Deficiencies in South
Korea’s hospital’s structures and processes during MERS outbreak
Middle East Respiratory Syndrome (MERS) is
a zoonotic pathogen that has been reported to cause recurrent spillovers on
humans. Initially known as human coronavirus EMC (for Erasmus Medical Center),
the infection was later renamed Middle East Respiratory Syndrome (MERS-CoV).
MERS-CoV is considered as a level C betacoronavirus that is found in humans and
camels, differing from other human betacoronaviruses. However, it is closely
linked to bat coronaviruses (WHO, 2015).
MERS was first reported in September 2012
in Saudi Arabia. The first incident involved a patient who had been admitted
with pneumonia and acute kidney injury in July 2012.
The MERS outbreak in South Korea in 2015 is
attributable to poor implementation of nosocomial infection control and
prevention procedures (Cowling et al., 2015). Infection control and prevention in
healthcare settings, particularly where patients are reported to have emerging
infectious diseases such as MERS, SARS (severe acute respiratory syndrome) and
Ebola, are invariably imperfect. There is need to be knowledgeable and skilled
about infectious diseases as well as to enhance the capacity to control and
prevent infectious diseases in local healthcare settings (Breban, Riou and Fontanet,
2013).
While the outbreak in South Korea was
contained within two months of the index MERS patient, initially it spread
quickly due to a few flaws in the South Korea hospital structure and processes.
Three major flows have been identified as contributing to the spread of the
disease from the index patient to become an outbreak that affected many people,
including a primary infection in China. These are the sudden appearance and
unfamiliarity of MERS-CoV in South Korea, the culture of the people and
ineffective infection control and prevention measures. These are
comprehensively discussed below.
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1) Sudden
appearance and unfamiliarity of MERS-CoV
The index case of MERS-CoV in South Korea
was reported on May 20, 2015. This was detected on a 68-year old man who had
travelled to the Middle East from April 18 to May 3. He developed symptoms a
week after returning to South Korea, seeking treatment on May 11 (Hsieh, 2015). The
average incubation period before symptoms in the outbreak was 6.7 days...
The man went to four hospitals before the
disease was finally diagnosed. He went to other hospitals after diagnosis where...
2) Culture
As discussed earlier, the culture of
accompanying, visiting and helping patients regardless their condition contributed
to outbreak of MERS-CoV in Seoul. Prior to contracting MERS-CoV, the patient
had pneumonia and an attendant productive cough. The cough produced mucus or
sputum because of chest congestion. The patient must have experienced the
symptoms at their worst when talking or waking up (Hsieh et al, 2014).
Proximity to close contacts and
outpatients meant that, when talking, the index patient’s wet coughs and smears...
Another contributory factor was the
culture of shopping around for doctors and hospitals, overcrowding in emergency
rooms, use of multi-bed rooms, and the custom of members aiding with nursing
care...
3) Ineffective
infection control
Infection control and prevention measures are crucial
to prevent spread of airborne diseases in healthcare facilities. People
susceptible to these diseases in a hospital setting include medical personnel who
have direct contact with patients, patients sharing ER/ICU with infected patients,
and visitors to the hospital (Kucharski and Edmunds 2015). Ineffective
infection control processes during South Korea’s MERS outbreak are attributable
to inadequate nosocomial infection control...
Conclusion
There is need to improve equipment,
supplies, facilities and standards of operations. In addition, the personnel in
healthcare facilities including doctors, nurses, administrative staff and others
need to...
It
is important to ensure proper control measures are put in place aimed at
abating nosocomial infections in designated healthcare settings that
accommodate suspect cases of emerging infectious diseases. Subsequently...
With an aim to strengthen the infection
control system, periodical regular training on the knowledge and skills of
control and prevention of emerging and unknown infectious disease as well as
emergency exercises pertaining to nosocomial infection events ought to be carried
out among healthcare workers (Nishiura et al., 2015).
References
Bakke SA, Botker MT, Riddervold
IS, Kirkegaard H, Christensen EF. (2014). Continuous
positive airway pressure and noninvasive ventilation in prehospital treatment
of patients with acute respiratory failure: a systematic review of controlled
studies. Scandinavian Journal of Trauma, Resuscitation and Emergency
Medicine, 22(1): 9.
...
Poletto C, Pelat C,
Levy-Bruhl D, Yazdanpanah Y, Boelle PY, Colizza V. (2014). Assessment of the Middle East respiratory syndrome coronavirus (MERS-CoV)
epidemic in the Middle East and risk of international spread using a novel
maximum likelihood analysis approach. Eurosurveillance. 2014;19(23).
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