparts in the 18–29 years age group and who had a chronic disease history. Conclusions: The COVID-19 pandemic had a significant negative impact on the mental health of HCPs and HSCUs in Kuwait. This highlights the need for proactive efforts to support their mental health and well-being through educational campaigns and psychological support programs.
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Ko JH, Lee JY, Kim HA, Kang SJ, Baek JY, Park SJ, Hyun M, Jo IJ, Chung CR, Kim YJ, Kang ES, Choi YK, Chang HH, Jung SI, Peck KR. Serologic Evaluation of Healthcare Workers Caring for COVID-19 Patients in the Republic of Korea. Front Microbiol 2020; 11:587613. [PMID: 33329460 PMCID: PMC7714715 DOI: 10.3389/fmicb.2020.587613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 10/28/2020] [Indexed: 12/12/2022] Open
Abstract
The safety of healthcare workers (HCWs) against severe acute respiratory syndrome virus 2 (SARS-CoV-2) transmission is an important aspect of managing the coronavirus disease 2019 (COVID-19) pandemic. In the South Korea, highly stringent infection prevention and control (IPC) guidelines are implemented, and reports of healthcare-associated SARS-CoV-2 transmission among HCWs are limited. However, subclinical infections may have been missed by the current symptom-based screening strategy. To evaluate the risk of undetected SARS-CoV-2 transmissions from COVID-19 patients to HCWs, we conducted a multicenter seroprevalence study after the first surge of the COVID-19 outbreak. A total of 432 HCWs were evaluated, comprising 309 HCWs designated to laboratory-confirmed COVID-19 patient care and 123 non-designated HCWs. Designated HCWs wore personal protective equipment including an N95 respirator, eye protection, hooded overalls, shoe covers, and inner and outer gloves. Use of a powered air-purifying respirator was recommended for aerosol-generating procedures or long-duration care activities. A high-sensitivity (99.1%) fluorescence immunoassay immunoglobulin G (IgG) kit was used as the initial screening test, and two enzyme-linked immunosorbent assay kits for total and IgG antibodies were used to confirm the test results. A microneutralization test was additionally performed to evaluate the neutralizing activity of positive specimens. Among the evaluated HCWs, none of the non-designated HCWs had a positive result, while one of the HCWs designated for COVID-19 patient care (1/309, 0.3%) was seropositive for SARS-CoV-2 with confirmed neutralizing activity (1:40). This finding suggests that subclinical seroconversion may occur among HCWs caring for COVID-19 patients, although the risk is low under strict IPC guidance.
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Affiliation(s)
- Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ji Yeon Lee
- Division of Infectious Diseases, Department of Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Hyun Ah Kim
- Division of Infectious Diseases, Department of Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Seung-Ji Kang
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Jin Yang Baek
- Asia Pacific Foundation for Infectious Diseases, Seoul, South Korea
| | - Su-Jin Park
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, South Korea
| | - Miri Hyun
- Division of Infectious Diseases, Department of Medicine, Keimyung University Dongsan Hospital, Keimyung University School of Medicine, Daegu, South Korea
| | - Ik Joon Jo
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Chi Ryang Chung
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Yae-Jean Kim
- Division of Infectious Diseases and Immunodeficiency, Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, South Korea
| | - Eun-Suk Kang
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Young Ki Choi
- College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, South Korea
| | - Hyun-Ha Chang
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Sook In Jung
- Division of Infectious Diseases, Department of Internal Medicine, Chonnam National University Medical School, Gwangju, South Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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Abstract
BACKGROUND In the global coronavirus disease 2019 (COVID-19) pandemic, to date, delivery of critically ill pregnant patients has predominantly been by cesarean. CASE A 27-year-old pregnant woman was admitted to a 166-bed community hospital at 33 weeks of gestation with acute hypoxemic respiratory failure secondary to COVID-19. She underwent mechanical ventilation for 9 days. While ventilated, she underwent induction of labor, resulting in a successful forceps assisted-vaginal birth. She was extubated on postpartum day 5 and discharged on postpartum day 10. The neonate was intubated for 24 hours but was otherwise healthy and discharged home at 36 2/7 weeks postmenstrual age. CONCLUSION Critically ill patients requiring mechanical ventilation, in this case due to COVID-19, may undergo induction of labor and vaginal delivery when carefully selected.
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Lee SS, Park JH, Kim GH, Kwon MY, Kim HY, Moon YJ, Kim SJ, Yun MJ. Emergency exploratory laparotomy in a COVID-19 patient - A case report. Anesth Pain Med (Seoul) 2020; 15:498-504. [PMID: 33329855 PMCID: PMC7724121 DOI: 10.17085/apm.20041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/25/2020] [Accepted: 09/02/2020] [Indexed: 01/10/2023] Open
Abstract
Background Surgeries in patients with coronavirus disease 2019 (COVID-19) put medical staff at a high risk of infection. We report the anesthetic management and infection control of a mechanically ventilated COVID-19 patient who underwent exploratory laparotomy for suspected duodenal ulcer perforation. Case A 73-year-old man, mechanically ventilated for confirmed COVID-19, showed clinical and radiographic signs of a perforated duodenal ulcer, and he was transferred under sedation and intubation to a negative-pressure operating room. The operating and assistant staff wore personal protective equipment. High-efficiency particulate absorbing filters were inserted into the expiratory circuits of the anesthesia machine and portable ventilator. No participating staff contracted COVID-19, although the patient later died due to pneumonia. Conclusions This report can contribute to establishing clinical guidelines for the surgical management and operation room setting of COVID-19 patients.
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Affiliation(s)
- Seong Su Lee
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Ji Hyun Park
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Gunn Hee Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Mi Young Kwon
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Hee Yeong Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Yeon Jin Moon
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Su Jin Kim
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
| | - Mi Jung Yun
- Department of Anesthesiology and Pain Medicine, National Medical Center, Seoul, Korea
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17
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Lee JS, Yum HK, Si HJ, Han SH, Park SY, Peck KR, Eom JS. Guidelines for Surgery of Confirmed or Suspected COVID-19 Patients. Infect Chemother 2020; 52:453-459. [PMID: 32869560 PMCID: PMC7533204 DOI: 10.3947/ic.2020.52.3.453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Indexed: 02/02/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) has spread widely across the world since January 2020. There are many challenges when caring for patients with COVID-19, one of which is infection prevention and control. In particular, in cases where surgery must absolutely be performed, special infection control may be required in order to perform surgery without spreading infection within the hospital. We aim to present potentially useful recommendations for non-deferrable surgery for COVID-19 patients based on in vivo and in vitro research and clinical experiences from many countries.
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Affiliation(s)
- Jin Seo Lee
- Division of Infectious Diseases, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Ho Kee Yum
- Inje University Seoul Paik Hospital, Respiratory and Critical Care Medicine, Seoul, Korea
| | - Hye Jin Si
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea
| | - Su Ha Han
- Department of Nursing, Soon Chun Hyang University, Cheonan, Korea
| | - So Yeon Park
- Division of Infectious Diseases, Kangdong Sacred Heart Hospital, Hallym University School of Medicine, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joong Sik Eom
- Division of Infectious Diseases, Department of Internal Medicine, Gil Medical Center, Gachon University College of Medicine, Incheon, Korea.
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Alphandéry E. The Potential of Various Nanotechnologies for Coronavirus Diagnosis/Treatment Highlighted through a Literature Analysis. Bioconjug Chem 2020; 31:1873-1882. [PMID: 32639742 PMCID: PMC7359670 DOI: 10.1021/acs.bioconjchem.0c00287] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/07/2020] [Indexed: 12/14/2022]
Abstract
With the current COVID-19 outbreak, it has become essential to develop efficient methods for the treatment and detection of this virus. Among the new approaches that could be tested, that relying on nanotechnology finds one of its main grounds in the similarity between nanoparticle (NP) and coronavirus (COV) sizes, which promotes NP-COV interactions. Since COVID-19 is very recent, most studies in this field have focused on other types of coronavirus than COVID-19, such as those involved in MERS or SARS diseases. Although their number is limited, they have led to promising results on various COV using a wide range of different types of nanosystems, e.g., nanoparticles, quantum dos, or nanoassemblies of polymers/proteins. Additional efforts deserve to be spent in this field to consolidate these findings. Here, I first summarize the different nanotechnology-based methods used for COV detection, i.e., optical, electrical, or PCR ones, whose sensitivity was improved by the presence of nanoparticles. Furthermore, I present vaccination methods, which comprise nanoparticles used either as adjuvants or as active principles. They often yield a better-controlled immune response, possibly due to an improved antigen presentation/processing than in non-nanoformulated vaccines. Certain antiviral approaches also took advantage of nanoparticle uses, leading to specific mechanisms such as the blocking of virus replication at the cellular level or the reduction of a COV induced apoptotic cellular death.
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Affiliation(s)
- Edouard Alphandéry
- Paris Sorbonne
Université, Muséum National
d’Histoire Naturelle, UMR CNRS 7590, IRD, Institut de
Minéralogie, de Physique des Matériaux et de
Cosmochimie, IMPMC, 75005, Paris, France
- Nanobacterie
SARL, 36 Boulevard Flandrin, 75116, Paris,
France
- Institute of Anatomy, UZH
University of Zurich, Winterthurerstrasse 190,
CH-8057, Zurich, Switzerland
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19
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Kim SW, Jo SJ, Lee H, Oh JH, Lim J, Lee SH, Choi JH, Lee J. Containment of a healthcare-associated COVID-19 outbreak in a university hospital in Seoul, Korea: A single-center experience. PLoS One 2020; 15:e0237692. [PMID: 32797094 PMCID: PMC7428087 DOI: 10.1371/journal.pone.0237692] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 07/31/2020] [Indexed: 01/08/2023] Open
Abstract
Background Our hospital experienced the first healthcare-associated COVID-19 outbreak in Seoul at the time the first COVID-19 cases were confirmed in Korea. The first confirmed COVID-19 patient was a hospital personnel who was in charge of transferring patients inside our hospital. To contain the virus spread, we shutdown our hospital, and tested all inpatients, medical staff members, and employees. Methods We retrospectively analyzed the results of SARS-CoV-2 RT-PCR testing according to the contact history, occupation, and presence of respiratory symptoms. Closed-circuit television (CCTV) was reviewed in the presence of an epidemiologist to identify individuals who came into contact with confirmed COVID-19 patients. Results A total of 3,091 respiratory samples from 2,924 individuals were obtained. Among 2,924 individuals, two inpatients, and one caregiver tested positive (positivity rate, 0.1%). Although all confirmed cases were linked to a general ward designated for pulmonology patients, no medical staff members, medical support personnel, or employees working at the same ward were infected. Contact with confirmed COVID-19 cases was frequent among inpatients and medical support personnel. The most common contact area was the general ward for pulmonology patients and medical support areas, including clinical and imaging examination rooms. Finally, the total number of hospital-associated infections was 14, consisting of four diagnosed at our hospital and ten diagnosed outside the hospital. Conclusions The robust control of the COVID-19 outbreak further minimized the transmission of SARS-CoV-2 in the hospital and local communities. However, there was also a debate over the appropriate period of hospital shutdown and testing of all hospital staff and patients. Future studies are required to refine and establish the in-hospital quarantine and de-isolation guidelines based on the epidemiological and clinical settings.
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Affiliation(s)
- Sei Won Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Jin Jo
- Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Heayon Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hwan Oh
- Division of Gastroenterology, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jihyang Lim
- Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Haak Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jehoon Lee
- Department of Laboratory Medicine, Eunpyeong St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
- * E-mail:
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20
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Li L, Liu S, He Y, Wang J, Ding W. Prevention of and control measures for nosocomial coronavirus disease (COVID-19): 2020 recommendations by authors at Renmin Hospital of Wuhan University. ASIAN BIOMED 2020; 14:169-174. [PMID: 37551385 PMCID: PMC10373401 DOI: 10.1515/abm-2020-0024] [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] [Indexed: 08/09/2023]
Abstract
The rapid global spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused the coronavirus disease 2019 (COVID-19) pandemic. Although COVID-19 is a class B infectious disease, the prevention and control measures used for it in China are commonly used for class A infectious diseases. In the process of the spread of the disease, hospitals will be a key point to influence this pandemic. To prevent and control nosocomial infection of SARS-CoV-2, methods and measures were formulated from the relevant laws and regulations of the National Health Commission of the People's Republic of China, practical experience of the pandemic, and evidence-based medicine in the hospitals fighting this disease. Thus, this report may provide useful recommendations for the prevention and control of COVID-19 in hospitals and clinics.
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Affiliation(s)
- Lan Li
- Surgical Clinic, Renmin Hospital of Wuhan University, Wuhan430060, China
| | - Siyang Liu
- Surgical Clinic, Renmin Hospital of Wuhan University, Wuhan430060, China
| | - Yuhong He
- Infection Control Office, Renmin Hospital of Wuhan University, Wuhan430060, China
| | - Jinsong Wang
- Infection Control Office, Renmin Hospital of Wuhan University, Wuhan430060, China
| | - Wenmao Ding
- Medical Administration Department, Renmin Hospital of Wuhan University, Wuhan430060, China
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21
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Kazzaz YM, Alkhalaf H, Alharbi M, Al Shaalan M, Almuneef M, Alshehri A, Alali H, AlHarbi T, Alzughaibi N, Alatassi A, Mahmoud AH, Aljuhani T, AlSaad A, Alqanatish J, Aldubayee M, Malik A, Al Amri A, Al Shebil S, Al Onazi M, Al Mutrafy AF, Al Moamary MS. Hospital preparedness and management of pediatric population during COVID-19 outbreak. Ann Thorac Med 2020; 15:107-117. [PMID: 32831931 PMCID: PMC7423210 DOI: 10.4103/atm.atm_212_20] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/06/2020] [Indexed: 02/07/2023] Open
Abstract
With the recent pandemic of Coronavirus disease-2019 (COVID-19), there has been a higher number of reported cases in children more than to the prior Corona Virus-related diseases, namely, severe acute respiratory syndrome and the Middle East respiratory syndrome. The rate of COVID-19 in children is lower than adults; however, due to high transmission rate, the number of reported cases in children has been increasing. With the rising numbers among children, it is imperative to develop preparedness plans for the pediatric population at the hospital level, departmental level, and patient care areas. This paper summarizes important considerations for pediatric hospital preparedness at the hospital level that includes workforce, equipment, supply; capacity planning, and infection prevention strategies, it also span over the management of COVID-19 pediatric patients in high-risk areas such as critical care areas, Emergency Department and operative rooms.
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Affiliation(s)
- Yasser M. Kazzaz
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hamad Alkhalaf
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Musaed Alharbi
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Al Shaalan
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Maha Almuneef
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ali Alshehri
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Hamza Alali
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Talal AlHarbi
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Hematology Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Nezar Alzughaibi
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulaleem Alatassi
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- Department of Quality and Patient Safety, Riyadh, Saudi Arabia
- Department of Intensive Care, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ahmed Haroun Mahmoud
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Talal Aljuhani
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ahmad AlSaad
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatric Anesthesia, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Jubran Alqanatish
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mohammed Aldubayee
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Amna Malik
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Asma Al Amri
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Saleh Al Shebil
- Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Milfi Al Onazi
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatrics Emergency, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdullah F. Al Mutrafy
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Pediatrics Emergency, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Mohamed S. Al Moamary
- College of medicine, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Department of Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Recommended operating room practice during the COVID-19 pandemic: systematic review. BJS Open 2020; 4:748-756. [PMID: 32395909 PMCID: PMC7272923 DOI: 10.1002/bjs5.50304] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/04/2020] [Indexed: 01/17/2023] Open
Abstract
Background The COVID‐19 pandemic poses a critical global public health crisis. Operating room (OR) best practice in this crisis is poorly defined. This systematic review was performed to identify contemporary evidence relating to OR practice in the context of COVID‐19. Methods MEDLINE was searched systematically using PubMed (search date 19 March 2020) for relevant studies in accordance with PRISMA guidelines. Documented practices and guidance were assessed to determine Oxford Centre for Evidence‐Based Medicine (OCEBM) levels of evidence, and recommendations for practice within five domains were extracted: physical OR, personnel, patient, procedure, and other factors. Results Thirty‐five articles were identified, of which 11 met eligibility criteria. Nine articles constituted expert opinion and two were retrospective studies. All articles originated from the Far East (China, 9; Singapore, 2); eight of the articles concerned general surgery. Common themes were identified within each domain, but all recommendations were based on low levels of evidence (median OCEBM level 5 (range 4–5)). The highest number of overlapping recommendations related to physical OR (8 articles) and procedural factors (13). Although few recommendations related to personnel factors, consensus was high in this domain, with all studies mandating the use of personal protective equipment. Conclusion There was little evidence to inform this systematic review, but there was consensus regarding many aspects of OR practice. Within the context of a rapidly evolving pandemic, timely amalgamation of global practice and experiences is needed to inform best practice.
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The psychological impact of COVID-19 pandemic on health care workers in a MERS-CoV endemic country. J Infect Public Health 2020; 13:877-882. [PMID: 32505461 PMCID: PMC7256548 DOI: 10.1016/j.jiph.2020.05.021] [Citation(s) in RCA: 177] [Impact Index Per Article: 44.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/20/2020] [Accepted: 05/21/2020] [Indexed: 01/08/2023] Open
Abstract
Background The global pandemic of coronavirus disease of 2019 (COVID-19) has led to unprecedented psychological stress on health workers (HCWs). We aimed to assess the psychological impact of COVID-19 on HCWs in comparison to the stress brought on by the Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic in Saudi Arabia. Method Between February 5th and 16th, 2020, 811 health-care workers (HCWs) of a tertiary care teaching hospital were invited to fill a questionnaire regarding concerns and worries about the novel coronavirus pandemic, along with Generalized Anxiety Disorder (GAD-7) Anxiety Severity screening tool. Results Out of 582 HCWs who completed the survey questionnaire (response rate of 71.8%), about 40% were exposed previously to MERS-CoV infected or suspected patients during a previous hospital outbreak. While there were no COVID-19 cases reported yet in Saudi Arabia at the time of data collection, still, the anxiety level from COVID-19 was significantly higher than that from MERS-CoV or seasonal influenza: 41.1% were more worried about COVID-19, 41.4% were similarly worried about both MERS-CoV and COVID-19, and 17.5% were more stressed by the previous MERS-CoV hospital outbreak. The most frequent concern was transmitting the infection to family and friends (2.71/5) than to themselves only (2.57/5). Conclusion Pandemic and epidemic infectious diseases such as COVID-19 or MERS-CoV impose a significant level of anxiety and stress on healthcare workers who are caring of infected patients, with their main concern being the risk of transmitting the infection to their families or to acquire it themselves. Therefore, optimizing the compliance of healthcare workers with the proper infection prevention and control measures is paramount during the infectious disease outbreak, to ensure their safety, to decrease the likelihood of getting infected or transmitting the infection to others, and consequently to alleviate their psychological stress and anxiety.
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Kim C, Kim JK, Yeo IH, Choe JY, Lee JE, Kang SJ, Park CS, Kwon KT, Hwang S. Appendectomy in patient with suspected COVID-19 with negative COVID-19 results: A case report. World J Clin Cases 2020; 8:1944-1949. [PMID: 32518785 PMCID: PMC7262723 DOI: 10.12998/wjcc.v8.i10.1944] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/30/2020] [Accepted: 05/16/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Even at present, we are in the middle of the novel coronavirus disease 2019 (COVID-19) pandemic and are facing challenges in trial and error. Presently, emergency surgery for patients with suspected COVID-19 is burdensome not only for patients but also for healthcare workers. Therefore, we established a surveillance system in the emergency room and established principles for managing patients suspected of COVID-19 who require emergency surgery.
CASE SUMMARY A 67-year-old man was diagnosed with appendicitis in March 2020. His wife was diagnosed with COVID-19 10 d earlier, and the patient was in close contact with her. The patient tested negative twice on an upper respiratory COVID-19 reverse transcription–polymerase chain reaction screening test, but chest X-ray and chest computed tomography revealed patchy ground-glass opacity in both upper lobes of the patient’s lungs. The same emergency surgery procedure for patients with confirmed COVID-19 was applied to this patient suspected of having the disease to ensure that surgery was not delayed while waiting for the reverse transcription–polymerase chain reaction results. A few hours after surgery, the upper respiratory tract specimen taken in the emergency room was negative for COVID-19 but the lower respiratory tract specimen was found to be positive for the disease.
CONCLUSION When COVID-19 is suspected, emergency surgery should be performed as for confirmed COVID-19 without delay.
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Affiliation(s)
- Changho Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - In Hwan Yeo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Jae Young Choe
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu 41944, South Korea
| | - Jeong Eun Lee
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - So Jeong Kang
- Department of Anesthesiology and Pain Medicine, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Chan Sub Park
- Department of Surgery, School of Medicine, Kyungpook National University, Kyungpook National University Hospital, Daegu 41944, South Korea
| | - Ki Tae Kwon
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea; Department of Infection Control, Kyungpook National University Chilgok Hospital, Daegu 41944, South Korea
| | - Soyoon Hwang
- Department of Internal Medicine, School of Medicine, Kyungpook National University, Daegu, Korea; Department of Infection Control, Kyungpook National University Chilgok Hospital, Daegu 41944, South Korea
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León Molina J, Abad-Corpa E. Disinfectants and antiseptics facing coronavirus: synthesis of evidence and recommendations. ENFERMERIA CLINICA 2020; 31:S84-S88. [PMID: 34629855 PMCID: PMC7241393 DOI: 10.1016/j.enfcli.2020.05.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/11/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To synthesize the available evidence on the use of antiseptics and disinfectants in the face of VIDOC-19 infection METHOD: Bibliographic search in the main databases (WOS, CCC, DIIDW, KJD, MEDLINE, RSCI, SCIELO, PubMed, BMJ Best Practice, Cochrane Library, UptoDate) and on the web of official bodies in March 2020, using descriptors and truncations. The search was limited to reviews published between 2016-2020. RESULTS Thirty-six papers were identified (no duplicates) of which 17 were selected for relevance and specificity and one paper was added from the literature review. In the documents finally used, no evidence was located, but experiences and recommendations of interest were found, highlighting the importance of material, environmental and, very significantly, hand disinfection. CONCLUSION There is no clear evidence, nor are there clear recommendations for the use of one or another antiseptic, although the action of sodium hypochlorite, ethanol and hydrogen peroxide is highlighted in comparison to others such as benzalkonium chloride, chlorhexidine digluconate, povidoeyodine and diluted ethyl alcohol. Particular importance is attached to their use in hand hygiene, the use of protective equipment and environmental disinfection.
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Affiliation(s)
- Joaquín León Molina
- Hospital Virgen de la Arrixaca. Servicio Murciano de Salud, ENFERAVANZA, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), Murcia, España
| | - Eva Abad-Corpa
- Facultad de Enfermería, Universidad de Murcia, Hospital Reina Sofía, Servicio Murciano de Salud, ENFERAVANZA, IMIB-Arrixaca. Investén-isciii, CIBERFES, Murcia, España
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The prevalence and influencing factors in anxiety in medical workers fighting COVID-19 in China: a cross-sectional survey. Epidemiol Infect 2020; 148:e98. [PMID: 32430088 PMCID: PMC7251286 DOI: 10.1017/s0950268820001107] [Citation(s) in RCA: 269] [Impact Index Per Article: 67.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) outbreak caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2 virus) has been sustained in China since December 2019, and has become a pandemic. The mental health of frontline medical staff is a concern. In this study, we aimed to identify the factors influencing medical worker anxiety in China during the COVID-19 outbreak. We conducted a cross-sectional study to estimate the prevalence of anxiety among medical staff in China from 10 February 2020 to 20 February 2020 using the Zung Self-rating Anxiety Scale (SAS) to assess anxiety, with the criteria of normal (⩽49), mild (50–59), moderate (60–70) and severe anxiety (⩾70). We used multivariable linear regression to determine the factors (e.g. having direct contact when treating infected patients, being a medical staff worker from Hubei province, being a suspect case) for anxiety. We also used adjusted models to confirm independent factors for anxiety after adjusting for gender, age, education and marital status. Of 512 medical staff in China, 164 (32.03%) had had direct contact treating infected patients. The prevalence of anxiety was 12.5%, with 53 workers suffering from mild (10.35%), seven workers suffering from moderate (1.36%) and four workers suffering from severe anxiety (0.78%). After adjusting for sociodemographic characteristics (gender, age, education and marital status), medical staff who had had direct contact treating infected patients experienced higher anxiety scores than those who had not had direct contact (β value = 2.33, confidence interval (CI) 0.65–4.00; P = 0.0068). A similar trend was observed in medical staff from Hubei province, compared with those from other parts of China (β value = 3.67, CI 1.44–5.89; P = 0.0013). The most important variable was suspect cases with high anxiety scores, compared to non-suspect cases (β value = 4.44, CI 1.55–7.33; P = 0.0028). In this survey of hospital medical workers during the COVID-19 outbreak in China, we found that study participants experienced anxiety symptoms, especially those who had direct clinical contact with infected patients; as did those in the worst affected areas, including Hubei province; and those who were suspect cases. Governments and healthcare authorities should proactively implement appropriate psychological intervention programmes, to prevent, alleviate or treat increased anxiety.
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Chung HS, Lee DE, Kim JK, Yeo IH, Kim C, Park J, Seo KS, Park SY, Kim JH, Kim G, Lee SH, Cheon JJ, Kim YH. Revised Triage and Surveillance Protocols for Temporary Emergency Department Closures in Tertiary Hospitals as a Response to COVID-19 Crisis in Daegu Metropolitan City. J Korean Med Sci 2020; 35:e189. [PMID: 32419401 PMCID: PMC7234857 DOI: 10.3346/jkms.2020.35.e189] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 05/05/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND When an emergency-care patient is diagnosed with an emerging infectious disease, hospitals in Korea may temporarily close their emergency departments (EDs) to prevent nosocomial transmission. Since February 2020, multiple, consecutive ED closures have occurred due to the coronavirus disease 2019 (COVID-19) crisis in Daegu. However, sudden ED closures are in contravention of laws for the provision of emergency medical care that enable the public to avail prompt, appropriate, and 24-hour emergency medical care. Therefore, this study ascertained the vulnerability of the ED at tertiary hospitals in Daegu with regard to the current standards. A revised triage and surveillance protocol has been proposed to tackle the current crisis. METHODS This study was retrospectively conducted at 6 level 1 or 2 EDs in a metropolitan city where ED closure due to COVID-19 occurred from February 18 to March 26, 2020. The present status of ED closure and patient characteristics and findings from chest radiography and laboratory investigations were assessed. Based on the experience from repeated ED closures and the modified systems that are currently used in EDs, revised triage and surveillance protocols have been developed and proposed. RESULTS During the study period, 6 level 1 or 2 emergency rooms included in the study were shut down 27 times for 769 hours. Thirty-one confirmed COVID-19 cases, of whom 7 died, were associated with the incidence of ED closure. Typical patient presentation with respiratory symptoms of COVID-19 was seen in less than 50% of patients, whereas abnormal findings on chest imaging investigations were detected in 93.5% of the study population. The chest radiography facility, resuscitation rooms, and triage area were moved to locations outside the ED, and a new surveillance protocol was applied to determine the factors warranting quarantine, including symptoms, chest radiographic findings, and exposure to a source of infection. The incidence of ED closures decreased after the implementation of the revised triage and surveillance protocols. CONCLUSION Triage screening by emergency physicians and surveillance protocols with an externally located chest imaging facility were effective in the early isolation of COVID-19 patients. In future outbreaks of emerging infectious diseases, efforts should be focused toward the provision of continued ED treatment with the implementation of revised triage and surveillance protocols.
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Affiliation(s)
- Han Sol Chung
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Dong Eun Lee
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jong Kun Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea.
| | - In Hwan Yeo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Changho Kim
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Jungbae Park
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Kang Suk Seo
- Department of Emergency Medicine, School of Medicine, Kyungpook National University, Daegu, Korea
| | - Sin Yul Park
- Department of Emergency Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jung Ho Kim
- Department of Emergency Medicine, College of Medicine, Yeungnam University, Daegu, Korea
| | - Gyunmoo Kim
- Department of Emergency Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Suk Hee Lee
- Department of Emergency Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jeon Jae Cheon
- Department of Emergency Medicine, Keimyung University Dongsan Hospital, Daegu, Korea
| | - Yang Hun Kim
- Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Korea
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Cho AJ, Lee HS, Lee YK, Jeon HJ, Park HC, Jeong DW, Kim YG, Lee SH, Lee CH, Yoo KD, Wong AK. Post-traumatic stress symptoms in hemodialysis patients with MERS-CoV exposure. Biopsychosoc Med 2020; 14:9. [PMID: 32308734 PMCID: PMC7156895 DOI: 10.1186/s13030-020-00181-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/23/2020] [Indexed: 12/26/2022] Open
Abstract
Background Post-traumatic stress symptoms can occur in patients with medical illness. During the Middle East Respiratory Syndrome (MERS) outbreak in South Korea in 2015, some dialysis patients in three centers who were incidentally exposed to patients or medical staff with confirmed MERS-CoV infection were isolated to interrupt the spread of the infection. We aimed to investigate post-traumatic stress symptoms and risk factors among these patients. Materials and methods In total, 116 hemodialysis (HD) patients in contact with MERS-CoV-confirmed subjects were isolated using three strategies, namely, single room isolation, cohort isolation, and self-quarantine. We used the Impact of Event Scale-Revised-Korean (IES-R-K) to examine post-traumatic stress symptoms at 12 months after the isolation period. Results Of the 116 HD patients, 27 were lost to follow-up. Of the 89 patients, 67 (75.3%) completed the questionnaires. Single room isolation was used on 40 (58.8%) of the patients, cohort isolation on 20 (29.4%), and self-imposed quarantine on 8 (11.8%). In total, 17.9% of participants (n = 12) reported post-traumatic stress symptoms exceeding the IES-R-K’s cutoff point (≧18). Prevalence rates of IES-R-K ≧18 did not differ significantly according to isolation method. However, isolation duration was linearly associated with the IES-R-K score (standardized β coefficient − 0.272, P = 0.026). Scores in Avoidance, Emotional numbing and Dissociation subscale were higher in patients with longer isolation period. Conclusion MERS was a traumatic experience for quarantined HD patients. IES-R-K scores were not significantly different by isolation methods. However, short isolation was associated with post-traumatic stress symptoms.
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Affiliation(s)
- A Jin Cho
- 1Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 07441 South Korea
| | - Hong-Seock Lee
- 2Hallym University College of Medicine, Psychiatry, Seoul, Republic of Korea
| | - Young-Ki Lee
- 1Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 07441 South Korea
| | - Hee Jung Jeon
- 1Department of Internal Medicine, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, 1, Singil-ro, Yeongdeungpo-gu, Seoul, 07441 South Korea
| | - Hayne Cho Park
- 3Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, South Korea
| | - Da-Wun Jeong
- 4Internal Medicine, Kyung Hee University at Kangdong, Seoul, Republic of Korea
| | - Yang-Gyun Kim
- 4Internal Medicine, Kyung Hee University at Kangdong, Seoul, Republic of Korea
| | - Sang-Ho Lee
- 4Internal Medicine, Kyung Hee University at Kangdong, Seoul, Republic of Korea
| | - Chang-Hee Lee
- Gangeung Medical Center, Anesthesiology, Gangeung, Republic of Korea
| | - Kyung Don Yoo
- 6Internal Medicine, Ulsan University Hospital, Ulsan, Republic of Korea
| | - Ae Kyeong Wong
- 2Hallym University College of Medicine, Psychiatry, Seoul, Republic of Korea
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Lee H, Heo JW, Kim SW, Lee J, Choi JH. A Lesson from Temporary Closing of a Single University-affiliated Hospital owing to In-Hospital Transmission of Coronavirus Disease 2019. J Korean Med Sci 2020; 35:e145. [PMID: 32242350 PMCID: PMC7131905 DOI: 10.3346/jkms.2020.35.e145] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 12/29/2022] Open
Affiliation(s)
- Heayon Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Won Heo
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sei Won Kim
- Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jehoon Lee
- Department of Laboratory Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jung Hyun Choi
- Division of Infectious Diseases, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Li N, Liu T, Chen H, Liao J, Li H, Luo Q, Song H, Xiang F, Tan J, Zhou J, Hu G, Yuan Z, Peng Y, Luo G. Management strategies for the burn ward during COVID-19 pandemic. Burns 2020; 46:756-761. [PMID: 32381449 PMCID: PMC7127442 DOI: 10.1016/j.burns.2020.03.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 03/27/2020] [Indexed: 12/13/2022]
Abstract
This study describes the Chinese Management strategies for the burn ward during COVID-19 pandemic. The strategies should include administrational management, environmental management, personnel management, and management of surgery, protective supplies, mental health and others. It is important to manage the patients and wards carefully and correctly to prevent epidemic of the virus in burn centers.
COVID-19 pandemic is sweeping the globe. Any outpatient or new inpatient especial in burn department during the pandemic should be as a potential infectious source of COVID-19. It is very important to manage the patients and wards carefully and correctly to prevent epidemic of the virus in burn centers. This paper provides some strategies regarding management of burn ward during the epidemic of COVID-19 or other respiratory infectious diseases.
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Affiliation(s)
- Ning Li
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Tingmin Liu
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Hualing Chen
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Jianmei Liao
- Department of Nursing, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China.
| | - Haisheng Li
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Qizhi Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Huapei Song
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Fei Xiang
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Jianglin Tan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Junyi Zhou
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Gaozhong Hu
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Zhiqiang Yuan
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Yizhi Peng
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China
| | - Gaoxing Luo
- Institute of Burn Research, State Key Laboratory of Trauma, Burns and Combined Injury, Southwest Hospital, Army Medical University (Third Military Medical University), Chongqing 400038, China.
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Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, Fang C, Huang D, Huang LQ, Huang Q, Han Y, Hu B, Hu F, Li BH, Li YR, Liang K, Lin LK, Luo LS, Ma J, Ma LL, Peng ZY, Pan YB, Pan ZY, Ren XQ, Sun HM, Wang Y, Wang YY, Weng H, Wei CJ, Wu DF, Xia J, Xiong Y, Xu HB, Yao XM, Yuan YF, Ye TS, Zhang XC, Zhang YW, Zhang YG, Zhang HM, Zhao Y, Zhao MJ, Zi H, Zeng XT, Wang YY, Wang XH. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res 2020. [PMID: 32029004 DOI: 10.1186/2fs40779-020-0233-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province; and then named "2019 novel coronavirus (2019-nCoV)" by the World Health Organization (WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world's attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development; we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control (including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
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Affiliation(s)
- Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lin Cai
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Zhen-Shun Cheng
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong Cheng
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Tong Deng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Yi-Pin Fan
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China
| | - Cheng Fang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Di Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lu-Qi Huang
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yong Han
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Bing-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Yi-Rong Li
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Li-Kai Lin
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Li-Sha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lin-Lu Ma
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhi-Yong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yun-Bao Pan
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhen-Yu Pan
- Division of Medical Affairs, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xue-Qun Ren
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Hui-Min Sun
- Division of Nursing Affairs, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ying Wang
- Office of Nosocomial Infection Control, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong Weng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Chao-Jie Wei
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Dong-Fang Wu
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jian Xia
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yong Xiong
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hai-Bo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiao-Mei Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Yu-Feng Yuan
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Tai-Sheng Ye
- Department of Traditional Chinese Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiao-Chun Zhang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ying-Wen Zhang
- Department of Traditional Chinese Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yin-Gao Zhang
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Hua-Min Zhang
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China
| | - Yan Zhao
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ming-Juan Zhao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hao Zi
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Global Health Institute, Wuhan University, Wuhan, 430072, China.
| | - Yong-Yan Wang
- China Academy of Chinese Medical Sciences, Beijing, 100700, China.
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China.
| | - Xing-Huan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China.
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Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, Fang C, Huang D, Huang LQ, Huang Q, Han Y, Hu B, Hu F, Li BH, Li YR, Liang K, Lin LK, Luo LS, Ma J, Ma LL, Peng ZY, Pan YB, Pan ZY, Ren XQ, Sun HM, Wang Y, Wang YY, Weng H, Wei CJ, Wu DF, Xia J, Xiong Y, Xu HB, Yao XM, Yuan YF, Ye TS, Zhang XC, Zhang YW, Zhang YG, Zhang HM, Zhao Y, Zhao MJ, Zi H, Zeng XT, Wang YY, Wang XH. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res 2020; 7:4. [PMID: 32029004 PMCID: PMC7003341 DOI: 10.1186/s40779-020-0233-6] [Citation(s) in RCA: 1115] [Impact Index Per Article: 278.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 01/30/2020] [Indexed: 11/19/2022] Open
Abstract
In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province; and then named "2019 novel coronavirus (2019-nCoV)" by the World Health Organization (WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world's attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development; we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control (including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
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Affiliation(s)
- Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lin Cai
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Zhen-Shun Cheng
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong Cheng
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Tong Deng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Yi-Pin Fan
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China
| | - Cheng Fang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Di Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lu-Qi Huang
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yong Han
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Bing-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Yi-Rong Li
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Li-Kai Lin
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Li-Sha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lin-Lu Ma
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhi-Yong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yun-Bao Pan
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhen-Yu Pan
- Division of Medical Affairs, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xue-Qun Ren
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Hui-Min Sun
- Division of Nursing Affairs, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ying Wang
- Office of Nosocomial Infection Control, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong Weng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Chao-Jie Wei
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Dong-Fang Wu
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jian Xia
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yong Xiong
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hai-Bo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiao-Mei Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Yu-Feng Yuan
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Tai-Sheng Ye
- Department of Traditional Chinese Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiao-Chun Zhang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ying-Wen Zhang
- Department of Traditional Chinese Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yin-Gao Zhang
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Hua-Min Zhang
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China
| | - Yan Zhao
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ming-Juan Zhao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hao Zi
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Global Health Institute, Wuhan University, Wuhan, 430072, China.
| | - Yong-Yan Wang
- China Academy of Chinese Medical Sciences, Beijing, 100700, China.
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China.
| | - Xing-Huan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China.
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Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, Fang C, Huang D, Huang LQ, Huang Q, Han Y, Hu B, Hu F, Li BH, Li YR, Liang K, Lin LK, Luo LS, Ma J, Ma LL, Peng ZY, Pan YB, Pan ZY, Ren XQ, Sun HM, Wang Y, Wang YY, Weng H, Wei CJ, Wu DF, Xia J, Xiong Y, Xu HB, Yao XM, Yuan YF, Ye TS, Zhang XC, Zhang YW, Zhang YG, Zhang HM, Zhao Y, Zhao MJ, Zi H, Zeng XT, Wang YY, Wang XH. A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med Res 2020. [PMID: 32029004 DOI: 10.11855/j.issn.0577-7402.2020.01.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/24/2023] Open
Abstract
In December 2019, a new type viral pneumonia cases occurred in Wuhan, Hubei Province; and then named "2019 novel coronavirus (2019-nCoV)" by the World Health Organization (WHO) on 12 January 2020. For it is a never been experienced respiratory disease before and with infection ability widely and quickly, it attracted the world's attention but without treatment and control manual. For the request from frontline clinicians and public health professionals of 2019-nCoV infected pneumonia management, an evidence-based guideline urgently needs to be developed. Therefore, we drafted this guideline according to the rapid advice guidelines methodology and general rules of WHO guideline development; we also added the first-hand management data of Zhongnan Hospital of Wuhan University. This guideline includes the guideline methodology, epidemiological characteristics, disease screening and population prevention, diagnosis, treatment and control (including traditional Chinese Medicine), nosocomial infection prevention and control, and disease nursing of the 2019-nCoV. Moreover, we also provide a whole process of a successful treatment case of the severe 2019-nCoV infected pneumonia and experience and lessons of hospital rescue for 2019-nCoV infections. This rapid advice guideline is suitable for the first frontline doctors and nurses, managers of hospitals and healthcare sections, community residents, public health persons, relevant researchers, and all person who are interested in the 2019-nCoV.
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Affiliation(s)
- Ying-Hui Jin
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lin Cai
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Zhen-Shun Cheng
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong Cheng
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Tong Deng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Yi-Pin Fan
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China
| | - Cheng Fang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Di Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lu-Qi Huang
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China
| | - Qiao Huang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yong Han
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Bo Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Fen Hu
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Bing-Hui Li
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Yi-Rong Li
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ke Liang
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Li-Kai Lin
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Li-Sha Luo
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jing Ma
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Lin-Lu Ma
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhi-Yong Peng
- Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yun-Bao Pan
- Department of Clinical Laboratory, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhen-Yu Pan
- Division of Medical Affairs, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xue-Qun Ren
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Hui-Min Sun
- Division of Nursing Affairs, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ying Wang
- Office of Nosocomial Infection Control, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yun-Yun Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hong Weng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Chao-Jie Wei
- Department of Respiratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Dong-Fang Wu
- Department of Pharmacy, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jian Xia
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yong Xiong
- Department of Infectious Diseases, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hai-Bo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiao-Mei Yao
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, L8S 4L8, Canada
| | - Yu-Feng Yuan
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Tai-Sheng Ye
- Department of Traditional Chinese Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xiao-Chun Zhang
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ying-Wen Zhang
- Department of Traditional Chinese Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Yin-Gao Zhang
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China
| | - Hua-Min Zhang
- China Academy of Chinese Medical Sciences, Beijing, 100700, China
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China
| | - Yan Zhao
- Emergency Center, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Ming-Juan Zhao
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hao Zi
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
- Institute of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, 475000, China
| | - Xian-Tao Zeng
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Global Health Institute, Wuhan University, Wuhan, 430072, China.
| | - Yong-Yan Wang
- China Academy of Chinese Medical Sciences, Beijing, 100700, China.
- China Center for Evidence Based Traditional Chinese Medicine (CCEBTCM), Beijing, 100700, China.
| | - Xing-Huan Wang
- Center for Evidence-Based and Translational Medicine, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
- Institute of Hospital Management, Wuhan University, Wuhan, 430071, China.
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Park J, Yoo SY, Ko JH, Lee SM, Chung YJ, Lee JH, Peck KR, Min JJ. Infection Prevention Measures for Surgical Procedures during a Middle East Respiratory Syndrome Outbreak in a Tertiary Care Hospital in South Korea. Sci Rep 2020; 10:325. [PMID: 31941957 PMCID: PMC6962363 DOI: 10.1038/s41598-019-57216-x] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 12/23/2019] [Indexed: 12/14/2022] Open
Abstract
In 2015, we experienced the largest in-hospital Middle East respiratory syndrome (MERS) outbreak outside the Arabian Peninsula. We share the infection prevention measures for surgical procedures during the unexpected outbreak at our hospital. We reviewed all forms of related documents and collected information through interviews with healthcare workers of our hospital. After the onset of outbreak, a multidisciplinary team devised institutional MERS-control guidelines. Two standard operating rooms were converted to temporary negative-pressure rooms by physically decreasing the inflow air volume (−4.7 Pa in the main room and −1.2 Pa in the anteroom). Healthcare workers were equipped with standard or enhanced personal protective equipment according to the MERS-related patient’s profile and symptoms. Six MERS-related patients underwent emergency surgery, including four MERS-exposed and two MERS-confirmed patients. Negative conversion of MERS-CoV polymerase chain reaction tests was noticed for MERS-confirmed patients before surgery. MERS-exposed patients were also tested twice preoperatively, all of which were negative. All operative procedures in MERS-related patients were performed without specific adverse events or perioperative MERS transmission. Our experience with setting up a temporary negative-pressure operation room and our conservative approach for managing MERS-related patients can be referred in cases of future unexpected MERS outbreaks in non-endemic countries.
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Affiliation(s)
- Jiyeon Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Yeon Yoo
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae-Hoon Ko
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sangmin M Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yoon Joo Chung
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Hwan Lee
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyong Ran Peck
- Division of Infectious Diseases, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
| | - Jeong Jin Min
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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The Middle East Respiratory Syndrome Coronavirus: An Emerging Virus of Global Threat. EMERGING AND REEMERGING VIRAL PATHOGENS 2020. [PMCID: PMC7148737 DOI: 10.1016/b978-0-12-819400-3.00008-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Middle East respiratory syndrome (MERS) is a viral respiratory illness caused by a coronavirus (CoV), first identified in Saudi Arabia in 2012. Since then, almost 2000 cases have been reported from 27 countries, with Saudi Arabia being the epicenter. This newly emerging virus is highly pathogenic and has a case mortality rate of 35%. It is similar to the CoV causing severe acute respiratory syndrome CoV (SARS-CoV) in that both belong to the genus beta CoVs that are of zoonotic origin and cause lower respiratory infection. The natural reservoir for MERS-CoV remains unknown. Serological studies indicate that most dromedary camels in the Middle East have been infected with this virus, and they maybe the potential intermediate host. However, the mode of transmission from camels to humans is poorly understood. The majority of confirmed human cases have resulted from human-to-human transmission, most probably via respiratory route. Patients most at risk of developing severe MERS-CoV infection appear to be those with underlying conditions such as diabetes, hypertension, obesity, cardiac diseases, chronic respiratory diseases, and cancer. Unlike SARS-CoV, MERS-CoV is considered an ongoing public health problem, particularly for the Middle East region. In this chapter, we outline the prevailing information regarding the emergence and epidemiology of this virus, its mode of transmission and pathogenicity, its clinical features, and the potential strategies for prevention.
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Willman M, Kobasa D, Kindrachuk J. A Comparative Analysis of Factors Influencing Two Outbreaks of Middle Eastern Respiratory Syndrome (MERS) in Saudi Arabia and South Korea. Viruses 2019; 11:v11121119. [PMID: 31817037 PMCID: PMC6950189 DOI: 10.3390/v11121119] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 11/27/2019] [Accepted: 12/02/2019] [Indexed: 01/06/2023] Open
Abstract
In 2012, an emerging viral infection was identified in Saudi Arabia that subsequently spread to 27 additional countries globally, though cases may have occurred elsewhere. The virus was ultimately named Middle Eastern Respiratory Syndrome Coronavirus (MERS-CoV), and has been endemic in Saudi Arabia since 2012. As of September 2019, 2468 laboratory-confirmed cases with 851 associated deaths have occurred with a case fatality rate of 34.4%, according to the World Health Organization. An imported case of MERS occurred in South Korea in 2015, stimulating a multi-month outbreak. Several distinguishing factors emerge upon epidemiological and sociological analysis of the two outbreaks including public awareness of the MERS outbreak, and transmission and synchronization of governing healthcare bodies. South Korea implemented a stringent healthcare model that protected patients and healthcare workers alike through prevention and high levels of public information. In addition, many details about MERS-CoV virology, transmission, pathological progression, and even the reservoir, remain unknown. This paper aims to delineate the key differences between the two regional outbreaks from both a healthcare and personal perspective including differing hospital practices, information and public knowledge, cultural practices, and reservoirs, among others. Further details about differing emergency outbreak responses, public information, and guidelines put in place to protect hospitals and citizens could improve the outcome of future MERS outbreaks.
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Affiliation(s)
- Marnie Willman
- High Containment Respiratory Viruses, Special Pathogens, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada; (M.W.); (D.K.)
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Darwyn Kobasa
- High Containment Respiratory Viruses, Special Pathogens, Public Health Agency of Canada, Winnipeg, MB R3E 3R2, Canada; (M.W.); (D.K.)
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Jason Kindrachuk
- Department of Medical Microbiology, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Correspondence: ; Tel.: +1-204-789-3807
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Ko JH, Kim SH, Lee NY, Kim YJ, Cho SY, Kang CI, Chung DR, Peck KR. Effects of environmental disinfection on the isolation of vancomycin-resistant Enterococcus after a hospital-associated outbreak of Middle East respiratory syndrome. Am J Infect Control 2019; 47:1516-1518. [PMID: 31307795 PMCID: PMC7115339 DOI: 10.1016/j.ajic.2019.05.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 05/31/2019] [Accepted: 05/31/2019] [Indexed: 02/08/2023]
Abstract
Environmental disinfection with sodium hypochlorite and hydrogen peroxide vapor was performed after a hospital-associated outbreak of Middle East respiratory syndrome. Although only 11% of total beds were disinfected, the isolation and vancomycin-resistance rates of Enterococcus spp significantly decreased for 2 months, whereas other multidrug-resistant organisms did not.
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Ki HK, Han SK, Son JS, Park SO. 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. BMC Pulm Med 2019; 19:190. [PMID: 31666061 PMCID: PMC6822455 DOI: 10.1186/s12890-019-0940-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2018] [Accepted: 09/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSIONS 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. TRIAL REGISTRATION NCT02605109 , date of registration: 11th November 2015.
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Affiliation(s)
- Hyun Kyun Ki
- Division of infectious diseases, Department of Internal Medicine, School of Medicine, Konkuk University, Konkuk University Medical Centre, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029, Republic of Korea
| | - Sang Kuk Han
- Department of Emergency Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, 108 Pyung-Dong, Jongno-Gu, Seoul, 110-746, Republic of Korea
| | - Jun Seong Son
- Division of Infectious Diseases, Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
| | - Sang O Park
- Department of Emergency Medicine, School of Medicine, Konkuk University, Konkuk University Medical Centre, 120-1 Neungdong-ro (Hwayang-dong), Gwangjin-gu, Seoul, 05029, Republic of Korea.
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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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Baharoon S, Memish ZA. MERS-CoV as an emerging respiratory illness: A review of prevention methods. Travel Med Infect Dis 2019; 32:101520. [PMID: 31730910 PMCID: PMC7110694 DOI: 10.1016/j.tmaid.2019.101520] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/10/2019] [Accepted: 11/11/2019] [Indexed: 12/15/2022]
Abstract
INTRODUCTION Middle East Respiratory Coronavirus Virus (MERS-CoV) first emerged from Saudi Arabia in 2012 and has since been recognized as a significant human respiratory pathogen on a global level. METHODS In this narrative review, we focus on the prevention of MERS-CoV. We searched PubMed, Embase, Cochrane, Scopus, and Google Scholar, using the following terms: 'MERS', 'MERS-CoV', 'Middle East respiratory syndrome' in combination with 'prevention' or 'infection control'. We also reviewed the references of each article to further include other studies or reports not identified by the search. RESULTS As of Nov 2019, a total of 2468 laboratory-confirmed cases of MERS-CoV were diagnosed mostly from Middle Eastern regions with a mortality rate of at least 35%. A major outbreak that occurred outside the Middle East (in South Korea) and infections reported from 27 countries. MERS-CoV has gained recognition as a pathogen of global significance. Prevention of MERS-CoV infection is a global public health priority. Healthcare facility transmission and by extension community transmission, the main amplifier of persistent outbreaks, can be prevented through early identification and isolation of infected humans. While MERS-CoV vaccine studies were initially hindered by multiple challenges, recent vaccine development for MERS-CoV is showing promise. CONCLUSIONS The main factors leading to sustainability of MERS-CoV infection in high risk courtiers is healthcare facility transmission. MERS-CoV transmission in healthcare facility mainly results from laps in infection control measures and late isolation of suspected cases. Preventive measures for MERS-CoV include disease control in camels, prevention of camel to human transmission.
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Affiliation(s)
- Salim Baharoon
- Infectious Disease Division, Department of Internal Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia,Department of Critical Care, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia,Professor of Critical Care, King Saud Bin Abdulaziz University for Health Science, Riyadh, Saudi Arabia
| | - Ziad A. Memish
- Infectious Diseases Division, Department of Medicine and Research Department, Prince Mohamed Bin Abdulaziz Hospital, Ministry of Health, Riyadh, Saudi Arabia,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA,Corresponding author. College of Medicine, Alfaisal University, P.O. Box 54146, Riyadh, 11514, Saudi Arabia
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Hwang SM, Na BJ, Jung Y, Lim HS, Seo JE, Park SA, Cho YS, Song EH, Seo JY, Kim SR, Lee GY, Kim SJ, Park YS, Seo H. Clinical and Laboratory Findings of Middle East Respiratory Syndrome Coronavirus Infection. Jpn J Infect Dis 2018; 72:160-167. [PMID: 30584196 DOI: 10.7883/yoken.jjid.2018.187] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
There is a paucity of data regarding the differentiating characteristics of patients with laboratory-confirmed and those negative for Middle East respiratory syndrome coronavirus (MERS-CoV) in South Korea. This hospital-based retrospective study compared MERS-CoV-positive and MERS-CoV-negative patients. A total of seven positive patients and 55 negative patients with a median age of 43 years (P = 0.845) were included. No statistical differences were observed with respect to their sex and the presence of comorbidities. At the time of admission, headache (28.6% vs. 3.6%; odds ratio [OR], 10.60; 95% confidence interval [CI], 1.22-92.27), myalgia (57.1% vs. 9.1%; OR, 13.33; 95% CI, 2.30-77.24), and diarrhea (57.1% vs. 14.5%; OR, 7.83; 95% CI, 1.47-41.79) were common among MERS-CoV-positive patients. MERS-CoV-positive patients were more likely to have a low platelet count (164 ± 76.57 vs. 240 ± 79.87) and eosinophil (0.27 ± 0.43 vs. 2.13 ± 2.01; P = 0.003). Chest radiography with diffuse bronchopneumonia was more frequent in MERS-CoV-positive patients than in negative patients (100% vs. 62.5%; P = 0.491). The symptoms of headache, myalgia, and diarrhea, as well as laboratory characteristics, including low platelet counts and eosinophil, and chest X-ray showing diffuse bronchopneumonia might enhance the ability to detect patients in South Korea infected with MERS-CoV.
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Affiliation(s)
- Se-Min Hwang
- Korea Centers for Disease Control and Prevention.,Department of Health Policy, Health & Welfare Bureau.,Department of Preventive Medicine, Korea University College of Medicine
| | - Baeg-Ju Na
- Seoul Metropolitan Government Civil Health Bueau
| | | | | | | | | | | | | | | | | | | | | | | | - Haesook Seo
- Department of Preventive Medicine, Korea University College of Medicine.,Department of Tuberculosis, Seobuk Hospital
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Oh MD, Park WB, Park SW, Choe PG, Bang JH, Song KH, Kim ES, Kim HB, Kim NJ. Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea. Korean J Intern Med 2018; 33:233-246. [PMID: 29506344 PMCID: PMC5840604 DOI: 10.3904/kjim.2018.031] [Citation(s) in RCA: 148] [Impact Index Per Article: 24.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/13/2018] [Indexed: 02/07/2023] Open
Abstract
Middle East Respiratory Syndrome coronavirus (MERS-CoV) was first isolated from a patient with severe pneumonia in 2012. The 2015 Korea outbreak of MERSCoV involved 186 cases, including 38 fatalities. A total of 83% of transmission events were due to five superspreaders, and 44% of the 186 MERS cases were the patients who had been exposed in nosocomial transmission at 16 hospitals. The epidemic lasted for 2 months and the government quarantined 16,993 individuals for 14 days to control the outbreak. This outbreak provides a unique opportunity to fill the gap in our knowledge of MERS-CoV infection. Therefore, in this paper, we review the literature on epidemiology, virology, clinical features, and prevention of MERS-CoV, which were acquired from the 2015 Korea outbreak of MERSCoV.
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Affiliation(s)
- Myoung-don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Kyoung-Ho Song
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Eu Suk Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hong Bin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
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Nam HS, Yeon MY, Park JW, Hong JY, Son JW. Healthcare worker infected with Middle East Respiratory Syndrome during cardiopulmonary resuscitation in Korea, 2015. Epidemiol Health 2017; 39:e2017052. [PMID: 29129042 PMCID: PMC5733382 DOI: 10.4178/epih.e2017052] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 11/12/2017] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES During the outbreak of the Middle East Respiratory Syndrome (MERS) in Korea in 2015, the Korea Centers for Disease Control and Prevention (KCDC) confirmed a case of MERS in a healthcare worker in Daejeon, South Korea. To verify the precise route of infection for the case, we conducted an in-depth epidemiological investigation in cooperation with the KCDC. METHODS We reviewed the MERS outbreak investigation report of the KCDC, and interviewed the healthcare worker who had recovered from MERS. Using the media interview data, we reaffirmed and supplemented the nature of the exposure. RESULTS The healthcare worker, a nurse, was infected while performing cardiopulmonary resuscitation (CPR) for a MERS patient in an isolation room. During the CPR which lasted for an hour, a large amount of body fluid was splashed. The nurse was presumed to have touched the mask to adjust its position during the CPR. She suggested that she was contaminated with the MERS patient's body fluids by wiping away the sweat from her face during the CPR. CONCLUSIONS The possible routes of infection may include the following: respiratory invasion of aerosols contaminated with MERS-coronavirus (MERS-CoV) through a gap between the face and mask; mucosal exposure to sweat contaminated with MERS-CoV; and contamination during doffing of personal protective equipment. The MERS guidelines should reflect this case to decrease the risk of infection during CPR.
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Affiliation(s)
- Hae-Sung Nam
- Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Korea
| | - Mi-Yeon Yeon
- Department of Preventive Medicine and Public Health, Chungnam National University School of Medicine, Daejeon, Korea
| | - Jung Wan Park
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Korea
| | - Jee-Young Hong
- Department of Preventive Medicine, Konyang University College of Medicine, Daejeon, Korea
| | - Ji Woong Son
- Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea
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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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Mahallawi WH. Case report: Detection of the Middle East respiratory syndrome corona virus (MERS-CoV) in nasal secretions of a dead human. J Taibah Univ Med Sci 2017; 13:302-304. [PMID: 31435338 PMCID: PMC6695009 DOI: 10.1016/j.jtumed.2017.07.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Revised: 07/17/2017] [Accepted: 07/23/2017] [Indexed: 12/31/2022] Open
Abstract
The Middle East respiratory syndrome coronavirus (MERS-CoV) has been recognized as a highly pathogenic virus that infects the human respiratory tract and has high morbidity and mortality. The MERS-CoV is a huge burden on Saudi Arabian health-care facilities, causing approximately 40% mortality. The transmission mechanism of the virus is still not well understood. Therefore, the prevention of any route of transmission is the best measure to arrest the spread of this disease. Using the real time polymerase chain reaction (RT-PCR), MERS-CoV was detected in the nasal secretions of a human cadaver. Full precautions should be applied and carefully followed to prevent the transmission of the virus, especially among health care workers.
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Affiliation(s)
- Waleed H. Mahallawi
- Corresponding address: Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taibah University, Almadinah Almunawwarah, Prince Naif bin Abdulaziz Rd, 300, KSA.
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46
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Park HC, Lee YK, Lee SH, Yoo KD, Jeon HJ, Ryu DR, Kim SN, Sohn SH, Chun RW, Choi KB. Middle East respiratory syndrome clinical practice guideline for hemodialysis facilities. Kidney Res Clin Pract 2017; 36:111-116. [PMID: 28680819 PMCID: PMC5491158 DOI: 10.23876/j.krcp.2017.36.2.111] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 03/20/2017] [Indexed: 01/30/2023] Open
Abstract
The Korean Society of Nephrology participated in the task force team consisting of government authorities and civilian experts to prevent and control the spread of Middle East respiratory syndrome (MERS) in 2015. The Korean Society of Nephrology MERS Task Force Team took an immediate action and drafted ‘the clinical recommendation for hemodialysis facilities’ to follow when the first and the only confirmed case was reported in the hemodialysis unit. Owing to the dedicated support from medical doctors, dialysis nurses, and related medical companies, we could prevent further transmission of MERS infection successfully in hemodialysis units. This special report describes the experience of infection control during MERS outbreak in 2015 and summarizes the contents of ‘the clinical practice guideline for hemodialysis facilities dealing with MERS patients’ built upon our previous experience.
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Affiliation(s)
- Hayne Cho Park
- Division of Nephrology, Department of Internal Medicine, Armed Forces Capital Hospital, Seongnam, Korea
| | - Young-Ki Lee
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Sang-Ho Lee
- Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Kyung Don Yoo
- Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Korea
| | - Hee Jung Jeon
- Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea
| | - Dong-Ryeol Ryu
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
| | - Seong Nam Kim
- Kim Seong Nam Internal Medicine Clinic, Seoul, Korea
| | | | - Rho Won Chun
- Chun Rho Won Internal Medicine Clinic, Seoul, Korea
| | - Kyu Bok Choi
- Department of Internal Medicine, School of Medicine, Ewha Womans University, Seoul, Korea
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47
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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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49
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Shin N, Kwag T, Park S, Kim YH. Effects of operational decisions on the diffusion of epidemic disease: A system dynamics modeling of the MERS-CoV outbreak in South Korea. J Theor Biol 2017; 421:39-50. [PMID: 28351702 PMCID: PMC7094130 DOI: 10.1016/j.jtbi.2017.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2016] [Revised: 03/08/2017] [Accepted: 03/20/2017] [Indexed: 12/16/2022]
Abstract
Development of a macro-level health system dynamics model. Performance measurements of epidemic disease diffusion and patient-care performance from an operational perspective. Comparison of economic and optimal patient room design performance under different infectivity scenarios. Comparison of secondary infection outcomes under different ER occupancy circumstances.
We evaluated the nosocomial outbreak of Middle East Respiratory Syndrome (MERS) Coronavirus (CoV) in the Republic of Korea, 2015, from a healthcare operations management perspective. Establishment of healthcare policy in South Korea provides patients’ freedom to select and visit multiple hospitals. Current policy enforces hospitals preference for multi-patient rooms to single-patient rooms, to lower financial burden. Existing healthcare systems tragically contributed to 186 MERS outbreak cases, starting from single “index patient” into three generations of secondary infections. By developing a macro-level health system dynamics model, we provide empirical knowledge to examining the case from both operational and financial perspectives. In our simulation, under base infectivity scenario, high emergency room occupancy circumstance contributed to an estimated average of 101 (917%) more infected patients, compared to when in low occupancy circumstance. Economic patient room design showed an estimated 702% increase in the number of infected patients, despite the overall 98% savings in total expected costs compared to optimal room design. This study provides first time, system dynamics model, performance measurements from an operational perspective. Importantly, the intent of this study was to provide evidence to motivate public, private, and government healthcare administrators’ recognition of current shortcomings, to optimize performance as a whole system, rather than mere individual aspects.
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Affiliation(s)
- Nina Shin
- Graduate School of Business, Seoul National University 1 Gwankak-ro, Gwanak-gu, 08826, Seoul, Republic of Korea.
| | - Taewoo Kwag
- Executive Director, Healthcare R&D, G-Doc Partners 78, Donggwang-ro 27-gil, Seocho-gu, 06582, Seoul, Republic of Korea.
| | - Sangwook Park
- Graduate School of Business, Seoul National University 1 Gwankak-ro, Gwanak-gu, 08826, Seoul, Republic of Korea.
| | - Yon Hui Kim
- Executive Director, Business Development, Corestem Inc., 24 Pangyo-ro 255beon-gil, Bundang-gu, Seongnam-si, Gyeonggi-do, 13486 Republic of Korea.
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50
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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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